Three other important tort reform bills are on Gov. Doyle’s desk. AB 1071 – statute of limitations in certain medical malpractice cases, AB 1072 – allowing evidence of collateral source payments, and AB 1074 – imposing a cap on attorney fees to ensure victims receive a greater portion of their damage award. All three bills are strongly supported by WHA.

SB 578 – Health Care Quality Improvement Act: Another WHA priority awaiting action by Governor Doyle is SB 578 — the Health Care Quality Improvement Act. This legislation would bring much-needed updates to Wisconsin’s antiquated peer review statutes. The bill passed both houses with massive support (of the 132 members of the Legislature, only three voted against – Sens. Hansen, Risser and Wirch). Some notable names in Wisconsin health care have weighed in with letters of support to Governor Doyle, and the Milwaukee Journal Sentinel just this week editorialized in favor of the legislation. The only opposition appears to be from the Wisconsin Academy of Trial Lawyers (WATL).

It is worth noting that in a last ditch attempt to derail both AB 1073 and SB 578, WATL lobbyists played the "medical errors card" in testimony, in a press release and via memo to the Legislature. WATL claims that doctors and hospitals are hiding behind AB 1073 as a way of dodging the "real" concerns of plaintiffs’ attorneys, which is apparently preventing medical errors. By the way, has anyone out there seen a trial lawyer or employee of WATL at a health care quality, safety or errors prevention forum lately? I didn’t think so.

In fact, WATL even blamed WHA and WMS for the demise of the Wisconsin Patient Safety Institute (huh?), an entity that both organizations devoted thousands of dollars and hours to getting off the ground and sustaining. The good news is, nationally recognized efforts such as CheckPoint, The Collaborative, Safe Care Wisconsin and other private/public projects have picked up the safety ball and run with it. SB 578 will assure that momentum continues.

Despite WATL’s Johnny-come-lately (or should I say, "transparent") interest in health care quality, safety and error prevention, which includes opposing SB 578, the Health Care Quality Improvement Act enjoys overwhelming support from those with a real interest in improving health care quality and we hope it will soon be signed into law.

Governor Jim Doyle has been confirmed as the luncheon keynote speaker at WHA’s 2006 Advocacy Day on April 5 at the Monona Terrace in Madison.

2006 Advocacy Day tops off a successful year of grassroots advocacy on priority issues such as restoring a cap on non-economic damages. It is a time to celebrate the efforts of your hospitals and staffs, and to continue to train our grassroots team for issues already on the horizon. There are only three weeks left, so send your registrations in today!

"The grassroots advocacy of our hospitals, their employees, trustees and volunteers has made a tremendous difference in WHA’s work to restore a cap on non-economic damages," said WHA President Steve Brenton. "We hope everyone will attend Advocacy Day so we can thank you and celebrate your efforts."

Advocacy Day is a free event where upwards of 450 hospital staff, trustees and volunteers converge on Madison. This year attendees will hear from John Fund, a member of the editorial page for The Wall Street Journal, and, back by popular demand, Christopher Kush, will provide interactive training on how to effectively communicate your message to legislators.

In addition to Governor Doyle’s address at the luncheon, WHA will present its prestigious All Star Grassroots Advocate award to one outstanding hospital and its Healthcare Advocate award to one outstanding legislator.

Don’t miss this important day. Register your hospital’s contingent today by logging on to www.wha.org/education/pdf/2006advocacy.pdf or by contacting Sherry Rabuck at WHA at 608-274-1820, or email srabuck@wha.org. You may also fax your registrations to 608-274-8554.

As with all of our Advocacy Days, WHA strongly encourages attendees to put your training into action by meeting with your legislators. Please contact WHA’s Angela Miloszewicz at 608-268-1801 by Monday, March 27 to have her schedule a legislative appointment on your behalf.

Reporter Dan Rather was living up to his usual journalistic standards a couple of weeks ago. His 60 Minutes segment on hospital treatment toward the uninsured included the hugely misleading theme of "hospitals charging the uninsured more than they expect to be paid from insurance companies." Rather took the now-familiar approach of using two isolated cases to draw a broad-brush conclusion that non-profit hospitals are gouging the uninsured, and he used K. B. Forbes – the "community activist" – as his authority on the issue. He topped off his effort by selectively editing his interview with Carmela Coyle of AHA, thereby leaving out facts that conflicted with his storyline. A number of other media outlets picked it up and essentially used the same theme.

Meanwhile, responsible policy makers were also weighing in. Senator Charles Grassley, Chairman of the Senate Finance Committee, sent a letter to the American Hospital Association asking for their help in identifying when an uninsured patient should receive charity care, and in defining community benefits. Senator Grassley, a friend of the hospital community, has been dogged in holding non-profit hospitals to behaviors that he feels is required by their status as charitable organizations. His latest effort shows that he and others in Washington expect non-profit hospitals to show that they have earned their tax exemption.

While these two events address the issue of uninsured patients and charity in wildly different ways, they both point out that the public and policy makers may have doubts about whether non-profit, community-based hospitals are fulfilling their responsibilities. If a poll were conducted of Wisconsin hospital CEOs, it is likely that there would be overwhelming opinion that they are, in fact, carrying out their responsibilities, by providing millions of dollars in charity care, free clinics, educating future health care workers, and so on.

Indeed, it is true that Wisconsin hospitals provide hundreds of millions of dollars in community benefits. But those facts are not getting out in the clear and consistent way that they should. That’s why WHA and its members are launching our voluntary Community Benefits Reporting Initiative. By the middle of this year, we will begin reporting on the community benefits hospitals provide, and on the effect that they have on citizens and patients in our communities. Wisconsin will hear about the many thousands of activities carried out and millions of dollars spent by their community hospitals to improve the health and lives of citizens most in need. They will learn that their hospitals make the effort to understand the needs of the community and put into place programs to meet those needs.

Next week marks the beginning of the initiative. WHA is conducting community benefits training sessions in Oconomowoc, Eau Claire, and Stevens Point. Over 156 staff representing 125 hospitals will attend these sessions – a good sign that members will be very involved in telling their story.

As many of you may know, I recently participated in a House Ways & Means subcommittee field hearing in Oak Creek to discuss a variety of issues regarding the recent Government Accountability Office (GAO) report on the wide variation in health care prices across the nation for PPOs participating in the Federal Employees Health Benefits Program. I realize a number of you raised concerns about how this report was interpreted and about several methodological issues.

While the GAO’s findings show that health care costs and prices in Wisconsin are higher than the national average, I have no interest in seeing this report used primarily to place blame for the skyrocketing health care costs we have been experiencing. Rather, this report should serve as a starting point for an open and honest dialogue between patients, doctors and hospitals, and providers, so that we can find viable solutions to the problems facing all of us.

In my view, health care should embrace market-based reforms in order to facilitate consumer involvement in health care decisions and promote provider competition. An important building block for fixing the health care marketplace is transparency – information necessary for decision-making facilitated by the rapid diffusion of information technology.

The time has come to empower individuals by giving them the resources they need to shop for health care based on quality and value. I do not believe universal single-payer coverage is the answer to our country’s health care woes. I believe doctors, hospitals, and providers should shape health care by publishing their actual prices in order to promote competition in the medical community, which can also lead to better quality health care for consumers. By moving towards a market-based system with a safety net for all uninsured, all health care providers will compete for patients’ business, rather than the government setting prices and reducing quality and outcomes.

I recently read the Hospitals & Health Networks article "Ahead of the Pack" that described the significant transparency initiatives that are being led by Wisconsin hospital and medical groups. I am proud of the fact that our state is recognized as a national leader when it comes to measuring and reporting quality information.

Make no mistake – the current health care marketplace is in need of serious repair. In order to accommodate the necessary transformation of the delivery and financing of health care services, we must engage patients and provide the information they need to act as judicious consumers. Transparency in health care will help us fix a broken system.

Wisconsin is fortunate to have health care leaders who are engaged in advancing a proactive transparency agenda. I want to support these initiatives and encourage their speedy evolution in order that we can transform the marketplace by improving outcomes and rewarding value.

The U.S. Senate began voting on amendments to the FY 07 budget resolution this week. In a striking departure from the President’s proposed budget, the Senate Budget Committee has already removed the President’s proposed $36 billion reduction to Medicare after hearing from Senators that the cuts went too deep. In approving its resolution, the Senate Budget Committee also failed to include reconciliation instructions for the Senate Finance Committee. This is a positive move and means that the Senate will now need 60 votes (a higher threshold) for any Medicare cuts.

In other positive news, not only did the Senate remove the President’s proposed Medicare reductions, but Senators such as Arlen Specter, a Republican from Pennsylvania, were even considering offering amendments to increase spending on health care.

The U.S. House, on the other hand, delayed committee work on a budget resolution until the week of March 27. It is not clear whether the House will parallel the tact taken by the Senate or if they will include Medicare cuts in their resolution. Additionally, it is unclear whether the House, unlike the Senate, will include reconciliation instructions.

In other news, Congress held several hearings of interest this week.

A subcommittee of the House Energy and Commerce Committee held a hearing on price transparency entitled, "What’s The Cost?: Proposals to Provide Consumers With Better Information About Healthcare Service Costs." Testifiers included Rep. Dan Lipinski (D-IL) and Newt Gingrich among others. Rep. Lipinski testified on his legislation, H.R. 3139, the Hospital Price Reporting and Disclosure Act. Access HR 3139 online at http://thomas.loc.gov/. Access hearing details at http://energycommerce.house.gov/108/Hearings/03152006hearing1813/hearing.htm#Transcript.

A subcommittee of the House Ways and Means Committee held a hearing on long term acute care hospitals and Medicare payment policies. Testifying at this hearing were Herb Kuhn, director for the Center for Medicare Management of the Centers for Medicare and Medicaid Services, and Mark Miller, executive director of the Medicare Payment Advisory Commission among others. Access their statements and other hearing information at http://waysandmeans.house.gov/hearings.asp?formmode=detail&hearing=469.

The full Senate Health Committee held a hearing entitled, "Enhancing Public Health and Medical Preparedness: Reauthorization of Public Health Security and Bioterrorism Preparedness and Response Act." Department of Health and Human Services Secretary Michael Leavitt was among the testifiers. Access committee details at http://help.senate.gov/Hearings/2006_03_16/2006_03_16.html.

The Wisconsin Health Insurance Risk-Sharing Plan (HIRSP) will become a public authority as of July 1, 2006, under legislation passed recently by the Wisconsin Legislature.

As transition activities continue, the state Senate has approved Governor Jim Doyle’s Board appointees. Included on the new HIRSP Board of Directors is Joe Kachelski, Vice President, WHA Information Center. Kachelski had served on the previous HIRSP Board since 2004.

HIRSP is the state’s health insurance program for medically uninsurable individuals who do not have access to employer-sponsored health insurance. The program currently covers approximately 19,000 people.

The HIRSP Board has approved a $210 million budget for Fiscal Year 2007. Provider payment rates will remain at 143.2 percent of Medical Assistance rates. The budget anticipates millions of dollars of program savings as a result of the implementation of Medicare Part D drug coverage.

By law, policyholder premiums are set to recover 60 percent of program costs. Health insurers and providers share the funding burden for the remaining 40 percent. Insurers pay assessments based on their respective Wisconsin market shares. Provider contributions are made in the form of reductions in the rates they would otherwise be paid under the HIRSP policy.

SB 457, a bill that makes confidential all information and documents provided by a hospital to the Department of Health and Family Services (DHFS) under the auspices of the State’s emerging trauma care system, passed both houses of the state Legislature late last week. The bill now awaits the signature of Governor Doyle.

DHFS, the State Trauma Advisory Council (STAC), the Regional Trauma Advisory Councils (RTACs) and trauma participants from throughout the state have been working for many years towards the implementation of a state trauma care system. The major goals of the trauma system are to decrease mortality and morbidity of severely injured patients and to match resources with the needs of the trauma patient. The development and implementation of improving trauma care for patients hinges to a large extent on access to performance improvement systems and programs, the development of statewide protocols for standardizing patient care, and access to regional and state data regarding trauma care. Improving quality outcomes and establishing baseline information on improving patient care requires the free exchange of data from hospitals into the DHFS trauma repository as well as the sharing of information at the local regional trauma advisory council.

SB 457, sponsored by Senator Ron Brown (R-Eau Claire), will provide clear and comprehensive legal protections for collaborative quality and performance improvement initiatives. Legal protections on discoverability will be provided for all information and documents procured by or furnished to DHFS, STAC, or RTACs in connection with performance improvement activities, certifications of hospital classification levels and documentation of the basis for hospitals’ certifications.

WHA remains committed to the implementation of our state’s trauma care system in partnership with DHFS, the state Legislature, the Administration, STAC and all providers of trauma care. It is our fervent hope that Governor Doyle will soon sign SB 457 into law.

The Nurse Leader Succession Program, supported by the WHA Foundation, Inc., was launched during the past two weeks through five workshops around the state with enthusiastic participation from what could be the next generation of Wisconsin’s nurse leaders.

Each participant was nominated by his/her nurse executive as a nurse employee with great leadership potential. Meeting in small groups of about 20, these future nurse leaders heard from current nurse executives, panel members of nurse managers, and graduate nursing programs/academic partners. The programs provided the opportunity to discuss leadership roles and to question existing leaders about the rewards and responsibilities of these roles. Each workshop also offered the chance to inquire about handling the difficult parts of the role, the expectations of employers and how to manage personal time in a leadership role.

The program offered the opportunity for WHA to collect information about nurse leader positions. In feedback forums, participants were asked to respond to questions like "Why are nursing leadership positions difficult to fill today?" and "What could hospitals do to make the positions more attractive to nurses?"

Participants left with a toolkit of ideas, web resources, books, a magazine subscription, and the names of peers and panel members. These toolkit resources were intended to carry the impact of the day into the future and offered continued encouragement, ideas and support while participants think about and plan their future nursing careers.

WHA members have often identified nursing leadership positions as difficult to fill. When asked, nurses are reluctant to apply for and take on the very challenging tasks of nursing leadership today. While most of the workshop participants articulated the attractiveness of making a difference at a different level, they also recognized the complexity, difficult tasks and very high expectations inherent in leadership roles in hospitals.

When leaving the workshops, energetic participants expressed thanks and enthusiasm. In addition to the compliment of being identified as nurses with leadership potential, they appreciated the chance to meet other future nurse leaders, discuss the issues they identified with leadership positions, learn from nurses currently in those roles, and have the toolkit as a useful takeaway.

Thank you to the WHA Foundation for funding this effort; thank you to the hospitals that nominated and provided pay to the attendees; and thank you to the future nurse leaders who made each program an energy-filled success.

The April 19 seminar, entitled "CMS Revised Conditions of Participation: What Every Hospital Needs to Know," will focus on helping hospitals comply with specific CMS-COP problem areas, including restraints, nursing care plans, informed consent history and physicals, verbal orders, legibility requirements, prohibition on "resume pre-op order" statements, as well as liability and physical documentation.

Additionally, attendees will learn details about COPs and what to do when CMS or the Department of Health surveyors arrive at your facility. Compliance officers, risk managers, quality managers, health information personnel, hospital legal counsel, chief executive officers, chief operating officers, nurse executives, and directors of utilization management are encouraged to attend.

The "CMS Revised Conditions of Participation: What Every Hospital Needs to Know" seminar will be held on April 19, 2006, from 8:30 am to 4:30 pm at the Holiday Inn in Wausau. A brochure with registration information is available on the Web site at www.wha.org, as well as online registration.

The April 20 program "EMTALA: Update 2006" is designed to focus on changes to the federal EMTALA law, use concrete examples, and make EMTALA understandable. Past attendees of this seminar have repeatedly commented that they were finally able to both understand the EMTALA law and apply it to their facilities.

A summary chart of all of the changes will be provided and discussed. Attendees will also receive a sample hospital policy and a CD containing multiple EMTALA resources. This program is designed for emergency department managers, physicians and nurses, OB managers and nurses, behavioral health directors/staff, psychiatrists, nurse supervisors and staff nurses, compliance officers, legal counsel, risk managers, and directors of hospital-based ambulance services.

The "EMTALA: Update 2006" seminar will be held on April 20, 2006, from 8:30 am to 4:30 pm at the Holiday Inn in Wausau. A brochure with registration is available on the Web site at www.wha.org, as well as online registration.

For registration questions, contact Sherry Rabuck at 608-274-1820 or srabuck@wha.org.

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