The Wisconsin Hospital Association held three news conferences on January 31 to draw attention to its new Hospital Workforce Report. The news conferences were held in Neenah at Theda Clark Medical Center; in Madison at St. Marys Hospital Medical Center; and in Milwaukee at the University of Wisconsin-Milwaukee College of Nursing.

State Rep. Leah Vukmir (R-Wauwatosa) spoke in Madison and Milwaukee, while Rep. Steve Wieckert (R-Appleton) was in Neenah. Both legislators acknowledged and voiced their appreciation for WHA’s leadership on the workforce issue.

Vukmir pointed out that projections indicate a need for 2,800 new RNs, and that there were only 1,400 graduates last year. "This will have a profound impact on our health care system, which WHA realizes. I am impressed that they are taking this on," she said.

In Neenah, Rep. Wieckert said WHA has identified a serious problem and is proposing solutions to what he called a "core problem of having shortages in the hospital workforce."

Roberta Gassman, Secretary of the Wisconsin Department of Workforce Development, said, "This report reinforces the importance of Governor Doyle’s agenda for preparing more Wisconsin workers for the well paying jobs of tomorrow, such as in health care, which will help support families and grow our economy."

While hospitals are doing "ok" now, WHA’s Judy Warmuth, vice president of workforce development and author of the Hospital Workforce Report, said the magnitude of the health care workforce shortage will grow in the future.

"The reality is that as hospital employees retire, it will be harder to replace them because there are fewer young people coming into the workplace and competition for these employees will be fierce," said Warmuth. "While all hospitals have efforts in place to develop a workforce that will meet their future needs, the concern is that it won’t be enough."

The solutions proposed by WHA include:

1. Continue efforts to create interest in health care careers.
2. Interest new audiences in health care careers.
3. Expand capacity in the educational system.
4. Encourage new educational strategies. Technology now offers a range of learning possibilities, but more will be needed in the future.
5. Create and develop faculty.
6. Obtain and retain funding.
7. Support new entrants into the health care workforce.

Spokespersons at the news conferences included:

Madison

Rep. Leah Vukmir
Joan Beglinger, V.P., Patient Care Services, St. Marys Hospital, Madison
Roberta Gassman, Secretary, Wisconsin Department of Workforce Development
Eric Borgerding, Senior Vice President, WHA

Milwaukee
Rep. Leah Vukmir
Sue Ela, RN, Senior Clinical V.P., Aurora Health Care
Sally Lundeen, Dean, UW-Milwaukee College of Nursing
George Quinn, Senior Vice President, WHA

Neenah
Rep. Steve Wieckert
Norma Tirado, Senior V.P, Employee Services, Agnesian HealthCare, Fond du Lac
Carolyn Friese, Assistant Administrator and CNO, St. Vincent Hospital, Green Bay
Judy Warmuth, V.P., Workforce Development, WHA

Press interest in the report ran high across the state, which provided WHA member hospitals with the opportunity to localize the issue and describe some of the programs that they have in place to recruit or retain employees.

"One thing we know, no matter what our hospitals do now it won’t be enough unless we collaborate with educators at all levels, university and technical college administrators, and officials within state government," Warmuth said.

DHFS has released an executive summary of a newly established disaster credentialing system that is in the process of implementation. A copy of that executive summary can be found at www.wha.org/disasterPreparedness/pdf/wdc_execsum2-05.pdf. Below is a brief summary of that executive summary.

In the case of a national or regional medical or health disaster, such as an incident of bioterrorism, health professionals would be asked to present themselves voluntarily to hospitals to provide service. Exactly how hospitals would validate the license, skills and credentials of these volunteers has been the work of a State Expert Panel made up of individuals from the Wisconsin Association of Medical Staff Services and staff from the Wisconsin Hospital Bioterrorism Preparedness Program. The charge to the Panel was to create a credentials verification process for volunteer health care professionals. The Expert Panel has been fortunate to have its work supported in part by supplemental funding from HRSA.

The result of these efforts is a proposed credentials verification system for the state of Wisconsin called Wisconsin Disaster Credentialing (WDC), a Web-based system that allows for real-time verification of physician credentials and access to hospital affiliation information of physicians.

Credentialing elements verified for all practitioners through WDC, include:

1. Professional License (all licenses held)
2. CMS sanction information
3. AMA Profile
4. Board Certification and Specialty Training
5. DEA License
6. National Practitioner Databank query

Wisconsin hospital-affiliated physicians will have additional information included in WDC (provided by hospitals):

1. Primary Contact Information
2. Medical Staff Category Status
3. Initial Appointment Date
4. Primary Practicing Specialty
5. Physician Special Skills (optional)
6. Limitations (optional)

Contact Bill Bazan at bbazan@mailbag.com or call 414-431-0105 for more information.

WHA recently partnered with the Hospice Organizations & Palliative Experts of Wisconsin (HOPE) to provide the publication "Hospice Conditions End Stage Matrix" to all Wisconsin hospitals.

The Matrix was developed by Health Care Excel (Indiana Medicare Quality Improvement Organization) to show the relationship between disease progression and terminal illness, which correlates with the appropriate time to use hospice services. It describes symptoms of a variety of medical conditions, including cancer, heart disease and stroke. It then lists symptoms that indicate the terminal stage of illness.

WHA’s Medicaid "down payment" advocacy agenda calls for:

1) Restoring Medical Education cuts enacted in 2003;

2) Enhancing the current Disproportionate Share Hospital (DSH) program to provide special payments for high Medicaid volume hospitals; and

3) Increasing woefully inadequate outpatient payment.

The following chart was developed to "make the case" for the Medicaid outpatient payment agenda. Current payments for expensive procedures amount to pennies on the dollar of costs. These are real examples from three Wisconsin hospitals.

Procedure                         Charge             Medicaid Pays         % of Charge Paid

Arteriogram                      $6,497.00               $93.38                             1.4%

Cataract Surgery                4,466.00                 94.00                             2.1%

Heart Catheterization          7,724.25                 93.38                             1.2%

Endoscopy                        2,067.00                124.00                             6.0%

Radiation Therapy              5,270.00                  93.38                             1.8%

MRI – Spine                      5,144.00                  93.38                             1.8%

Cholecystectomy               9,289.00                124.00                             1.3%

Tonsillectomy                    3,621.00                  94.00                             2.6%

Hernia Repair                   13,281.71                 93.28                              0.7%

MVA Level II Trauma 1        1,381.75                 96.38                             0.8%

Pediatric Level II Trauma     7,199.75                110.11                             1.5%

Carpal Tunnel                     3,337.00                 94.00                             2.8%

Breast Biopsy                    3,146.00                 94.00                             3.0%

One could argue that $96 for emergency room care following a serious car accident is about as close to "free care" as it comes. But that’s not the case, just ask any employer who is making up the difference, who is feeling the impact of cost shifting, who is paying the "Hidden Tax." Talk all you want about cutting state spending and reducing the tax burden, the "Hidden Health Care Tax" is alive, well and growing.

A budget bill that further erodes such outrageous payment rates in the name of "reforming Medicaid" or "balancing the state budget" will simply be another example of the Governor and/or Legislature’s willingness to transfer the true cost of their programs to Wisconsin employers.

Steve Brenton
President

The Medical College of Wisconsin and Children’s Hospital and Health System held a ceremonial groundbreaking on January 31 to begin construction of a $117 million joint research facility. Executives and board leaders from both institutions were on hand for the ceremony, as well as Wisconsin Governor Jim Doyle and U.S. Senator Herb Kohl. The first phase of the research facility is expected to open in December 2006.

The new facility will provide shared research space and two wings of laboratories, one for the health system’s new Children’s Research Institute and the other for the Medical College’s Biomedical Research Building. It will be located adjacent to both the Medical College and Children’s Hospital, just south of Watertown Plank Road on the campus of the Milwaukee Regional Medical Center.

"The facilities will bring together the best and brightest minds in medicine and research to unlock the answers for illnesses and injuries that affect both children and adults," said T. Michael Bolger, JD, president and CEO of the Medical College of Wisconsin.

"With the inception of Children’s Research Institute earlier this year, one of our objectives was to determine the best way to provide both laboratory space and organizational support to continue to expand our pediatric research efforts," said Jon E. Vice, president and chief executive officer, Children’s Hospital and Health System. "After careful study and collaboration with the Medical College, we determined that new facilities that share resources would best serve the mission of each organization."

The Medical College will provide $77 million of funding support for the project, and Children’s Hospital and Health System will provide $40 million. The state of Wisconsin has granted $25 million for the project as an investment in biotechnology in the Milwaukee area. "This is a great opportunity that will advance medical research and ensure that Wisconsin remains a national leader in biomedical research," said Governor Doyle. "This facility will leverage millions of dollars in additional federal funds which will translate into stronger economic growth for our state."

The focus of this year’s annual Health Care Administrative Professionals Conference is "The Support Staff Professional Who Makes a Difference." This program is designed for executive assistants, administrative assistants, business office managers, secretaries and other support staff to explore the evolving roles, functions and expectations of the support staff professional, specifically in a health care organization. Attendees will learn to identify key fundamental skills and characteristics that will help define a truly valued support staff professional, capable of making a significant positive difference in fulfilling your organization’s goals and objectives.

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 April 22 at the Blue Harbor Resort & Conference Center in Sheboygan. It opens with an optional networking reception and dinner on the evening of April 21 and continues with a full day of education on April 22.

Periodically throughout the past decade, accredited organizations have requested that the Joint Commission change its pricing structure to comport with billing approaches used by other accrediting bodies, which spread survey fees over the entire accreditation cycle. Unfortunately, the accreditation process that the Joint Commission had in place during this period did not support such a change. However, beginning in January 2006 – after which all regular accreditation surveys will be conducted on an unannounced basis – the use of an annual subscription approach for the payment of accreditation fees will become fully consistent with the substantially continuous nature of the new accreditation process.

For all accreditation programs, the new fee structure will involve an annual base fee, which recognizes that significant accreditation-related services are now provided on a more continuous basis between on-site surveys, and a separate fee to cover the direct costs of the on-site survey in the year(s) in which it occurs. Although the specifics of the new fee structure will not be finalized until April 2005, the annual fee for most organizations will range from 15 to 25% of the current triennial (or biennial) survey fee. The new pricing model is explicitly designed to be revenue-neutral to the Joint Commission over a running three-year period.

Although the Joint Commission believes that the move to a subscription billing methodology will be well received by most accredited organizations over time, making their way through the transition process will not be without its challenges. Financial modeling of different methods to transitioning to the new billing approach makes it clear that the Joint Commission’s only realistic alternative is to convert all accredited organizations to the new model on January 1, 2006. This means that all accredited organizations will be asked to pay their first annual accreditation participation fee under the new fee structure in January 2006.

During the second quarter of 2005, the Joint Commission intends to enter into new accreditation contracts with all accredited organizations. This contract will generally describe the services that the Joint Commission plans to provide to the health care organization each year. In addition, to assist accredited organizations in the preparation of their 2006 budgets, this contract will also provide an estimate of the organization’s fees under the new subscription billing model.

If you have any questions before you receive your accreditation contract, call Paige Rodgers, chief financial officer of the Joint Commission, at 630-792-5685.

Is there someone on your staff who needs to become familiar with the chargemaster and how it affects hospital reimbursement? Is there anyone new to his or her role in the business office, as part of the coding staff, in case management, or the administrative team? Pass along this information about attending the important seminar, "Chargemaster 101: Starting at the Beginning."

The seminar, scheduled for February 22, will teach the basics of the hospital chargemaster and the tools needed to keep this vital document up-to-date, as well as the basics to conducting a chargemaster review, including continual updates and maintenance.

The seminar will be held from 9 am to 4 pm at the Holiday Inn, Madison East. A brochure and a registration form are available online at www.wha.org. Easy, online registration is also available on WHA’s Web site. This seminar is approved for five (5) continuing education hours by the American Health Information Management Association (AHIMA). Encourage someone from your team who could benefit from this basics course to attend.