Meeting via conference call on March 14, the WHA Board unanimously passed a motion directing staff to "stay the course in ongoing efforts to defeat the Doyle Administration’s hospital tax proposal." The Board’s motion also noted the importance of "continuing to advance a Medicaid payment improvement agenda, funded by revenues from the tobacco tax proposal, consistent with current Board policy."

"WHA Board members are pleased with Association efforts to date that have so effectively called into question the wisdom of enacting a hospital tax that will be used to replace General Purpose Revenues that currently pay for health care programs, including Medicaid," said WHA Board Chair Bob Fale. "Members are also pleased with staff work that demonstrates that the Administration’s plan is a hugely flawed approach that fails to deliver the promised millions of dollars in higher Medicaid payments."

"Member unity on this issue to date has been extraordinary," said Board member and Council on Public Policy Chair David Olson. "Board members clearly recognize the need to present a united front…notwithstanding ongoing efforts by Administration officials to try to convince some hospitals that this is a good idea. That approach is clearly failing, in part due to the absence of credibility in the Administration’s own plan," Olson added.

WHA staff noted that three meetings to discuss aspects of the tax proposal have been held with Department of Administration officials. Those officials appeared to agree at a meeting this week with a WHA suggestion that an independent consultant be retained who will help sort through issues identified in a recent WHA analysis associated with proposed hospital payment provisions.

"The intent would be to seek an independent analysis based on current law and on actual precedents in other states," said WHA President Steve Brenton. "We made it clear that this idea is not a retreat from our opposition to the tax but instead an effort to find common ground around the actual facts surrounding the Governor’s plan."

State Senator Jon Erpenbach (D-Middleton) joined WHA’s Public Policy Council meeting on March 13. Erpenbach took over in January as the chair of the State Senate Health & Human Services Committee. This was his first time meeting with the Council.

Sen. Erpenbach provided Council members an overview of what he considers to be elements of a health care reform proposal, as the issue continues to be on the minds of individuals across the state.

"[Health care] is essentially all we’re hearing about in our districts," said Erpenbach. "[Constituents] want something done now."

What that "something" is will certainly vary, but Sen. Erpenbach thinks it should include: coverage for everyone, children up to 18 free, mental health parity and dental care. The Senator added that he thought a baseline benefit coverage should be similar to what state employees receive (plus mental health/dental). He also added that he would like to see more collaboration from hospitals in terms of sharing equipment and space.

During the ensuing discussion, Council members indicated to Sen. Erpenbach that it will be essential to address or at least include in the discussion the issues of utilization and individual behavior, as these are huge cost drivers in the health care system.

"If we’re going to have health care reform, I’ve always thought individuals have to have some financial stake, but it can’t be so much that they’re discouraged from even getting involved," said Erpenbach. "My job is to try and bring everyone together in a bipartisan way."

The Council thanked Sen. Erpenbach for his time and indicated they look forward to a continued dialogue on these important issues.

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The Wisconsin Department of Health and Family Services (DHFS) officially unveiled a five-year action plan to facilitate widespread adoption of health information technology (HIT) and health information exchange (HIE) at its eHealth Implementation Summit on March 15.

During the past year, an eHealth board appointed by Governor Doyle worked to develop Wisconsin’s eHealth Action Plan. The Action Plan, finalized in December 2006, includes:

Janet Marchibroda, CEO and founder of eHealth Initiatives, a national think tank, commended Wisconsin’s collaborative approach to eHealth implementation. "Social capital formation is necessary for leaders to identify and coalesce divergent interests in a common cause," she said. She congratulated those in attendance for their foresight.

DHFS Secretary Kevin Hayden told attendees "Wisconsin plans to take an incremental approach addressing HIT and HIE simultaneously. We will start with projects that build infrastructure and use standards consistent with national developments."

Governor Doyle said, "I want to be the first governor of a state with a fully interoperable health care system with all the necessary information. We have great building blocks for an interoperable system in Wisconsin due to existing centralized electronic health records in several large health systems, the support of organizations such as Epic, GE and others, and our excellent public health system."

Governor Doyle included $20 million in his 2007-2009 budget to establish an eHealth grant program for acquisition of technology for small provider groups and safety-net providers.

Senator Decker has been a longstanding critic of Wisconsin’s community hospitals. At one time or another over the past decade, Senator Decker has supported a return to Certificate of Need (state approval of hospital capital spending), re-establishment of Hospital Rate Setting (abolished in 1986) and, as recently as 2002, a Hospital Building Moratorium. Senator Decker chairs the powerful Senate Finance Committee and in that capacity has significant influence in shaping health care policy, especially in the Senate.

Senator Decker’s "billion dollars" is a significant overstatement (actual patient care margins are roughly half that number and sharply declining, according to recent WHA DataBank information from the first nine months of 2006). But the best way for Wisconsin hospitals to effectively refute the profit soundbite is to: (1) regularly explain how hospitals invest "profits" back into the health care infrastructure of their communities; 2) constantly remind the public of how hospitals are DIFFERENT than for-profit organizations whose missions...unlike ours...do not commit to the level of community benefits that Wisconsin hospitals provide 24/7; and 3) do a much better job of quantifying how "profits" are deployed to underwrite money-losing health care programs that for-profit organizations would have discarded long ago.

Regarding this latter point, it is simply a fact of health care delivery economics that "profitable" hospital services tend to underwrite unprofitable, but much needed, community health services and facilities like nursing homes, home health care, hospice services, primary care clinics, community dental clinics, health education and behavioral health programs.

The reality is that in Wisconsin there’s a state mandate to report individual hospital fiscal performance—but no similar mandate to report the not-so-favorable financial performance of these very necessary programs and services that are often part of a larger hospital system. Hence....hospitals are vulnerable to profitability arguments that use incomplete data.

WHA staff has begun an effort, targeted initially at a handful of members, to collect more specific information that will allow us to explain this important issue using a more robust information base. We look forward to member participation in this effort and the resulting improved public policy understanding of an important reality.

Steve Brenton,
President

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Registration information for this free event is available at www.wha.org.

To schedule an appointment to meet with your legislator on the afternoon of May 1, contact Angela Miloszewicz directly at 608-268-1801.

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Planning today to meet tomorrow’s health care workforce needs is a top priority among Wisconsin hospitals. The WHA Council on Workforce met March 15 in Madison and heard from two Wisconsin health care systems that are deeply involved in workforce planning.

Linda Mingus, human resource services, Aurora Health Care–Oshkosh, and Anne Liners Brett, health sciences and public services, Moraine Park Technical College, described the regional planning being done by the Fox Valley Healthcare Alliance. According to the presenters, organizations that are often in a competitive relationship can collaborate on data collection, standardize health requirements for students, enhance clinical opportunities, and recruit for job shadowing experiences. The Alliance has been in existence for two years and hopes to obtain grants to expand into online clinical placement for student experiences. Liners Brett believes the success of this alliance is found in its regional nature. "Individuals and organizations are willing to participate when it is obvious that there is clear value and local applicability within the process," she said.

Jan Bultema and Kristin Kutz, of the University of Wisconsin Hospital and Clinics, presented workforce planning at the facility level. The human resources staff at UWHC utilizes a process aimed at helping individual work areas improve their targeted HR metrics. The process is customized to the work group, data driven and fast tracked. Leadership from the HR department takes each team through a 30-day process to achieve targeted success. Bultema believes the project’s success is based on data that is well organized and presented, a shared commitment between HR and work groups, and excellence in team leadership.

WHA Senior Vice President Eric Borgerding reported to the Council on the Proposed 2007-2009 Wisconsin Biennial Budget. He placed special emphasis on the proposed hospital tax and health care reform proposals likely to be discussed during this legislative session.

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This week, WHA’s PricePoint Web site, a product of the WHA Information Center, was featured as a price transparency innovator in a report prepared for the National Governor’s Association (NGA). According to the report, prepared by Deloitte Center for Health Solutions, there are three considerations that must be included in best practices for alerting and communicating with consumers about prices for health care services:

Wisconsin was one of the first states to make information on hospital prices readily available through www.wipricepoint.org. According to WHA Information Center Vice President Joe Kachelski, PricePoint is viewed as a national model for price transparency, which has led several hospital associations to contract with WHAIC to implement PricePoint in their states.

"Consumer-directed and high-deductible health plans are accelerating the need for price information across the nation. Hospital associations can play a lead role in promoting price transparency," Kachelski said. Eight other states have implemented PricePoint, and eight more are in various stages of development, according to Kachelski.

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On Monday, July 10, 2006, about 2:30 a.m, five blasts from a propane gas leak collapsed a 136-year-old grocery store, burned down a cottage where a Michigan couple were killed and damaged a maintenance building that also includes several living units in Ellison Bay, an unincorporated village of about 150 residents near the tip of the Door County peninsula, authorities said. The cottage was part of the Cedar Grove Resort, where 49 people were staying.

To respond to the crisis in Ellison Bay, Wisconsin, Door County Memorial Hospital/Ministry Health Care (DCMH) called a "code black," an emergency designation that readied the Sturgeon Bay hospital for handling the casualties.

John Storms, a registered nurse and house supervisor who was in charge of hospital operations then, made the call.

"We started hearing about the situation on our radio in the ER, and I talked to people at the scene. I knew at the time how serious this was and that we needed to get more doctors and employees into the hospital to respond to the situation," Storms said.

"We needed to call a code black. It puts a process in place in the event of a disaster. It could be a mass casualty or something like a spill-over on the highway, but we call the code," added Jeff Wilson, DCMH’s director of emergency services.

"More than 40 doctors, nurses and ancillary staff, who were not otherwise on duty, came into the hospital to care for the injured and offer support services," said Gerald M. Worrick, DCMH President/CEO. "Staff participates in mock disaster drills each spring and fall to prepare them for emergencies such as the one Monday. In my 18 years at DCMH, we have never called a real code black," said Worrick.

"We have to ensure that we are continually prepared for emergencies and we practice these things. This is the first time that I remember activating a code black. The response was incredible," said Jody Boes, vice president, patient care services. "Basically what we did was show our commitment to our patients and our commitment to an outstanding response."

Eight people arrived in the hospital emergency room shortly after 4 a.m., according to Wilson. Four were treated by DCMH physicians and staff for minor burns and injuries; one had a broken collarbone. They were released at about 6:30 a.m. Monday.

Four other patients, in critical condition with internal injures and major fractures, were stabilized by hospital staff and transferred to the Level 1 Trauma Center at St. Vincent Hospital, Green Bay.

"I think that was very impressive; in about two and one-half hours, we had everyone treated and placed appropriately," Wilson said.

On April 5 and 12, WHA will offer a two-part audioconference focused on reducing medication errors, presented by Sue Dill Calloway, RN, MSN, JD, a nurse attorney and the director of risk management for OHIC Insurance Company.

Medication errors are the most common type of medical error. A recent Institute of Medicine (IOM) report estimated that an average hospital patient is subject to one medication error per day (with considerable variation in rate across facilities). Participants will hear about the evidence-based literature and how it demonstrates more than 100 tips for what hospitals and other health care facilities can do to reduce medication errors and improve patient safety.

This program will also cover selected Joint Commission standards; the Centers for Medicare and Medicaid Services hospital conditions of participation standards on safe medication use; the Joint Commission’s national patient safety goals for 2007 that address medications; medication reconciliation; and tips to reduce medication errors. You’ll learn about the 2006 IOM Preventing Medication Errors study that identified gaps in the knowledge base with regard to medication errors. This program is a must for any facility that wants to decrease medication errors and improve patient safety.

This program is recommended for anyone involved in the medication process or who is interested in reducing medication errors in health care, especially pharmacists, physicians, nurse educators and nurses, risk managers, hospital attorneys, compliance officers, quality and performance improvement coordinators, chief nursing officers, patient safety officers, Joint Commission coordinators, nurse managers, pharmacy staff, policy and procedure committee members, case managers, nurse supervisors, medication team members, patient safety committee members, and others who participate in the medication process should attend.

Register for the Safe Medication Use 2007 audioconference series to educate your entire staff in a short period of time without incurring multiple registration fees or travel expenses. The registration fee includes one toll-free telephone connection to each presentation, so you can gather numerous staff members in one room to "attend" for one economical price. Prior to the event, you will receive the PowerPoint presentation, which you can distribute to all participants.

For more information about the content or to register, visit the education section of WHA’s Web site at www.wha.org. Part I of the webinar is scheduled for Thursday, April 5, from 10 am – 12 pm CST, and Part II is scheduled for Thursday, April 12, from 10 am – 12 pm CST. The fee to participate in both parts of the two-part series is $359 per site. Advance registration is required to ensure delivery of instructional materials and call-in instructions, which will be distributed after the registration cut-off date of April 2.

For registration questions, contact Lisa Geishirt at 608-274-1820 or email lgeishirt@wha.org.

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On May 15, WHA will offer a webinar on infection control during construction and renovation activities in health care facilities and the Joint Commission’s related patient care standards.

Exposure to environmental or airborne pathogens in hospitals can cause adverse patient outcomes and also illness among health care workers. Rarely are hospitals implicated in disease transmissions from environmental pathogens; however, it can be a significant problem. This offering addresses ways to prevent environmental infections and strategies to ensure compliance with JCAHO standards. Attendees will learn which patient populations are most affected by construction and renovation activities, the resources for infection control professionals to use for guidance during construction/renovation activities, and the requirements of an Infection Control Risk Analysis.

This program is for chief nursing officers and directors of nursing, JCAHO coordinators, medical directors, safety officers and staff, performance improvement staff, professional staff nurses, clinical staff, infection control staff, environmental services, engineering, facility managers, and nursing home administrators.

Register for the Infection Control & JCAHO webinar to educate your entire staff in a short period of time without incurring multiple registration fees or travel expenses. The registration fee includes one toll-free telephone connection to each presentation, so you can gather numerous staff members in one room to "attend" for one economical price. Prior to the event, you will receive the PowerPoint presentation, which you can distribute to all participants.

For more information about the content or to register, visit the education section of WHA’s Web site at www.wha.org. The webinar is scheduled Tuesday, May 15, from 12-1 pm CST. The fee to participate is $169 per site. Advance registration is required to ensure delivery of instructional materials and call-in instructions, which will be distributed after the registration cut-off date of May 1.

For registration questions, contact Lisa Geishirt at 608-274-1820 or email lgeishirt@wha.org .

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