Agenda and registration information for the October conference will be distributed in August. If you have any questions about the Quality & Safety Showcase, contact Dana Richardson or Jennifer Frank at 608-274-1820, or email at drichardson@wha.org or jfrank@wha.org

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As a reminder, Wisconsin Organization of Nurse Executives (WONE) will host its annual convention for nurse managers and leaders on April 23-25 in Madison. Vicki George, senior vice president & chief nursing officer for Catholic Health Initiatives, will open the event by speaking on the benefits of achieving magnet status for your health care organization.

Anyone who has responsibilities in leading and managing nursing staff will benefit from the educational agenda and is welcome. Attendance is not limited to current WONE members or to nurses.

A brochure and registration form are available on the WHA Web site at www.wha.org. For more information on the program content, contact Jennifer Frank at 608-274-1820 or email at jfrank@wha.org. For registration questions, contact Bridget Gifford at 608-274-1820 or email at bgifford@wha.org.

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A February 18 article published in the Annals of Internal Medicine validates the fact that Medicare is not a value purchaser. The article underscores the fact that the quality of care delivered to Medicare beneficiaries in "high-spending" states, as indicated by evidenced-based measurements, is no better—and in most cases, far worse—than what Medicare beneficiaries in low-spending states receive.

At a time when the national health care debate is about to focus on Medicare "reform" in the guise of facilitating a voucher-based system that is unlikely to work in low-spending and rural areas of the nation, there is a tremendous opportunity for fee-for-service "reform" that will reward low cost, high quality Medicare providers. The time has come for the Medicare program to begin paying hospitals and physicians an incentive based on above-average performance as measured by high quality and cost effectiveness.

Members of Congress, especially lawmakers from upper Midwestern states, should rally around the notion that the Medicare program recognize quality and efficiency and develop an incentive payment that will encourage hospitals and physicians on a state-by-state basis to provide high quality care in a most cost effective manner.

Such a proposal has been discussed and developed over the past several weeks by WHA staff and shared with regional colleagues. Our proposal is fair and cost effective and can be a template for congressional discussion and action. It rewards states where providers are efficient and provide high quality care based on already accepted evidence-based measurements. States in which providers fail to meet quality/cost targets won’t receive incentive payments but will be motivated to move into the incentive status to capture the bonus payments. States would be annually ranked across both cost and quality measures, and hospitals and physicians in states that have the highest cumulative combined scores would receive a 5% "add-on" as an incentive to retain outstanding performance.

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The FDA issued a warning that hospitals and pharmacies could have unknowingly purchased a counterfeit version of the drug, Procrit. Hospitals are warned to carefull check for differences in the packaging and vials. The aluminum seal on the vial of real Procrit is smooth, not dented. The closure seals on the outer carton of real Procrit have writing on the underside and have a residue when peeled away. The FDA has identified three batches of fake drug: P007645, exp., 10-2004; P004677, exp., 02-2004; and P004839, exp. 02-2004.

Anyone who finds counterfeits should quarantine them and call the FDA at 800-835-4709 or Ortho Biotech - 800-325-7504.

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Rep. Ron Kind offered an amendment to the 2004 Budget bill which would make permanent the equalization of the standardized rate included in the 2003 omnibus budget bill. This enhanced payment for nearly 75 Wisconsin hospitals is set to expire September 30, 2004. WHA President Steve Brenton and WHA Chair Jerry Worrick sent strong letters of support for the amendment.

March 13, 2003

La Crosse Tribune
Eau Claire Leader Telegram

Dear Editor:

Representative Ron Kind’s support and leadership on Medicare equity issues that continue to plague Wisconsin hospitals and physicians is admirable and noteworthy. His pursuit of an amendment just last week that would provide additional reimbursement to a significant majority of Wisconsin hospitals is a case in point.

The health care cost issue, especially as reflected in insurance premiums, is perhaps the top public policy issue facing Wisconsin businesses who struggle to provide adequate health insurance coverage for employees and their families. Experts suggest that as much as 15 percent of health insurance premiums directly relate to cost shifting caused by government programs, especially Medicare. That cost shift is the result of the failure of those programs to pay their fair share of health care costs. And, unfortunately, Wisconsin is a national leader when it comes to poor Medicare payment for hospitals and physicians.

In Washington, D.C., Rep. Kind is viewed as a strong champion for rural health care and for ongoing efforts to "fix" longstanding Medicare payment flaws. This recent effort is yet another example of that leadership.

Sincerely,
Steve Brenton, President

March 11, 2003

Representative Ron Kind
1406 Longworth House Office Building
Washington DC 20515

Dear Representative Kind,

On behalf of the 130 member hospitals of the Wisconsin Hospital Association, let me share our enthusiastic support for your 2004 budget amendment to make permanent the equalization in the standardized base payment for inpatient care which was included in the 2003 Omnibus Budget Bill.

The provision, which is scheduled to expire September 30, 2003, is bringing meaningful relief from inadequate rates to nearly 75 Wisconsin hospitals. This provision is an important step in providing more adequate Medicare payments for Wisconsin’s Medicare beneficiaries and the hospitals that meet their health care needs 24/7.

Your leadership on this issue is appreciated.

Sincerely,
Gerald Worrick, WHA Chairman

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WHA President Steve Brenton wrote a letter to the new Secretary of the Wisconsin Department of Regulation and Licensing, Donsia Strong Hill, on March 11 congratulating her on her appointment and expressing his interest in working with her on a number of matters, most importantly workforce issues.

Brenton’s letter conveyed his regret that WHA members and their staff had an unnecessarily difficult time obtaining licenses or certificates issued by the department. WHA encouraged the department to reduce or eliminate the impediments that currently make licensing and therefore staffing unduly burdensome. The letter, below, is posted on www.wha.org under Legal & Regulatory.

Dear Secretary Strong Hill:

Congratulations on your appointment as Secretary of the Wisconsin Department of Regulation and Licensing. A priority for the Wisconsin Hospital Association is finding solutions for the severe health care worker shortage in this state. Your department regulates a number of the professions that are impacted most dramatically by the shortage. I look forward to working with you on the important licensing issues that can help address the shortage.

Regrettably, I am hearing from some of the WHA member hospitals that their human relations staffs have been having a difficult time with the Department of Regulation and Licensing’s system when attempting to obtain nursing licenses for out-of-state nurses who would like to practice in Wisconsin. Specifically, they have not been advised when more documentation was needed before a license could be granted; they have had a difficult time connecting with a "real" person at the Department when they had questions; and, once speaking with a "real" person, they have been curtly told to consult the Web site.

Health care worker issues are crucial in this state and many private and public entities have an important role in ensuring that Wisconsin citizens have access to appropriately staffed health care facilities. I know that working together, we will reduce some of the impediments that currently make staffing issues more difficult.

Call me if you would like to discuss these or any other issues. Again, congratulations and I look forward to working with you.

Sincerely,

Steve Brenton, President

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Over 111 volunteers, trustees and hospital staff have registered for Advocacy Day on April 8, 2003. Get your registration in soon!

Helene Nelson, the recently appointed secretary of the Department of Health and Family Services, was honored at a reception as part of the events surrounding Cover the Uninsured Week (March 10-16). More than 100 people representing Milwaukee area hospitals, health care systems, public health agencies and a variety of human service organizations, welcomed Secretary Nelson at a reception co-sponsored by the Partnership for Healthy Milwaukee and WHA.

Leo Brideau, president and CEO of Columbia St. Mary’s, welcomed Secretary Nelson, and said, "We are most appreciative of Governor Doyle’s commitment to maintaining the Medicaid safety net funding in his budget proposal to the legislature and the people of Wisconsin. Be assured of our support and willingness to work with you as you oversee a most important and challenging department within State government." Brideau went on to say, "The health care community stands ready to work with you. We believe that health care is a basic human need that should be accessible to all. Together we can find solutions."

Secretary Nelson introduced two new members of her DHFS team - Deputy Secretary of DHFS Kenneth Munson and Administrator of the Division of Health Care Financing Mark Moody. "We at the department are most appreciative of the support of the Wisconsin Hospital Association and its members throughout the State during this most challenging time. I look forward to both partnering and learning from the private health care and human services sector as we move into the future. My door is always open,"she said.

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There is a new initiative within the Commonwealth Fund’s Quality of Care for Underserved Populations program. The initiative is designed to identify causes and consequences of poor communication in medical settings and to evaluate methods to address communication barriers for underserved patients. As many as five grants of up to $125,000 each will be awarded under this initiative. For more information, please go to www.cmwf.org/programs/underservedrfp.asp.

The "JCAHO Survey Preparation Trends" seminar is scheduled for Friday, May 2, in Wausau. Learn about the "make-or-break" issues of current JCAHO accreditation visits, as well as revisions to the process planned for 2004. Participants will leave the seminar with specifics on what should be done to prepare for these significant survey process changes.

Attendance is open to and encouraged for all hospital survey preparation team members, but is especially important and timely to those hospitals scheduled for JCAHO surveys within the first six months of 2004.

This seminar will be held on Friday, May 2, 2003, from 9 am to 4 pm at Stoney Creek Inn in Wausau. A brochure and registration form are included in this week’s packet and on the Web site at www.wha.org. Team attendance is encouraged, and a registration fee discount for teams of three or more individuals from the same facility is available.

For more information on the program content, contact Jennifer Frank at 608-274-1820 or email at jfrank@wha.org. For registration questions, contact Bridget Gifford at 608-274-1820 or email at bgifford@wha.org.

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The Centers for Medicare & Medicaid Services (CMS) is initiating efforts to make comparative performance information on hospitals publicly available, perhaps as early as this year. Such information, they believe, can help consumers make more informed choices when selecting a hospital and can create incentives for hospitals to improve the care they provide. As part of this effort, CMS plans to create a standard instrument and methodology that will be used to collect and report information on hospital patients’ experience with the care they receive. While CMS is saying participation is voluntary, it will be required in order to receive Medicare payments.

Many hospitals already collect information on their patients’ satisfaction with care. However, there currently is no national standard for collecting such information that would allow comparisons across all hospitals. In order to make "apples to apples" comparisons to support consumer choice it is necessary to have a standard measurement approach. This initiative will create a standard survey instrument and data collection methodology for measuring patient experience with care that will be put in the public domain and can be used by hospitals or other interested parties to collect comparable data.

How can hospitals prepare for this survey? That question was posed to the WHA Medical and Professional Affairs Council on March 11. Dana Richardson, WHA vice president of Quality Initiatives, told the council that the CMS survey is a hybrid of patient satisfaction surveys that are now being used by hospitals. Jason Rau, from the Picker Institute and Doug Sumner from Connected Learning presented a web-based training program to the council that hospitals can use to prepare for the survey.

Rau explained that patient satisfaction surveys continually yield high satisfaction rates but provide little information in the way of comparison between hospitals. Surveys on patient experiences tend to uncover patient concerns about their hospital stay which can be of value to the hospital in quality improvement efforts, as well as to consumers for hospital selection purposes. Rau said CMS plans to develop survey questions that are report-based, rather than rating based and get to behavior rather than attitude.

The dimensions of care that could be included in the first survey include: respect for preferences, coordination of care, involvement of family, access to care, information and communication, emotional support, continuity and transition, and physicial comfort. A team of measurement experts at CMS is evaluating the candidate measures and have developed a draft instrument from them that is currently being piloted in three states.

Sumner demonstrated the product his company has developed to train hospital staff members on the dimensions of care that will be measured by CMS. The advantages of the training program he presented were that it is self-paced, available 24/7 through the web, offers CEU credit, and can be customized. Richardson said WHA would investigate this opportunity further in an effort to assist hospitals in their preparation for this publicly-reported survey tool.

For more information on the CMS proposed patient experience survey, contact Dana Richardson drichardson@wha.org 608-274-1820.

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In a time when consumers want more control and fewer restrictions and employers need a better solution for cost control, consumer driven health offers the promise of both.

Consumer driven health care gets consumers engaged in the selection and purchase of their care. Briefly, here’s how it works:

—Each enrolled employee has a Health Savings Account (HSA), into which the employer allocates health care dollars each year. For example, the employer might set aside $1,000 for each employee with single coverage and $2,000 for each employee with family coverage. The employee decides what health care services he or she wishes to purchase, without the typical restrictions of current plans. Unused dollars can be saved from year to year, giving the employee more options for future health care needs—and a strong incentive to spend wisely.

—Traditional health coverage protects employees should their expenses exceed their annual HSA allocation and after they have paid a specified out-of-pocket amount.

—Finally, employees have access to an array of on-line health and financial tools and other resources to help them manage their health care dollars.b This is a vital component of the program: consumer driven health care requires that consumers have access to the information they need, when they need it.

Find out more by contacting Jim Malicki, WHA Financial Solutions, Inc., at 800-362-4121 or read more in Solutions Spotlight, included in the packet.

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BIOSAFE Kids, a tax-exempt 501(c) (3) charitable organization, would like to help underserved children and adults affected by diabetes. In doing so, BIOSAFE Kids is distributing free and low-cost Hemoglobin A1c test kits for patient self-collection. Our goal is to provide health care professionals with another tool, the Hemoglobin A1c test kit, so that they may provide their underserved patients with free and low-cost health care. To receive a free 5-Pack at no cost or obligation to you, simply visit: www.biosafekids.org/freetest.htm.

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Please complete your membership satisfaction survey, either on-line or in written format, by March 28. Member participation in the confidential survey is critical to the success of this effort, and collective results will be used to create WHA’s new strategic plan. For questions, contact Jennifer Frank at 608-274-1820 or jfrank@wha.org.