About 40 Wisconsin health care leaders, which included a dozen hospital and health system representatives, attended an invitational White House Regional Forum on Health Care Reform in Dearborn, Michigan, March 12.

The event was hosted by Wisconsin Governor Jim Doyle, Michigan Governor Jennifer Granholm and Melody Barnes, senior domestic policy advisor for the Obama Administration. The stated purpose of the Forum was to engage participants in discussions about improving the nation’s health system. The goal is to develop specific legislation and enact meaningful reform in 2009.

The Regional Forum opened with a video recorded earlier in the week by President Obama tasking the group to identify ideas that can be fashioned into a larger health reform initiative. An overview was then provided by Barnes who described the primary objectives of the Obama Administration as expansion of coverage for American families and "bringing down health care costs" that were described as "unsustainable."

Prepared meeting materials developed by Governor Doyle’s staff highlighted Wisconsin Leadership on top health care goals that align with the Obama Administration’s outcome priorities. "Wisconsin is proud to be a national leader in expanding coverage through our BadgerCare Plus initiatives," Doyle told participants. "We are well on our way to providing at least basic coverage to tens of thousands of uninsured patients and families and in the process closing the gap on our goal of providing coverage to 98 percent of Wisconsin citizens."

Responding to a specific question from Governor Doyle regarding essential elements needed to advance health reform, Leo Brideau, CEO of Columbia St. Mary’s and chair of WHA’s Health Reform Task Force cited the need to "change the current financial incentives for delivering care; reduce unnecessary care, including end of life care; and invest in new infrastructure required to improve access." Brideau also said that "100 percent access and coverage is a moral imperative" and noted that the Dartmouth Atlas is a roadmap for understanding the disparity and variation in resource utilization.

In commenting on the Forum content, WHA Board Chair Mike Schafer said that "many of the comments today align well with WHA’s reform principles, and it was also important that several speakers discussed the unique challenges and access issues facing our rural patients and providers."

"The Forum was a nice opportunity to bring different perspectives together in one room and provide input about the difficult challenges that we face in moving from high level consensus to the specific details that will be required to move forward," said WHA President Steve Brenton. "But there’s no question that the commitment and energy behind national and state level reform is present and sustainable."

A bipartisan panel of state legislators is confirmed for the panel discussion at Advocacy Day 2009 on April 1. The focus of the panel discussion will include a variety of issues including cost, access, quality, and the impact the economy is having on health care and hospitals.

Confirmed panelists are:

State Senator Bob Jauch (D-Poplar), Chair, Senate Committee on Children, Families and Workforce Development

State Senator Dale Schultz (R-Richland Center), Member, Senate Committee on Public Health, Senior Issues, Long Term Care and Job Creation

State Representative Jon Richards (D-Milwaukee), Chair, Assembly Health & Healthcare Reform Committee

State Representative Jeff Stone (R-Greenfield), Member, Assembly Health & Healthcare Reform Committee

Advocacy Day is a free event where 600 hospital employees, trustees and volunteers converge on Madison. This year Rick Pollack of the American Hospital Association will describe what is happening in Congress, Governor Jim Doyle will speak at noon, and attendees will be briefed by WHA’s Government Relations staff in advance of their legislative visits later that afternoon.

You will come away from this event knowing what issues are hot in Madison and Congress, how they impact your hospital, and what you can do to make a positive difference. Don’t delay. Register today! Online registration and the full brochure are available at www.wha.org/governmentRelations/advocacy_day.aspx.

Under EFCA, a fundamental tenet of American Democracy—the secret ballot—is replaced in union organizing with a card check system. With card check, a union must be recognized and no secret ballot allowed if 50 percent plus one signs a card. The legislation also includes two other equally concerning provisions: binding arbitration by a federal arbitration board if a contract is not agreed to within 120 days and increased penalties on employers only for unfair labor practices during union organizing.

Due to concerns with these fundamental changes, both of Wisconsin’s major newspapers, the Milwaukee Journal Sentinel and the Wisconsin State Journal (Madison), editorialized against EFCA this week.

"We believe that the woefully misnamed Employee Free Choice Act could well hurt the very workers in Wisconsin that it professes to help," read the Milwaukee Journal Sentinel editorial against EFCA. (www.jsonline.com/news/opinion/40870897.html)

And from the Wisconsin State Journal editorial, "When the Rev. Al Sharpton and former Democratic presidential candidate George McGovern are on the same side as Republican strategist Karl Rove and the U.S. Chamber of Commerce, the issue must cut across the political spectrum to reach a fundamental American value. So it is with a proposal to take away the right to a secret ballot in union-organizing elections. The proposal is wrong." (www.madison.com/wsj/home/opinion/442033)

In related news, the U.S. Senate Health, Education, Labor & Pensions Committee held a hearing on the topic, and there is talk the bill may come before the Senate first.

The Wisconsin Hospital Association will continue to join with others across the state in raising concerns with our Members of Congress about EFCA. To express your opinions, log onto WHA’s "email my legislators" at www.wha.org/speakUp/congressional.aspx.

A group of at least a half dozen Senate Democrats are having second thoughts about supporting legislation that would ban secret ballots in union organizing elections and mandate that federal arbitrators impose contract terms on businesses that fail to reach contract agreements with their unions.

The battle over the misnamed "Employee Free Choice Act" is likely to heat up over the next few weeks with employers labeling the legislation a "job killer" and labor unions calling in their IOU’s from Democratic congressional leaders. President Obama indicated as late as this week that he will sign the legislation if it reaches his desk.

The notable new political dynamic today is the fact that a handful of moderate Democrats, including Wisconsin Senator Herb Kohl, have recently expressed reservations about the bill. This is the same bill that they all supported last year. But that was before November 4, and the legislation never would have become law due to the absolute certainty of a presidential veto. All of that has changed.

One of those moderate Democrats is Arkansas Senator Blanche Lincoln. In a recent interview she noted that "I have 90,000 Arkansans who need a job, and that’s my number one priority." Lincoln also called the legislation "divisive…something we don’t need right now."

Washington observers say that some lawmakers are currently scrambling for a compromise that will placate labor while neutralizing business opposition. But it’s difficult to fathom a compromise that accommodates address of the two central issues. Either you have a secret ballot or you don’t. Same goes with binding arbitration.

Look for a lot of vitriol and cash to be spent on this issue in coming weeks. War chests are brimming with dollars that will be spent in swing districts to influence the decisions of the handful of undecideds. Importantly, WHA is working with a statewide coalition of organizations committed to educating the public on the importance of preserving employee right to secret ballot on an issue as important as unionization.

Steve Brenton,
President

First-term legislator State Rep. Keith Ripp (R-Lodi) visited Columbus Community Hospital for the first time this week after his election in November. This is yet another example of a Wisconsin hospital building relationships with legislators.

Doug Lyon started his presentation at WHA’s Community Benefit Training Session March 6 in Wisconsin Dells with an admission: Every Friday he reads all the community benefits stories in WHA’s newsletter, The Valued Voice.

"We work with a lot of states, but Wisconsin is one of the best in quantifying and describing its hospitals’ community benefit programs and services. We are always impressed with the community benefit stories in Valued Voice. WHA does a great job celebrating and communicating what hospitals do in their communities," Lyon said. "In bad economic times, these programs are essential, and it is important to continue reporting these stories," he added.

Lyon, who owns Lyon Software, a popular community benefit collection software tool, emphasized the importance of having a community benefit plan to the 80 participants. He stressed that it must be shared with the hospital Board of Directors and it requires strong backing from hospital administration.

Two hospitals presented best practices at the seminar. Steve Sparks, director of public relations and marketing at St. Mary’s Hospital, Madison and Robert Speer, community benefit director at ProHealth Care, Waukesha each described their successful efforts in increasing community and employee awareness of their hospital’s activities in this area.

Mary Kay Grasmick, WHA vice president, communications, said 100 percent of Wisconsin’s member hospitals complete the WHA community benefits survey. The numbers are important, but the stories convey the real impact that hospital’s efforts in the community have on the lives of the people they touch. She said in 2009, the theme of the WHA Annual Community Benefit Report will be how hospitals continue to serve their communities, even in times of economic distress.

"Your charity care, free clinics and all the other screenings and programs that you make available to people have a more urgent feel these days. People are, more than ever, grateful and appreciative of your efforts," according to Grasmick.

Grasmick said the deadline for submitting stories for the 2009 report is August 1, 2009.

Lyon fielded numerous questions about the new Schedule H. Hospitals are reminded that the American Hospital Association is offering a free service to help tax-exempt hospitals field test the Internal Revenue Service’s new Schedule H for community benefit reporting. Hospitals have until April 1 to submit the form to Ernst & Young tax specialists retained by AHA and receive feedback to help them clarify and improve their responses. Participating hospitals also can see aggregated information on how other similar hospitals completed the form, with identifying information removed.

Hospitals can complete the mock Schedule H online at https://survey.ey.com/ScheduleHProject/ or download a copy to mail or fax to the consultant. Hospitals must file Part V of Schedule H with the IRS for tax year 2008 and begin filing the full schedule for tax year 2009.

Wisconsin Organization of Nurse Executives (W-ONE) will host its annual convention for nurse leaders and managers April 29-May 1 in Stevens Point. Back by popular demand is keynote presenter Tim Porter-O’Grady, who will present two sessions—one focused on confronting the new economic and environmental challenges to nurse leaders and the second focused on leading in a multi-generational workplace. The agenda will also include a variety of interesting and timely concurrent session topics and the opportunity to network and share with other nurse leaders.

In an effort to support the W-ONE membership, the W-ONE Board has decided to reduce the registration fees for the 2009 event, and those discounted prices are reflected in the convention brochure, which is included in this week’s packet and available online at www.w-one.org.

On February 17, 2009, President Obama signed into law the American Recovery and Reinvestment Act of 2009 (ARRA). The Act contains legislation that amends the Consolidated Omnibus Budget Reconciliation Act (COBRA). Employees who lose group health plan coverage due to involuntary termination will now be eligible for a 65 percent federal subsidy payment toward the cost of their COBRA premiums. The termination must occur between September 1, 2008 and December 31, 2009. The employee will pay 35 percent of the premium cost under the plan’s normal payment procedures. The entity that receives the 35 percent payment (e.g., employer, multiemployer, or insurer) is then entitled to receive the 65 percent subsidy as either a payroll credit or refund payment.

Eligible employees may receive the subsidy up to nine months or until the individual becomes eligible for another group health plan or Medicare. The subsidy applies to both federal COBRA and similar state continuation coverage. The subsidy applies to all group health plans offered through continuation coverage except for health FSA coverage.

Within 60 days of the Act’s enactment date, the group health plan must send a notification to those individuals who were involuntarily terminated since September 1, 2008 and who would be eligible for the subsidy payment. Those who are not currently continuing coverage through COBRA would be given a new election period that ends 60 days after the date of the notice. The coverage would be effective on the first period of coverage following the enactment date. The period of coverage for most plans is monthly. Thus, the first period of coverage following the enactment date will typically be March 1, 2009. If the COBRA election will result in a gap of 63 days or more, the gap in coverage shall be disregarded for purposes of pre-existing condition exclusions. The maximum period of coverage under COBRA is not extended. The 18-month period of coverage would continue to be counted from the original qualifying event.

The Departments of Labor and Health and Human Services are expected to release a model notice within 30 days of the Act’s effective date. Going forward, a plan’s COBRA Election Notice should be revised to include an explanation of the eligibility, provisions, and conditions of the subsidy program.

For additional information, including more details about the required notification, contact our office at 800-362-7121 or whafs@wha.org, visit www.whafs.com/section6.cfm to download the document Compliance Update: COBRA as Amended by the American Recovery and Reinvestment Act of 2009, or visit www.whafs.com/section7.cfm to listen to the HR Focus webinar COBRA Update: ARRA Amendments.

There is a rising and important need for qualified individuals to fill vital health care positions in communities across the country. Studies have shown that interest in a particular career begins before high school. Divine Savior Healthcare created a program called Club Scrub. The goal of this program is to nurture interest in health careers at the middle school level (7th and 8th graders) through hands on, interactive activities that will take place at the hospital, in partnership with the local school system. Club Scrub hopes to foster interest in the students and encourage them to take the middle school and high school classes necessary to prepare them for health care careers after high school or for college enrollment.

Divine Savior Healthcare has hosted several successful Club Scrub programs. The groups learned about various careers in rehabilitation, respiratory therapy, surgery, radiology, emergency room and many more through six one-hour sessions.

A sexual assault is brutal, both physically and emotionally. Survivors of sexual assault need specialized care that addresses both their health and psychological condition.

For the first time, sexual assault victims in Waukesha County have a safe refuge.

ProHealth Care’s Waukesha Memorial Hospital has become the regional hub for a new Sexual Assault Response Team and host to the county’s new comprehensive sexual assault program, known as SANE.

"We know there is a fair amount of incidents of sexual assault that go unreported, and part of that is a result of systems that are not in place to give quality care," said Dan Burns, director of emergency and trauma services for Waukesha Memorial Hospital. "Now there are."

As part of the SANE program, Waukesha Memorial has a dedicated space within the hospital for adult victims of sexual assault. A sexual assault nurse examiner (SANE) who is specially trained in forensic evidence collection is on call 24/7 through Waukesha Memorial’s Emergency Department. An advocate and a sexual assault nurse examiner attend to the patient upon her/his arrival in a comfortable, private room.

"This is true community service and a credit to the attitude of ProHealth Care to subsidize and offer SANE to the community—Waukesha has needed this program for a long time," says Waukesha County District Attorney Brad Schimel. "Sexual assault victims are frightened and aren’t sure what to do. Most are not going to drive to Milwaukee for a treatment center. They want to go to their local hospital."

ProHealth Care responded to community need and worked collaboratively with The Women’s Center in Waukesha, the Waukesha County District Attorney’s Office, Elmbrook Memorial Hospital, Community Memorial Hospital, Aurora Sinai Medical Center, the Child Advocacy Center of Waukesha, the police department and other agencies to make this program a reality.

"I can’t overstate the importance of this initiative from ProHealth Care," says Schimel. "It’s an important asset to the District Attorney’s office, law enforcement and victims of sexual assault. These cases can be very destructive, so we need to collect the best evidence and preserve it properly so we can get to the truth as quickly as we can. ProHealth Care has a very competent and devoted team offering the specialized medical services that we need to accomplish this."

After nine months of operation, 41 patients have been cared for through the SANE Program at Waukesha Memorial. "The SANE Program will make Waukesha County a better place to live for a long time to come," says Schimel.

Each year, Luther Midelfort Chippewa Valley invites the Colfax Elementary School 2nd graders to the clinic in Colfax for their annual Kid’s Day. During Kid’s Day, the students are able to visit stations at the clinic that are designed to educate them about their health and some of the services the clinic offers.

The children are able to see an x-ray machine and to view some examples of what to look for in an x-ray picture. The attending physician assistant at the clinic demonstrates to the group how a cast is put on and discusses why casts are needed. Other stations include the Luther Midelfort Annie Anatomy doll which shows how the body’s organs all work together to keep our bodies running. The importance of good hand washing is also demonstrated by having them watch a germ video, doing a hand washing exercise and showing them slides of bacteria under a microscope. Other staff members at the clinic help do blood pressure and pulse checks, get their height and weight measurements, and take their picture to give them an idea of what happens at a clinic appointment. It is a great opportunity for the children to become aware of the importance of taking care of themselves.

Parenthood is said to be one of the hardest yet most loved job one will ever do. Newborns simply do not come with "instruction manuals." Saint Michael’s Hospital’s Postpartum Home Visit Program recognized these challenges and began offering a home visit by a registered nurse shortly after the mother is discharged, where a brief physical and a social assessment, can be done with the family. Home visits can help parents who are often sleep-deprived, stressed, facing a new situation, and are unsure of themselves.

"We offer a home visit to all first-time moms, because it’s a stressful time," said Amy Bakken, a postpartum home visit nurse at Saint Michael’s Hospital. "We’re able to tell parents, ‘We know this is hard for you, it’s hard for everyone. So we’ll help you understand why your baby does what it does, so you can help baby sleep better.’ We offer encouragement and a morale boost for patients."

Whether it’s a referral to a long-term home visit program or just knowing where a "play group" can be found, the postpartum home visit nurses can assist a family in finding support or a helping hand.

"I know this program makes an impact, because I see people around the community who recognize me, six or ten years later, saying, ‘You were that nurse that came to my house, and it was so great to be able to talk about all of the questions I had as a new mother’," added Bakken. "The fact that they remember me after a one-hour visit stands out. It shows that there’s value to these programs."

Home Visits are set up while the family is still in the hospital and are offered to all first-time parents as well as any family experiencing stress in their lives. Last year, 379 home visits were completed. Funding for the postpartum home visits comes from Portage County ($16,500) as well as the Ministry Health Care Fund ($19,000). This program and other "family support" programs in Portage County are coordinated by the "Right from the Start Coalition," a group of community members working to coordinate family support programs.

Guests enjoyed "A Happy Healthy Cooking Demo—Cooking up Strategies to Prevent Diabetes" at Upland Hills Health recently. The event gave guests insight on cooking to prevent diabetes or its complications.

Dr. Paul Biere from Family Practice Associates and Elizabeth Berkey, Director of Nutrition Services, spoke to guests about the growing trend of diabetes and pre-diabetes. Both speakers emphasized the importance of physical activity and healthy eating to prevent the disease and its complications.

The crowd then enjoyed a cooking demonstration by Dietician Jaime Austin and Nutrition Services Supervisor Lisa Bowers, who cooked up three delicious and healthy dishes, including a pasta dish and a delicious berry dessert. Austin also answered cooking and diet questions from the audience. The dishes she prepared were then enjoyed for dinner.

Educational materials and some food samples were also available for guests to pick up as they left the event, rounding out an enjoyable night of great food and company, and a dash of learning sprinkled in.

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