President Bush unveiled his federal budget proposal for fiscal year (FY) 2009 this past week. To the dismay of the nation’s hospitals, his budget cuts an unprecedented $182 billion from Medicare over the next five years—more than $135 billion of those cuts coming from hospitals. The impact on Wisconsin hospitals will be a loss of $1.38 billion over the next five years.

As soon as it was released, the budget proposal vaulted to the top of WHA’s federal advocacy priorities and will be a topic of discussions when WHA travels to Washington, DC in early April for the American Hospital Association’s Annual Meeting & Hill visits.

"The proposed cuts to hospitals are untenable," said WHA President Steve Brenton. "We will strongly urge our Members of Congress to reject payment cuts for a program that already underpays hospitals. Wisconsin hospital leaders should consider joining us in DC for legislative meetings in April."

The majority of the President’s proposed budget cuts come from the following provisions:

• A three-year freeze in the market basket update, then a cut of 0.65 percent annually thereafter for:
• Inpatient acute care
• Outpatient care
• Inpatient rehab facility services
• Skilled nursing facility services
• A five-year freeze in the payment update for home health, then a cut of 0.65 percent annually thereafter
• A 30 percent cut to Medicare disproportionate share hospital payments phased in over two years
• Cut in Medicare indirect medical education (IME) adjustment from 5.5 percent to 2.2 percent phased in over three years
• Elimination of IME payments to hospitals for Medicare Advantage beneficiaries
• Elimination of Medicare bad debt reimbursement phased in over four years
• A five percent cut to reimbursement for capital payment beginning in FY 2009

Additional Medicare cuts include:

• Reinstatement of the "75 Percent Rule" for inpatient rehabilitation facilities.
• Establishment of a hospital value-based purchasing program ($1.7 billion over five years)
• Elimination of payment for "never events" ($190 million over five years).
• Making payments site-neutral for five conditions treated in skilled nursing and inpatient rehabilitation facilities ($1.7 billion over five years).
• Reinstatement of long-term care hospital payment cuts and the "25 Percent Rule" in addition to a three-year freeze in payments, with cuts of 0.65 percent annually thereafter ($2.9 billion over five years).
• Revisions to the inpatient transfer policy thresholds ($510 million over five years).

Please contact Jenny Boese at 608-268-1816 or jboese@wha.org for details about the AHA Annual Meeting & Hill visits. WHA will schedule all Capitol Hill visits for Tuesday, April 8. A WHA-member issues briefing and dinner will also take place on Monday, April 7.

Log onto www.aha.org/aha/advocacy/annual-meeting/08-index.html for AHA Annual Meeting information and registration.

HEAT ACTION ALERT

Reps. Richard Neal (D-MA) and Phil English (R-PA) are asking their U.S. House colleagues to sign a "dear colleague" letter urging federal Budget Committee leaders to reject the President’s nearly $200 billion in proposed Medicare and Medicaid cuts, of which $135 billion would come from hospitals. The Budget Committee will soon begin debating this budget, and we need your help in getting Wisconsin’s House members to sign on to this letter.

The letter will be sent to Budget Committee Chairman John Spratt (D-SC) and Ranking Member Paul Ryan (R-WI) and urges the Committee to "demonstrate its commitment to Medicare and Medicaid."

According to reports filed with the new Government Accountability Board, out of 694 registered lobbying organizations, WHA logged the fifth most lobbying hours during the second half of 2007. WHA’s lobbying expenditures were also some of the highest reported.

WHA logged 2,383 lobbying hours and $372,786.66 in lobbying expenditures during the period. During all of 2007, WHA logged 5,031 total lobbying hours, including 934 hours communicating directly with elected officials and state agency staff, a 53 percent increase in lobbying communication hours compared to 2006 and a 30 percent increase compared to 2005, the last state budget year.

"WHA’s presence at the Capitol has continued to grow over the last few years, and 2007 was no exception," said Eric Borgerding, WHA executive vice president.

Lobbying on Medicaid funding in the state budget accounted for 50 percent of WHA’s lobbying hours. WHA also registered lobbying hours on issues and bills including health care reform, maintaining workers’ compensation payments to providers, the Quality Improvement Act, transparency and disclosure bills, and providing immunity to hospitals that report information to prospective employers about allegations or violations of clinical or ethical standards by former employees.

"While the state budget dominated discussions at the Capitol well into the fall, there has also been a flurry of other legislation important to hospitals," said Borgerding. "We have a strong, veteran team at WHA that, as this report shows, knows its way around the Capitol. WHA will continue to aggressively and effectively advocate for our members as the current legislative session quickly wraps up early this spring."

The Centers for Medicare & Medicaid Services (CMS) granted the AHA’s request to allow the nation’s more than 1,200 critical access hospitals (CAH) to submit and publicly report outpatient quality data.

Hospitals participating in Medicare’s outpatient prospective payment system (PPS) are required to submit data on seven outpatient quality measures to receive a full payment update in fiscal year 2008.

Five of those measures are related to heart attack transfers and two are related to surgical care.

A CMS contractor for the outpatient quality reporting program announced in December that CAHs would not be allowed to submit the outpatient measures, because they receive cost-based reimbursements from Medicare and thus do not participate in the program’s PPS.

CAH leaders took issue with that announcement, saying that just because they are small doesn’t mean that they don’t do as well on quality measures as their larger counterparts. The AHA also made that case in a January 11 letter to CMS Acting Administrator Kerry Weems.

The Wisconsin Council on Medical Education and Workforce (WCMEW) was created as a result of a report co-authored by WHA and the Wisconsin Medical Society on Wisconsin’s future physician workforce, entitled: "Who Will Care for Our Patients," which was released in 2004. That report established goals to address the current and expected future shortage of physicians in Wisconsin. Over the past three years, the Council has played an important role in raising public awareness about—and finding solutions to—Wisconsin’s physician workforce issues.

The mission of WCMEW is to serve as a catalyst in helping achieve the goals outlined in the 2004 report:

• Recruit, enroll and train in Wisconsin’s medical schools individuals who are likely to practice in Wisconsin, especially underserved areas of the state.
• Develop care delivery models that will enhance and leverage physician resources.
• Create an environment and targeted programs that encourage physicians to enter and remain in practice in Wisconsin. That environment and targeted programs should also be beneficial in encouraging physicians to return to Wisconsin to practice medicine.
• Provide for adequate and targeted funding for graduate medical education.
• Develop an infrastructure to guide medical education policy in Wisconsin.

Activities and accomplishments for the first three years include:

• The Wisconsin Academy for Rural Medicine (WARM), a school-within-a-school of the UW Medical School, has been established, and began admitting its first students in 2007. Thirteen students will be enrolled in 2008, and annual enrollment will be increased to reach 25 students in the next three years. This represents an increase of 17 percent in the total number of medical students enrolled at UW Medical School.
• The Council, working with the Wisconsin Medical Society Foundation, developed a program to provide funding for WARM medical students, including a combination of scholarships, fellowships, and loan repayment.
• WCMEW surveyed a number of larger medical groups about their experience with advanced practice providers (APP). The results of that survey are being used to design education programs for health systems and to assist the UW Medical School in developing a team-based medical education model.
• WCMEW has worked collaboratively with other organizations to advocate for enhanced Medicaid funding for GME.

During 2008, WCMEW will:

• Implement a Web-based physician recruitment portal targeted at physicians practicing outside Wisconsin who have some Wisconsin affiliation.
• Working with the Wisconsin Medical Society, survey Wisconsin physicians and medical directors to identify practice settings, current and future physician supply, and recruitment/retention issues.
• Evaluate resident physician education programs in Wisconsin as a means of leveraging recruitment of new physicians to our state.
• Publish an updated Wisconsin physician workforce report.

If you have questions about WCMEW, please contact Dr. Charles Shabino or George Quinn at WHA.

Wristband color standards and the proposed Quality Improvement Act were two of the agenda items discussed at the February 6 WHA Medical and Professional Affairs Council meeting in Madison. WHA’s Dana Richardson and Kathleen Caron said a WHA Task Force met recently to review the use of colored wristbands and to determine if standardization would be beneficial. Many hospitals use colored wristbands to denote patient status, such as "Do Not Resuscitate" or "Fall Risk." If the Task Force determines that using the same colors statewide would have benefits, it will develop a recommendation.

Richardson said several western states have standardized wristband colors, but there is not an effort to do so on a national scale. Three Midwestern states— Illinois, Michigan and Minnesota— have all standardized on the same colors, however. Caron said the Task Force expects to wrap up its work later this spring.

Quality Improvement Act Important to Patient Safety, Quality Efforts

WHA General Counsel Laura Leitch provided a status report on the Quality Improvement Act (QIA). Leitch said the QIA would expand quality improvement activities and public reporting of health care quality and safety measures in Wisconsin, strengthen the regulatory environment, and help ensure an adequate health care workforce. Leitch emphasized, "The real focus of the QIA is, of course, our patients, who deserve high quality and continuously improving health care."

Leitch said the QIA consists of four important changes to the current peer review statutes. First, the QIA would strengthen, clarify, and provide protections against the use of peer review and quality improvement investigations and reports in civil proceedings. In order to improve the quality and safety of health care, providers must be able to evaluate care across providers, within health care systems, and beyond organizational lines. In addition, patients and payers are demanding increased public reporting of performance information. To support this key evolution, the underlying investigations and reports must be protected from use in future civil actions. It is important to note that the QIA would not interfere with a plaintiff’s attorney’s ability to do his or her own investigation.

The QIA also would protect current and expanded peer review and quality improvement investigations in criminal proceedings. Providers are reluctant to participate in peer review and quality improvement activities because of the fear that their statements could be used against them in a criminal proceeding. Quality improvement participants must know that they are not unwittingly participating in a criminal investigation. Again, the QIA would not interfere with a prosecutor’s ability to do his or her own investigation.

In addition to protecting private quality improvement activities, the QIA would protect and strengthen the current regulatory system. Under the bill, the information gathered as part of a regulatory investigation could not be used in a criminal prosecution.

Finally, Leitch explained that the QIA would maintain medical malpractice as a matter for the civil, not criminal, courts. A health care provider who makes an error may lose his or her license, livelihood, and be subjected to civil penalties and civil suit. Add to that the prospect of criminal penalties, including jail time, for making an unintentional medical error and it will do nothing but add to Wisconsin’s shortage of health care providers. In order to attract and retain the best and the brightest, people must know that the rewards of the profession outweigh the risks. The QIA would permit criminal charges for an act or omission that was intentional or reckless, but not for negligence.

Adverse Event Reporting Systems and Non-Payment Policies

The Council also discussed systems in use in other states to report adverse events. Richardson said the most mature adverse event reporting system is in Minnesota. This system is overseen by the Minnesota Department of Health, Office of Health Facilities Complaints (OHFC) under a legislative mandate and jointly accessed by the OHFC and the Minnesota Hospital Association. Reported events include the National Quality Forum’s (NQF) 28 Serious Reportable Events. A major update of Minnesota’s Peer Review statutes preceded the implementation of Minnesota’s reporting system.

The Minnesota law also requires that a public report, Adverse Health Events in Minnesota Hospitals, be published on an annual basis. In 2006, 154 events were reported. Other states, including but not limited to, California, Illinois, Massachusetts, Missouri, New Jersey and Tennessee have enacted legislation to report serious adverse events. The West Virginia Hospital Association has taken a different approach by supporting a voluntary reporting system for all adverse events and near misses. The information collected is used exclusively by participating hospitals to facilitate safety improvement efforts within the hospital.

The Council also discussed the AHA Guidelines on non-payment for serious reportable events and reviewed the list of eight hospital-acquired conditions for which CMS will deny payment.

U.S. Rep Tammy Baldwin took time out recently to visit Beloit Memorial Hospital. During her visit she was able to see the new CT scanner, purchased with her assistance in obtaining a federal grant. She also toured the hospital’s emergency room, which is currently undergoing a major update and expansion over the next three years.

The health care workforce shortage is an ongoing concern in Wisconsin hospitals. With hospitals reporting significant vacancy rates in their workforce as long-time employees retire, the WHA Employee Pride Program assumes even more importance as a tool to attract new workers and reward existing workers in the field of health care.

The Wisconsin Health Care Employee Pride Program gives employees the opportunity to share why they love their career of service to others, while giving the Association a moment to honor and celebrate their contributions to their hospital, community and profession.

A designated leader from administration, human resources, public relations or patient care from WHA member hospitals is asked to coordinate the program. Employees are encouraged to submit to the hospital a one-page essay, poem, or story that explains why they chose to work in health care. From those essays, a committee at the hospital will pick one employee to represent their hospital. That employee will be honored at a reception and dinner May 1 at the Kalahari Resort in Wisconsin Dells.

Last year, 68 hospital employees were honored at the Pride recognition dinner and award ceremony. This year we hope to recognize even more employees and to publicize their essays more widely in an effort to interest others in joining the health care workforce.

The Wisconsin Hospital Association, along with the Wisconsin Society of Healthcare Human Resources Administration, the Wisconsin Organization of Nurse Executives, and the Wisconsin Healthcare Public Relations and Marketing Society, is proud to sponsor the Wisconsin Health Care Employee Pride Program 2008.

Don’t miss this opportunity to participate in the 2008 Pride Program. Pride Program materials are available on WHA’s Web site at www.wha.org/workforce/pride_2008.aspx. For more information contact Shannon Nelson at snelson@wha.org or Mary Kay Grasmick at mgrasmick@wha.org, or call 608-274-1820.

The Wisconsin Healthcare Public Relations & Marketing Society (WHPRMS) and the Wisconsin Hospital Association are co-sponsoring "Health Care Marketing MBA in Just a Day," March 6 at the Country Springs Hotel in Pewaukee. The workshop will show participants how the key marketing-related disciplines—market research and assessment, marketing strategy and planning, and marketing communications—are most effective when used in an integrated approach. The workshop provides beginning and intermediate-level marketers with the tools to lead, manage and integrate primary market research, environmental assessment, patient pathway analysis, business development, strategic marketing and effective marketing communications.

Workshops leaders are: Kristin Baird, president, Baird Consulting, Inc. based in Fort Atkinson; Jean Hitchcock, vice president of marketing and communications for Scripps Health, and Cheryl Stone, president of Cheryl Stone & Associates. All three have extensive experience in health care marketing and management.

Making the transition from being a staff person one day to a supervisor or manager the next is a pretty significant step for nearly everyone. Those who make the leap discover they not only carry responsibility for high productivity combined with financial and regulatory prudence, but also must balance human relations skills to work closely and collaboratively with others.

Individuals who are new to hospital mid-level management, as well as experienced managers seeking a refresher, will find the "Leaping from Staff to Management" series helpful in making that initial leap.

Part one of the series, "You’re a Manager… Now What?" will be offered March 12 at The Lodge at Cedar Creek in Rothschild, and will explore the basics of management and leadership in theory and applied practice, and will lay the groundwork for continued development of leadership and management skills. Part two of the series, "The Next Steps," is scheduled March 13 also at The Lodge at Cedar Creek in Rothschild, and will focus on learning and reviewing realistic and workable techniques for managing and leading people that will help ensure continued effectiveness and success.

New or experienced managers can register for either individual session, or discount pricing is offered to those registering for the full two-part series.

Need to learn more about Recovery Audit Contractors? Looking for information related to WHA’s nationally recognized CheckPoint (www.wicheckpoint.org) and PricePoint (www.wipricepoint.org) programs? Start your search at www.wha.org, and click on the WHA Toolkit. WHA staff has researched and developed background papers on 22 health care issues, including billing and collection, dental access, health care costs, and uncompensated care. It’s a fast way to start your research, be connected to additional resources, and find the contact information for the WHA staff person who has expertise in that subject area. If you have an idea for a new paper that you think should be added to the WHA Toolkit, contact Mary Kay Grasmick, WHA, at mgrasmick@wha.org or 608-274-1820.

When Julie Salomon, Clinical Nutritionist at University of Wisconsin Hospital and Clinics was asked to make a presentation to a second-grade class, she did what she always does: She donned her fruity blouse and hat, a la Carmen Miranda, and shared with the youngsters three important messages on nutrition. But it wasn’t until weeks later that she realized the messages she planted that day had taken root in the form of inspiration for the students.

Julie and the other nutritionists at UW Hospital and Clinics often take their message of nutritional wellness to community and school events and wellness fairs. At those events, and for this group of second-graders, Julie boils things down to three key directives:

Colorize— the more colors you eat the better;
Minimize — cut down on junk food, large portions, sweetened beverages, etc.; and
Mobilize — exercise.

To reinforce this approach, she brought along some exotic ethic fruits and vegetables to illustrate just how diverse fruits and vegetables can be.

A few weeks later, Julie was surprised to receive an invitation back to the class to pick up a gift. There, she was presented a new customized hat, featuring the students’ names with a corresponding fruit or vegetable. There was Gabe the gourd, and Jack the jalapeno. Julie was moved to tears, as she realized how her message had been embraced by these students and had fostered further discovery.

A few weeks later, Julie was invited back to the school again, this time for an end-of-year assembly. To her amazement, Julie and the rest of the school were treated to a full length, choreographed, hip-hop song, performed by the students with lyrics featuring her nutritional message of colorize, minimize and mobilize. What had begun as a class visit with a simple message grew into a fun example of just how easy healthy living can be for both kids and adults. Here is some of that song:

"Follow our example — please imitate,
Healthy eating you can celebrate.
Make your style totally elite
And wish someone bon appetite."

Friends, listen to our cries,
Its something you should memorize,
When it comes to food you gotta -
When it comes to food you gotta-
When it comes to food you gotta-

COLORIZE, MINIMIZE, MOBILIZE!
WHAT?
COLORIZE, MINIMIZE, MOBILIZE!
Huh?
COLORIZE, MINIMIZE, MOBILIZE!

Community Care made available through Tomah Memorial Hospital (TMH) provided a Wisconsin man the opportunity to take control of his life and reach financial independence.

In a recent letter to Tomah Memorial, the patient said he was "surprised" to learn that his hospital bill—for treatment of asthma—"qualified to be paid by a special fund set up by the hospital."

At the time he was admitted, he did not have insurance. It was his goal to get out of debt from his small business and someday become a police officer. He also was to get married and start a family at the time of his hospitalization.

Today, the man is a full-time police officer in a Wisconsin city, with a family, including three children.

The man felt it was the Community Care at Tomah Memorial Hospital that made an impact on his life. "I believe that the timing of that financial help from the hospital encouraged me toward the hope of financial independence," he wrote in his letter. "I am so thankful a fund had been set up to help people that truly wanted to turn a corner and get rid of debt," he wrote.

The man also contributed $1,000 to TMH saying, "it would make me very happy, if the situation arises, to help someone else as you have helped me."

Did you know that May is national Stroke Awareness Month and April is Youth Sports Safety Month? There are literally hundreds of health care observances. Now you can find a list of them on WHA’s Web site at www.wha.org/education/national_observances.aspx. If you prefer hard copy, the 2008 edition of the Health Observances and Recognition Days Calendar can be purchased from the Society for Healthcare Strategy & Market Development at their Web site, www.shsmd.org.

HR Solutions, Inc., a consulting firm specializing in employee engagement and exit surveys, announced the 2007 Employee Engagement Award Winners. This award recognizes the top organizations in which employees rated the highest in job satisfaction scores among the 2007 Employee Engagement Survey participants. The organization with the highest overall job satisfaction score was Stoughton Hospital, Stoughton with 91.5 percent favorable. Shawano Medical Center was also recognized for improving the most from their previous survey.

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