The leaders of the State Senate and State Assembly and the Chairs of the respective health committees are all confirmed to speak at Advocacy Day on May 1. You won’t want to miss their panel discussion as they provide insight into health care issues facing Wisconsin and answer your questions as well.

Legislative Leadership Panel (confirmed):

• Sen. Jon Erpenbach (D-Middleton), Chair, Senate Health & Human Services Committee
• Rep. Michael Huebsch (R-West Salem), Assembly Speaker
• Sen. Judy Robson (D-Beloit), Senate Majority Leader
• Rep. Leah Vukmir (R-Wauwatosa), Chair, Assembly Health & Health Care Reform Committee

In addition to the panel discussion, Advocacy Day’s keynote will be given by Kellyanne Conway, well-known and recognized pollster, who will provide attendees with the lay of the land on American and Wisconsin public opinion. After hearing from luncheon speaker Wisconsin Attorney General J.B. Van Hollen, be prepared to learn why developing relationships with your legislators is so important.

Grassroots specialist Amy Showalter builds on the day’s training so you are prepared and excited for the most important part of the day—your legislative visits that afternoon (transportation to and from the Capitol is available). With a state budget bill proposing a 1 percent gross revenues tax on every hospital, Advocacy Day 2007 couldn’t be more perfectly timed for you to talk personally with your legislators or their staffs about the tax.

Hospital employees, trustees and volunteers from all over the state are already registered, and with over 550 expected at this year’s event, make sure you register today!

A complete program and registration form are available online at www.wha.org/governmentRelations/advocacy_day.aspx. 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.

The Legislature’s budget-writing committee took public testimony this week in Rhinelander, including testimony from Dorothy Skye, MD Associate Medical Director for Primary Care Services for Ministry Medical Group’s Northern Region. Dr. Skye’s testimony highlighted key Medicaid related provisions in the state budget.

During her testimony Dr. Skye called attention to the budget’s removal of $873 million in general purpose dollars from Medicaid and replacing it with revenue from a hospital tax, cigarette tax and raid of the Injured Patients & Families Compensation Fund. She called this approach "deeply troubling."

"I am concerned that short-sighted money shifting will leave health care consumers short-shrifted," she said. "Keeping the Medicaid budget intact by not transferring nearly $900 million out, and keeping in the cigarette tax increase, would allow us to increase Medicaid reimbursement, expand BadgerCare as the Governor has proposed, help smokers quit, and prevent youth from ever trying to smoke. All of this can be done without a hospital tax."

Before serving in an administrative role with Ministry, Dr. Skye practiced as an OB/Gyn for 25 years, 20 of which were in Northern Wisconsin. As a clinician, Dr. Skye saw first-hand how tobacco related diseases impacted her patients.

"I have witnessed, again and again, the ill effects of cigarettes on those who chose to smoke and those who are exposed involuntarily," she said. "For my pregnant patients who smoked there were sometimes very negative outcomes for the baby, including low birth weight and even fetal death. Children who survive the toxic effects of tobacco during pregnancy, but are exposed to second hand smoke after birth, are at greater risk of sudden infant death, ear and lung infections and asthma."

She urged the committee to support the proposed $1.25 per pack cigarette tax to help address this issue, citing statistics that showed doing so would prevent an estimated 84,000 Wisconsin children from becoming smokers and encourage 42,500 current adult smokers to quit.

"Yes, Ministry supports an increase in the cigarette tax, because while people don’t choose to become sick, they do choose to smoke. And when they smoke, they cost all of us in health care dollars and in overall health," she closed.

Wisconsin was a top-performing state in the nation in 2006 on measures of blood sugar and cholesterol control among diabetics, and it also could boast that four of the top 50 commercial health plans in America are based in Wisconsin. Those facts were shared by Margaret E. O’ Kane, president of the National Committee for Quality Assurance (NCQA), an independent, non-profit organization whose mission is to improve the quality of health care across the country. Kane’s presentation was sponsored by Group Health Cooperative in Madison.

Kane said Wisconsin is a leader in publicly reporting quality measures. There are three fundamentals to quality improvement:

• Measurement: We can’t improve what we don’t measure
• Transparency: Quality data must be translated into understandable, actionable reports for consumers and purchasers
• Accountability: Once we can measure we can hold everyone accountable for improvement

The move to consumer-directed health plans is a concern, Kane said, because some of the plans shift cost to the patient at the front-end and present barriers for people who should seek care sooner. "Cost shifting to the sick is not a good strategy," Kane cautioned.

Over time, the health care delivery system must remove payment systems that now favor bad care or those that pay for more care because of bad quality. Quality is unreliable and costs are too high in health care, which indicates that our health insurance system is failing, according to Kane. "Half of the small employers in the country don’t offer health insurance anymore," she said. "Health care costs are a contributing factor to Delphi, GM and other Fortune 100 firm woes and health expenses," she added.

The main purpose of the health care system is not to deliver better health care, but to deliver better health, according to Kane, a principle that aligns with WHA’s ServePoint Program (www.wiservepoint.org).

"Improving the health status of the people who live in our state is at the heart of every community service that is delivered by our hospitals," said Mary Kay Grasmick, WHA vice president of communications. "As we start to see the early results of our 2006 community benefit survey come in, and the stories that accompany that survey, it is evident that keeping people healthy is a priority for our hospitals," she added. (See Community Benefit story on page 8.)

AHA has released an overview of the "frequently asked questions" the Centers for Medicare and Medicaid Services (CMS) recently issued to state Medicaid directors concerning the implementation of Section 6032 of the Deficit Reduction Act (DRA). DRA Section 6032 requires providers who receive at least $5 million annually in Medicaid payments to establish and disseminate written policies for their employees, contractors, and agents related to state and federal false claims laws.

AHA’s overview, CMS’s frequently asked questions, and other information concerning DRA Section 6032 are available on the WHA Web site at www.wha.org on the Legal and Regulatory page.

Legislators and the general public hear a lot about costs associated with Wisconsin’s Medicaid program. But the real facts surrounding Medicaid—Wisconsin’s program providing health care services for our most vulnerable populations—are widely misunderstood.

Over the next few weeks this column will pinpoint a number of common "myths" about Wisconsin’s Medicaid program and shed light on the actual "facts" using current data that is often absent from discussions about Medicaid costs.

MYTH: Medicaid is taking over Wisconsin’s state budget.

FACT: Wisconsin’s Medicaid program comprises a relatively low percentage of the state’s budget. According to the National Association of State Budget Officers, Medicaid represents just under 14 percent of the Wisconsin state budget, a figure well below the national average and below surrounding states such as Illinois (28 percent), Minnesota (22 percent) and Iowa (19 percent).

MYTH: The Medicaid program is exploding – mainly due to use of health care services and higher provider payments.

FACT: While Medicaid costs have increased in recent years, it has been a result of a greater number of people enrolled in the program. In fact, enrollment has increased by 119 percent over the past seven years! This is largely due to the Governor and Legislature creating new Medicaid programs like BadgerCare and SeniorCare.

Next week’s myths…spending on hospitals and physicians is the major Medicaid cost driver, and health care provider rates go up every year under Medicaid.

Steve Brenton
President

The Wisconsin Chapter of ACHE is offering three upcoming regional networking and education programs:

A collection of changes to the existing health care system aimed at improving access to quality health care, reducing the overall cost of health care, and increasing the focus on preventive care and disease management. Senator Carol Roessler will review details of the proposal and discuss the impact on Medicaid reimbursement, long-term care reimbursement, consumer-driven health care, and the improvement of health care quality and access.

April 26: 2007 State Health Care Policy Update
Wheaton Franciscan Healthcare in Wauwatosa, 7:15 - 9 a.m.

Wisconsin Hospital Association CEO Steve Brenton presents an update of federal and state health care policy and the state budget.

May 2: Comparing Approaches to State Health Reform: Does It Matter?
Meriter Hospital Community Health Education Center, Madison, 8 - 9:30 a.m.

A description and discussion of two different approaches to state health reform, presented by Roger Formisano, PhD, vice president for leadership and strategy development for the UW Medical Foundation. Gain a better understanding of the different approaches states are taking to expand health care coverage for citizens, learn more about the proposed mechanisms for financing expanded coverage, and become aware of how the proposed reform could impact the health delivery system.

The purpose of the Wisconsin Chapter of ACHE’s regional programs is to provide convenient and cost-effective educational and networking events for chapter members throughout Wisconsin, that focus on state-specific, region-specific and/or current events, and to increase the value of state chapter membership.

More information on each program and online registration is available at www.ache-wi.org under Events, or contact Sherry Rabuck at WHA, at srabuck@wha.org or 608-274-1820.

Mary Hansen, FACHE, vice president, acute care, Community Health Network/Berlin Memorial Hospital, has been appointed to the Council of Regents, the legislative body of the American College of Healthcare Executives (ACHE). As a Regent, Hansen will represent ACHE’s health care executive members in the state of Wisconsin. The Council of Regents serves as the vital link between ACHE and affiliates by approving governance and membership regulations as well as promoting ACHE programs, services and activities within their respective areas.

Now in its fifth year, Cover the Uninsured Week (CTUW) is an initiative of the Robert Wood Johnson Foundation in cooperation with 18 national partners including the American Hospital Association and the Catholic Health Association. The purpose of this week is to build support through public awareness of the health care needs of the most vulnerable in our communities.

In Milwaukee, Columbia-St. Mary’s Health Care System has provided leadership in assembling representatives from Wheaton Franciscan, Aurora, Froedtert Community Memorial, and Children’s health systems, along with the University of Wisconsin Milwaukee’s School of Health Sciences and the Partnership for a Healthy Milwaukee, in planning week-long activities highlighting public awareness of the uninsured in the community.

Among the activities for CTUW will be a phone bank at WTMJ Channel 4 that will operate on Friday, April 20, during the evening news between 4 and 5:30 p.m. Financial Access workers from the health systems will be available to provide information regarding resources in the community and to help callers determine their eligibility for existing health care programs.

On Tuesday evening, April 24, keynote speaker Jack Glaser, senior vice-president, Theology and Ethics, St. Joseph’s Health System in Orange, California, and founder of the Center for Healthcare Reform, will speak on "Creating the Healthcare System We Never Built." Leo Brideau, CEO of Columbia-St. Mary’s Health Care System, will introduce Jack Glaser for the event, which will be held at the Italian Community Center in Milwaukee with a reception beginning at 6 p.m. Please contact either Mark Repenshek at 414-326-2659, or Debbe Horgan at dhorgan@columbia-stmarys.org to make your reservations.

Thursday, April 26, will highlight the "Milwaukee Community Health Centers: Yesterday, Today and Tomorrow" at an event being held at the Milwaukee County War Memorial from 5-7 p.m. Among the speakers will be Bevan Baker, Health Commissioner for the City of Milwaukee, State Senator Spencer Coggs, who also chairs the board of Milwaukee Health Services Health Center, Stephanie Harrison, executive director of the Wisconsin Association of Primary Health Care, and Bill Petasnick, CEO of Froedtert Community Memorial Health System who will speak on the newly evolving Milwaukee Health Care Partnership. A panel discussion featuring the four CEOs of the Community Health Centers will provide overviews of their respective health centers and their unique role in serving the uninsured. RSVP to Stacie Sjogren at ssjogren@uwm.edu.

The week’s activities will conclude with a prayer breakfast at Cardinal Stritch University from 7:30-10 a.m. The breakfast and presentation by the Reverend Joseph Ellwanger, former pastor at Cross Lutheran Church, which sponsors a free clinic for the uninsured, will be held in the Sister Camille Kliebhan Conference Center on the Cardinal Stritch University Campus. RSVP by calling 414-961-3765.

There are no charges for any of these events. For more information, contact Bill Bazan, WHA’s vice president, Metro Milwaukee, at bbazan@mailbag.com.

WHA is providing leadership with a coalition that includes the Wisconsin Medical Society, the Alzheimer’s Association, the Coalition for Wisconsin Aging Groups, the Elder Law Center, and Gundersen Lutheran Health Care System in La Crosse, among others. The purpose of this coalition is to introduce into the legislative process a surrogate decision-making bill.

Common law tradition and the medical profession have traditionally recognized the right of capable adults to accept or reject medical or surgical interventions affecting their own medical condition. The application of recent advances in medical science and technology increasingly involves patients who are unconscious or incapacitated. The right to make medical treatment decisions should be extended to a person who is incapacitated and does not have an advance directive like a power of attorney for health care. Wisconsin law has a gap in it that makes no statutory provision for health care decision-making by an incapacitated person who does not have an advance directive.

The bill draft that is being worked on would create a list of family members and friends that the attending physician could call upon to make needed medical decisions. The goal of this bill is to assist in defining what decisions can be made and by whom to avoid unnecessary burdens of a legal process on families, and to ensure that the patient get the best, most appropriate medical care possible.

Bernard "Bud" Hammes, senior ethicist with Gundersen Lutheran Health Care, says this about a surrogate decision-making bill: "While some groups may view this bill as an effort to limit care, since it allows family members to forgo medical treatment in certain circumstances, the purpose of this bill is not to bias family toward forgoing treatment. Rather the purpose is to ensure that those who are most closely related to the patient are able to make decisions that provide the best care."

Ultimately this bill sets up clearer standards and processes to provide better protections for an incapacitated patient. The bill in no way undermines the power of attorney for health care, but is seen as a needed adjunct in the health care decision-making process.

If you have any questions, contact Bill Bazan, WHA’s vice president, Metro Milwaukee, at bbazan@mailbag.com.

Bill Bazan, WHA’s vice president of Metro Milwaukee, and Dennis Tomczyk, Director of the Hospital Disaster Preparedness Program, just completed seven regional meetings to brief senior management about hospital disaster preparedness. Meetings were held in Milwaukee, Neenah, Madison, La Crosse, Green Bay, Eau Claire and Wausau. All meetings were well attended and participants appreciated hearing what has been accomplished and what is still being planned.

For those not able to participate in these luncheon briefings, a teleconference is being scheduled for Wednesday, April 25, 2007 at 9 a.m. The teleconference will last approximately one hour. The presentation can be downloaded from the WHA Web site at www.wha.org and can be printed for reference during the teleconference. The call-in number is 800-559-9370 and the call ID is 17578406.

We hope that you will be able to take advantage of this opportunity to be brought up-date on the significant accomplishments made by Wisconsin hospitals in disaster preparedness.

Wisconsin Literacy is offering a one-day "Health Literacy Summit" June 21 in Wisconsin Dells. The Summit will focus on communication between health care professionals and adult literacy educators and the exchange of ideas on how to improve the delivery of health care to Wisconsin adults with low literacy and limited English speaking skills.

The Summit will include a keynote address by Marsha Tait, ProLiteracy America’s senior vice president; a report by Paul Smith, MD, UW Department of Family Medicine; regional breakout sessions; workshops on creating documents for low literate adults; and a practitioners’ panel focusing on health literacy initiatives throughout the state.

WHA Foundation is one of the sponsors of this free event, and as a sponsor and a participant in the planning process, we encourage your involvement. Since a major outcome of this Summit will be the facilitation and future implementation of regional health literacy initiatives, we recommend that you register if you are in a position to pursue health literacy initiatives at a local and regional level.

Due to limited space, this round of invitations has a registration deadline of April 30, 2007. Also, it is requested that no more than two representatives from an organization register, due to the limited space, so please forward this information to the most appropriate person(s) in your organization.

To register online, go to: www.wisconsinliteracy.org/events/healthliteracysummit07/registration/

Registration ID: guest; Password: health

Lakeview Medical Center (LMC), the Barron County Office on Aging, the University of Wisconsin-Barron County and Wisconsin Indianhead Technical College teamed up for the 50-Plus Challenge to Live Well, an event to encourage adults age 50 and over to add activity to their lifestyle for health.

Older Americans are more sedentary, contributing to a variety of health-related problems as they age. The 50-Plus program was developed to increase awareness of health issues related to an inactive lifestyle and provide people with enjoyable ideas and examples of activities they could easily pursue on their own or with friends.

Held in Rice Lake, the 50-Plus Challenge to Live Well featured free health screenings, information and demonstrations on recreational activities and hobbies, as well as guest speakers. Each participant received a "Passport to Health," requiring participation in at least 12 activities to qualify for prizes like a free three-month membership in LMC’s Health & Wellness Center.

The free health screenings included blood pressure, body fat, lung function, vision, blood sugar, body mass index and strength tests. Participants could partake in interactive tests to show their level of fitness and were given easy, everyday activities they could do to improve their lifestyle. They were also given information about activities and hobbies that could help sharpen their physical and mental skills.

More than 250 participants, aged 50+, turned out for the event.

Submit hospital community benefit stories to Mary Kay Grasmick, editor, at mgrasmick@wha.org.

One advantage of a claims-made policy is the insurer is more likely to be around when a claim becomes payable. With an occurrence policy, the insurance companies that wrote policies in previous years may no longer be around. The length of time between an occurrence and resolution in court can be as long as 15 years to 20 years. A carrier in business today may not be in business after 15 years. Claims-made policyholders are able to move their past years of coverage with them to the companies they switch to without having to buy tail coverage as long as they maintain their original retroactive date.

With an occurrence policy, the financial burden of estimating incurred but not reported losses rests with the carrier. This makes reserve-setting more difficult for the insurers, especially for long tail lines of coverage like medical liability insurance. During the previous soft market, there were a number of medical liability carriers that either went insolvent or quit writing medical liability coverage in Wisconsin. Many of these carriers (PHICO, MMI, OHIC) wrote a high volume of occurrence policies, and the development of losses on those policies significantly contributed to their financial difficulties.

During soft market phases, medical liability carriers often add coverage enhancements to make their product more attractive. During the previous soft market cycle, carriers added coverage features such as administrative defense coverage, contingent excess coverage, and Medicare billing errors and omissions defense coverage. Holders of claims-made policies generally are able to take advantage of new coverage features sooner.

Next month - how to evaluate the cost of claims-made versus occurrence coverage.

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