The WHA Task Force on Access and Coverage met Friday, March 23, to review and discuss ongoing state and federal health reform initiatives.

AHA Chair-elect Bill Petasnick led discussion of ongoing efforts to develop and advance a national initiative framed around "five pillars" that represent key principles including: Health Coverage for All Supported by All, Focus on Wellness, Better Value, Care that is Coordinated, and Access to Information. "The AHA leadership is excited about this effort and committed to promoting a unified health policy that can be embraced by 2008 Presidential candidates," Petasnick said, noting that "AHA is reaching out to members and to key stakeholders to obtain necessary input in an effort to build diverse and sustainable support for the effort."

Task Force Chair Leo Brideau said "members provided terrific input and commented favorably on the AHA effort, to date." Brideau noted that "AHA’s ‘five pillars’ align well with WHA’s access and coverage principles, adopted by the Board last October."

Task Force members also heard and provided input on emerging initiatives that are likely to be considered by the Wisconsin Legislature later this year. "There is tremendous interest in ‘doing something’ about health care in 2007," said WHA Senior Vice President Eric Borgerding. "But there is great diversity and an absence of consensus on just what can be done legislatively. The menu of options is large and may grow."

WHA staff shared with Task Force members a draft of an initiative (Healthier Choices 2007) being developed by WHA, WMC, WMS and the Wisconsin Association of Health Plans. The initiative describes an approach that relies on a combination of government and private sector-actions designed to enhance access and coverage by improving health status, promoting disease management, improving the health care marketplace, and reducing the "hidden tax" resulting from poor government payments.

"Healthier Choices 2007 addresses the notion that health care costs are driven by utilization of services," said WHA president, Steve Brenton. "Absent effective chronic disease management and wellness promotion, stabilization of costs will just not happen." Brenton noted that Healthier Choices 2007 represents a consensus approach that is embraced by the four organizations and is not the only public policy initiative that will be on the Association’s advocacy agenda.

This week Gundersen Lutheran Health System of La Crosse and St. Joseph’s Hospital of Chippewa Falls testified before the Joint Finance Committee (JFC) against the Governor’s proposed hospital tax. Their testimony came during the JFC’s budget hearing in Chippewa Falls.

Gundersen Lutheran’s Joan Curran testified that system would lose between $1.15 and $2.2 million during the biennium under the proposed hospital tax.

"The proposed hospital tax will have a direct, negative impact on Gundersen Lutheran’s ability to continue providing high quality and affordable care to our patients," her written testimony stated. "Our argument against the hospital tax is not based on risk-averse assumptions. State and federal rules are clear, and they allow us to model out the proposed hospital tax using real data."

One of the arguments against the tax is how much Wisconsin can actually receive back from the federal government under the Medicaid program. Otherwise known as the "Medicare Upper Payment Limit" (UPL), this Federal UPL provision caps the amount of reimbursement for Medicaid to the Medicare fee-for-service amounts. Under an analysis done by WHA, the UPL poses significant problems and would likely result is a majority of Wisconsin’s community hospitals losing under the tax.

During his testimony, CEO David Fish of St. Joseph’s Hospital called the hospital tax a "cost-shift Cadillac." It looks great at the curb, but when the Cadillac pulls away from the curb at the start of the second biennium, numerous providers will not be able to drive it, there’ll be no gas left in the tank and costs may well be further shifted onto other individuals and businesses who are already feeling the pinch. "Cost-shift Cadillacs look good at the curb … and that’s where they ought to stay," Fish said.

Fish commended the Governor for his desire to increase health care coverage but urged legislators to move beyond gimmicks and produce a program that serves the needy while ensuring sustainability.

Hospital testimony also highlighted how the proposed budget removes some $850+ million in general purpose revenue dollars for the Medicaid program and replaces those stable dollars with dollars from the hospital tax, the tobacco tax and other sources.

"Wisconsin should keep the base GPR funding in the Medicaid program and add tobacco tax revenues to fund new health care initiatives and increase provider payment rates," Joan Curran testified. "Unfortunately, tobacco tax revenues are being used to replace GPR rather than build upon them, and we believe this is a fundamental misstep and a missed opportunity to reduce health care costs and improve access in Wisconsin."

Curran was also able to testify on the hospital tax and health care reform at a March 22 public hearing held in Eau Claire by the Senate Health and Human Services Committee. The committee has been traveling the state in the past several weeks to take public testimony.

In the coming week, more hospitals will testify at the final two JFC hearings being held. WHA thanks these and many other hospitals for their grassroots efforts to date against the hospital tax.

WHA is happy to introduce Paul Merline as its new vice president for Government Affairs.

Merline comes to WHA with solid experience in government relations and health care. Since early 2004, he has been with the Wisconsin Association of Health Plans as the legislative/agency liaison and most recently as director of government affairs. Previously, Merline was the government relations specialist for the Wisconsin Restaurant Association and also served as a staff person to State Representative Gene Hahn. Prior to working in the Capitol, he managed partner relations for a Madison software developer and spent time as a research specialist for the University of Wisconsin-Madison.

"Paul is an experienced lobbyist, very professional and well respected inside and outside the Capitol," said WHA Senior Vice President Eric Borgerding. "He’ll hit the ground running, and we are excited to have him join the hospital team."

"I am thrilled by the opportunity to join the Wisconsin Hospital Association," Merline said. "I’m eager to contribute to an already-strong lobbying team and continue developing essential and lasting Association relationships with policymakers."

Merline graduated from the University of Wisconsin-Madison with degrees in political science, economics and international relations. He resides near Lodi with his wife Karen and enjoys fishing, hunting and other outdoor activities.

Merline begins on April 2 and succeeds Jodi Bloch who, after three years of top-notch lobbying and advocacy, has decided to stay home with her young family. "We welcome Paul and wish Jodi and her family all the best," Borgerding said.

Sen. Dan Kapanke (R-La Crosse) was joined by local hospital officials at a press conference this week to speak out against the proposed tax on hospitals. Participants included: President/CEO Robert Nesse, MD, of Franciscan Skemp Healthcare, Inc; External Affairs Executive Director Joan Curran of Gundersen Lutheran Health System; CEO Bill Bruce of St. Joseph’s Community Hospital of Hillsboro; and COO Connie Achenbach of Prairie du Chien Memorial Hospital.

"This tax is bad for my constituents, period," Kapanke said at the press conference. "We must not allow Madison’s bad budgeting to make health care more expensive or more difficult to access for our citizens."

Connie Achenbach agreed. "There is no place for a tax on sick people. It’s borrowing from Peter to pay Paul."

Dr. Robert Nesse’s statements expressed concerns about the proposal’s failure to include the fundamental changes that must be embraced in order to improve health care access, quality and equitable reimbursement. He indicated there are many quality ideas out there, "but a tax on hospital care of sick people is not one of them….We deserve better than this from state government."

Bill Bruce, CEO at St. Joseph’s Hospital offered his own unique perspective on the hospital tax. As a hospital that owns a nursing home, Bruce has seen the tax scenario play out before. It was only about a dozen years ago that a bed tax was levied on the state’s nursing homes in order to leverage more federal Medicaid dollars to increase provider reimbursements. Today, that bed tax continues to be increased, including a proposed $52/bed increase in this budget, with many nursing homes still on the brink. In fact, the State itself has said that roughly 50 percent of nursing homes are at "financial risk."

"The reality is that the shortfall between Medicaid reimbursement and the cost of providing nursing home care has increased over the last five years," Bruce said. "We fear the hospital tax will have the same effect."

Here are five compelling reasons why the Joint Finance Committee should reject Governor Doyle’s Patient Compensation Fund (PCF) proposal:

1. A PCF raid is just plain wrong. The PCF belongs to the injured patients and families it was created to compensate. Until the funds are awarded to those families, the PCF board needs to be the sole facilitator of spending these funds on Wisconsin’s patients and families.

2. PCF rates for medical professionals will rapidly increase further…Another "provider tax." PCF rates have increased by 30 percent in just the last two years alone. These increases were necessary to offset current and future risks and prevent deficits in the PCF.

                    2005             -                                 ($693,409)
                    2006         + 25%                             ($924,545)
                    2007          + 5%                              ($970,772)

The PCF Board recently completed an actuarial study of the fund; the results showed a neutral balance. The Legislative Audit Bureau cited the PCF’s net balance as $59.9 million. Whichever figure is used, the raid will result in a deficit of $115 to $175 million. The deficit will need to be eliminated through increased provider rates on top of the 30 percent rate increase since 2005. Essentially, this is another "provider tax" to fund the state budget.

3. A PCF raid will exacerbate physician recruitment and retention problems in Wisconsin. If we make practicing in Wisconsin for medical professionals more expensive than other states, they simply will not come here. Given the rising medical malpractice insurance costs in Wisconsin, we must remember that the average student loan debt for a young doctor is more than $130,000. Similarly, there is an unmet need for 506 additional primary care physicians in Wisconsin, according to a 2004 report by the Wisconsin Hospital Association and Wisconsin Medical Society.

4. Taking funds away from health care providers diverts resources from direct patient care. This year, Gundersen Lutheran will pay $970,772 to the PCF. What could Gundersen Lutheran have done with the 25 percent rate increase ($231,236) we paid to the PCF last year?

Jeff Thompson, MD
CEO, Gundersen Lutheran Health System, La Crosse, WI

Advocacy Day 2007 is slated this year for May 1 at the Monona Terrace in Madison, so mark your calendars now! Make plans now to join the more than 500 health care professionals, trustees and volunteers from across the state who attend WHA’s Advocacy Day each year.

WHA has a great line up of speakers, including keynote speaker Kellyanne Conway, a nationally regarded and highly quoted pollster, who will share with attendees the pulse of the nation on important issues and the politics surrounding them. Governor Doyle and legislative leaders have been invited to participate in the luncheon keynote address and a legislative leadership panel discussion, respectively.

The highlight of Advocacy Day is always the hundreds of attendees who take what they’ve learned during the day and put that into action by meeting with their legislators in the afternoon. Last year one attendee had this to say about being involved with the afternoon’s legislative visits, "I like being part of influencing the Legislature." And when another attendee was asked what could persuade him to go on a visit, said, "I don’t need persuasion; I will [visit] next year."

To help educate and train Advocacy Day 2007 attendees for their legislative meetings, nationally known grassroots guru Amy Showalter of The Showalter Group will provide a customized presentation on effectively meeting with legislators. She will demonstrate why face-to-face meetings are the most powerful tool in the grassroots toolkit and how to make your legislative visit successful.

With the State Capitol only a scant two blocks away (transportation will be available), meeting with legislators or their staffs has never been more convenient or more important. Hospitals are facing a great number of legislative issues this year and it is essential for legislators to hear first hand from hospital employees, trustees and volunteers about the impact of those issues on your hospitals and the communities you serve.

As always, Advocacy Day is a free event, so register your hospital contingent today. A complete program and registration form are available in this week’s packet and on-line at www.wha.org. For questions, contact Jenny Boese at 608-268-1816 or jboese@wha.org. For questions specific to registration, contact Sherry Rabuck at srabuck@wha.org or 608-274-1820.

To schedule your appointment to meet with your legislator on the afternoon of May 1, contact Angela Miloszewicz directly at 608-268-1801.

The Texas Hospital Association (THA) launched its PricePoint Web site on Tuesday, March 27, bringing to ten the number of states using WHA Information Center’s PricePoint system.

With 254 counties and about 400 hospitals, Texas is the largest state thus far to adopt PricePoint to provide hospital pricing and utilization information to the public.

"More than anything, Texas PricePoint is designed to promote consumer/hospital interaction," said Dan Stultz, M.D., FACP, FACHE, president/CEO of THA. "This Web site is especially helpful for people who participate in consumer-directed health plans, such as health savings accounts or health reimbursement accounts."

PricePoint systems are also operating in Georgia, Iowa, New Hampshire, New Mexico, Oregon, Utah, Virginia and Washington. As many as eight other hospital associations may launch PricePoint Web sites in the next year.

Kristy Wiltrout, RN, and Dr. Brian Woody of Vernon Memorial Healthcare’s (VMH) Hirsch Clinic, have taken the love of reading to their own children to another level, and are now helping to enhance the lives of patients and their families. In September of 2006, the Reach Out and Read (ROR) program launched at Hirsch Clinic-VMH. In order to become a part of this national literacy initiative, Wiltrout and Woody underwent an application process. Once accepted, Hirsch Clinic-VMH was awarded $900 to establish the program and purchase books. Reach Out and Read builds upon the unique relationship that exists between medical providers and parents. Wiltrout says, "This is a great opportunity to promote childhood development and learning on a routine basis."

The ROR program trains doctors and nurses to advise parents about the importance of reading aloud to their children and to present children with books at their pediatric check-ups. Children of all economic backgrounds from ages six months to five years are given two developmentally appropriate books at routine well-child check-ups. As a result of attending the appointments over a child’s first five years, this program helps to provide an enriching personal library.

It is a vision of this literacy driven team, to have ROR implemented and available at all VMH clinics.

Submit hospital community benefit stories to Mary Kay Grasmick, editor, mgrasmick@wha.org or call 608-274-1820.

Wisconsin Organization of Nurse Executives (W-ONE) will host its annual convention for nurse leaders and managers from April 18-20 in Green Bay. The convention, with a theme of "Leading Your Team in a New Age for Health Care," will be keynoted by Tim Porter O’Grady, internationally known for his work with shared governance models, clinical leadership, conflict, and health futures. The agenda will also include a variety of interesting breakout session topics, the opportunity to network, and wrap with a presentation by Marie Manthey.

The convention will be held at the KI 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.