In a hearing room filled with dozens of supporting organizations and health care providers, including hospitals, nurses and statewide health care and business representatives at the State Capitol, Assembly Bill (AB) 863 received strong bi-partisan approval this week from the Assembly Health and Health Care Reform Committee.

Also known as the Health Care Quality Improvement Act, AB 863 aims to improve patient safety and the quality of health care provided in Wisconsin. AB 863 would accomplish this by encouraging more comprehensive and robust peer review and quality improvement activities and protecting and strengthening the current regulatory system. The bill promotes these crucial activities by clarifying and strengthening protections against the use of quality improvement and regulatory investigations and reports in civil and criminal proceedings. For example, with AB 863, providers could evaluate the care provided across systems and provider types rather than the overly cramped reviews that are the object of the current statute. Importantly, the bill would also foster additional public reporting initiatives. Finally, AB 863 would maintain medical malpractice as a matter for the civil, not criminal, courts.

Shortly after passing on an 11-2 committee vote, AB 863 was scheduled for a vote on the Assembly floor next Tuesday, March 11.

Voting "Yes" on AB 863 were: Reps. Vukmir, Moulton, Lasse, Wieckert, Strachota, Newcomer, Nygren, Zipperer, Wasserman, Shilling and Vruwink.

Voting "No" on AB 863 were: Reps. Benedict and Seidel.

After the hearing, the author of the proposal, Rep. Scott Newcomer (R-Hartland) said, "As the author of AB 863, I am pleased that our leadership in the State Assembly has scheduled the Bill for debate on the floor of the Assembly. I am hopeful that my colleagues in the Legislature will realize the need for this legislation that will allow our state’s health care providers to push quality improvement activities to the next level, keeping Wisconsin in the lead nationally. The bottom line is that this will help ensure Wisconsin’s patients receive safer and more efficient and effectively delivered health care."

Testifying alongside Rep. Newcomer were Dana Richardson, WHA vice president of quality and Laura Leitch, WHA general counsel. Richardson testified, "Wisconsin health care providers are anxious to move forward with innovative strategies to improve health care in Wisconsin. This bill is an important step in the right direction."

Kirsten Albers from Meriter Hospital in Madison, Gina Dennik-Champion from the Wisconsin Nurses Association, Stephanie Bloomingdale from the Wisconsin Federation of Nurses and Health Professionals and several nurses also testified in support of the bill. There were an additional 57 registrations in favor of the proposal.

The only group to register in opposition to the proposal was the Wisconsin Association for Justice (formerly known as the Wisconsin Association of Trial Lawyers). Trial attorney Keith Clifford argued that if criminal charges and jail sentences were not available as possible punishments in cases of medical malpractice, health care providers should accept punitive damages in return. Punitive damages would be money paid by a provider that would be in addition to the possible loss of license, job, livelihood, monetary penalties, and the non-economic and unlimited economic money awards in malpractice cases. After his comments on the bill, Committee Chair Representative Leah Vukmir (R-Wauwatosa) said simply that she would side with patients and health care providers rather than trial lawyers.

Organizations supporting the Quality Improvement Act include:

Wisconsin Hospital Association
Wisconsin Nurses Association
Wisconsin Federation of Nurses and Health Professionals
Wisconsin Medical Society
Marshfield Clinic
Gundersen Lutheran Health System
Aurora Health Care
University of Wisconsin Hospitals and Clinics
Wisconsin Primary Health Care Association
Wisconsin Manufacturers and Commerce
Pharmacy Society of Wisconsin
Rural Wisconsin Health Cooperative
Ministry Health Care
Wisconsin Physical Therapists Association
Wisconsin Dietetic Association
Meriter Health Services
American College of Nurse-Midwives (WI Chapter)
ProHealth Care
Bay Area Medical Center, Inc.
Children’s Hospital of Wisconsin
Wisconsin Health Care Association
Wisconsin Assisted Living Association
SSM Health Care of Wisconsin
St. Mary’s Hospital - Madison
Dean Health System
Froedtert and Community Health, Inc.
Mercy Health System
Wisconsin Association of Homes and Services for the Aging
Affinity Health System
Wheaton Franciscan Healthcare
Columbia St. Mary’s, Inc.
Wisconsin Society for Healthcare Risk Management
Wisconsin Society of Podiatric Medicine
Agnesian HealthCare/St. Agnes Hospital – Fond du Lac
Wisconsin Academy of Family Physicians
Aspirus Wausau Hospital
Franciscan Skemp Healthcare-Mayo Health System

The Assembly and Senate this week passed a WHA-supported bill that aims to improve the safety, quality and efficiency of Wisconsin hospitals by facilitating the development of better, more comprehensive electronic medical records that improve patient care communication between providers. It is expected that the Governor will sign the bill into law.

"This is a significant victory for hospitals and the everyday efforts they take to improve patient safety and quality," said Matthew Stanford, WHA associate counsel. "By removing statutory barriers to communication that impede patient care and the implementation of interoperable electronic medical records, this bill will help Wisconsin hospitals stay on the forefront of providing the safest, highest quality care."

A recent survey conducted by the WHA Information Center shows that 67 percent of Wisconsin hospitals have either fully or partially implemented key components of an integrated electronic system. Many of these systems have gone online in just the last few years. However, high implementation costs and antiquated laws stand in the way of broader adoption and improvement of these systems.

The bill also helps pave the way to expand the efforts of multi-facility health information exchanges such as the Milwaukee Emergency Department Linkage Project. The Project is a collaborative effort of the Wisconsin Health Information Exchange, the Milwaukee Health Care Partnership, DHFS, and Microsoft to implement a system to securely share medical information across 10 Milwaukee area hospitals. The Project will support the work of the Milwaukee Health Care Partnership, a public/private collaborative to improve the coordination and continuity of health care for the medically underserved in Milwaukee County. The Partnership is governed by CEOs from local hospital systems and FQHCs, state and county government representatives, and WHA.

"This bill is a great first step to removing barriers to more robust health information exchange in Wisconsin," said Kim Pemble, executive director of the Wisconsin Health Information Exchange. "Improving care coordination through health information exchange will help improve patient safety, improve quality of care, and reduce cost."

"This is an exciting day for hospitals, health care providers, and their patients," added Cathy Hansen, director, health information services, St. Croix Regional Medical Center, St. Croix Falls.

Hansen played a key role as a member of the Governor’s eHealth Care Quality and Patient Safety Board in developing and recommending the proposals contained in the bill.

"A lot of work by a lot of people went into this bill to help set public policy that facilitates the development of electronic medical records and exchanges while still maintaining patient privacy," said Hansen.

"While there are additional statutory barriers to communication and electronic medical records not addressed in this bill, WHA supports this bill as a good first step," added Stanford. "The exchanges of information permitted by this bill will improve the flow of information between providers and will help hospitals further advance Wisconsin’s already nationally-recognized high levels of quality and safe care," he added.

In Wisconsin, we see Medicare beneficiaries not knowing they are MA enrollees or finding that insurers can dictate their care. We’ve also witnessed providers entrapped in endlessly malfunctioning insurer bureaucracies. And these are results that have occurred before these insurers gain enough marketshare to flip their "open" networks to closed ones.

Whether this is the best way to add value for MA beneficiaries and whether it is worth the additional cost to Medicare, begs further debate. In the meantime, the Centers for Medicare and Medicaid Services (CMS) should be required to (1) mandate complete disclosure of benefits before enrollment, (2) hold all MA plans accountable for their actions with beneficiaries and providers by establishing a set of publicly-reported minimum performance standards and (3) establish clear pathways for beneficiaries and providers to register complaints and to correct problems.

Wisconsin Insurance Commissioner Sean Dilweg hit the nail on the head when he testified last May before the Subcommittee on Health of the House Committee on Ways and Means. "We need the ability to hold companies responsible for the acts of their agents in Medicare Advantage as we currently have for all other insurance products…consumers should be able to go directly to their state insurance departments to resolve problems, rather than having to call CMS who seems to have neither the manpower nor the expertise to deal with many of these types of complaints."

In regards to the Private Fee-For-Service variant of MA most common in rural Wisconsin, CMS should also require them to (1) offer cost-based providers the choice of a cost settlement or their interim rate plus a fixed percentage, (2) participate in quality of care reporting comparable to local health plans and providers, and (3) protect the beneficiary’s right to access local services, such as swing beds, when they are needed.

We all need to recognize Medicare Advantage as the unprecedented federal subsidy it is and the potential it has to facilitate the takeover of Wisconsin health care by mega-national insurers.

These are just a few of the comments WHA received last year from some of the 600 individuals who attended Advocacy Day in Madison. Advocacy Day 2008 is slated this year for May 15 at the Monona Terrace in Madison, so mark your calendars now!

This year’s keynote speaker is well-respected journalist Fred Barnes. Barnes, current co-host of "The Beltway Boys" on Fox News, will give attendees a birds-eye look of Elections 2008. The morning sessions will be rounded out by a legislative leadership panel—always a highlight for attendees.

The most important aspect of Advocacy Day is the hundreds of hospital employees, trustees and volunteers who take what they’ve learned during the day and put that into action by meeting with their legislators in the afternoon. WHA schedules all visits and provides a legislative issues briefing beforehand. To facilitate legislative visits even more, this year’s agenda is slightly modified—we’ve moved up the time for visits, thereby allowing attendees to be on the road earlier.

With the State Capitol only a scant two blocks away (transportation available), we want to do everything possible to ensure you meet with your legislators. It’s never been more convenient or more important. Hospitals continue to face a great number of legislative issues and we have a lot of great stories to tell, too (for starters, Wisconsin hospitals are rated #1 in the nation in quality!). Tell your legislators how you feel about your hospital and your community. It’s this first-hand interaction by you—employees, trustees and volunteers—that has the greatest impact.

Plan to join more than 600 of your peers from across the state at Advocacy Day 2008 May 15. A complete program and registration form are available online at www.wha.org. Watch for a copy of the Advocacy Day 2008 brochure in next week’s Friday Packet.

For questions, contact Jenny Boese at 608-268-1816 or jboese@wha.org. For questions specific to registration, contact Lisa Geishirt at lgeishirt@wha.org or at 608-274-1820.

The Centers for Medicare & Medicaid Services (CMS) announced this past week that the Medicare Recovery Audit Contractor (RAC) program found $371.5 million in improper Medicare payments in 2007 in the demonstration states (California, Florida, New York) where the RAC Program has been operating. CMS indicates nearly $440 million has been collected since the program began in 2005. The RAC program identifies improper Medicare payments – both overpayments and underpayments – and is being rolled out nationwide over the next year. Wisconsin is scheduled to see the RAC program in 2009.

CMS indicates 96 percent of the improper payments identified by the RACs in 2007 were overpayments collected from health care providers; the remaining 4 percent were underpayments repaid to health care providers. The overpayments collected during FY 2007, ending Sept. 30, 2007, were $124.6 million in Florida ($9.8 million in 2006); $120.1 million in California ($29.2 million in 2006); and $112.5 million in New York ($25.6 million in 2006), a total of $357.2 million ($64.6 million in 2006). The underpayments refunded to health care providers during FY 2007 were $4.1 million in Florida, $8.4 million in California and $1.8 million in New York, a total of $14.3 million.

"It is clear that CMS is committed to this program and believes it has been successful—despite the numerous documented problems hospitals in the demonstration states have encountered," said WHA President Steve Brenton. "In preparation for the reality of the RAC program in Wisconsin, WHA is taking steps to ready our hospitals for 2009 implementation, including the creation of a multi-disciplinary RAC Task Force, led by Divine Savior CEO Mike Decker."

The WHA RAC Task Force will hold its first meeting April 2 and will discuss the CMS RAC Status Document, an overview of the RAC program and problems as well as next steps. Watch The Valued Voice for frequent RAC updates.

Invitations to WHA’s 2008 compensation surveys were emailed March 3 and 4. Your participation in these surveys ensures you have up-to-date information available to benchmark your salary information against other Wisconsin hospital and health system executives.

WHA’s annual Executive Compensation Survey collects salary data on over 25 positions, and the Physician Compensation Survey (new for 2008) collects salary data on over 70 positions. The survey deadline is March 28, 2008.

A link to the survey site is posted at www.wha.org on the home page under "Quick Clicks."

WHA corporate members continue to contribute significant financial support to WHA in 2008. Corporate member support currently amounts to nearly $200,000 for this year.

A special thank you goes to five organizations who have once again renewed their memberships as Corporate Champions for 2008, each contributing $10,000: FinCore Solutions, The MHA Group, WHA Financial Solutions, C. G. Schmidt and Hall Render Killian Heath & Lyman P.S.C

Additionally, in 2008, WHA has eight Corporate Partners, each contributing $5,000. The 2008 Corporate Partners include: The Boldt Company, Dairyland Healthcare Solutions, The Delta Companies, Eppstein Uhen: Architects, Lincoln Financial Group, Marshall Erdman & Associates, The MMIC Group, and Sodexho Health Care Services. A big thanks to each of those organizations as well.

A list of all current 2008 WHA corporate members is included in this week’s packet. Full company descriptions are included in the 2008 Member Directory and on the WHA website (www.wha.org). Please watch your mailbox for your copy of the "2008 Business Connection," a directory of services provided by corporate members distributed directly to a variety of hospital decision-makers.

You will continue to see and hear about these WHA supporters in a number of ways throughout 2008. Please remember to consider these corporate member organizations when you have a need in your hospital and pass their information on to other decision-makers in your facility. Additionally, thank them for their support of WHA and health care in Wisconsin when you see them at events such as the Wisconsin Rural Health Conference, the Annual Convention and the Wisconsin Quality & Safety Forum. Additionally, encourage companies that work with your hospital to consider supporting WHA through corporate membership.

What is it like to work in health care? The occasional headline indicating unhappy workers and unrewarding work are proven untrue by the powerful essays hospital employees write as Pride Program entries. This program, designed to celebrate the pride that health care employees have in their work, and the contributions that they make to their patients, their community, and their profession, provides powerful stories of the rewards of working in health care.

In 2003, the Marathon County Health Assessment identified six community health priorities, one of which was "Obesity and Related Disorders." Aspirus Wausau Hospital’s Sue Gantner and Rick Nevers helped form the committee Healthy Eating, Active Living, or HEAL, to address the problem of obesity. Today, Gantner and Nevers serve as HEAL co-chairs with Judy Burrows from the Marathon County Health Department. Their hard work and leadership have produced exciting results that are improving the health of Marathon County.

"This is primary prevention at its best," Gantner said. "It isn’t about disease detection, and it’s about keeping people healthy."

HEAL has been very busy, and has produced some wonderful results. The group has created a strong coalition of more than 90 members, and targeted specific areas, such as worksites and schools.

HEAL Worksites collaborates with businesses to improve work environments and keep employees healthy. This group helped develop a Worksite Wellness Resource Kit, which is now available to employers throughout the state.

HEAL Schools has proved a wonderful tool for healthy change, by working with local schools to complete the US Centers for Disease Control and Prevention School Health Index.

To fund its initiatives, HEAL organizers secured a $450,000 "Footprints to Health" grant from the UW Department of Medicine and Public Health, which has been used to:

• Work in seven school neighborhoods to increase physical activity and healthy food choices
• Initiate the Active Family Challenge, targeting the seven school neighborhoods.
• Create the Active Family Resource Guide outlining area recreational and exercise resources.
• Perform the Primary Care Assessment Survey to identify the ways family physicians communicate obesity guidelines to patients. This will culminate in a CME conference for primary care professionals in September 2007.
• Identify Safe Routes to School that encourage walking and biking by outlining the best routes for kids.

Julie Willems Van Dijk, Health Officer for the Marathon County Health Department, believes the key to HEAL’s success is that its leadership has engaged the community in a multi-pronged approach to combating obesity. Interventions have been designed that address behavior at all levels.

"Sue Gantner and Rick Nevers have been incredibly valuable leaders and have helped the community see the expensive and harmful effects obesity has on health," she said. "They truly understand that solving the problem of obesity requires cultural change and they have the staying power to make such change happen."

That staying power will be vital, as the group’s work is just beginning. Through HEAL’s involvement in a newly formed Marathon County Metropolitan Planning Commission subcommittee for bicyclists and pedestrians, HEAL Pathways is helping create a 10-year plan for a comprehensive bicycle and pedestrian path system.

"Senior Day: Taking Charge of Your Health," a free wellness event held last October in Barron focused on the importance of medication management. Luther Midelfort Northland, then Barron Medical Center, sponsored the event together with the Barron County Office on Aging and Barron County Aging & Disability Resource Center. All three facilities had identified the management of medications to be a major concern for the health and welfare of its area’s senior population.

"Helpful Hints for Managing Medications" was presented to the 29 participants by a hospital pharmacist. Other topics included "Supplements and Herbs" to help them learn more about how medications can be affected by the foods we eat as well as the dietary supplements we take. A benefit specialist presented information on, "Paying for Medications" and the various programs that help seniors afford their medications, including Medicare Part D, Wisconsin’s Senior Care, CWAG’s Prescription Drug Program and others. She also presented information about assistance for low-income seniors that reduces deductibles and monthly premiums.

Pharmacists were available to meet individually to answer questions and concerns about their medications and possible drug interactions. Participants were encouraged to bring in their prescriptions, along with a list of all the medications they were taking. The event concluded with a panel discussion with all the speakers to provide an opportunity for seniors to get answers to their medication questions.