It started with a simple idea…create an online resource that will help people seeking to learn more about the care they should expect to receive in a Wisconsin hospital. Two years later, every Wisconsin hospital is participating in the Wisconsin Hospital Association’s CheckPoint program (www.wicheckpoint.org).

The CheckPoint program was designed to address the growing demand that health care purchasers and consumers have for information that is helpful as they seek to learn more about their health care needs and expected treatment. More than 80 percent of those who have Internet access report that they have searched for health-related information and, of those, nearly 30 percent have looked for information on a particular doctor or hospital, according to statistics gathered by the Pew Internet & American Life Project.

CheckPoint provides consumers with reliable information on five error prevention goals and 14 key clinical interventions that medical experts agree should be taken to treat heart attacks, heart failure and pneumonia—the three most common causes of hospitalization in Wisconsin. Also included in CheckPoint are eight interventions that are known to help prevent surgical infections. And more measures will be added soon.

A recent national report claimed that patients are only receiving 55 percent of the care that research has shown they should be given for their condition. WHA’s Dana Richardson, vice president for quality initiatives, said that consumers don’t need to look any farther than CheckPoint to see that Wisconsin hospitals are performing "well above the national average in providing recommended care to patients."

"In fact, we know that we have eliminated two unsafe practices statewide by removing concentrated electrolytes from patient care areas, and by using only free-flow protected intravenous pumps in all hospitals," Richardson added. "Both of those practices were targeted in CheckPoint."

While public information is important to consumers as they navigate the health care system, physicians and hospitals have found public information equally as important for their continuous internal improvement efforts. All measures reported in CheckPoint have shown improvement, but two areas in particular have shown dramatic progress—pneumonia vaccination and smoking cessation counseling.

"Although vaccinations have historically been provided in community settings, hospitals are now making it a priority to vaccinate high risk patients who come into the hospital with pneumonia," according to Richardson. "Since we started measuring how many patients receive smoking cessation counseling while being treated for heart attack, congestive heart failure or pneumonia, we’ve found that it is now becoming a common practice for all patients to receive this counseling during their hospitalization," she added.

Wisconsin "is a national model" in Hospital Public Reporting

The success of CheckPoint has not escaped the attention of those outside of the medical community. Seven Wisconsin health plans currently link to the WHA CheckPoint Web site, while 16 business organizations share the information. State legislators have also noticed the impact that CheckPoint has had in the two years since its inception.

Rep. Curt Gielow (R-Mequon), who chairs the Assembly Committee on Medicaid Reform, praised the program. "The WHA CheckPoint program, which celebrates its second anniversary this month, has put all Wisconsin hospitals in a leadership position among hospitals across the country by serving as the model for transparency initiatives nationwide," Gielow said.

Nancy Nankivil-Bennett is director of strategic health policy at the Wisconsin Department of Employee Trust Funds (ETF) and a member of the Wisconsin Quality Steering Committee, the group that directs the development of CheckPoint. ETF administers retirement and other benefit programs for more than 500,000 Wisconsin Retirement System (WRS) participants and 1,400 state and local government employers making it the largest purchaser of health care in Wisconsin.

"The Wisconsin Hospital Association’s Checkpoint Initiative can be considered one of our state’s best emerging health care assets. The balance of leadership, accountability and sheer will demonstrated by the Association has pushed public reporting of hospital quality and safety to the forefront in Wisconsin. As purchasers and consumers of health care, we now have the responsibility to act wisely on the available information," Nankivil-Bennett explained.

WHA President Steve Brenton says Wisconsin hospitals participate in CheckPoint because it is their mission to serve and improve the health status of their communities.

"Hospitals want to be accountable to the patients they serve. Buying health care is not as simple as buying a car. Consumers encounter complex medical terms and procedures at the same time that they may be under stress because they or a family member are ill," Brenton said. "What we are really trying to do with CheckPoint is provide understandable information to patients and purchasers of health care so they can actively participate in decisions that will impact their health."

CheckPoint was the first voluntary hospital public reporting effort of its kind in the nation to achieve 100 percent participation. "Wisconsin’s hospitals have demonstrated real leadership in their creation of and commitment to CheckPoint. It is a unique program that helps patients, families and employers better understand hospital quality and safety information in their state," said Richard Davidson, president of the American Hospital Association. "It’s great to see this statewide effort achieve a two year milestone of providing an important resource for consumers as they make informed health care decisions. They have become a model for others to emulate."

Registrations for WHA’s Advocacy Day 2006 soared over 500 this past week. Over 220 of those individuals will then take what they have learned on important hospital health care issues and meet that afternoon with almost 100 members of the 132-member state Legislature.

If you haven’t sent your registration in yet, it’s not too late. Join with hospital administrators, nurse leaders, employees, trustees and volunteers from across Wisconsin on April 5 for this premier grassroots event. Hear from key political leaders like confirmed luncheon keynote Governor Jim Doyle and bipartisan members of the Legislature’s leadership including Senate Majority Leader Dale Schultz (R-Richland Center), Sen. Judy Robson (D-Beloit) and Rep. Sheldon Wasserman (D-Mequon).

Learn about what’s happening on the national scene from morning keynote speaker John Fund, a member of the editorial board of The Wall Street Journal, and then round out the day with grassroots expert Christopher Kush, back by popular demand, as he educates and motivates attendees on how to put their knowledge into action during their afternoon legislative visits.

There are only a few days left to register for this FREE event. To register, log on to www.wha.org/education/pdf/2006advocacy.pdf or contact Sherry Rabuck at WHA, 608-274-1820, or email srabuck@wha.org. You may also fax your registrations to 608-274-8554.

As with all of WHA’s Advocacy Days, WHA strongly encourages attendees to put their training into action by meeting with their legislators in the afternoon of April 5. Please contact WHA’s Angela Miloszewicz at 608-268-1801 as soon as possible to inquire about scheduling your legislative meeting.

The WHA Leadership Survey was distributed directly to hospital and health system leaders in electronic and written format last week. Please complete either the online or written version of the survey by April 17.

On March 27 Governor Doyle signed into law AB 981 – legislation that will provide for a slight, yet much needed, increase in Medicaid payments to Wisconsin’s nursing homes. The bill also directed funding from higher than expected state revenue collections to the Medicaid program in order to stave off a massive projected deficit for the 2005-07 biennium. The legislation, and long process it took to get there, was strongly supported by WHA.

"This is a double dose of good news for hospitals, particularly those that own or subsidize nursing homes," said WHA’s Eric Borgerding. "With one piece of legislation, Republicans and Democrats came together to fix the Medicaid deficit, stave of future cuts and deliver a much needed payment increase. We are very pleased with this outcome and to have been involved with the Wisconsin Health Care Association and the Wisconsin Association of Homes and Services for the Aging to help make it happen."

AB 981 (now Act 211) provides $76 million GPR to fill the projected 2005-07 deficit. AB 981 also provides $3,047,200 (all funds) in 2005-06 to provide a one-time supplemental payment to nursing homes that provided care to Medicaid recipients in state fiscal year 2004-05. The measure also provides $23,815,500 (all funds) in state fiscal year 2006-07 to increase reimbursement to nursing homes. It is estimated that the $23.8 million would, on average, increase MA rates by approximately 2.8 percent from the current rate facilities receive.

Over half of Wisconsin’s hospitals own or are affiliated with a nursing home. In almost all cases, revenues generated by the partner hospital are used to subsidize nursing home operations and ultimately keep the facility open and providing long-term care services to the local community.

Though signed into law last week, AB 981 has its roots in the 2005-07 biennial budget bill. The Legislature appropriated funding to increase Medicaid payments for nursing homes and outpatient hospital services. Those increases were vetoed by Governor Doyle and subsequent attempts to override the vetoes failed. However, the issue was kept on the front burner by the Legislature, particularly Senators Brown, Fitzgerald and Jauch and Representatives Rhoades and Kaufert. The result, AB 981 and its amendments, was negotiated with the Doyle administration and ultimately signed into law.

AB 981 illustrates the "from crisis to crisis" nature with which the state addresses Medicaid, a situation that must change, according to WHA.

"Despite this good news, there is a brewing crisis in Medicaid that cannot remain unaddressed," said WHA President Steve Brenton. "We are basically treading water in some areas and sinking in others. Hospitals, particularly those serving disproportionate shares of Medicaid patients, cannot be paid as little as $74 for surgeries that cost thousands to perform, and be expected to remain viable. We have to address this situation in the 2007-09 budget, and WHA will focus a great deal of its firepower on this target."

According to recent figures compiled by WHA, MA payments to hospitals slipped to 49 percent of what it cost to deliver care in 2005. That’s down from 53 percent of cost in 2004. The total amount of hospital costs unpaid by Medicaid, and added to the health care bills for employers and their employees, rose to $546 million — a staggering 21 percent increase in one year.

The doctor told the patient that his tests looked good. But more tests might be needed to definitively confirm he was OK.

They walked past me last week as I sat on a stool in the hallway with my three-year-old sleeping on my lap, five stitches in her lip from a fall six hours before. I was waiting for paperwork as I overheard the conversation.

At one point, the 30-something patient stopped in his tracks and sheepishly asked the doctor about the cost of the extra tests. The doctor assured him his health insurance would cover it.

The doctor added, however, that the patient could go home if he was satisfied with the initial tests and didn’t want more.

They never discussed, at least not within earshot, a dollar figure for the extra tests. And the risk of not getting the tests was never quantified. Was the risk one-in-10 or one-in-10,000 that something terrible might go undetected?

I wondered, as I sat there, if I was witnessing a key problem with our increasingly-costly health care system: Patients with insurance don’t have to weigh the actual cost of most procedures against the likelihood of benefit.

This point was part of a recent ABC News documentary by Peter Jennings that aired after his death from cancer. Medical care is one of the few products we purchase without a price tag attached. Patients simply want to know if a procedure is covered. If it is, patients assume more medical care—and more expensive medical care—is better care.

But Jennings found that’s not always true. A Dartmouth Medical School study suggested more medical care often leads to worse outcomes. And while we all love to blame insurance companies for skyrocketing costs, the real reason we’re paying so much more is that we are using so much more care.

Jennings interviewed a Whole Foods executive who compared shopping for health care with shopping for groceries. If customers came into his natural food store without having to consider cost, they’d rack up much bigger bills and probably take home more food than they needed.

Similarly, when customers go to the doctor, they want everything they might need—if it’s covered.

I was grateful to the team of doctors, nurses, technicians and receptionists at Meriter who helped my daughter in the middle of the night. They were attentive, caring and thorough. My daughter received cherry-flavored topical numbing gel to dull the pain of a subsequent shot. And her lip was carefully and precisely stitched even though an initial examination had raised the possibility of more expensive plastic surgery.

I can’t imagine I would have changed anything had I known the costs up front. Yet injecting some fiscal reality into my decisions couldn’t have hurt.

For example, if I had pushed hard for plastic surgery because my insurance would cover it, I’ll bet I would have got it. Jennings’ report suggests too many of us are insisting on too much care. And doctors, fearing lawsuits, often comply with our wishes for exhaustive tests to make sure they don’t miss something.

Also, researchers continue to hatch amazing yet expensive ways to prolong our lives.

But do we really want health care costs to grow to the point that our employers are spending as much on our insurance as they are on our salaries?

At some point, we have to accept a little more risk—just like we do when we drive home from the hospital on roads that sometimes host deadly car crashes.

I sat in the E.R. with two competing impulses. My mind was OK with the nearby patient not getting the extra tests his doctor suggested. The tests might bring peace of mind, but so would a vacation for the same money.

Then my heart told me that if that patient was my son, I would insist on the extra tests.

Somehow we have to balance our emotional urge to spend whatever it takes with a sober look at what it all costs.

Scott Milfred
Editorial Page Editor
Wisconsin State Journal
Madison, Wisconsin

Remember, the deadline to submit your honored employee’s name and essay to WHA for the Wisconsin Health Care Employee Pride Program is April 7, and the deadline for reserving a sleeping room at the Blue Harbor Resort is April 14 (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.

The Wisconsin Health Care Employee Pride Program celebrates the pride and caring that health care employees bring to their work. We hope you and your hospital plan to be part of that celebration on May 4 at the Blue Harbor Resort in Sheboygan. 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 May 4 meeting those being honored and showcasing the moving Pride stories.

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

With the 2005-06 legislative session winding to a close, a handful of issues still remain to be addressed. The most controversial of those is the Taxpayer Protection Amendment (TPA), the second attempt in two years at limiting the amount of state spending through an amendment to the Wisconsin Constitution.

The TPA is slightly different than its 2004 predecessor, the Taxpayer Bill of Rights (TABOR), in that it places limits on growth in state revenues rather than growth in state spending. WHA joined several other health care organizations in opposing TABOR in 2004. And no matter how it’s sliced, WHA and other health care providers remain concerned about the impact the new amendment will have on government created health care programs.

"From our perspective, it’s hard to watch hospital Medicaid payments drop below 50 percent of cost, and the ‘Hidden Health Care Tax’ rise to $546 million in 2005 and not be concerned about the TPA," said WHA President Steve Brenton. "This is the situation that has developed without a constitutional limit on spending; what will happen with one?"

The recent good news on Medicaid (see article above on AB 981, titled "Nursing Home Payment Increase Now Law") does little to assuage the fears of health care leaders surrounding the TPA.

"The theory behind the TPA is that it will force lawmakers to prioritize spending and limited state dollars, and that sure makes sense," Brenton said. "But notwithstanding the recent good news, historically unfunded Medicaid program expansions and the consistent exacerbation of the ‘Hidden Health Care Tax’ indicate quite clearly that actually paying for the Medicaid program has rarely been a political priority."

WHA will join with others over the coming weeks to express its growing concerns with the TPA and its unintended consequences.

A position paper on a proposed constitutional amendment, the Taxpayer Protection Amendment, is now available in WHA’s Toolkit.

In 2004, the Wisconsin Legislature debated an amendment to the Wisconsin constitution limiting government spending. It was called the Taxpayer Bill of Rights (TABOR). While no final product came to a vote then, a similar proposal called the Taxpayer Protection Amendment (TPA) is being discussed in the waning days of this 2005-06 legislative session.

The TPA seeks to limit government spending by controlling growth on the revenue side of the equation. The goal of controlling taxes and spending is laudable, and while TABOR/TPA proposals may seem attractive on the surface, they could also assure that the grossly inadequate payments hospitals receive from Medicaid (without a TPA) will continue at current levels or become even worse. As a constitutional amendment, the TPA could have a very negative, and very permanent, impact on the Medicaid budget – effectively locking in some of the worst Medicaid hospital payment rates in the country and perpetuating the "Hidden Health Care Tax."

Wisconsin Governor James Doyle signed legislation into law in Appleton this week that will help create an important collaboration between the public and private sectors designed to produce useful information on the cost and quality of health care.

The bill, AB 907, facilitates and funds the state’s participation in the Wisconsin Health Information Organization (WHIO), a non-profit entity created by health care providers, insurance companies and employer groups to develop a statewide data warehouse of administrative claims data.

"This is very important legislation. It will put Wisconsin in the forefront of a worldwide movement to provide information on cost and quality to purchasers of health care," said Rep. Gregg Underheim, (R-Oshkosh), chair, Assembly Health Committee.

Insurers will submit claims data to the WHIO warehouse, which will allow for confidential tracking, analysis and measurement of the quality and cost of entire episodes of care across multiple delivery systems, not just the charges for a hospital procedure or doctor’s office visit.

"The data that WHIO will compile will help us change the way we purchase, provide and pay for health care. It will help consumers make more informed decisions, based on value," said John Toussaint, MD, president and CEO of ThedaCare of the Fox Cities and chairman of the WHIO board of directors.

"State government is the largest purchaser of health care in Wisconsin. I commend the Governor and the Legislature for using the state’s purchasing power to drive change in the health care marketplace.

Greater transparency of health care quality and cost data is an essential step," said Toussaint, who also referenced WHA’s CheckPoint and PricePoint initiatives.

Initially, medical and pharmacy claims data will be submitted to WHIO for aggregation and analysis. Medicaid data will be added later. WHIO could have data available for a public report in 2007.

"Health care purchasers and consumers will be able to use the data to make more value-based buying decisions. Health care professionals can use the data to benchmark and drive further quality improvements," Toussaint said.

Doyle signed AB 907 during a ceremony at the Appleton Medical Center, where he also signed into law three other pieces of health care-related legislation. (See related stories in this week’s Valued Voice.)

The Wisconsin Health Information Organization is a voluntary public-private partnership bringing together the state’s key health care stakeholders to develop a statewide warehouse of health care data that spans providers and systems.

On March 29 Governor Doyle signed AB 659, authored by Rep. Al Ott (R-Brillion), which clarifies the informed consent process for tissue donation and AB 830, authored by Rep. Steve Wieckert (R-Appleton), which regulates the organ and tissue donation process in coroners’ case. WHA worked with the bills’ authors and interested parties to address concerns that WHA raised regarding provisions in the original drafts, which have since been removed or clarified.

"Both Reps. Ott and Wieckert and their staffs were very thoughtful in addressing the issues and concerns raised by WHA early on in the drafting process, and we’d like to thank them for working with us to produce laws that clarify the process for providers while enabling patients and their families to make more informed choices and facilitate more donation," said WHA’s Jodi Bloch, vice president of government affairs.

AB 659 known as the "Informed Consent Law" for tissue donation will provide more clarity to the tissue donation process for donors and their families by requiring that all requests for anatomical gifts of tissue include two short statements that briefly describe the wide range of uses for donated tissue along with explaining that the donor/donor family has the right to limit or restrict the use of the donated tissue. Originally the bill would have required an impossible task of essentially requiring that hospitals guarantee that contracted tissue banks and the bank’s subcontractors complied with the wishes of the patient if they chose to limit the donation for cosmetic, international or for-profit use. WHA explained that hospitals cannot control the process and be responsible once the donation has left the hospital and Rep. Ott agreed. Hospitals will need to change their document of gift forms by October 1, 2006 to make sure these new statements in Wisconsin Statute are included.

Bloch comments that, "the new requirement to provide this information on the consent form strikes the right balance by providing the additional information that donors and their families need without being overly burdensome on the providers."

Forfeitures of between $500-$1,000 will be assessed for failure to include the two statements on the donation form. WHA also worked to reduce these forfeitures, which are much less than those in the original bill, which called for penalties of up to $10,000 and court costs along with a possible citing on the provider for unprofessional conduct, which has also been removed.

AB 830 in part clarifies the role of coroners in the tissue donation process. WHA had heard from members in some parts of the state that in cases where it was a coroner’s case and the death occurred in the hospital, coroners were attempting to use the tissue bank that they had a contract with instead of using the tissue bank that the hospital had a contract with. This was posing a problem for hospitals because federal regulations overseeing hospital practice with regards to tissue donation conflicted with the coroner’s desire to use another tissue bank. AB 830 makes it clear to the coroners because it codifies federal regulation in state statute that says that in cases where the death occurs in the hospital, the tissue bank that the hospital has a contract with must be used in the tissue donation process unless the hospital’s tissue bank turns the donation down. Then the hospital’s tissue bank will contact the coroner to explore the possibility of donation with the coroner’s tissue bank.

Working to address concerns brought forth by the UW Hospital’s organ procurement organization and Executive Director Dr. Tony D’Alessandro, AB 830 also establishes procedures that will make it harder for coroners to object to organ donation, thereby ensuring Wisconsin continues its strong tradition of organ and tissue donation.

For more information, contact WHA’s Jodi Bloch at jbloch@wha.org or 608-274-1820.

Last week, 80 physician leaders from 28 different hospitals throughout the state attended the Wisconsin Hospital Association’s first "Physician Leadership Development Conference," held at The American Club in Kohler. The much higher than anticipated attendance, coupled with high attendee evaluation scores, showed that there is certainly a need for this type of education in Wisconsin, and the curriculum was appropriate for a ‘first step’ conference, making the event an overall success.

Presented by American College of Physician Executives (ACPE) faculty, the conference was designed to assist new and potential physician leaders make the leap from their traditional clinical training to taking a new managerial approach to decision-making, problem solving, communication and negotiation.

"The interactive dialog between faculty and attendees, as well as extensive networking added greatly to the success of the conference," according to Charles Shabino, MD, senior medical advisor for WHA and conference attendee.

Faculty focused on moving from process to results; establishing standards of behavior and performance; managing conflict and giving feedback; managing a disruptive physician; how to reward, punish, sanction and discipline effectively; identifying your own leadership style; and how to run a meeting effectively.

"WHA is committed to helping our members identify and develop physician leadership as a core Association program priority," said Steve Brenton, WHA president.

The idea for a conference of this type to be held in-state, as a way to offer high-quality leadership education without the high travel and lodging costs of many of the out-of-state programs, came from members of WHA’s Council on Medical & Professional Affairs, many of whom are physician and nursing leaders in their own organizations.

The Council assisted in developing the curriculum for this "first step" in physician leadership education. Attendee evaluations also showed strong interest in WHA offering a "second step" conference, exposing these new physician leaders to additional important health care topics.

If you have been in a movie theatre lately, or read the movie listings in the local paper, you might have noticed "The Grandfather of Green Bay" opened on Friday, March 24 in Wisconsin. The movie, filmed in Marinette, provided some employees at Bay Area Medical Center (BAMC) their "four seconds of fame," according to John Hofer, BAMC public relations and marketing director. (It is rumored a certain CEO can be spotted in a scene...)

BAMC provided housing for the two dozen film crew members in the second floor area of the Menominee building while the film was being shot in 2004. Director Schwaba said without help from BAMC, the movie would not have been possible. As his way of thanking the hospital, Schwaba will donate a portion of the Marinette ticket receipts to the BAMC foundation.

The film has spent the last two years being shown at film festivals around the country looking for a distributor. In fact, it was one of the films featured at the Madison Film Festival last year. It was named the best comedy of 2005 at the Midwest Independent Festival, and earlier this year the Marcus Corporation picked it up for Wisconsin distribution.

Why would a hospital do this?

"We saw it as a community benefit, with tens of thousands of dollars being spent locally during the production. We had the ability to help make it happen and so we did," according to Hofer. "Many BAMC employees also had a chance to be extras and get an inside look at how movies are made."

And as a little extra incentive, BAMC is offering free tickets to the movie for employees who submit examples of community benefits that BAMC delivers to the community.

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

Time is running out to register for the Wisconsin Organization of Nurse Executives (W-ONE) 2006 annual convention for nurse leaders and managers. Register today to experience the "W-ONE Jungle Safari Adventure." Hear great presentations, network with colleagues, see old friends and make some new ones.

Barbara Mackoff, MA, PhD, will open the convention as the keynote speaker, where she’ll explore how exceptional leaders understand and learn to use their own experiences as leaders, and translate them into powerful habits of mind for leading and inspiring others. Mackoff is a widely acclaimed expert on the psychological dimensions of effective leadership – on how great leaders think.

The convention will be held at the Kalahari Resort in Wisconsin Dells. 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.