Calling it a "sick tax," hospital officials across the state are reacting to the news that Governor Doyle is considering including a hospital tax in his state budget. While Gov. Doyle would not confirm that a hospital tax would be in his budget, the Journal Sentinel confirmed that he will try to follow the lead of Illinois and other states by proposing the tax. The Governor, quoted in the Journal Sentinel: "The federal government has sort of opened up certain methods by which they will provide more money to the states." Doyle said, "Any state has to be looking at those."

In his Valued Voice President’s Column this week, WHA President Steve Brenton said the hospital tax would likely become the "de facto ‘bank’ to fund the Administration’s 2007-2008 budget." The talk of a hospital tax follows Doyle’s announcement for millions of dollars in new spending for K-12 schools, higher education and other programs, which, according to Brenton, will create a "BIG budget hole."

WHA Senior Vice President Eric Borgerding said while the Administration has not released the details, one thing is certain: patients will pay. Donna Sollenberger, CEO at UW Hospital and Clinics, agreed. "Ultimately, what you’re saying is you’re going to tax sick people," if a tax is imposed on hospitals.

Borgerding said we don’t need to speculate in Wisconsin how the provider tax will affect hospitals. Wisconsin has experience with provider taxes already in its nursing homes.

John Sauer, executive director of the Wisconsin Association of Homes and Services for the Aging, is all too familiar with the impact that the nursing home bed tax has had on long-term care facilities in Wisconsin.

Sauer said that nursing homes are not fully reimbursed for the tax that they pay, which leads to increased costs for patients. In addition, Sauer said, "Our history shows there’s an endless number of attempts to raise the tax to meet the state’s needs."

Mike Schafer, CEO, Spooner Health System, which includes both a hospital and a nursing home, urged the Governor to consider other means to meet the projected budget deficit. "The Governor is trying to cover more people at the expense of those who buy health insurance. Maybe the state needs to live within its means a little better," said Schafer.

While the Governor points to other states that have considered or passed a hospital tax, Jim Woodward, the new CEO of Meriter Hospital in Madison, recently relocated to Madison from Virginia, where a hospital tax was proposed, and later defeated. "A hospital tax might help us for a while, but I think we need to look at this more broadly and from a principle standpoint. I believe such a tax is bad for health care, hospitals, and the patients we serve, even if a few benefit for a short period of time. What are needed are long-term solutions to the under-funding of government programs. A hospital tax sets in motion a bad precedent," Woodward said.

A hospital tax was defeated in New Jersey, and Connecticut just dumped their hospital tax after a decade. Jennifer Jackson, CEO of the Connecticut Hospital Association said, "When we hear other states are considering a hospital tax, we think, ‘Boy, they don’t know what they’re getting into.’"

Legislators from both parties denounced a hospital tax.

Sen. Jeff Plale (D-South Milwaukee) is opposed to the idea of a tax. "We’re trying to drive health care costs down—not up," he said. Assembly Speaker Mike Huebsch called the hospital tax "a shell game."

"One of the biggest concerns of people across the state, business and families, is the cost of health care. Now we’re going to tax that. This completely flies in the face of us trying to get a handle on the cost of health care," according to Huebsch.

Senate Minority Leader Scott Fitzgerald (R-Juneau) said, "A bipartisan effort to kill the sick tax would send a clean message to taxpayers that they’re our number one priority.

Rural and urban hospital leaders alike voiced their opposition to a tax.

Tomah Memorial CEO Phil Stuart said if the proposal to impose a tax on hospitals to pay for health initiatives comes to pass, consumers would end up paying more money for services. "The public really doesn’t gain anything by the proposal," he said.

The WHA Board will meet next week to advise staff on strategy to fight the "sick tax" while advancing the Association’s commitment to supporting coverage improvement initiatives and hiking woefully inadequate provider payment rates.

I am looking at my term from two different perspectives. One is statewide—issues that affect everyone in the state of Wisconsin. Secondly are issues that affect the 89th District. Statewide, I’d put health care, education and the economy as top priorities. Speaking specifically to the 89th district, transportation and the completion of Highway 41 between Oconto and Peshtigo are at the top of my list.

Recently a nurse was criminally charged by the State Dept. of Justice for an unintentional medication error that resulted, sadly, in a death. The unprecedented criminal charges have sent shockwaves through the health care community and will have very serious implications for Wisconsin. Would you support legislation to protect our health care workforce from fear of exposure to criminal charges and prison time for unintentional errors?

I would definitely support legislation that would protect health care workers who make unintentional errors. There is no place for criminal prosecution for an honest mistake. Mistakes happen whether you are a legislator or a health care worker. It is a different issue if it is intentional, but by criminalizing medical mistakes you provide a disincentive for the best and brightest to go into health care for something we all do – make mistakes.

As a member of the Assembly Health & Health Care Reform Committee, which will analyze various health care reform proposals in the coming year, what do you see as the key principles a health care reform proposal should include to be effective? What role do you see hospitals having in the health care reform debate?

The quality of care in hospitals nationally is outstanding. Our citizens live longer, and that is a good thing. The unfortunate side effect is that it is putting a strain on our health care system. One major problem is that Medicaid and Medicare reimbursement is not keeping pace, and until it does, we can’t fix it here in Wisconsin. It is going to take a federal solution. There is a lot of cost shifting going on. As we begin in earnest conversations about health care reform in Wisconsin, hospitals must be at the table and they can play a role, including educating the public. As an independent insurance agent, I know insurance companies and hospitals get beat up. All players, including consumers, shoulder the responsibility, and all are equally responsible for helping to find a solution. Lifestyle choices, smoking, obesity, all add to problems we see in the health care system. I’d like to see some initiatives for prevention and wellness as part of any legislative solution. We have seen success arise in businesses that implement these initiatives on their own. We need more of those ideas to become practice. I favor private sector solutions to the problems because people want to make their own health care decisions. They don’t want to see the bureaucracy doing that for them.

Wisconsin’s Medicaid and BadgerCare programs pay hospitals about 49 cents for every dollar it costs hospitals to care for these patients. The situation is much the same for Wisconsin’s nursing homes, many of which are owned/subsidized by hospitals. Do you believe providers should be able to more adequately recover their costs for providing care to these patients?

Hospitals are businesses, and I don’t believe they should shoulder a disproportionate share of the burden.

Tobacco-related diseases cost Wisconsin’s Medicaid program $442 million annually. There have been recent proposals to increase the cigarette tax. The Governor’s Healthy Wisconsin Board recently recommended increasing it by $1 and devoting that to state health programs, including increases for provider Medicaid reimbursements, and Governor Doyle proposed increasing it by $1.25. Would you support a cigarette tax increase and use it to increase Medicaid payments to hospitals?

At this point at time, I am not sure I have a definite opinion on raising the cigarette tax. My biggest concern is that once collected, money in segregated funds has historically been used for other purposes. For me to be on board, I need assurances that those actions will not be repeated.

Access to dental health is a growing problem in Wisconsin. Hospitals across the state continue to wrestle with the problem up close when individuals who cannot find a dentist utilize the emergency room for their dental health needs. What do you think government can do to help with this access crisis?

One of the problems that dentists tell me they have is that patients who utilize Medicaid or are uninsured are less likely to show up at scheduled appointments. From what I’ve heard, the dentists are willing to serve these patients, but over time, their experience with setting appointments and keeping them has not been good. It leaves a hole in their schedule and affects their ability to care for other patients. We need to come up with some common sense solutions that work for both providers and patients, like perhaps taking the service to the patient in settings like schools that are perhaps easier to access.

Other comments?

We need to look at the issue of equity in the health care system due to cost and the ability to participate in health care networks. We have inequities in our access to care based on cost. It shouldn’t come down to where you live as to whether you can access a health care service. Ten years ago there was no managed care north of Green Bay. Over time, it has become better and now there are 2-3 networks available in northeast Wisconsin.

This week President Bush released his proposed budget. According to the American Hospital Association (AHA), these cuts would have a "devastating" impact on hospitals if enacted. The impact of Medicare cuts on Wisconsin hospitals would exceed $362 million according to an AHA analysis. AHA estimates over $100 billion in cuts—$75.9 billion to Medicare and $25.7 billion to Medicaid, nationally.

Major Medicare Cuts

• Inpatient & Outpatient Cuts — market basket minus 0.65 percent for 2008-2012 for a total projected savings of $13.8 billion for inpatients and $3.4 billion for outpatient over five years
• Inpatient Rehab Facilities Cuts — market basket kept at 0 percent in 2008 then market basket minus 0.65 percent from 2009-2012 for a total projected savings of $1.9 billion over five years
• Skilled Nursing Facilities — again, 0 percent in 2008 with market basket minus 0.65 percent in 2009-2012 for a total projected savings of $9.2 billion over those five years
• Phase out of Medicare bad debt payments over four years of $7.2 billion
• Proposal to eliminate Medicare payments for "never events" for a total projected savings of $190 million over 5 years
• IME "double" payments eliminated for Medicare Advantage (payments will no longer go directly to hospital) for a total projected savings over five years of $4.37 billion.

• Budget codifies recently proposed regulations which cut Medicaid
• Proposed reduction in DSH payments
• SCHIP reauthorization but at an insufficient level to address program needs/growth
• Reduction in federal medical education payments

"WHA will work closely with members of the Wisconsin Congressional Delegation to make sure that proposed payment reductions are rejected," said WHA President Steve Brenton.

On February 13, Governor Doyle’s 2007-09 Budget initiative will be unveiled. Based on information released over the past several weeks, the Doyle budget will strongly emphasize expanding health care coverage to vulnerable populations. The Governor’s admirable goal is to see that 98 percent of Wisconsin citizens have coverage for basic health care services by the end of the biennium.

On paper, WHA’s new access and coverage principles are likely to align nicely with the Doyle Administration health initiatives. And the already announced plan to significantly increase the tobacco tax to fund coverage expansions and tobacco cessation programs represents a longstanding WHA advocacy priority. Unfortunately, the Doyle health care plan is also likely to propose a hospital tax that will be used to backfill a structural "cost to continue" Medicaid budget deficit…and perhaps other Administration state budget priorities.

The fact is that there is plenty of money available from the higher tobacco tax and the proposed Tobacco Litigation Settlement bond refinancing to fund the Medicaid deficit, targeted coverage expansions and much needed Medicaid provider rate increases. The problem…is basic budget math. That means that other announced Administration budget priorities…K-12, UW System, etc…are vacuuming up available state revenues and creating a BIG budget hole. Thus a HOSPITAL TAX has likely become the de facto "bank" to fund the Administration’s 2007-09 budget.

In addition to being a troublesome precedent and a disturbing decision to tax a provider group that hasn’t had a Medicaid payment increase in almost a decade, the hospital "sick tax," once enacted, will become the first "go to" option every time the state budget experiences an "unanticipated" Medicaid cost overrun. And from past experience, that will be a frequent occurrence.

Let’s imagine that next December, State Budget staff announces that state spending on SeniorCare is exceeding budget forecasts by 12 percent, thus leaving a $14 million deficit that will grow to $36 million by the end of the biennium. Anyone wish to speculate on the likely funding option to fill this budget hole, especially given the precedent established just a few months earlier? That scenario is exactly what has happened to the nursing home bed tax, and is the reason why most nursing home executives recoil at even the mention of a tax they agreed to support a decade ago.

It’s important to remember that the Legislature will discuss and debate the budget legislation for the next five months. WHA will continue our ongoing efforts to improve Medicaid payment rates and support responsible initiatives that expand access and coverage for vulnerable populations. These initiatives should be underwritten with new revenues generated by tobacco tax increases…not a hospital "sick" tax assessed on community hospitals.

Steve Brenton,
President

Newly-elected Senator Jim Sullivan (D-Wauwatosa) toured Children’s Hospital of Wisconsin (CHW) on January 29, 2007. Sen. Sullivan toured the Pediatric Extended Care Clinic and heard how the program began 10 years ago in partnership with the state. This clinic is a group care facility for children who require eight hours or more of nursing care per day. Children receive educational services, nursing care, social stimulation, therapies and other services.

During his visit, Sen. Sullivan also toured the Pediatric Intensive Care Unit and the Neonatal Intensive Care Unit, which was redesigned with help from a special federal appropriation. Sullivan also had a chance to visit the new Hematology/Oncology/Blood and Marrow Transplant (HOT) unit. CHW Executive Vice President and Chief Operating Officer Cindy Christensen led the tour.

Afterwards, CHW leaders, including Tom Gazzana and Chris Holmes, met with Sen. Sullivan to discuss health care costs, Medicaid reimbursement, a possible hospital tax and other relevant health care issues.

If your hospital has recently hosted an elected official, please let HEAT know by contacting Jenny Boese at jboese@wha.org or 608-268-1816.

The Wisconsin Collaborative for Healthcare Quality, in partnership with the Wisconsin Hospital Association, the Wisconsin Medical Society, and HOPE of WI, received a $600,000 grant from Aligning Forces for Quality, The Regional Market Project, a national program of the Robert Wood Johnson Foundation (RWJF).

The premise of Aligning Forces for Quality is that no single person, group or profession can improve care for chronic conditions throughout a community without the support of others. As its name suggests, Aligning Forces for Quality seeks to drive quality improvement by aligning key forces, including health care providers (physicians/physician groups, nurses, clinics), health care purchasers (employers and insurers) and health care consumers (patients).

The program seeks to help the providers deliver better care and the consumers make better choices by moving on three complementary fronts to:

• Help providers improve their own ability to deliver quality care
• Help providers measure and publicly report their performance
• Help patients and consumers understand their vital role in recognizing and demanding high-quality care

Wisconsin joins 13 other grantees in the three-year, $14-million program. The selection process and intensive site visits confirmed Wisconsin has taken significant steps toward the program’s goals and have the capacity for further improvement. In that spirit, the grant will leverage the infrastructure and momentum of the existing public reporting initiatives in Wisconsin, while helping to strengthen the use of information to support both quality improvement and consumer engagement.

"It is a great honor for Wisconsin to receive a grant from the RWJ Foundation, given the level of competition for this funding. One of the key reasons Wisconsin received this grant is due to the comprehensive infrastructure we are creating to collaboratively improve care, publicly report information, and educate consumers about their role in health care today. This funding will further advance work already in progress," said WHA Vice President Dana Richardson.

It was another stellar performance for health care organizations at the 2007 Wisconsin Forward Award (WFA) ceremony held February 7 at the Overture Center in Madison. Three organizations, Wheaton Franciscan Healthcare-All Saints, Racine; Meriter Hospital, Madison; and Luther Midelfort, Mayo Health System, Eau Claire, received the Governor’s Forward Award of Excellence. Over the past ten years, only six other organizations have received the Governor’s Forward Award of Excellence. Seven hospitals/health systems received the Wisconsin Forward Award.

"By using the Criteria for Performance Excellence and WFA’s rigorous review process, health care organizations in Wisconsin are leading the way in improving health care outcomes, providing safe, efficient, and effective care, and developing innovative solutions to issues such as the shortage of health care workers. Hospitals participating in the WFA program are going beyond what is required to continually raise the performance bar. Why? Because they know their patients, their communities, and their employees expect no less," according to Elizabeth Menzer, executive director, Wisconsin Forward Award.

Remember to sign up for one of the seven regional luncheon meetings planned for hospital executives to focus on their hospital’s emergency preparedness planning. WHA is encouraging at least one senior-level hospital leader from each hospital and system to attend. You can find information about the scheduled dates and locations on WHA’s Web site at www.wha.org.

For more information about the content of the meetings, contact Bill Bazan at 414-431-0105 or bbazan@mailbag.com. For questions regarding registration, contact Lisa Geishirt at 608-274-1820 or lgeishirt@wha.org.

On February 28, WHA is offering a two-hour webinar and audioconference entitled "Race & Ethnicity Data Collection. At the conclusion of the session, participants will understand the importance of collecting race and ethnicity data, be able to assess current data collection practices, have the knowledge to accurately collect race and ethnicity data in a systematic way, and know how to use these data to improve quality of care and accurately assess resource needs to meet community needs.

Some of the most publicized medical errors in Wisconsin, as well as other states, occurred in 2006. These events triggered many questions related to error prevention, the process once an error has occurred, and the accountability of a medical error. WHA recognized the need to facilitate a deeper understanding of the just culture model.

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 one-day seminar will be presented by David Marx, JD, president of Outcomes Engineering, a risk management firm that focuses on helping high-risk organizations develop safety supportive practices and culture. Marx spoke at WHA’s 2005 Quality & Safety Forum, where he gave a broad overview of the concept of just culture. The March 22 session will take a deeper look at the principles of just culture. Attendees will have the ability to assess their organization and make identified changes.

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. A full registration brochure will be available in next week’s Friday Packet at www.wha.org. For registration questions, contact Lisa Geishirt at WHA, 608-274-1820 or lgeishirt@wha.org.

It’s tough being a parent – even tougher if you’re a single teenager trying to balance school, work, relationships and finances. Fortunately for teen parents living in and near Marshfield, help is available. The Kiddie Kaboose childcare facility, a service of the Health Birth Program of Saint Joseph’s Hospital, assists teenagers with childcare needs. To enroll a child in Kiddie Kaboose, a parent must first attend the Nurturing Program offered by the hospital that offers parenting education specifically designed for teens and their families. Area schools strongly support the Saint Joseph’s Nurturing Program and have offered their parenting students credit for competing all of its session. Since their introduction in 1990, the Nurturing Program and other Healthy Birth Programs have helped hundreds of Marshfield area teenagers better adjust to the new responsibility of parenting.

With participation in many employer-sponsored wellness programs at an all-time high, American workers want improved wellness and are taking personal steps to battle rising health costs. These findings, from the Principal Financial Well-Being Index^SM, describe wellness attitudes and behaviors among American workers. The results of the national survey, commissioned by the Principal Financial Group®, reveal some significant changes from the prior year:

• Participation in on-site health screenings has increased to more than 79 percent, up from just 68 percent in 2005.
• The majority of those surveyed (65 percent) have implemented a personalized action plan for high-risk conditions, up from only 45 percent in the previous year.
• Fitness facility use is not just catching on – it has nearly doubled. Now 60 percent of employees take advantage of this benefit when offered (compared to 38 percent in 2005).

Beyond Cost Containment

Employers have yet another reason to look to wellness - results from the Index show wellness programs encourage employees to work harder and stay longer at their job. More than half (51 percent) of those surveyed say a wellness program offered through their employer encourages them to work harder and perform better. At the same time, 55 percent of workers say having a wellness program in place encourages them to stay with their current employer.

Employees Benefit

If feeling healthier isn’t enough, workers also see personal financial impact from participating in wellness programs. When asked, over half of those surveyed (58 percent) say "my family and me" benefit the most financially from the reduced costs associated with wellness programs. Reduced personal health care costs would be one of the reasons 38 percent of those surveyed would be willing to sign up for a wellness program. The majority of those workers (61 percent) feel employer-sponsored wellness programs can be successful in combating rising health care costs.

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