The late Illinois Senate Minority Leader Everett Dirkson once said, "When I feel the heat, I see the light." It’s a great statement on the power of grassroots advocacy, and it’s exactly what WHA is doing through our newly launched Hospitals Education & Advocacy Team (HEAT) grassroots program – helping you bring heat and light directly to your legislators on issues of importance to your hospital and the communities you serve. HEAT replaces the program referred to as "Healthy Advocates" in order to turbo-charge WHA’s grassroots advocacy efforts.

Medicaid funding will be the first issue HEAT tackles, so if you needed a good reason to join, you have it! The Legislature is currently reviewing the state budget bill, which includes funding levels for Medicaid. Outpatient reimbursement rates for Medicaid are extremely low, resulting in reimbursement rates for hospitals of just $94 for procedures like an MRI or a tonsillectomy. When Medicaid reimburses hospitals so dismally, the costs are shifted onto private payers in the form of premium increases — to the tune of $450 million. That’s Wisconsin’s "hidden health care tax."

Do your legislators know there’s a hidden health care tax? Do they know how Medicaid funding impacts your hospitals and your communities? They need to, and HEAT will provide you with the tools to effectively tell them.

HEAT gives you the information, the insight, the strategy and the assistance you need in order to communicate with your legislators on issues of importance to the members of WHA. When you join HEAT expect to receive legislative fact sheets, legislative alerts when timely action is needed, the Capitol Connection e-newsletter, our grassroots advocacy toolkit, and more. The program is specifically designed to facilitate your grassroots involvement – whether that be writing a letter or coming to WHA’s annual Advocacy Day on May 11 in Madison – so the voice of hospitals and their employees is heard loud and clear by the Legislature and Governor Doyle.

HEAT is free of charge to join. The only requirement is that you care about your hospital and your communities enough to do something for them!

WHA’s annual Advocacy Day is a key event for Wisconsin hospitals. It is an opportunity to improve our grassroots effectiveness, while learning about the issues that will shape the future of health care delivery in Wisconsin. Make plans now to attend WHA’s Advocacy Day on May 11 in Madison.

There is an interesting line-up of speakers this year, including Washington correspondent Mark Shields, who has spent 30 years covering American politics, and Christopher Kush, who has trained thousands of federal, state and local advocates to effectively advocate for their issues.

The day will be capped by the most important event – a visit to your legislator at the Capitol. You are welcome to make your own legislative appointments, and can find your legislator’s contact information in the Speak Up section of WHA’s Web site at www.wha.org/speakUp. Also, WHA will gladly assist you in making your appointment. If you want WHA to schedule an appointment for you, call Angela Miloszewicz directly at 608-268-1801, by Monday, May 2.

The Wisconsin Health Care Employee Pride Program celebrates "the pride and caring that you bring to your work." We hope you and your hospital plan to be part of that celebration on April 28 at the Kalahari Resort in Wisconsin Dells.

To participate, a member hospital must submit the name of its Pride Program honoree to WHA by April 1, 2005. With only one week to go, we know that many of you are in the process of making the difficult decision about who will be your honored representative. Pride honorees consistently tell WHA that the Pride Program recognition and award dinner are a career highlight.

WHA is looking forward to receiving the names of the many honorees from around the state within the next week, and then on April 28 meeting those being honored and showcasing the moving Pride stories.

Remember, Pride honorees must be submitted to WHA by April 1, and the deadline for reserving a sleeping room at the Kalahari Resort is April 7 (or when the group block is full – and it’s filling up fast!). Access Pride Program submission materials on the Web site at www.wha.org.

For more information, contact Mary Kay Grasmick at mgrasmick@wha.org or Shannon Nelson at snelson@wha.org, or call 608-274-1820.

For the past year, the Wisconsin Hospital Association has participated in the Workers Compensation Advisory Council’s Medical Cost Study Committee. The purpose of the Committee was to determine whether medical costs within the Workers Compensation system are reasonable and whether medical costs could be reduced. The Committee included representatives of business, labor, and health care providers.

Evidence presented by and to the Committee indicated that the Wisconsin Workers Compensation system is, for the most part, cost effective and efficient, as reflected in reduced premiums for employers over the last several years. That said, the Committee is recommending three proposals to the Council that should increase the cost effectiveness of the program. The proposals include a pharmacy fee schedule (average wholesale price plus a dispensing fee); treatment parameters to be used as a guideline in necessity of treatment disputes; and restrictions on health care providers who are regularly "outliers" in their professions regarding the treatment provided. The Council will now consider these proposals.

The Workers Compensation insurers advocated for the imposition of a fee schedule in the program similar to the fee schedule in the Minnesota Workers Compensation system. The Minnesota Hospital Association recently had to fight a proposed 30 percent cut to their fee schedule (would have been a $70 million loss to Minnesota hospitals). "Our concern was that the Workers Compensation program would become one more government program that doesn’t pay its bills," said WHA Senior Vice President Eric Borgerding. "WHA members certainly understand the need for the Workers Compensation system to be cost effective. We’re pleased that the Committee focused on potential problems within the system without making changes that would harm providers and impact access to care for Wisconsin workers."

A study released last week on health care cost efficiency in the Greater Milwaukee area validates claims by a number of organizations, including the Wisconsin Manufacturers & Commerce (WMC), that Medicaid underpayment is a "hidden tax" on health insurance premiums.

The study, undertaken for the Greater Milwaukee Business Foundation on Health, Inc. (GMBFH) by two well respected national consulting firms (Milliman USA and Mercer), concludes that the cost shift burden to the private sector from Medicaid’s "hidden tax" is one of the most important factors driving variation in Milwaukee area health system cost differentials and a major factor behind rising health insurance premiums.

Importantly, the study’s conclusions suggest that an increase in Medicaid payment rates and address of the larger uninsured issue by the Greater Milwaukee community are needed to dampen rising health insurance costs. Specifically, the GMBFH study points out that government health care programs at all levels must be responsible for paying their fair share of costs so that the "hidden tax" burden is not continually shifted to the private sector.

We welcome the addition of this credible evidence to the ongoing discussion of health care "cost drivers" and the role that government payment shortfalls play in propelling health insurance premiums higher. The evidence is overwhelming…and WHA’s "down payment" Medicaid agenda this year is a prescription that begins to address the problem. As we noted in press statements last week, "even in a challenging state budget environment, we cannot let another year go by without beginning to address the ‘hidden tax’."

Steve Brenton
President

Special note: As Medicaid budget discussions heat up, observers increasingly note the low level of understanding of Wisconsin’s program. That’s not unusual given the complexity of the program and the fact that sound bites are the hard currency of communication strategies in our State Capitol. To address this challenge, WHA staff is in the final stages of developing a "Wisconsin Medicaid Myths" brochure designed to specifically answer nine commonly identified "myths" associated with the program. We’ll make these brochures widely available and highlight the "myths" over the next few weeks in The Valued Voice.

The Assembly Committee on Colleges and Universities held a hearing Tuesday, March 22, 2005 on Assembly Bill 246 authored by Representative Steve Wieckert (R-Appleton). The purpose of the bill is to require that all districts within the Wisconsin Technical College System (WTCS) create a common curriculum and common admission standards for each of the health occupations. WHA has supported this legislation as part of our goal to create and maintain an adequate health care workforce. This legislation is also a component of "Healthier Choices," the health reform package developed by WHA, WMC and the Wisconsin Association of Health Plans. The bill is a piece of the "100 Day Agenda" announced by Assembly Republican leadership in September.

The bills components are:

• Common requirements for admission allow a student to inquire about, understand and comply with admission expectations in any technical district and be confident that work would meet expectations in every district.
• Common curriculum in health occupations would mean that each district uses the same courses, same course numbers and same learning outcomes across each health occupations curriculum

WHA’s Judy Warmuth testified in support of the bills.

"The advantage to common admission standards and common curricula is that a learner who may have begun an application process, or a program, in a technical college district but who must leave a program, or who moves, has the flexibility of resuming that process without penalty, loss of credit, time or money," Warmuth told the Committee.

"We feel strongly that relocation, changes in life situations and waiting lists cause students to move among districts," Warmuth continued. "Dramatically different standards from one school to another, like those that exist now, discourage learners, perhaps to the point that they never complete a program, never become a health professional."

WHA was joined by several other groups that support the bill, including Meriter Hospital in Madison, the Wisconsin Manufacturers & Commerce, and over a dozen nursing home administrator members of the Wisconsin Health Care Association

The Wisconsin Technical College System, a representative of the Technical College Districts, Technical College Faculty and the president of the Wisconsin Physical Therapy Association testified in opposition to the bill. They took positions that the bill was not needed, that students do not transfer, that students do not find the differences among districts difficult and that no improvements to the health care workforce would result.

WHA will continue to work on behalf of this legislation and welcomes examples and stories from hospitals where students have been penalized when attempting to move from one technical district to another while completing a health occupation program.

Hospitals that train family medicine residents must comply with regulations regarding compensation of faculty providing training in nonhospital settings as of January 1, 2005. Compensation must be made by the hospital claiming the resident’s time for IME and DME purposes.

The hospital must comply with one of the provisions below:

1.  Written affiliation agreement is not required if monetary or in-kind payment is made to the preceptor by the hospital by the end of the third month following the month in which the teaching services occurred. Or

2.  If hospital continues to use a written affiliation agreement with the non-hospital site, it must document that the hospital:

• Will incur the resident’s salary and fringe benefits
• Provide reasonable compensation to the nonhospital site for supervisory teaching activities
• Indicate the supervisory teaching compensation amount (either the monetary amount or what was offered in in-kind contributions)

Reminder: the written agreement must be signed and dated prior to the time the training is provided.

If you need more specific information about compliance now that the moratorium is expired, go to www.stfm.org, click on Legislative Affairs, then Key Issues, then GME.

With the input of a variety of WHA members and partnering organizations, an outstanding agenda has been developed for the 2005 Wisconsin Rural Health Conference. This year’s event is scheduled for June 22-24, 2005, at the Kalahari Resort & Convention Center in Wisconsin Dells.

Keynote speaker Leland Kaiser, PhD, renowned health care futurist will open the conference with a look at "Our Changing World of Rural Health," examining new challenges and opportunities for rural health care providers, how they will affect delivery of and access to health care, and the vital skills, attitudes and behaviors needed to thrive in this new environment.

Watch for the full conference brochure with registration information to be included in WHA’s Friday Packet and available online at www.wha.org in mid-April.