On the last day of the 2003-04 legislative session, the Assembly passed Senate Bill 372, a bill that amends section 146.82 of the Wisconsin Statutes to permit hospitals and other providers to use health care information for purposes of health care operations (see 1/16/04 and 2/6/04 issues of The Valued Voice). The Governor is expected to sign SB 372 into law.

In brief, this change would address a major inconsistency between the federal Health Insurance Portability and Accountability Act of 1996 ("HIPAA") regulations and state law. Under HIPAA, providers may use health care information for purposes of payment, treatment, and operations without first obtaining specific patient consent. Under Wisconsin law, however, providers may use the information only for purposes of payment or treatment, but not for health care operations. This inconsistency between state and federal law is making it nearly impossible for the health care community to implement and comply with HIPAA and state law.

In order to win passage of this important yet technical bill, WHA lobbyists needed to carefully work through the minefields of partisan disputes between the legislature and the Administration. Strong relationships with both branches permitted this change to be accomplished in a bipartisan fashion. Lobbyists from Dean Health Systems and Marshfield Clinic also logged many hard hours to see SB 372 pass.

This change is a piece of WHA’s larger regulatory reform agenda, in which WHA is attempting to pursue regulatory changes that will help reduce health care costs through more consistent and efficient regulation. Specifically concerning HIPAA, the federal government itself estimates that the cost of implementing HIPAA for the health care community will exceed $17 billion over ten years. Unfortunately, the cost for Wisconsin health care providers will be higher than estimated in part because of the inconsistency between state and federal law.

WHA continues to pursue amendments to Chapter 146 and other statutes to reduce the regulatory burden for Wisconsin hospitals. These efforts are aimed at providing important patient protections while permitting health care to be delivered in an efficient and effective manner.

The deadline to submit the name of one employee to be honored at the Wisconsin Hospital Employee Pride Program 2004 is just around the corner. Each hospital’s honored employee’s name and his/her written story or audio/videotape is due to WHA by April 7.

Please note that each hospital may choose and submit the name of one employee to be honored at the 2004 Pride Program. A reception and dinner will be held on Thursday, May 6, at the Kalahari Resort in Wisconsin Dells to honor these employees from around the state.

The formal submission form, reception/dinner registration form, and information about making hotel reservations at the Kalahari Resort can be found on the WHA Web site at www.wha.org. Click on the Pride Program information on the home page to be linked to all the appropriate information.

Pride Program Timeline

March 31, 2004 - Deadline for employees to submit their Pride Program story to their hospital representative

April 7, 2004 - Deadline for hospital representative to submit the following to WHA:
                       1) ONE employee's essay, poem, or tape;
                       2) That employee's signed Application; and
                       3) A completed Submission Form

April 14, 2004 - Deadline for reserving a sleeping room at the Kalahari Resort (WHA group rate of $99 for standard room expires after this date)

April 23, 2004 - Deadline for hospital representative to submit the registration form for the reception and dinner to WHA (honored employee, hospital representative attending, and all guests must be registered with WHA by this date)

May 6, 2004 - Pride Program Reception and Dinner at Kalahari Resort in Wisconsin Dells

WHA, 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, are proud to sponsor the Wisconsin Hospital Employee Pride Program 2004. This program is designed to celebrate the pride that hospital employees have in their work and recognize the contributions that they make to their patients, their community and to their profession.

Don’t miss this opportunity to honor one of your employees through the 2004 Pride Program. For more information contact Mary Kay Grasmick at mgrasmick@wha.org, or Shannon Nelson at snelson@wha.org, or call 608-274-1820.

Hospitals will receive letters next week from WHA Information Center, L.L.C. regarding the sale of its data products.

"The most important thing for hospitals to know is that the annual ongoing cost of collecting and disseminating data will be about $1 million less as a result of privatizing the Bureau of Health Information’s functions," said Joe Kachelski, WHA Information Center vice president.

As part of the privatization initiative, hospital assessments that were used to fund BHI’s operations were repealed.

Data fees will be higher than in the past because the ongoing operations of the Information Center will not be subsidized by assessment revenue; data sales will be the Information Center’s only revenue source. By contrast, BHI collected about seven dollars in assessment revenue for every one dollar of fixed-price data sales revenue.

"Even considering the increase in data fees," Kachelski said, "the elimination of the hospital assessment typically means that hospital purchasers will pay significantly less for their data than in the past."

Kachelski said that WHA Information Center applied four principles in developing its fee structure:

• Revenue from data sales must cover ongoing operational costs.
• Larger facilities should continue to contribute relatively greater amounts to the cost of data collection operations than smaller facilities.
• Fees should vary on the basis of the number and size of the facilities that ultimately access and use the data.
• The fee structure should result in most facility purchasers paying less for privatized data collection (through data fees) than for government-run data collection (through data fees and BHI assessments).

Kachelski said these principles led to the creation of three purchaser categories, with different fee schedules applying to each. Hospitals purchasing data directly from WHA Information Center occupy the middle tier.

The Information Center is currently processing data from the fourth quarter of 2003. Data sets from that quarter will be available for purchase in mid-May. "We’ve heard overwhelmingly positive feedback from hospitals about our new data submission process," Kachelski said. "We anticipate that our data customers will be equally pleased with the quality and timeliness of our products."

Even a major snowstorm didn’t stop the Vikingland CheckPoint Regional meeting on March 5. While snow swirled outside, inside Hayward Area Memorial Hospital, members of the region listened in via phone lines and in person as Dana Richardson and Mary Kay Grasmick from WHA reviewed the preparations for the public launch of CheckPoint on March 30.

The WHA Member Advisory and related information is the product of a WHA workgroup that recently reviewed the documents and found them relevant and useful for today’s environment. In approving the Advisory, the WHA Board wished to make it clear that issues associated with measuring and reporting hospital quality and safety should be free from competitive pressures that influence much of today’s delivery environment. And as we near the rollout of the CheckPoint initiative, it bears repeating that the hospital field’s commitment to public reporting, while admirable, at the same time is in its infancy. Quality and safety measures included in the CheckPoint report present only part of the overall health care picture in hospitals. Over time, the reports will become more comprehensive and increasingly beneficial to users of the information. For those reasons, the WHA Board wholeheartedly endorsed the notion that it is inappropriate for our members, the news media and others to overstate individual hospital comparisons associated with the CheckPoint initiative and other measurement tools.

• Last week’s Valued Voice included a news item indicating that proposed 2005 Wisconsin Medicare wage index changes are overwhelmingly positive. In fact, 11 of the 12 Wisconsin wage index areas are likely to increase October 1, representing a multi-million dollar Medicare payment improvement in the upcoming federal fiscal year.

It’s important to note that WHA commits a substantial investment in time and resources each year in our efforts to help hospitals properly prepare the S-3 worksheets of their Medicare cost reports…the critical source of the wage index data. In partnership with R-C Healthcare Management, Inc., WHA holds education sessions and coordinates a thorough review of the wage data that is the foundation of the Medicare wage index. That investment is clearly making a difference and WHA’s commitment to regulatory advocacy via our focus on maximizing wage index adjustments will continue.

• The State of Wisconsin Ethics Board now ranks WHA among the "big players" in the Madison lobbying scene. According to the just-released 2003 report, WHA’s government affairs team logged over 3,000 hours lobbying state lawmakers and bureaucrats on a variety of key issues of concern to the state’s hospitals and health systems. WHA ranked 6th highest of the 651 registered lobbying organizations in 2003, devoting almost $425,000 to efforts aimed at influencing and advancing our advocacy agenda. And no organization devoted more time lobbying on Medicaid issues included in the 2003-05 Wisconsin budget, an effort likely to be ongoing as we focus on a challenging budget environment that places the Medicaid program at high risk.

Steve Brenton
President

Gather the health care and hospital supporters in your community and head to WHA’s Advocacy Day on April 7 at Monona Terrace in Madison.

Advocacy Day is a key event for Wisconsin hospitals. It is an opportunity to improve our grassroots effectiveness, while learning about the issues that will shape the future of health care delivery in Wisconsin.

Bring your grassroots team, key leaders, volunteers, auxilians, and trustees to this important event. It’s easy to register, and Advocacy Day is a free event to all participants. You can register a variety of ways:

- complete the registration form included in this week’s packet and fax to 608-274-8554;
- print the registration form from the Web site, complete and fax to 608-274-8554; or
- email your registration information to Sherry Rabuck at srabuck@wha.org or call Sherry at 608-274-1820. Register today!

Join the organizations already registered!

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While the bad news for most physicians has been increasing malpractice premiums, there is finally some good news. Wisconsin still remains a good place for insurance companies to write business. Our Patient Compensation Fund (PCF) and Tort Reform is attracting new carriers to the state. We are starting to see some competitiveness in the market that has been missing for quite awhile. While you shouldn’t expect rate decreases, we are at least seeing increases being held to a minimum.

Read the entire update in Solutions Spotlight, included in this week’s packet.

After a break of several months, the Task Force created by House Speaker Gard to study the Wisconsin Technical College System (WTCS) met on March 3, 2004. The agenda included a review of a collaborative proposal by the UW colleges and WTCS and a discussion regarding progress on the Recommendations made by the Task Force in October.

UW Colleges Chancellor, William Messner shared a joint proposal of the UW Colleges and UW extension to expand opportunities for students to obtain an associate degree. Discussion by the group focused on the agreement that successful growth of Wisconsin’s economy will require more state residents with bachelors’ degrees (currently, Wisconsin ranks 31st in number of residents with this degree). There was not full consensus on who should be serving the adult learner at the associate degree level. The UW colleges asserted that they need to increase access for these adults and the Technical College System responded that they already serve this audience as part of their mission.

There was much discussion by the Task Force members of the need for ‘transparency’ for students. Many examples were provided of students who had completed studies at a Wisconsin Technical College, been unable to transfer those credits to a UW system school and had to choose between repeating coursework to obtain credit or attending a private college or an out of state institution which would recognize the work previously done. Nino Amato reported that there are more than 400 articulation agreements in place between Technical Colleges and the UW, but Technical School graduates still can’t get a baccalaureate degree.

Deborah Mahaffey provided a progress report on credit transfer. In 1991-92 only 1,553 students successfully transferred credits from a technical college to a UW system institution. In 2002-03 that number increased to 3,206. Her report (available at www.wha.org, in the workforce section) addresses each recommendation of this task force and outlines progress made or work undertaken.

While both the university system and the Wisconsin technical college system articulated a commitment to collaboration on the recommendations, it is unclear what, if any, actions will be taken by the legislative team who sit on the task force.

On March 5, 2004, the Department of Health and Family Services forwarded proposed administrative rule HFS 117 to the legislature for consideration by the standing committees in the Assembly and the Senate. As discussed previously in Valued Voice, HFS 117 will establish the fees a health care provider may charge for requested copies of medical records. WHA testified in opposition to the proposed rule during DHFS’s public comment period and remains opposed to the rule.

As proposed by DHFS, health care providers could charge no more than 31 cents per page for medical records requested by individuals or their personal representatives and no more than 31 cents per page plus a per request charge of $15 ($12.50 for requests under five pages) for all other requestors, including lawyers involved in suing health care providers. WHA testified that these fees are less than the cost to provide medical record copy services and requested that DHFS increase the proposed fees prior to submitting the rule to the legislature. Health care providers and the Association for Health Information Outsourcing Services were uniformly opposed to DHFS’s proposed fees while the Wisconsin Academy of Trial Attorneys and the State Bar of Wisconsin support the proposed fees.

WHA is requesting that the standing committees in the Assembly and the Senate hold public hearings on the proposed rule and object to the rule until the rule accurately reflects the true cost of providing medical record copy fee services.

Governor Doyle has announced 36 appointments to the State Council on Workforce Investment. The council functions as the federally required authority to direct funds and policy under the Workforce Investment Act (WIA) of 1998. The WIA was passed to consolidate and coordinate all of the workforce preparation and development programs into a unified workforce investment system. In addition to dispersing federal funds, the council is responsible for strategic targeting of resources, labor market information, public-private partnerships and intergovernmental coordination. The purposes of the council are to:

• Promote the use of economic and labor market information to ensure evidence-based policy recommendations to guide the state’s broad workforce development system.
• Recommend policies to strategically target state training and education resources.
• Foster and support public-private partnerships and intergovernmental cooperation and coordination in the building of Wisconsin’s workforce.
• Develop and implement initiatives that invest in Wisconsin’s workforce and establish measures to monitor progress towards achieving objectives.
• Function as the federally required Workforce Investment Act (WIA) state council to ensure that the WIA funds are used as required by federal law, to support the workforce goals of the state, and to disperse state dislocated worker grants

Wisconsin’s Council on Workforce Investment has not traditionally included membership from the health care industry. The appointment of Tirado-Kellenberger is one of several which suggests that the Governor sees and understands that growing Wisconsin’s economy requires participation of the health care industry. The number and quality of health care jobs continues to increase. The Department of Labor recently indicated that registered nursing is the position with the largest potential growth.

The Joint Commission on Accreditation of Healthcare Organizations has identified miscommunication, or lack of communication, as one of the top five reasons that wrong things happen to patients. In the medical, legal and regulatory driven environment in which health care professionals work, it is essential that written communication, specifically medical record documentation, is done properly.

The May 14 seminar "Improving Medical Record Review and Documentation" will take an intensive look at medical record review/documentation and address how hospitals can build an organizational framework to support this process. Medical records directors, nurse executives and managers, compliance officers, quality managers and medical staff directors should consider attending this important event.

The seminar will be held on May 14, 2004, from 8:30 am to 3:30 pm at The Crowne Plaza in Madison. A brochure and a registration form are included in this week’s packet and on the web site at www.wha.org. Easy, on-line registration is available as well.

The Wisconsin Hospital Association’s Quality & Safety Forum and the Wisconsin Patient Safety Institute’s Forum will come together in 2004 to offer the new, co-sponsored Wisconsin Quality & Safety Forum. The 2004 Forum is scheduled for October 18-19, 2004, at The Plaza Hotel in Eau Claire, Wisconsin.

The 2004 Forum will provide thought-provoking education and networking opportunities for health care quality directors, risk managers, CEOs/administrators, clinician managers, physicians, nurses, pharmacists, patient advocates, health care purchasers, researchers, educators, students, legislators, regulators, and other policy makers. More than 200 attendees are expected.

The 2004 Forum will combine education with a showcase of projects focused on current quality improvement and/or patient safety initiatives, submitted by a diverse group including health care providers, researchers, coalitions, advocacy groups and others from across the state. The call for project submissions for the 2004 Forum will be distributed on March 19 with all submissions due to WHA by May 21.

Final agenda and registration information for the 2004 Forum will be distributed in mid-August. If you have any questions about the Wisconsin Quality & Safety Forum, contact Dana Richardson or Jennifer Frank at WHA, 608-274-1820, or at drichardson@wha.org or jfrank@wha.org.

Hospitals can play a leading role in their communities on May 12 by joining together in promoting Wisconsin Stroke Alert. This statewide, one-day intensive public campaign will educate all the people of the state about the signs and symptoms of stroke – and about the importance of calling 911 immediately if those symptoms appear.

In anticipation of the summer months and the possibility of unusual disease strains, the Wisconsin Division of Public Health (DPH) reminds partners in the health field that the State and local health departments are available around-the-clock for emergency reporting or consultation.

"The Wisconsin DPH requests the help of hospitals in providing this information to all clinics and medical providers throughout the state," said Lorna Will, Bioterrorism Surveillance Epidemiologist. DPH has epidemiologists and physicians available for consultation by calling the 24-hour emergency hotline number: 608-258-0099. A live operator will contact technical staff for assistance with chemical spills, communicable disease outbreaks, natural disasters, radiological or nuclear incidents, or any other event that needs a cooperative response among all health providers.

A poster with this emergency number can be downloaded from the HAN (www.han.wisc.edu, topic Wisconsin Public Health) and posted in hospitals and clinics. Also, local health departments all have 3-deep phone coverage on a 24/7 basis.

"We encourage all clinicians to post the State’s hotline number as well as the telephone numbers of local health departments," said Herb Bostrom, Wisconsin DPH, Director of the Bureau of Communicable Disease. "Even if the incident turns out not to be an emergency, we need to be notified sooner rather than later so we can lend assistance and share information with our medical partners."

Congratulations to Colleen Dolata, Ripon Medical Center, who received a Rural Wisconsin Health Ambassador Award. The complete list of recipients appeared in the March 5 issue of The Valued Voice.

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