WHA’s Task Force on Access and Coverage met March 13 with two health care leaders who are likely to chart a health reform agenda in 2009 and beyond. Members also reviewed national health care reform initiatives that will likely be in play this year.

State Representative Jon Richards (D-Milwaukee), chairperson of the Assembly Committee on Health and Health Care Reform met with Task Force members and described his perspectives and priorities on health care reform. Richards indicated that his four goals for reform include: reducing costs, achieving universal coverage, advancing wellness and prevention, and improving Wisconsin’s already high quality of care.

Richards pointed to six specific legislative ideas that he intends to advance in 2009, including: health insurance reform, focusing on portability and limiting pre-existing condition exclusions; encouraging greater use of physician orders for life-sustaining treatment (POLST) document for end of life care; prohibiting the practice of pharmaceutical companies distributing free gifts and other promotional materials to physicians; banning smoking in all places statewide; increased transparency for all health care providers; and uniformity for insurance applications and provider claims.

Wisconsin State Medicaid Director Jason Helgerson briefed Task Force members on the status of BadgerCare Plus and statewide implementation of coverage for low income, uninsured childless adults. Helgerson noted that 115,000 individuals had enrolled in BadgerCare Plus, including 73,000 children, and that 30 percent of all applications are arriving online.

Helgerson thanked WHA for "your support in speeding the implementation of Childless Adult coverage statewide via the hospital assessment." That program is now up and running in Milwaukee County and will begin statewide enrollment on July 1, 2009. Helgerson said the state is expecting between 50,000 and 60,000 participants in the program. He also indicated support for Medicaid payment reform and said Wisconsin’s integrated delivery organizations represent a strong catalyst for managing care and chronic illness.

WHA President Steve Brenton and Task Force Chair Leo Brideau discussed their participation with Governor Jim Doyle and others in Dearborn, Michigan the previous day at the Regional White House Forum on Health Care Reform. Brenton and Brideau indicated that it is clear the new administration intends to see that a major federal initiative passes in 2009 that will focus on universal coverage and meaningful, sustainable cost containment. Brenton said there is a strong consensus that something should be done this year but "the details will likely generate significant debate." Brideau noted that a specific plan that has a lot of Democrat leadership input will emerge this spring and that "some are talking optimistically of passage by the August recess."

Task Force members also learned of the latest health care reform proposals at the state level from WHA Executive Vice President Eric Borgerding. Most of the legislative efforts are likely to focus on incremental reform initiatives that align with WHA’s current health reform principles.

Health Reform was the topic this week when the Assembly Committee on Health and Health Care Reform held an informational hearing at Theda Clark Medical Center in Neenah. The committee heard from invited speakers and the public and later had the opportunity to tour the Theda Clark campus.

"Cost and quality improvements are key," said Committee Chairman Representative Jon Richards (D-Milwaukee) as he opened the hearing. Richards added that improving coverage for services and moving from a ‘sick’ care system to a more outcomes-based approach for health care also should be among the goals for reform.

Dr. Dean Gruner, president and CEO of ThedaCare, was the first featured speaker to testify and began his presentation by noting that only a small percentage of the patients generate a majority of the costs in health care. Gruner said that by focusing on keeping people healthy to begin with, much of the expensive care later on can be eliminated.

Dr. Gruner provided detailed results from ThedaCare’s delivery reform efforts in the areas of chronic disease management and preventive care where they receive consistently high ambulatory measurement rankings by the Wisconsin Collaborative for Healthcare Quality (WCHQ), a statewide group of organizations dedicated to improving the quality and cost-effectiveness of health care. ThedaCare’s results are at or near the top for measuring testing related to diabetes management and preventive care screenings, including cervical and breast cancer.

In discussing their ongoing reform efforts, Dr. Gruner emphasized the importance of maintaining respect for people, always striving for continuous improvement and learning to see and eliminate waste wherever it is found. He said ensuring that the correct care is consistently provided is critical. "We know a lot about medicine," he said. "But overall, we need to do a better job of applying what we’ve learned."

Dr. Gruner said that future areas of emphasis should be to improve overall health care value – getting the best care for the best price – and to focus on setting goals for continuous quality improvement, including saving time, increasing efficiency and increasing consistency.

Also testifying was Dr. John Toussaint, founder and president of ThedaCare’s Center for Healthcare Value and the former president and CEO of ThedaCare.

Dr. Toussaint outlined a number of his recommendations for health care reform from a public policy perspective, including ideas on payment reform and the importance of ensuring that patients realize they too have responsibility for improving the care of their own health.

Included among his recommendations for improving health care, Dr. Toussaint listed: the need for a healthier population, a more cost-effective health care system, maintaining a choice of providers, public reporting of provider information and results, access to basic health care insurance, high quality health care with no mistakes in delivery, and responsive and timely access to health care.

Dr. Toussaint highlighted the cost-saving component of ThedaCare’s efforts in chronic disease management, noting that their focused efforts on diabetes alone have lead to $1.3 million in annual savings. Discussing payment reform, Toussaint said the payment component needs to move away from sickness care. "Physician reward needs to instead be on keeping people well."

Toussaint added that patients must take responsibility for their own health but said the key is finding what will encourage individuals to engage in reforming how they take care of themselves.

Also testifying at the hearing were David Newby, president of Wisconsin AFL-CIO, and David Reimer, director of policy and planning for Community Advocates, Inc.

Reforming America’s health care system is not an option; it’s a must. Health care costs us too much, it’s not available to all Americans, some of the care we get is unnecessary, and we spend far more on treating the sick than on keeping people well.

We spend more per person on health care than any nation in the world. If we spent only as much per person as Germany, we would reduce our health care costs by nearly $1 trillion, more than enough to pay for universal coverage many times over. Health care costs are the leading cause of personal bankruptcy among Americans, and its costs hamstring America’s businesses in the competitive world economy. And at our current rate of spending, the Medicare Trust Fund will be out of money in eight years!

One in six Americans has no health insurance coverage and as a result, 2/3 of them put off needed health care. The U.S. is the only developed nation in the world that doesn’t treat health care as a basic human right. We should be ashamed.

Those of us fortunate enough to have health insurance face a bewildering maze of choices, rules, restrictions and paperwork. And with dramatically increasing deductibles and co-insurance, even those with insurance are finding health care increasingly unaffordable.

Primary care doctors who are crucially important in helping us stay healthy are an endangered species. In 1997, nearly 3,200 U.S. Medical School graduates chose to enter primary care; in 2007 only 1,600 did. Doctors and hospitals are paid virtually nothing to keep us well, but are rewarded to treat us when we’re sick. Financial incentives need to get fixed.

Something has to change! And we appear to be at a tipping point. It’s springtime for health reform, and proposals are popping up all over! How do we make sense of them? Let me suggest a few criteria for judging these proposals:

• Does the proposal have a goal of providing access to health care for all the people in this country? This is a moral imperative, not just a policy question.
• Does the proposal include credible strategies to slow the growth of health care costs? If not, our health care system is not sustainable.
• Does the proposal require change on everyone’s part: government, business, health care providers, insurers, and consumers? We all have a shared responsibility to reform health care. It’s not up to the other guy.
• Does the proposal include payment reform that provides incentives for individuals to avoid unhealthy lifestyles and for doctors to help keep their patients healthy? Does it adequately reward primary care?
• Is the proposal realistic? Beware claims that a totally free market approach will solve our problems. Reliance on a competitive model of health care is partly responsible for the mess we’re in, so more of the same won’t help. Be equally leery of 100 percent government solutions; they are too risky, and Americans won’t accept them. As admirable as the British and Canadian systems are, they are not compatible with American culture.

We need to build on our pluralistic health system. We can look to countries like Switzerland, Germany and Japan (to name a few) who have managed to achieve the goals we seek through a mix of public and free enterprise solutions that preserve choice, achieve universal coverage, and provide quality care at 2/3 the cost of the U.S. health system.

The healthy debate that has begun in Washington is encouraging, but eventually the debate must end and our elected leaders must act. Time is running out!

This op ed was published in the Milwaukee Journal Sentinel on March 15, 2009.

Advocacy Day is on April 1 (just one week away) and falls right during action on the state budget. If you and your hospital contingent have yet to submit registrations, please do so immediately, as we are moving into the final preparations for this great grassroots event. You won’t want to miss this day.

Hear from keynote speaker Rick Pollack, executive vice president of the American Hospital Association, on what President Obama and Congress are proposing for health care. Then learn from Governor Doyle and state legislators about health care issues pending in Madison. You will be able to use this information and the WHA legislative issues briefing when you meet personally with your legislators or their staff later that afternoon.

Register immediately for Advocacy Day 2009 on April 1. Online registration and full details are available at www.wha.org/governmentRelations/advocacy_day.aspx.

"Medical cost containment" is back on the table as the Workers Compensation Advisory Council begins this legislative session’s "agreed to" bill process. At the Council meeting last Friday, March 13, the management and labor representatives on the Council exchanged their proposals for the new legislation. Among a number of other proposals, management’s proposals included "Institute an effective medical cost containment system" and indicated that management would present a specific proposal in the near future. Copies of both the management and labor proposals are available on the WHA Web site.

The Council is comprised of 11 voting members: five representatives of management; five representatives of labor unions; and the Administrator of Workers Compensation Division, Department of Workforce Development. The Council also includes a number of non-voting members: representatives of Workers Compensation insurers, the Wisconsin Hospital Association, the Wisconsin Medical Society, and the Wisconsin Chiropractic Association.

Wisconsin’s Workers Compensation system is often lauded. According to the Workers Compensation Research Institute, injured workers fare better under Wisconsin’s Workers Compensation system than in almost any other state studied by the Institute. In Wisconsin, while employers pay less in aggregate for medical care compared to most other study states, injured workers report better medical outcomes and, unlike many other states, have few problems accessing care. Workers here are the most likely to return to work.

The Council’s schedule calls for it to complete its "agreed to" bill by July. The Legislature traditionally adopts the Council’s biennial bill without amendment. WHA, the Medical Society and chiropractic association will meet with the Wisconsin Manufacturers and Commerce and the Insurance Alliance next week to discuss the goals and details of management’s medical cost containment proposal. Watch The Valued Voice for updates on the Council’s "agreed to" bill discussions.

More than 50 physician leaders representing 31 Wisconsin hospitals and clinics attended the Wisconsin Hospital Association’s fourth annual "Physician Leadership Development Conference," held March 13-14 at The American Club in Kohler.

The conference is designed to help physicians bridge the gap between their traditional clinical training and the new leadership approaches to decision-making and problem solving. According to WHA Senior Medical Advisor Chuck Shabino, physicians find great value in participating in the conference.

"The opportunity to learn essential leadership skills, network with fellow physician leaders and build relationships with hospital colleagues away from the everyday rush makes this conference successful. The fact that physicians attend year after year speaks well of their perception of its value to them," according to Shabino.

WHA’s Jennifer Frank, the conference planner, said the idea for this type of educational opportunity for physicians originated from WHA’s Council on Medical and Professional Affairs as a way to offer nationally-recognized leadership education without the high travel and lodging costs of many out-of-state programs. In 2009, nearly three-quarters of the registrants were repeat attendees from at least one previous year.

The 2010 event is scheduled March 12-13 at The American Club in Kohler. Share this date with your medical staff and encourage new and potential physician leaders to consider attending. The conference offers a discounted "host" registration option, allowing a member of the hospital administration to attend with the physician leaders.

With a record-high rate of graduating medical students matching into their desired residency March 19, University of Wisconsin School of Medicine and Public Health leaders are cheering another highlight: more students are choosing to stay in the state for their residency training and about 40 percent plan to pursue a residency in primary care—where physicians nationwide are badly needed.

At the Match Day ceremony March 19 at the school, the 170 graduating students learned where they will spend the next three to five years of their career. Associate Dean of Students Dr. Patrick McBride says 96 percent—the highest match rate in the school’s history—matched into their preferred specialty.

"We are thrilled that so many students chose to stay in Wisconsin and to respond to the increased demands in our state for primary care physicians," said McBride. "We are very happy that our students were able to match into the specialty they want, and they are in the very best residency programs in their specialties."

Despite the growing national shortage of doctors in primary care (usually defined as internal medicine, family medicine and pediatrics), most medical graduates still opt to enter other specialties such as cardiology, orthopedics, and surgery. But McBride says all specialties have shortages, and UW matched students in nearly all specialties, with approximately 40 percent of UW medical school graduates selecting a primary care residency.

"The percentages at UW opting for a primary care residency have been fairly stable in the neighborhood of 40 percent for several years now," he said. "We are very happy that we continue to graduate students to meet the health care needs of our state and nation. Compared to other schools throughout the country, we are doing very well in our specialty distribution."

The school also put more students than usual into military positions, including three female students who plan to become military surgeons.

Just more than one-fifth of the student body chose a residency at UW, an outcome McBride says reflects well on the faculty and staff of UW Hospitals and Clinics and UW family medicine training programs.

The medical school class of 2009 will graduate in May, and most will begin their residencies in June and July.

WHA Senior Vice President George Quinn said, "We are pleased to see the numbers of graduates staying in Wisconsin stabilizing a bit. However, we remain concerned about whether the future supply of physicians will be adequate to meet our long-term needs."

Two major initiatives involving numerous state hospital associations, their patient safety partners and member hospitals are focusing on the elimination of central line-associated bloodstream infections (CLABSI) in hospitals. "On the CUSP: Stop Bloodstream Infections" is the collective term to describe two similar efforts to successfully reduce infections and save lives in America’s hospitals. The project, which began September 30, 2008 and continues through September 29, 2011, is based on a system developed by Peter J. Pronovost, M.D., Ph.D, of the Johns Hopkins University Quality and Safety Research Group, and later implemented statewide in Michigan by the Johns Hopkins Quality and Safety Research Group and the Michigan Health & Hospital Association (MHA) Keystone Center for Patient Safety and Quality.

The first project is spearheaded by the Johns Hopkins Quality and Safety Research Group in partnership with the MHA Keystone Center for Patient Safety & Quality and is funded by donations and the Sandler Foundation of the Jewish Community Endowment Fund. The following organizations have been selected to participate in the Hopkins-led project:

• Arkansas Hospital Association
• Connecticut Hospital Association
• Georgia Hospital Association
• Coordinating Agencies of Hawaii
• Illinois Hospital Association
• Indiana Hospital Association
• Minnesota Hospital Association
• Missouri Hospital Association
• New Hampshire Foundation for Healthy Communities
• New Jersey Hospital Association
• New Mexico Hospital Association
• Healthcare Association of New York State
• Oklahoma Hospital Association
• Oregon Hospital Association
• South Carolina Hospital Association
• Tennessee Hospital Association
• West Virginia Hospital Association
• Wisconsin Hospital Association

The second project is the "National Implementation of the Comprehensive Unit-Based Safety Program (CUSP) to reduce Central Line-Associated Bloodstream Infections in the ICU," funded by the Agency for Healthcare Research and Quality (AHRQ). The following 10 states have been selected to participate in this infection reduction program:

• California Hospital Association in collaboration with the California Hospital Patient Safety Organization
• Colorado Hospital Association
• Florida Hospital Association
• Massachusetts Hospital Association
• Nebraska Hospital Association
• The North Carolina Center for Hospital Quality and Patient Safety
• Ohio Patient Safety Institute in collaboration with the Ohio Hospital Association
• Hospital & Healthsystem Association of Pennsylvania
• Texas Hospital Association
• Washington State Hospital Association

"These projects have enormous potential to eliminate bloodstream infections that clinicians at one time believed were inevitable," said John R. Combes, M.D., senior fellow at the Health Research & Educational Trust (HRET) and co-investigator of the AHRQ-funded project. "We are enthusiastic about working with these state associations and their partners to build an infrastructure that will support the widespread dissemination and adoption of this and other patient safety innovations."

WHA will be enrolling Wisconsin hospitals in this project beginning April 2009, with an anticipated start date in June 2009.

"WHA has led several collaborative learning projects over the past few years. From this experience, we have learned that bringing together a large number of dedicated practitioners in a noncompetitive environment to solve the tough, clinical problems that all hospitals face is a great way to spread improvement," according to Dana Richardson, WHA vice president, quality. "By participating in this project, our hospitals will have access to a wealth of knowledge and experience from all across the United States."

For more information about the On the CUSP: Stop Bloodstream Infections project, contact Dana Richardson at drichardson@wha.org or 608-274-1820.

The United States is a nation built on independence and the pursuit of happiness. For a group of individuals at St. Elizabeth Hospital in Appleton, they are ensuring independence for seniors by updating and remodeling homes through Rebuilding Together Fox Valley (RTFV).

RTFV consists of community members and organizational teams who help low-income homeowners, especially seniors, complete minor renovation and construction needs on their homes. The goal is to help homeowners remain self sufficient and independent in their own homes.

"We can do something simple, like installing grab bars in a bathroom, and it makes a huge difference on the quality of life for the homeowner," says Steve Kappell, facilities services director for St. Elizabeth Hospital and member of the St. Elizabeth RTFV team.

A team of senior management members from St. Elizabeth Hospital joined RTFV, and skilled tradespeople, like Kappell, work with volunteers on home improvement projects in Appleton, Combined Locks, Little Chute, Kaukauna, Kimberly, Menasha and Neenah. The services are free to the homeowners, but they must meet service qualifications.

RTFV has helped more than 30 homeowners in 2007 and hopes to help 125 homeowners per year by 2010. The St. Elizabeth team completed its first project house in late June and believes it was a great way to bring teammates together outside the hospital setting.

"It’s a very rewarding experience," says Kappell. "I get to work with a great team of people who are doing something that really helps our community."

Getting patients back on their feet safely as quickly as possible following surgery is one of the primary goals of Joint School, a program developed by health care providers at AMCMC.

Joint School offers information from numerous clinical disciplines in the treatment, care and rehabilitation of joint replacement surgeries. The information helps patients understand their recovery process, hastens recovery and ensures greater safety once patients are back in their homes.

Joint School instructors include a surgeon, staff nurses, occupational and physical therapists and the hospital’s pharmacist.

Before their surgeries, patients attend Joint School with their care partner who will help them during the recovery process. That may mean performing exercises to strengthen muscles before surgery or getting equipment that will make it easier for them to access their homes, neighborhoods and communities.

Twenty-seven years ago the cities of Menominee, Michigan and Marinette, Wisconsin each had their own hospital. Each hospital had an enthusiastic group of bicyclists who, in 1983, started the Menominee River Century (MRC) Bike ride.

The hospitals merged in 1985 to become Bay Area Medical Center. The ride continued to grow and was managed by many of that same original group of volunteers until five years ago when their leadership sought assistance, and Bay Area Medical Center expanded its role from a sponsor to ride management.

The MRC is one of the largest rides in Wisconsin and features four different routes that wind through the most picturesque parts of Marinette and Menominee Counties. This year nearly 1,300 riders participated.

Over 70 percent of the riders are from out of town, which means the event has a significant economic impact for the community. This year’s rider survey places their spending while in the community at over $112,000.

Bay Area Medical Center has also used the ride’s visibility to take a higher profile in the areas of biking as healthy exercise and bicycle safety. This has included sponsoring bike safety and inspection events, lobbying for bike lane construction, and financial support for local and state biking organizations.

"Had we not learned how to properly install our child safety seat, our five month old daughter would have been ejected out the back window," said Steffany Caputo of Kenosha, Wisconsin, recounting the motor vehicle accident that nearly took her life, and that of her husband and daughter. "The base of the car seat was twisted. The locking clips were bent. But there wasn’t a scratch on our daughter."

Months before the accident, Steffany had attended a free child safety seat inspection provided by the Safe Kids Coalition of Kenosha and Racine Counties. "I credit the program 100 percent for saving our daughter’s life."

Wheaton Franciscan Healthcare – All Saints is the lead agency for the Safe Kids Coalition of Kenosha and Racine Counties. Through this program, local health care workers, fire fighters, police officers, educators, and others partner to teach kids, daycare workers, and parents about preventing injuries to children.

"After the accident I kept thinking, something good has to come of this," Steffany related. She became a volunteer with Safe Kids and soon gained certification through the program as a Child Passenger Safety Technician. "I felt like I needed to put my experience to good use and get certified."

All Saints’ Erin Donaldson serves as Safe Kids Coordinator for the Kenosha and Racine coalition. "As lead agency, All Saints provides office space, staff, marketing, and financial support through our philanthropic arm, All Saints Foundation," she explained.

Part of Safe Kids Worldwide, the Kenosha and Racine Coalition works to bring attention to areas like motor vehicle safety, bicycle and pedestrian safety, poisoning risks, product recalls, safe sleeping practices, and more.

"Preventable injury is the number one killer of kids up to age 14," Erin explained. "The safer kids are out there, the less likely they are to end up in our Emergency Department."