A week after the Senate voted to override the Governor’s veto of concealed carry legislation, the Assembly failed by one vote to sustain the override. Three elected officials switched their votes to reflect their party’s line. After voting against the legislation, Reps. Luther Olson (R-Berlin) and John Townsend (R-Fond du Lac) voted to override the Governor’s veto and after voting for the legislation, Rep. Gary Sherman (D-Port Wing) voted with his party’s Governor to uphold the veto.

Immediately after the vote, the National Rifle Association (NRA) issued vows of retribution in November, and is now publicly targeting Sherman for defeat in this fall’s election. The NRA has also vowed the bill will be up again in 2005, promising that the next bill will be in the form they want, meaning without all of the amendments (including a WHA-backed exemption for hospitals and clinics) that were attached to this bill.

"That’s a strange political calculation," said WHA’s Eric Borgerding. "Without the hospital exemption, as well as several others, this bill may not have passed both houses and certainly would not have come so close to a veto override."

When round two comes in 2005, WHA will work again to ensure that the exemptions for hospitals and other health care facilities are included.

SB 372 passed the Senate by a vote of 29-4 on February 4. The identical Assembly companion bill (AB 727) passed the Assembly two weeks ago. SB 372/AB 727 would amend Wisconsin law making it consistent with the HIPAA Privacy Rule, which permits providers to release medical records without patient consent for purposes of treatment, payment and health care operations. Wisconsin law does not allow the exception for health care operations, which include activities like quality assessment, audits, legal services and competency review. To see how your Senator voted on SB 372, go to www.legis.state.wi.us/2003/data/votes/sv0405.pdf .

The bills are identical, differing only in their house of origin and bill number. The bills enjoy bipartisan legislative support, including from the Doyle Administration. In a matter of a few minutes and painless voice vote, one of these bills could be on the Governor’s desk and signed into law. So, why aren’t they, the outside observer may ask?

Because in the current reality of Madison, these sound pieces of public policy are caught in limbo due to severe partisan squabbling between the Governor and legislative leaders — squabbling that has the potential of paralyzing the remainder of the 2003-04 legislative session (which ends in five short weeks), and jeopardizing not only AB 727/SB 372, but also critical funding for the Medicaid program (more on the Medicaid situation in next week’s issue of Valued Voice).

Eight Wisconsin hospital-based health systems received a top 100 ranking in a just-released report from a Chicago-based research firm, Verispan. The firm ranked the top 100 health care networks among the nation’s 568 regional systems. The Verispan analysis rates each system on clinical and financial performance and measures the degree of integration in a variety of categories.

Wisconsin systems included in the report are: Covenant Healthcare, Milwaukee; Aurora Health Care, Milwaukee; Mercy Health System, Janesville; Affinity Health System, Menasha; Gundersen Lutheran Health System, La Crosse; University of Wisconsin Hospital & Clinics, Madison; ThedaCare, Appleton; and All Saints Healthcare, Racine.

In a Modern Healthcare February 2, 2004 article, Covenant Healthcare President and CEO Paul Dell Uomo said that his Milwaukee-based hospital and physician system has improved quality and cut costs by "coordinating care and clinical best practices throughout our system." Covenant ranked third in the Verispan survey.

"Wisconsin is a nationally recognized leader in community level health care integration," said WHA President Steve Brenton, responding to the Modern Healthcare special report. "It’s a fact that no other state in the nation had more systems that made this top 100 list than did Wisconsin, and system integration is a proven factor in advancing clinical and financial improvement and success."

AHA members should soon be receiving materials for the AHA Annual Meeting in Washington, D.C. scheduled for May 2-5. The AHA has altered the schedule to accommodate hill visits on Wednesday, May 5 when most Congressional members are in town.

This meeting is an opportunity for Wisconsin hospital leaders to meet with other hospital leaders from across the country, be briefed on up-to-the-minute issues and activities on Capitol Hill, and visit with each member of the Wisconsin delegation and their legislative staff.

WHA staff will be making appointments with members of the Wisconsin delegation for hill visits. Those attending are asked to contact Ann Lucas at alucas@wha.org with their travel plans. For more information, contact Ann Lucas.

Data must be submitted to the CMS national warehouse by February 15.

• The Legislative Audit Bureau report on Medicaid patient emergency department (ED) usage presents an excellent opportunity to engage the Wisconsin Legislature, the Department of Health and Family Services and other shareholders on this significant and emerging public policy issue. Much like the health care cost issue, the "drivers" influencing skyrocketing ED use are many and they are complex. Access to primary care physicians, cultural issues ("I want it now!") and a woeful absence of primary care clinical capacity, especially in Milwaukee, are among the reasons behind the disturbing trend. And simple solutions like leveling a costly "co-pay" on Medicaid patients may do little more than drive hospital bad debt higher. This is a big picture issue that needs substantive study and meaningful solutions.
  
• Modern Healthcare Editor David Burda, in a January 26, 2004 opinion piece, made a number of excellent points regarding the uninsured "crisis." Among other things, Burda suggested that a "common-sense perspective" should be used in addressing the issue. Burda pointed out that 85% of the U.S. population does have private or public health insurance. "Consequently, to solve the problem of the uninsured, solutions should be targeted at those 15.2% of people without coverage."

Burda sensibly suggests an incremental approach that "targets the people who need both basic and catastrophic coverage." Burda also points out that some supporters of universal coverage view incrementalism as "blasphemy" and "use the problem of the uninsured to pursue their politically driven ideal of a health care utopia."

• More news from California regarding the unintended consequences of a bad idea that became law. Almost nine out of ten California hospitals recently surveyed by the California Healthcare Association (CHA) indicate that they have regularly been out of compliance with that state’s nurse-to-patient staffing ratios. In addition to being "illegal," many of those hospitals have been forced to divert ambulances to other facilities in an attempt to comply with the law.

California requires hospitals to be in continuous compliance with "etched in stone" staffing levels 24/7. Earlier this month, the new law forced the closure of Santa Teresita Hospital in Duarte, California. CHA is challenging certain aspects of the law in court.

Steve Brenton
President

The FY 2005 federal budget introduced by President Bush on February 2 was devoid of Medicare or Medicaid cuts. The $2.4 trillion budget, while preserving the gains in Medicare payments achieved last year, does, nevertheless, propose a "pay as you go" strategy which will require any increases in spending to be offset by cuts in other programs. The budget abandons the Administration’s Medicaid reform plan introduced last year, calls for additional scrutiny of intergovernmental transfer (IGT) arrangements, limits strategies to increase federal match dollars, and encourages state flexibility through the use of Medicaid waivers.

The bill now moves to the respective budget committees in each house for consideration and debate.

I am pleased to offer a perspective on the Institute of Medicine’s recent report, Insuring America’s Health. I do so as a member of the IOM Committee on the Consequences of Uninsurance, which has worked on this issue over the past 3½ years, as well as CEO of the Employer Health Care Alliance Cooperative of Madison, a health care purchasing cooperative for more than 160 member companies.

While those of us who work in health care may understand the impact of the uninsured, the fact is that uninsurance is not a universally recognized and understood problem; indeed, the general public holds some common misperceptions about uninsurance that have endured for years. For that reason, the task requested of the IOM was twofold: one, to assess and analyze existing research on the impact of the lack of health insurance; and, two, to boldly communicate the Committee’s findings and conclusions to the general public. The Committee accomplished this through a series of six reports (which can be found, along with brief summaries, at the project’s website, www.iom.edu/uninsured) designed to create a clearer understanding of the widespread negative effects of uninsurance on individuals, families, communities and the nation as a whole. We have examined the evidence showing the impact of the uninsured on our nation’s hospitals, physicians and other caregivers, as well as the broader impact on public and community health.

The term, "universal health care coverage" has not been mentioned much in public discourse since the debates in the mid-90s over Clinton’s health plan. The confluence of an election year, spiraling health costs and insurance premiums, and the increased shift of insurance costs to employees, has made the issue more urgent. While tempting to do so, our job was not to craft yet another proposal, but to stimulate the public and political debate and provide guidance to it, based on our research. We recommend action at the national level to extend coverage to all across the country.

The Committee also developed principles which can be used to assess the various proposals being touted by presidential candidates and health policy advocates and to design new strategies for coverage. The principles evolved from the evidence analyzed in our previous five reports. They do not attempt to define all aspects of a coverage strategy, only those within the scope of our work and for which we had good evidence. While it may not seem controversial to some that we say health care coverage should be universal, continuous, affordable to individuals and families, affordable and sustainable for the country, and should promote access to high-quality care, the fact that there is now scientific evidence to support these principles makes them more compelling and useful for policymakers.

The choice between a pluralistic model and a single-payer approach reflects personal and political values and is best made through the political process; it does not reflect a principle that could be determined through the Committee’s research. Moreover, the issue of controlling cost and utilization under any reform scenario is very real. In reality, the uninsured are often priced out of the system and the burden of the care they eventually receive is not equitably distributed. Any plan to achieve universal coverage will need some mechanism to restrain costs and utilization if it is to be affordable for both individuals and society, although the extension of coverage need not wait until the whole health system has been reformed.

Finally, the Committee recognized that crafting a detailed strategy for achieving universal coverage will be controversial and will necessitate a careful consideration of trade-offs among competing alternatives. However, we believe that the pursuit of such a strategy is a matter of enlightened self-interest for all Americans. If we can muster a bi-partisan political will, we can generate the creativity needed to create an acceptable proposal.

It was standing room only at WHA’s North Central Region meeting on February 4 in Wausau. WHA staff previewed the CheckPoint^SM Web site with the group, and discussed specifics related to the public release of the program, scheduled March 30.

Michelle Boylan, VP of Quality at Community Health Care, Wausau, and an original member of a WHA task force that studied public reporting a couple of years ago, said she was impressed with the work that has been accomplished in developing the program, enlisting member support, and now, rolling the program out to the public. "We’ve come a really long way in about a year in launching a program dedicated to providing information on hospital quality and safety to consumers, employers and to hospitals," Boylan commented.

In reviewing the past year, WHA Vice President Dana Richardson listed among the major accomplishments:

• Successfully coordinated an understanding of the program benefits that led to nearly all Wisconsin hospitals volunteering to participate in CheckPoint^SM
• Built an automated, sustainable data submission process for clinical measures that capitalizes on an existing data process
• Developed measurement specifications and a system for entering the data into CheckPoint for the safety goals
• Identified structure and topics to include in the web site including supporting information (site plan) and a reporting application
• Created an identifiable brand— CheckPoint^SM.

"By creating a strong and flexible infrastructure, we can maintain the existing measures as well as add additional measures in response to consumer and provider needs," said Richardson.

The schedule for the remaining WHA regional CheckPoint^SM meetings follows:

West Central: February 11, Myrtle Werth Hospital, Menomonie, 10-12 pm
Southern: February 13, Divine Savior Hospital, Portage, 11:30-1:30 pm
Southeastern: February 25, University Club, Milwaukee, 10am
Vikingland: March 5, Hayward Area Memorial Hospital, Hayward, 10 am

If you have not registered to attend one of the above WHA regional meetings, contact Mary Kay Grasmick at mgrasmick@wha.org or 608-274-1820.

Show your support of the CheckPoint^SM program by wearing a lapel pin with the CheckPoint^SM logo on it. Better yet, buy a whole bunch of them and hand them out to your employees on March 30, the day that CheckPoint^SM will be publicly announced statewide.

In preparation of the public launch of the CheckPoint^SM program on March 30, WHA has ordered lapel pins. At $2.25 each, it is an easy way to spread the word about CheckPoint^SM among hospital and clinic employees. An order form is enclosed in the packet, or is available at www.wha.org. For more information, contact Shannon Nelson at snelson@wha.org or 608-274-1820.

The Wisconsin Heart Hospital opened January 26 in Wauwatosa. The facility is a joint venture affiliate of Covenant Healthcare System, local physicians and community investors. The state-of-the-art facility has services and medical experts focused on cardiovascular care and a full-service emergency department that will be in operation 24 hours a day.

Paul Dell Uomo, Covenant Healthcare president & CEO, said, "The Wisconsin Heart Hospital is an integral part of Covenant’s commitment to improve the quality of patient care while managing health care costs for our patients. We believe that this focused approach will help us as to contain overall health care costs as well as fulfill our mission to provide exceptional and compassionate health care service."

The grand opening was marked with a ribbon cutting ceremony attended by leaders from the Milwaukee business community, physicians, local residents and a number of elected officials.

Meriter’s new Child & Adolescent Psychiatric Hospital will officially open on Madison’s far west side on February 11. The 22–bed hospital was the site of an open house on February 5. Speakers included Wisconsin’s First Lady, Jessica Doyle.

Meriter has offered child and adolescent treatment at its West Washington Avenue campus in downtown Madison for the past 15 years; the adolescent program opened in 1988 and the child program in 1995. The new facility doubles the square footage for patients and staff and provides each child with a private room and bathroom. In the past, patients were sometimes turned away because of incompatibility issues.

Child and Adolescent Psychiatry Program Nurse Manager Sherry Casali, RN, said, "Meriter has always been committed to providing an inpatient program as part of the full range of psychiatric care we provide children in this community. Without this program and facility, it would be difficult for local parents to participate. That’s important, because family involvement plays a crucial role in helping us successfully treat child and adolescent patients."

The Hermes Monato, Jr. Essay Prize was established in 1993 to honor the memory of Hermes Monato, Jr., a December 1990 graduate who worked at the Rural Wisconsin Health Cooperative, as well as to highlight the importance of rural health. A $1,000 prize is awarded annually for the best rural health paper. It is open to all students of the University of Wisconsin. Students are encouraged to write on a rural health topic for a regular class and then submit a copy to the Rural Wisconsin Health Cooperative as an entry by April 15.

There are no rigid requirements for length, format, etc., but should include some of the following attributes:

• relevant to rural communities
• improves quality of care
• innovative
• team/relationship oriented
• practical
• applicable to networking, cooperatives
• multi-disciplinary

The few. The proud. The nurses. Health care may need the moxie of the U.S. Marines, if not their slogan, to rally enough troops to handle the number of older patients now on the horizon.

"What’s unnerving is the average age of RNs," says the Wisconsin Hospital Association’s Judy Warmuth, an RN herself, referring to a "bulge of nurses at 45 or so." In short, many of these people will be retiring at the very time the number of older patients will balloon.

"The growth in health care is going to be rather phenomenal in the next 25 to 30 years simply because of the growth in the number of older people," said Terry Ludeman, Chief of the Office of Economic Advisors for Wisconsin’s Department of Workforce Development (DWD). That prospect aside, the need for these professionals is great today.

Ten thousand health care jobs become available in Wisconsin every year, notes Ludeman, and this tremendous demand has forced wages higher.

Nurses are in especially short supply across Wisconsin, and can command $27 an hour or more. Because they’re the single largest occupational group in hospitals, the nurse shortage tends to get the most attention. But the need for health care professionals goes way beyond nursing.

Wisconsin Medical Society President Paul Wertsch, MD, has recognized the severity of the coming health care workforce shortage and has devoted his entire presidential year to raising public consciousness about it.

The Wisconsin Technical College System (WTCS), which produces two-thirds of Wisconsin’s health care workers, is struggling to keep up with the demand. "Radiography is hot," says WTCS President Richard Carpenter. "We can’t keep up with the demand there." The training demand isn’t much lower for other health care fields, either.

Retaining workers has become a priority in health care institutions, especially since Wisconsin has a high rate of nurses and other health professionals who have quit to pursue other careers, many as consultants. But hospitals are making an effort to make these jobs more attractive. For instance, hospital dress codes have been restructured so the male nurse’s uniform looks more masculine. To reduce the physical strain on nurses, some hospitals have instituted a no-lift program through the use of new machinery.

The Centers for Medicare & Medicaid Services recently announced two new policies that will increase reimbursement to critical access hospitals (CAH) for services to Medicare beneficiaries, and will allow these hospitals to use up to 25 beds for acute care services. These policies implement provisions in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 intended to bolster health care services in rural areas.

Under policies in effect prior to the new Medicare law, these hospitals could not have more than 15 beds for acute care. As a result of the new law, as implemented by the policies announced, a critical access hospital can have up to 25 beds designated as either acute care beds or swing beds — beds that may at times be used for acute care, and at other times for post-acute care. For more details on this provision, see CMS transmittal 68 which can be found at http://cms.hhs.gov/manuals/pm_trans/R68CP.pdf