Representatives from UW Hospital and Clinics (UWHC) and Aurora Health Care testified in front of the budget-writing Joint Finance Committee on Thursday, March 17. The hearing, held at the State Capitol in Madison, was the last of several held statewide to gather public comments on Governor Doyle’s proposed 2005-07 state budget.

Both organizations focused on WHA’s highest priority issue in 2005 – Medicaid. The Graduate Medical Education (GME) and Essential Access City Hospital (EACH) programs, along with atrocious payment rates hospitals receive for outpatient care, were the primary focus.

"State Graduate Medical Education funding needs to be increased in order to ensure an adequate supply of physicians in Wisconsin and to prevent further cost shifts," said Carl Getto, MD, senior vice president of medical affairs, UWHC, and chair of the Wisconsin Council on Medical Education and Workforce.

According to Getto, UWHC provides graduate medical education for 497 physician residents. The direct cost for training those residents is $29.1 million annually. Government reimbursement for those costs is only $8.25 million. "Those unpaid costs are shifted and become a "hidden tax" on employers," Getto said.

Hospitals like UWHC are further disadvantaged due to the lack of recognition for the added costs incurred for their teaching programs and related complex services rendered, Getto noted. While such shortfalls are presently made up largely through additional charges to commercial insurance companies, this level of cost is not sustainable in the long run. UWHC believes that eventually insurers and employers will exclude teaching hospitals from their provider networks to reduce costs resulting in a financial crisis for teaching hospitals.

In March of 2003, WHA and the Wisconsin Medical Society released a joint report raising concerns about possible physician shortages in Wisconsin. The report underscored the importance of Wisconsin’s GME program and the role it plays in not only training more physicians, but training physicians who will stay and practice in Wisconsin.

In response to a question from Rep. David Ward, Getto explained that 80 percent of the state funding goes to four major teaching hospitals; UWHC, Aurora, Children’s Hospital of Milwaukee and Froedtert. Over 30 community hospitals across Wisconsin including those in Madison, Eau Claire, Wausau, and La Crosse, also receive GME funding to help defray the cost of educating new physicians for Wisconsin.

Testifying on behalf of Aurora Health Care was Paul Nannis, vice president of government and community relations. Nannis focused his remarks on the Medicaid’s Essential Access City Hospital (EACH) program, GME and outpatient reimbursement.

EACH is an additional Medicaid payment that is made to Aurora Sinai Medical Center due to its high number of Medicaid patients. "Given the enormous percentage of Medicaid patients served by Aurora Sinai Medical Center, Sinai receives a supplemental EACH payment of $4.7 million," Nannis said.

According to Nannis, in 2004, Medicaid covered 43.7 percent of Sinai Medical Center’s total inpatient days. WHA estimates that in 2004, Medicaid paid Wisconsin hospitals an average of 55 cents for every dollar it cost them to provide care to Medicaid patients. Other studies estimate the percent of hospital cost reimbursed to be much lower, especially in Milwaukee.

"We are also very concerned about hospital outpatient payments," said Nannis. "Hospitals have not seen an increase in this area for years."

According to WHA, Wisconsin’s Medicaid program is paying some hospitals as little as $93 for outpatient surgeries that cost thousands to perform.

Nannis’s comments about Medicaid ring true for many other hospitals. "There are hospitals all across Wisconsin, and especially in Milwaukee, that are struggling with Medicaid," said WHA’s Eric Borgerding. "The cost of providing care continues to go up, Medicaid reimbursement rates continue to go down, and Wisconsin employers pay the bill."

More than 190 health care providers attended the "Safe Patient Handling Conference" on March 16 at the Chula Vista Resort in Wisconsin Dells. The conference, sponsored by WHA and the Wisconsin Department of Workforce Development (DWD), was a project of the Select Committee on Health Care Workforce Development. Featured as speakers were health care provider organizations that have taken steps toward implementing processes for a safe patient lifting and moving environment.

Attracting and maintaining the workforce necessary to care for our patients is a primary concern for hospitals. Lifting, moving and positioning patients are absolutely necessary parts of work in health care. "It is very important that people who are entering health occupations not be deterred by the physical demands of the job. It is equally important to consider the physical needs of experienced workers," said Judy Warmuth, vice president of workforce development for WHA. "Advances in how we move, transfer and lift patients benefit the current and future workforce and make transfer a safer activity for patients."

Arun Garg, Ph.D., a national expert on ergonomics in the health care setting, delivered the keynote address. Garg and his colleagues at the University of Wisconsin-Milwaukee College of Engineering and Applied Science have been leaders in identifying and seeking solutions for injuries related to lifting and moving patients in health care settings.

Mike Murphy from St. Joseph’s Community Hospital in West Bend discussed designing new patient rooms with safety as the key design feature. Simple ideas such as every room having the same layout, attention to noise level and handrail support from bed to bathroom can be built into new rooms.

DWD Secretary Roberta Gassman explained that the conference brought experts in health care together with those who are familiar with the newest technologies and processes in patient handling.

"We are working in partnership with Wisconsin hospitals and other health care providers to find proactive strategies to improve the health care workplace," Gassman added.

Mount View Care Center in Wausau has implemented a Falls Protocol which involves environmental changes, early patient assessments and careful review of every event. These actions have reduced the number and severity of falls and have heightened the awareness of all staff.

The S.A.F.E. (Safe Accident Free Environment) Lifting Program implemented at St. Luke’s Medical Center in Milwaukee was described by Tabitha Sheen and Mary Doherty of Aurora Health Care. The complexity of such a project, which included maintenance staff, laundry, purchasing, all patient care staff and leadership could be overwhelming if not well planned. Aurora’s implementation plan and the impressive results were reported to the group.

Jan Neuman, RN, director of nursing at Rusk County Memorial Hospital and Nursing Home in Ladysmith said they have implemented policies where nearly all patient lifting is done with assistive devices.

"We evaluate the level of mobility of all our patients," Neuman said. "After the assessment, we match the patient’s need for assistance with our assistive equipment to ensure their safety during their hospital stay."

It was just one year ago this month that the Wisconsin Hospital Association launched what was one of the very first statewide voluntary public reporting programs in the country. What started as an idea at the WHA Board Planning session in 2002 has grown into one of the premiere hospital public reporting efforts in the nation. The Web site has accommodated more than a quarter of a million requests for information since its inception in March 2004.

"Wisconsin hospitals stepped up and assumed the lead in public reporting," said WHA President Steve Brenton. "Since the CheckPoint Web site was introduced, it has been updated four times, we have added four new measures, and recently approved the addition of three new measure sets over the next few years."

"The Wisconsin Quality Steering Committee and the WHA Board have both provided excellent guidance and direction over the past year as they have reviewed measures for inclusion in the program and suggested other strategies to accommodate consumer and purchaser interest in CheckPoint," according to Brenton.

The success of CheckPoint^SM is based wholly on the fact that Wisconsin hospitals embraced the concept and committed the resources that are needed to make a statewide public reporting program successful, commented Dana Richardson, WHA’s vice president of quality.

"I can’t thank the member hospitals enough for their innovative ideas and their hard work to make what was a brand new initiative the success that it is today," Richardson said. "Hospital leaders are the reason why consumers in every community in Wisconsin have access to valid, reliable measures of the quality and safety of care they can expect to receive in their community hospital."

The CheckPoint Web site (www.wicheckpoint.org) updates quarterly, the most recent completed on March 15 with new demographic, medical services and error prevention data. WHA now has 117 (97 percent of those eligible) hospitals reporting one or more medical services measures, and 106 (87 percent of those eligible) hospitals reporting the error prevention measures.

The U.S. Senate voted Thursday to protect Medicaid from cuts. The amendment, supported by the American Hospital Association, was offered by Sen. Gordon Smith and passed by a 52-48 vote. Both Wisconsin Senators Feingold and Kohl voted in favor. 

The Smith amendment creates a reserve fund for the establishment of a Bipartisan Medicaid Commission to consider and recommend appropriate reforms to the Medicaid program, and to strike Medicaid cuts to protect states and vulnerable populations.

The Wisconsin Hospital Association supported the amendment and will continue to work with members of the Wisconsin Congressional Delegation to prevent new Medicare and Medicaid cuts in 2005.

The Critical Access Hospital (CAH) program is the most important and successful federal rural health initiative since the Hill-Burton program of the 1960s. While that program paved the way for the financing of rural health infrastructure, CAH designation has allowed Medicare-dependent rural hospitals to survive the vagaries of inadequate Medicare prospective payment.

Just how successful has the CAH program been? There are now more than 1,000 Critical Access Hospitals located in virtually every state in the nation. The program has been particularly successful in the upper midwestern states of Kansas, Nebraska, the Dakotas, Iowa, Minnesota and Wisconsin. Wisconsin currently has 50 CAHs with five more in the pipeline.

In June, the Medicare Payment Advisory Commission (MedPAC) will release a report to Congress on the impact of recent changes to the program that have liberalized eligibility criteria. The data is expected to show that CAH designation has improved the financial health of CAHs. But given the fact that MedPAC is involved, we can also expect recommendations aimed at curbing costs of the program.

Tim Size, executive director, Rural Wisconsin Health Cooperative, recently prepared a map (see page 3 Valued Voice pdf to view map) showing the geographic locations of current designated Critical Access Hospitals. The nationwide success of the program makes a compelling case that access for rural Americans has been maintained and improved because of the CAH program. The small investment of Medicare dollars required to fund the program is paying dividends in rural America…and that’s the case we look forward to making later this year.

Steve Brenton
President

The Wisconsin Hospital Association in cooperation with the Hospital Bioterrorism Preparedness Program, Wisconsin Division of Public Health, is sponsoring free of charge a four-part series on emergency preparedness topics that are targeted for senior management at Wisconsin hospitals. No registration is required.

The PowerPoint presentation and appropriate articles for the March 23 teleconference are posted on the WHA Web site at www.wha.org/disasterPreparedness/leadership_series.aspx. Wisconsin hospitals have been diligently working on building surge capacity for a mass casualty incident and have so far been the recipients of more than $20 million to help with this effort. This series focuses on the role that senior managers will play in a mass casualty incident. The target audience for this series is:

• Hospital CEOs, Presidents, Administrators
• Vice Presidents
• Chief Medical Officers
• Members of the Boards of Directors
• Other senior managers

The seminars included in the series are:

Wednesday, March 23, 2005, 1–2 pm: "Executive Leadership Challenges in a Mass Casualty Incident"

• "I know my hospital can deal with the disaster today. I am not sure how we will be able to handle it on the second day." Anonymous CEO
• Managing a workforce that is anxious, afraid and emotionally affected by the disaster
• Managing operations with reduced resources
• The implications for our patients and staff when the "Standard of Care" is the "greatest good for the greatest number"

Wednesday, April 20, 2005, 1–2 pm: "Executive Leadership’s Role in the National Response Plan"

• "There is no way that we will be able to manage this by ourselves." Anonymous CEO
• The federal, state and local assets that will be available to assist your hospital
• Your hospital Incident Command Center and your Incident Commander are in charge

Tuesday, May 17, 2005, 1–2 pm: "How the Hospital Emergency Preparedness Plan Will Unfold in a CBRNE Incident"

• An overview of how the Wisconsin Hospital Emergency Preparedness Plan (WHEPP) will unfold in a biological, mass trauma or chemical incident
• How "your hospital’s level of readiness" is being measured
• The resources that are available to help your hospital increase its level of readiness

Tuesday, June 21, 2005, 1–2 pm: "Assuring That There Is Not a Legal and Financial Disaster at My Hospital After the Disaster"

• Recovery is a major component of any disaster plan
• There are legal and financial questions for which there are answers
• There are legal and financial questions for which there are not yet answers
• What resources are available to help hospitals with these legal and financial dilemmas

The toll free call in number for each of the four teleconferences is: 888-296-1938; the identification code number is 972184. The format will include 30 minutes of presentation, followed by 30 minutes for questions and discussion.

The Wisconsin Healthcare Public Relations and Marketing Society (WHPRMS) is sponsoring a professional development day in conjunction with the WHA Advocacy Day on May 11 in Madison. Susan Solomon, vice president of marketing and corporate communications for MemorialCare Medical Centers, a five-hospital system in Southern California, will present, "Building Powerful Healthcare Brands" on May 11 at 1 pm at Monona Terrace in Madison.

The cost to attend is $50 for members and $65 for non-members. Participants in the branding seminar are welcome to attend WHA’s Advocacy Day morning sessions and hear Governor Doyle (invited) speak at the luncheon. WHA’s Advocacy Day does not have a registration fee, and lunch is included.

The Wisconsin Forum for Healthcare Strategy (WFHS) is holding a seminar on April 13 at the Embassy Suites Hotel in Brookfield that will focus on achieving higher levels of patient satisfaction. The session, "Simply the Best: Achieving Extraordinary Levels of Service and Operational Excellence," will feature Kelly Rozier, RN, from Baptist Health Care Leadership Institute.

Rozier, an experienced clinical consultant, will describe how Baptist Health Care went from the 19th percentile in patient satisfaction to the 99th percentile. It also earned them industry accolades, including the Malcolm Baldrige National Quality Award. A reactor panel of hospital experts from South Carolina, Pennsylvania and Ontario, moderated by WHA’s Dana Richardson, will share their experiences related to quality and service improvements and how to manage cultural change.

The American College of Healthcare Executives named William Schoenhard, executive vice president and chief operating officer at SSM Health Care, St. Louis, as its chairman-elect at the ACHE’s 48th Congress held in Chicago.

SSM Health Care sponsors two hospitals in Wisconsin: St. Marys Hospital Medical Center in Madison and St. Clare Hospital and Health Services in Baraboo.

Trinity Health in Minot, North Dakota, is seeking a Vice President, Medical Affairs. Trinity Health is a privately owned, not-for-profit multi-specialty, integrated health care facility providing service to north central and western North Dakota and eastern Montana. The vice president, medical affairs is a key member of the senior management team, contributing to the strategic plan, bringing the concerns, issues and needs of the medical group forward, while fostering a close and mutually beneficial relationship between the medical staff and hospital leadership. Visit www.trinityhealth.org for additional information.

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