Make plans now to join the more than 500 health care professionals, trustees and volunteers from across the state who will attend WHA’s Advocacy Day on May 1 in Madison.

WHA has a great line up of speakers, including Kellyanne Conway, a nationally-regarded and highly-quoted pollster, who will deliver Advocacy Day’s morning keynote address. Conway will cut through the rhetoric to provide 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. Nationally-known grassroots guru Amy Showalter will provide a session on how to effectively meet with your legislator, and then put all these tools into action when you visit with your legislators in the afternoon.

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. Again this year, WHA will present an Advocacy Award to a group or individual that has demonstrated a keen understanding of and dedication to grassroots advocacy.

As always, Advocacy Day is a free event, so register your hospital contingent today. Register by visiting www.wha.org to view the brochure and registration information. Printed copies of the Advocacy Day brochure and registration form are included in this week’s packet. For questions, contact Jenny Boese at 608-274-1820, or email jboese@wha.org. For registration information, contact Sherry Rabuck at 608-274-1820, or email srabuck@wha.org.

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

HHS Secretary Michael Leavitt spoke in Milwaukee at Bucyrus International on March 7, encouraging business leaders to support the Department of Health and Human Services value-driven health care initiative. More than 50 Wisconsin businesses pledged support for the initiative following Leavitt’s speech. The goal of the initiative is to improve health care quality and lower costs by providing quality of care information about hospitals, physicians, price and cost; increasing the use of electronic health records; and rewarding excellence.

Leavitt noted that we are not very good at measuring quality, but "we are going to get better at it." He also said the only thing that can change health care is the creation of a marketplace. He believes that medical organizations must step forward and define an "episode of care," which could serve as a guideline consumers could use to compare costs among providers, driving competition.

In addition to having a health care system based on competition, Leavitt said, "We need to ensure access. People need a connection with a primary care physician." He noted that he is aware there are several proposals in Wisconsin designed to increase access. He acknowledged the severe shortage of primary care physicians and said the shortage is a result of a health care system based on treating sickness, rather than promoting wellness.

"We don’t reward primary care doctors with our current system. Best we can do to solve it is to have a value-driven system in place and ensure all Americans have access to an affordable basic health care plan," he said.

"WHA agrees with Secretary Leavitt’s call for increased transparency and the need for purchasers to reward value," said WHA President Steve Brenton. "Wisconsin is a national leader in provider-led initiatives that are designed to advance those objectives, and we are pleased with the Secretary’s commitment to our shared values."

This week individuals representing Wisconsin hospitals traveled to Washington, DC to take part in the American Hospital Association’s budget advocacy day. Individuals were able to meet with Members of Congress and their staffs to discuss the negative impact of the President’s proposed budget on hospitals and the need to fund the State Children’s Health Insurance Program (SCHIP).

Hospital representatives alerted Members of Congress to Wisconsin’s situation under the SCHIP program. Wisconsin uses SCHIP funds for BadgerCare and is one of an estimated 14 states that will see shortfalls this year unless Congress reauthorizes SCHIP. While there is much support for SCHIP, there are some substantial areas of disagreement, particularly with covering adults under the program.

During a meeting with Sen. Feingold’s office, Legislative Assistant Joy McGlaun told the group, "Senator Feingold is committed to working to prevent any individual from being dropped from the rolls of BadgerCare and has taken action to see that Wisconsin does not see a shortfall in SCHIP. In February, he led a coalition of 23 senators in contacting the Senate Finance Committee to urge continuation of adult coverage. Additionally, Senator Feingold has contacted Senate leadership and requested that the Senate take immediate legislative action to address the SCHIP shortfall. As an original cosponsor of S. 401, the Keep Children Covered Act of 2007, he is already supporting efforts to fix this problem."

In addition to the SCHIP funds, individuals also alerted legislators to the impact on hospitals under the current budget proposal. Wisconsin hospitals are estimated to lose roughly $360 million due primarily to Medicare reductions in the inpatient and outpatient market-basket updates along with several other provisions.

"Hospitals across the state will see losses under this proposed budget, and we wanted to provide that message directly to our legislators and their staff members," said Jenny Boese, WHA vice president of external relations & member advocacy. "We appreciated the chance to meet with them and were encouraged by the responses we received."

Many of Wisconsin’s Congressional Delegation, including Sens. Kohl and Feingold and Congs. Moore, Kagen and Baldwin, have already signed on "dear colleague" letters in opposition to the proposed budget reductions. WHA thanks them for their important support.

Proposed "treatment guidelines" for the Wisconsin Worker’s Compensation Program are being promulgated as an administrative rule by the Wisconsin Department of Workforce Development. Public hearings on the proposed rule will be held at various locations around the state on March 22, 2007.

2005 Wisconsin Act 172 directs DWD to promulgate rules establishing standards for determining the necessity of treatment provided to injured employees and provides that the rules establishing the standards shall, to the greatest extent possible, be consistent with Minnesota worker’s compensation treatment parameters. Additional information concerning hearing locations and a detailed description of the proposed rule is available on the WHA Web site under Legal and Regulatory.

So, where are we just four weeks after Governor Doyle unveiled his plan to levy a $420 million tax on Wisconsin’s community hospitals?

Some may recall that one of the few lawmakers willing to immediately endorse the tax complained that, "The hospitals are criticizing it before they’ve even seen a plan." Well, we were right. Our thorough review of "the plan" including extensive research of federal law and regulation, lead us to the conclusion that the promised hundreds of millions of dollars in higher hospital payments is inaccurate, is based on massive assumptions and shaky methodologies, and perpetuates the troubling notion of taxing Medicaid providers to pay Medicaid providers. This is especially concerning, given that there is a much better, far less controversial, and surely more stable alternative in play.

Before focusing on that better alternative, it’s important to underscore WHA’s recent research that "followed the money" going in and out of the Health Care Quality Fund — the new vehicle to house the hospital tax and other revenues included in the Administration’s budget. As confirmed in the Legislative Fiscal Bureau (LFB) analysis released this week, the Fund’s revenue stream decreases in just two years, but it’s funding obligations increase massively....setting the stage for a significantly higher hospital tax in 2009. As correctly predicted by WHA one month ago, community hospitals become the "de facto bank" to pay for rising health care expenses and budget transfers (see below) well into the future.

What’s become of the TOBACCO TAX MONEY? The Governor’s proposed higher tobacco taxes will generate $546 million over the biennium. When matched with federal dollars, that’s $1.3 billion over the biennium that can be used to: finance the relatively modest Medicaid "cost-to-continue" budget deficit ($195 million); pay for proposed health care coverage expansions; and fund much needed hospital, physician and nursing home rate increases. But don’t just take our word for it; last December Governor Doyle’s Healthy Wisconsin Council unanimously endorsed this very approach.

But instead, and as confirmed by the LFB analysis, the Administration’s plan removes over $900 million in existing/base revenue (GPR- "general purpose revenue") from the Medicaid program to be used for other state spending. That funding hole must be backfilled...and it is...unfortunately with all of the proposed tobacco tax revenue and $120 million from the hospital tax.

Two years ago the Joint Finance Committee, in an unprecedented unanimous, bipartisan vote, rejected the use of one-time money from the Patients Compensation Fund, new bonding, funding transfers, skims from the nursing home bed tax, and other shell-game budgeting and crafted a sound Medicaid budget funded with real dollars. At the risk of sounding melodramatic, for those legislators and veteran Capitol watchers who were there, it was a proud day in the history of Wisconsin state budgets—and it can be done again.

Steve Brenton,
President

Over the past two weeks the hospitals in the greater Green Bay area have been united in their grassroots efforts against the proposed hospital tax. From jointly meeting with their state Senator to testifying at a Senate Health and Human Services Committee hearing, these area hospitals are showing why they should be considered grassroots all-stars!

Last week, area hospitals met with state Senator Dave Hansen (D-Green Bay) on the proposed hospital tax. Sen. Hansen is a member of the Joint Finance Committee currently reviewing the budget bill and will play an integral role in the final outcome of the budget bill. Therefore, the hospitals in his district wanted to communicate their strong concerns with the tax and explain why Sen. Hansen should oppose its continued inclusion in the budget bill.

"As everyone knows, budgets by nature are complicated, and this budget is no exception. Difficult choices must be made, and I appreciate the opportunity to meet with the professionals in charge of providing health care to our region," said Sen. Hansen. "As expected, the conversation was very informative, and I am grateful for the chance to hear their concerns."

Hospital representatives attending the meeting were Joe Neidenbach and Tom Bayer from St. Vincent’s, George Kerwin and Jim Dietsche from Bellin, and Heidi Selberg from St. Mary’s.

"As those who are impacted by the proposed hospital tax, we need to make sure our elected officials are aware of the facts and ramifications of this policy," said St. Vincent Hospital CEO Joe Neidenbach. "Not only did we want to explain why a tax on hospitals is bad public policy, but we wanted Sen. Hansen to know that we are united in our opposition. We appreciated the time he took to meet with us."

Bay Area Medical Center (BAMC)—unable to attend the meeting due to the blizzard that hit the day before—expressed concerns with the tax in a follow-up letter to Sen. Hansen.

"I have already seen the Governor’s proposed ‘winners and losers’ list and already recognize that Bay Area Medical Center lies on the ‘losers’ side of this proposal," wrote BAMC CEO David Olson. "Taxing hospitals after years of providing no increase in Wisconsin Medicaid reimbursement is not the solution to increasing health care coverage for all Wisconsin citizens."

In addition to meeting with Sen. Hansen, representatives from St. Vincent, Bellin and St. Mary’s Hospitals also seized the opportunity to testify at a Senate Health Committee hearing held this week in Green Bay. Those testifying before the State Senate Health and Human Services Committee were Bellin CEO and CFO George Kerwin and Jim Dietsche, St. Vincent CFO Karl Appleton and St. Mary’s Public Relations Director Heidi Selberg.

These hospital representatives provided committee members with an analysis on the proposed hospital tax as well as information on WHA’s Task Force on Access and Coverage, which developed a set of eight reform principles that any health care reform proposal must include.

"As a member of the Task Force on Access and Coverage that developed this set of principles, I wanted to personally share them with the Committee," said George Kerwin. "I hope these reform principles will be considered as we all work to address this important issue."

Recently Jim Woodward, Meriter’s new president and CEO, met with Congresswoman Tammy Baldwin. Baldwin’s district includes the Madison area. During the meeting Cong. Baldwin was able to provide Woodward with information on pending health care issues at the federal level, including her own Health Partnership through Creative Federalism Act and the reauthorization of the State Children’s Health Insurance Program (SCHIP).

As a member of the House Energy & Commerce Committee, Baldwin spoke with Woodward about the Committee’s work to reauthorize SCHIP, which Wisconsin uses to fund its BadgerCare program. "SCHIP provides health care to about 6 million children who do not qualify for Medicaid," Cong. Baldwin said. "This reauthorization provides us with an opportunity to strengthen and expand SCHIP, so that programs like BadgerCare can successfully continue."

Cong. Baldwin also provided insight to a proposal she reintroduced this session of Congress, the Health Partnership through Creative Federalism Act (H.R. 506). Rather than prescribe a one-size-fits-all approach, H.R. 506 encourages states to be innovative in their approaches to providing health care coverage to the uninsured. The legislation then provides states with federal assistance to plan and implement these innovations.

The Wisconsin Hospital Association joins with the Wisconsin Manufacturers and Commerce and many other businesses and organizations to co-sponsor "Business Day in Madison." This annual event brings business leaders from across Wisconsin to Madison to learn about issues impacting the business community, to meet with their legislators on these important issues, and to network with one another. This year’s event takes place at Madison’s Monona Terrace on April 4.

Former House Speaker and Founder of the Center for Health Transformation Newt Gingrich will provide his vision for the health care system of the future—one that is patient-centered, technologically-integrated, knowledge-intense and innovation-rich. Department of Health and Human Services Secretary Michael Leavitt will provide a presentation on his vision for a healthier and more hopeful America.

As usual, WHA’s government affairs staff will hold a members-only briefing in the morning on key legislative issues, including a proposed 1 percent tax on a hospital’s gross revenues. The briefing is in preparation for anticipated visits by hospital leaders with their legislators later in the afternoon.

In response to questions from hospitals regarding the filing of birth certificates, the Office of Vital Records is holding an information session at St. Elizabeth Hospital in Appleton on March 27. The agenda includes discussion of the following:

1. Filing timeliness – importance
2. Quality of data and importance
3. Social Security number requests - length of time to receive, rules, etc.
4. Fetal death reports and COBRIS (Certificate of birth resulting in a still birth)
5. Surrogate births - procedures for filing worksheet
6. Safe Haven babies - procedures for filing worksheets
7. Adoptions-procedures for filing worksheets
8. Refusals of information from parents - how to handle
9. Infant deaths - procedures for filing worksheets and death records
10. Other (as time allows)

The training will be from 9 a.m.-1 p.m. at the Helen Fowler Conference Room, St. Elizabeth Hospital, Appleton. The room is on the second floor of the main entrance. There is no fee, but registration is required and seating is limited. To register, contact Jane Kraus, Vital Records Program supervisor at KrausJL@dhfs.state.wi.us or 608-267-7814.

"Healthy birth outcomes" will become the mantra of a statewide task force that is being assembled by the Department of Health and Family Services. Bill Bazan, vice president of Metro Milwaukee for WHA, will represent the Association in this collaborative venture.

In 2004, Wisconsin achieved the Healthy People 2010 goal of 4.5 infant deaths per 1,000 live births for white infants. However, in that same year, African American babies in Wisconsin died at the rate of 19.2 per 1,000 births—4.3 times the rate of white babies. This is a disparity ratio as high as any in the nation.

This task force will promote state, local and community coordination and action to improve birth outcomes, including developing and implementing effective, evidence-based strategies to eliminate disparities. Initial efforts will focus on African American births and infant mortality in southeastern and southern Wisconsin.

Two of the deliverables for this project will be: 1) to replicate successful best practices for providers and consumers and identify the resources to implement them statewide; and 2) to develop a business case for the total cost of eliminating disparities.

The initial meeting of the task force took place March 9 at the Black Holocaust Museum in Milwaukee.

As part of their 2006-2007 Team Nutrition and Physical Education/Activity Project, Roosevelt IDEA School has partnered with Saint Michael’s Hospital and Ministry Medical Group in Stevens Point, who supplied pedometers to all 65 fourth graders at the Plover elementary school. Grant monies through the Wisconsin Department of Public Instruction (DPI) will help support the year-long program and the purchase of educational materials.

"The 10,000 steps walking program and pedometer partnership was a natural for the ‘activity’ portion of this project," said Brant Bergeron, director of public and community relations for Ministry Health Care. "With the success 10,000 steps has seen throughout the area the past few years, getting people up and walking, there’s no better way for Saint Michael’s Hospital and Ministry Medical Group to support Roosevelt, the health of their students, and this DPI grant."

"We are going to walk around the world," said Faye Miller, fourth grade teacher at Roosevelt IDEA School. "The fourth graders have a big map up, and we are going to put up charts to keep track of our steps and figure out how many steps equal a mile. We’ll then convert the steps to miles to check out our distance and monitor our progress," Miller said.

A picnic at the end of the school year is planned to celebrate the success of the program, and the teachers and children will be recruiting as many friends and family members as possible to participate in the Walk Wisconsin event on June 2, 2007. (www.walkwisconsin.com)

The Wisconsin Healthcare Public Relations and Marketing Society (WHPRMS) is offering a professional development session that will help public relations, marketing and communications health care professionals to have influence on strategy and key decisions within their organizations. The program will cover health care hot topics—including health care costs, reimbursement issues, public reporting, billing of the uninsured and pending legislation—and, you’ll learn to give advice more strategically and more powerfully on these types of issues.

The program will be led by Jim Lukaszewski, who is one of the nation’s top public relations consultants, with more than 25 years of experience in dealing with sensitive issues facing corporate, nonprofit, government and international C-Suite executives. PR Week lists him as one of 22 crunch-time counselors who should be on the speed dial in a crisis.

The WHPRMS event coincides with WHA’s Advocacy Day, which will be held May 1 at Monona Terrace in Madison.The WHPRMS seminar will be in the afternoon, which will allow registrants to attend the WHA Advocacy Day program in the morning and the WHPRMS seminar in the afternoon.

The cost to attend the WHPRMS community benefit seminar is $95 for WHPRMS members, and $125 for non-members. WHA Advocacy Day is a free event, and it includes lunch. A registration form for the WHPRMS professional development day event is included in this week’s packet, and is available at www.whprms.org. For information, contact Siobhan Marks at smarks@wi.rr.com or 414-719-0531. For information on WHA’s Advocacy Day, go to www.wha.org. You can register for both events on the WHPRMS registration form.

As Wisconsin’s "safe haven" infant abandonment law turns six in April, Safe Place for Newborns celebrates the many lives saved. Terry Walsh, executive director of Safe Place for Newborns of Wisconsin asks hospitals to remind all their employees of the law and the procedures to follow if someone hands over a baby.

This law, commonly known as the "safe haven law" or Wisconsin Act 2, went into effect in April 2001. It says a parent may confidentially hand over her unwanted, unharmed newborn, up to three days old, to any hospital employee, EMT, or police professional in the state without fear of prosecution.

Under Wisconsin’s law, a parent can go to any hospital employee, tell them she wants to leave the baby with Safe Place for Newborns, and she won’t have to fear that police will be called, Walsh explained. The newborn will be given any needed medical attention then placed in foster care for adoption.

"More than 30 babies are alive today because Wisconsin recognized that we needed a safe place for newborns," said Terry Walsh, executive director of Safe Place for Newborns of Wis., Inc. "Just as important, there are many mothers who won’t face years in prison because they safely relinquished their unwanted newborns to a hospital employee."

"We can’t stop letting people know this law exists," Walsh said. "Today’s youth were barely teens when the law passed. They need the information now."

For more information, contact Terry Spevacek Walsh at Safe Place for Newborns, 608-225-5544.

One of the key decisions you need to make when evaluating alternative medical liability insurance options is the choice between the occurrence and claims-made coverage forms. There has been a great deal of debate over which form of coverage is better. However, while the form of coverage is a key consideration, it should not be the sole consideration. It should be separated from the context of the insurance contract. An occurrence policy with inferior coverage features is not going to compare favorably to a claims-made policy with robust coverage features. The value of the policy form is going to depend on the coverage it buys.

The Basics
A policy written on a claims-made basis means the policy in force at the time a claim is made against you will pay for losses, regardless of when they occurred in the past, assuming no retroactive inception date restriction. When a claims-made policy expires, so does its coverage, even for events that occurred during the policy year but were not reported. An Extended Reporting Endorsement (tail coverage) provided by the policy extends the reporting time for occurrences during the policy period.

A policy written on an occurrence basis means the policy in force at the time the claim occurred would pay for the losses, even if that policy has expired.

Advantages of the Occurrence Coverage Form
The first advantage with occurrence policies is that they are valid years after they have lapsed. As long as the insurer is in business, a hospital can apply a claim against the policy for any incidents that happened while the policy was in force. Because of this, it is important to never throw away an occurrence policy after it lapses—keep it in a safe place.

Another advantage with an occurrence policy is a hospital does not have to worry about canceling their policy when they decide to move to a different insurer. The old coverage remains locked to cover them for any incidents that happened during the term of the policy.

And finally, while occurrence policies are almost always more expensive than claims-made policies, the cost of tail insurance is included, eliminating a contingent liability for the potential cost of the tail coverage that exists for claims-made policies.

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