Are there enough physicians in Wisconsin today? What about the future? The results of an in-depth study aimed at answering those questions will be presented at news conferences Monday, March 22 at the 16th Street Community Clinic, Milwaukee, and again at UW Hospital & Clinics, Madison.

The report is the work product of the Task Force on Wisconsin’s Future Physician Workforce. Staffed by the Wisconsin Hospital Association and chaired by Leo Brideau, CEO, Columbia-St. Mary’s, the committee included representatives from Wisconsin’s academic medical centers, hospital CEOs, physicians, and the Wisconsin Medical Society.

The task force identified a current shortage that is causing patients to increasingly travel longer distances to seek care, wait to receive care, or, because of these barriers, not seek care at all.

Stagnant growth in the physician workforce, combined with a growing - and aging - population, mean that the problem will grow worse with each passing year. And it takes a decade to educate a doctor, so the task force recommends "aggressive management" of the problem starting now.

"The report comes at a time when the state has all but eliminated its share of support for graduate and resident medical training," said WHA President Steve Brenton. "Abandoning graduate medical education will only hasten the impending crisis.

The Task Force believes if strategic steps are taken now, Wisconsin can avert a brewing crisis. Brief remarks will be made by the following spokespersons at the news conferences:

Leo Brideau, chair, Wisconsin’s Future Physician Workforce Task Force, and CEO, Columbia-St. Mary’s: Averting Tomorrow’s Physician Crisis Today

Paul Wertsch, MD, President, Wisconsin Medical Society: Aging Physicians, Aging Patients: Demographics are NOT in our Favor

Bevan Baker, Director of Health Operations, City of Milwaukee Health Dept.: Inner City Milwaukee: The Crisis of Care is NOW

Amy Liepert, Third Year Medical Student, Medical College of Wisconsin: How to Attract Students to Medical School Who’ll Stay in Badger State

Carl Getto, MD, Senior VP, Medical Affairs, UW Hospital & Clinics: The Role of Wisconsin’s Medical Schools

Bobbe Teigen, CEO, Sauk Prairie Memorial Hospital; Task Force Vice-chair: Is the Problem Worse in Rural Wisconsin?

George Quinn, Sr. VP, WHA: The Study Results: Sizing Up the Problem

On March 30 consumers, employers and hospitals will get their first chance to view quality and error prevention data from 116 Wisconsin hospitals. CheckPoint^SM represents the initial rollout of what promises to be the most comprehensive, voluntary reporting initiative in the country.

"The participation rate, which represents close to 99% of statewide admissions, is a testimonial to our hospitals’ commitment to report on the quality and safety of the care they provide in their communities," said WHA President Steve Brenton.

The week of March 22, hospitals will receive a quantity of bookmarks that can be distributed to employees, physicians, and left in waiting rooms. A copy of the new bookmark is included in this week’s packet.

Seven Wisconsin hospitals landed on Solucient’s inaugural list of the "100 Most-Improved Hospitals." With the 100 Top Most Efficient Hospital’s award in its tenth year, Solucient used five years of data to analyze performance. Wisconsin hospitals that made the list include:

Columbia-St. Mary’s, Inc., Milwaukee - Teaching Hospitals
St. Marys Hospital Medical Center, Madison – Teaching Hospitals
St. Elizabeth Hospital, Appleton – Medium Community hospitals
Burnett Medical Center, Grantsburg – Small Community Hospitals
St. Mary’s Hospital, Ozaukee – Small Community Hospitals
Tomah Memorial Hospital – Small Community Hospitals

"Wisconsin hospitals are committed to providing high quality, affordable health care in their communities. It is certainly no surprise that our hospitals are performing right up there with the best in the nation, as identified through Solucient’s performance criteria," said WHA President Steve Brenton.

To select hospitals for its list of 100 improved performers, Solucient analyzed Medicare cost reports and Medicare Provider Analysis and Review, or Med PAR, data from federal fiscal years 1996 through 2001. A total of 2,866 hospitals were included in the study.

Solucient groups hospitals into five categories and then compares hospitals within each category. Those categories are: major teaching hospitals with 400 or more beds and significant teaching involvement; teaching hospitals with 200 to 399 beds; large community hospitals with 250 or more beds; medium community hospitals with 100 to 249 beds; and small community hospitals with 25 to 99 beds.

Sen. Dale Schultz (R-Richland Center) introduced SB 530 that is a part of WHA’s Healthier Choices legislative initiatives, which would require the Department of Health and Family Services (DHFS) to develop, implement and periodically update the payment method for reimbursing hospitals under the state’s Medicaid program. If the bill becomes law, the statute would require that the reimbursement rate developed by DHFS for each hospital be reasonable and adequate to meet the costs that must be incurred by an efficiently and economically-operated facility in order to provide care and services in conformity with state and federal statutes and regulations, and quality and safety standards. The new payment method would not apply to hospitals that are reimbursed based on their costs, including critical access hospitals.

WHA applauds Sen. Schultz for introducing SB 530. WHA will work closely with him to try to advance this important piece of legislation in the upcoming extraordinary session this spring (see the following Valued Voice article).

While the Legislature is wrapping up final business in the legislative session over the next few days, both the Assembly and the Senate have indicated that they will come back in late April or early May for an extraordinary session that will likely focus on health care, campaign finance reform and the taxpayer’s bill of rights (TABOR). This spring WHA looks forward to working hand-in-hand with our elected officials on health care reform proposals including many WHA-backed Healthier Choices initiatives like the Boren Amendment legislation (see above Valued Voice article for more information) in addition to legislation designed to grow the health care workforce along with other legislative initiatives whose goal is to cut red tape and control costs. Watch for more specifics as these bills are developed and advanced through the legislative process.

With the 2003-04 legislative session just about over, now is a good time to take a step back and reflect on what we accomplished, tangibly and otherwise, under the Capitol dome. While there were some disappointments we will not forget, the last 15 months have been a period of tremendous growth and accomplishment for WHA, including our advocacy efforts here in Madison. Here are just a few highlights.

Medicaid: A budget deficit of $3.2 billion squelched any efforts to improve abysmal reimbursement rates or alleviate cost shifting. The cuts to GME a year ago are still fresh in our minds — restoration is a top priority. Efforts to eliminate rural hospital supplements were squarely defeated — unlikely to be proposed again. The GAMP program was preserved and lives to fight another day. Across-the-board cuts were averted and mid-year payments cuts (so prevalent in other states) were kept off the table when the Governor and Legislature took action last month on a debt refinancing plan used to partially address a projected $400 million MA deficit – a bipartisan solution heavily lobbied by WHA.

The MA problem is far from solved, but hospitals will clearly be at the table (hopefully not on the table) when the Legislature returns in 2005 to tackle this ongoing challenge.

Health Care Reform: As single-payer plans, and variations thereof, were garnering attention in the Capitol, WHA went on the reform offensive and partnered with payer and employer allies to develop Healthier Choices — a comprehensive, market-based set of reforms aimed at refocusing this debate. The consumer-focused alternative, Healthier Choices has positioned WHA to be a leader in any coming health reform debate. And this may be well timed; as it is quite possible the Legislature will return in April to specifically address health care reform (see related article in this issue of Valued Voice).

Regulation: While other states are enacting (and now regretting) laws to ban mandatory overtime and mandate patient staffing ratios, these proposals were shut down in Wisconsin. Other efforts to license hospital CEOs and create massive and duplicative new data bureaucracies were also soundly defeated. At the same time, WHA drafted and passed important legislation conforming state law to federal (HIPAA) law on medical records usage (this bill should become law next month). In addition, we anticipate several other WHA regulatory reforms included in Healthier Choices to resurface as part of any spring session on health care reform.

Health Care Information: We enacted the seemingly impossible notion of privatizing (to WHA) hospital data collection and ending the hospital data assessment. After 13 years under state control, this program is poised to break new ground under WHA’s leadership. This, coupled with our innovative, "no legislation necessary" CheckPoint program, has positioned WHA as the leader in health care information, able to speak with a credible voice in and out of the Capitol.

Workforce: Health care workforce is now a priority with the Legislature and Doyle Administration. WHA-backed legislation was enacted to reallocate WTCS training funding into health care. There is now greater legislative scrutiny of the health profession education system, including criteria for admission and overly restrictive requirements for educators. And here again, several WHA workforce proposals may surface in a spring health care session. Strong partnerships have also been built between WHA and DWD.

Capitol Presence: The Wisconsin Ethics Board now counts WHA as one of the state’s "Big Players" in lobbying, ranking in the top 15 in hours lobbied (eighth) and expenditures (sixth) out of 651 lobbying organizations. According to Ethics Board Director Roth Judd, "If you imagine a crowded room full of special interests, you’ll see there are voices that are significantly louder than the rest – by several magnitudes." — That now includes all of us folks.

WHA does not shy away from, nor will we ever apologize for, an aggressive and proactive approach to lobbying and advocacy. Our members expect and deserve nothing less, and that is what we continuously strive to deliver.

Credibility: I saved this for last because it so clearly part of everything we have accomplished, and everything we will accomplish. Over these past 15 (if not 24) months, there is no question that WHA has regained its stature as a lobbying organization in the Capitol — well on our way to becoming one of the most influential players in Madison. This credibility ripples through everything we do, and building it is not possible without strong and active members like ours – thank you!

Together, we have taken some rather significant steps over the past 15 months. But instead of resting on these accomplishments, we are continuously looking ahead. The challenges ahead are no less daunting than those we leave behind, and the opportunities are even more promising.

Registration is really picking up for WHA’s 2004 Advocacy Day in Madison. Join the 62 organizations who have already made plans to travel to Madison on April 7. It’s easy to register, and Advocacy Day is a free event to all participants. You can register a variety of ways:

 Print the registration form from the Web site, complete and fax to 608-274-8554

 Email your registration information to Sherry Rabuck at srabuck@wha.org 

 Call Sherry at 608-274-1820.

Register today! Join the organizations already registered!

Affinity Health System
Agnesian HealthCare
Aurora Health Care
Aurora Lakeland Medical Center Associates
Aurora Medical Center of Manitowoc County
Auxiliary of Riverside Medical Center
Bellin Health System
Beloit Memorial Hospital
Black River Memorial Hospital
Boscobel Area Health Care
Children’s Health System, Inc.
Columbia St. Mary’s, Inc.
Columbus Community Hospital
Community Health Care/Wausau Hospital
Community Memorial Hospital, Menomonee Falls
Divine Savior Healthcare
Door County Memorial Hospital
Eagle River Memorial Hospital
Elmbrook Memorial Hospital
Flambeau Hospital
Franciscan Skemp Auxiliary
Franciscan Skemp Healthcare
Friends of Watertown Memorial Hospital
Grant Regional Health Center
Gundersen Lutheran
Hess Memorial Hospital
Lakeview Medical Center
Lakeview Rehabilitation Center
Memorial Health Center, Medford
Memorial Hospital of Lafayette County
Memorial Medical Center, Ashland
Mercy Medical Center
Meriter Hospital
Monroe Clinic Auxiliary
Moundview Memorial Hospital and Clinics, Inc.
Oconomowoc Memorial Hospital Auxiliary
Partners Health Systems, Inc.
Plunkett Raysich Architects
Prairie du Chien Memorial Hospital
ProHealth Care, Inc.
Reedsburg Area Medical Center
River Falls Area Hospital
Rural Wisconsin Health Cooperative
SSM Health Care of Wisconsin
Saint Joseph’s Hospital, Marshfield
St. Elizabeth Hospital
St. Joseph’s Community Health Services, Inc.
St. Joseph’s Community Hospital, West Bend
St. Mary’s Hospital Medical Center, Green Bay
St. Marys Hospital Medical Center, Madison
St. Mary’s Hospital of Superior
St. Mary’s Hospital, Rhinelander
St. Nicholas Hospital
St. Vincent Hospital
Stoughton Hospital
The Monroe Clinic
UW Hospital & Clinics
Volunteers In Partnership with Beloit Memorial Hospital
WHA Financial Solutions, Inc.
WI Health & Educ. Facilities Authority
Waukesha Health System
Waukesha Memorial Hospital

The 2004 Wisconsin Quality & Safety Forum, co-sponsored by the Wisconsin Hospital Association and the Wisconsin Patient Safety Institute, will once again combine education with showcased projects focused on current quality and safety improvement initiatives submitted by hospitals, other health care providers, patient safety improvement teams, health researchers and educators, and others from across the state.

A project submission packet for the 2004 Wisconsin Quality & Safety Forum is included in this week’s packet and on WHA’s web site at www.wha.org. Examples of projects eligible for submission include those that enhance organization-wide improvement culture and structure, are undertaken to improve quality or safety of care, and demonstrate how quality improvement practices are utilized in an organization. All submissions are due to WHA by May 21. For questions about project submission, contact Brian Competente at 608-274-1820 or bcompetente@wha.org.

The Outpatient Code Editor (OCE) is one of the most important components of the APC payment system. Presenting both challenges and frustrations to most coding and billing staff, the OCE is quite often misunderstood. During the May 20 seminar "Outpatient Cost Editor: Friend or Foe?," attendees will review the 60 edits, gain exposure to the role modifiers play in the billing functionality, and receive actual clinical documentation and coding examples.

The seminar will be held on May 20, 2004, from 9 am to 4 pm at Holiday Inn in Stevens Point. A brochure and a registration form are included in this week’s packet and on the web site at www.wha.org. On-line registration is available. The American Health Information Management Association (AHIMA) has approved this seminar for five (5) continuing education hours.

There is still time to register for the Wisconsin Organization of Nurse Executives (W-ONE) annual convention for nurse leaders and managers on April 28-30 in Green Bay. Mary Foley, immediate past president of the American Nurses Association, will open the event by focusing on rediscovering the role of today’s nurse leader.

The convention will be held at the KI Convention Center/Regency Suites in downtown Green Bay. Anyone who has responsibilities in leading and managing RNs will benefit from the educational agenda and is welcome. Attendance is not limited to current W-ONE members or to registered nurses.

A brochure and registration form are available on the W-ONE web site at www.w-one.org or by calling 608-268-1806. CEUs will be applied for and granted through Aurora Health Care, Nursing Education Department, Milwaukee.

Legislative veterans including Assembly Health Committee member Rep. DuWayne Johnsrud (R-Eastman) representing the 96th Assembly District, and Rep. Wayne Wood (D-Janesville) representing the 44th Assembly District, have announced their retirements from the Legislature.

Citing personal reasons for leaving the Legislature, Rep. DuWayne Johnsrud (R-Eastman) will not seek re-election in the 96th Assembly District to spend more time with his family in addition to doing more farming. Johnsrud has represented the 96th District since 1984. WHA members may recently remember Rep. Johnsrud for advocating for a ban on mandatory overtime for nurses in the last two legislative sessions, for a requirement that hospital CEOs be licensed, for legislation recreating the certificate of need and hospital rate setting -- all of which WHA worked hard to defeat. On a more positive note, in the last budget Rep. Johnsrud was instrumental in defeating Gov. Doyle’s proposed elimination of the MA rural hospital supplement.

Rep. Wood has served in the Legislature for the last 28 years. The 74-year-old veteran legislator said he made the decision to retire last year, but did not make it public at the time because he did not want his announcement to impact pending legislation.

Wisconsin Forward Award (WFA) is seeking members for their Board of Examiners.  Examiners, both individually and as part of teams, review written award applications based on the WFA/Baldrige Criteria for Performance Excellence (available on the WFA website at www.forwardaward.org). Some Examiners also participate in on-site visits to organizations being reviewed. At the end of the review process, Examiner teams develop feedback reports for the applicants, detailing their strengths and opportunities for improvement to assist them in reaching the next level of excellence. During the entire process, the Examiners are supported by mentors, judges, team leaders, and the WFA staff.

Wisconsin Forward Award is committed to having its largest and most diverse Board of Examiners for 2004. Application information is available at www.forwardaward.org or contact WFA at 608-663-5300. The deadline for application is April 23, 2004.

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