"Government’s role in health care reform should begin with paying the cost of its own program," WHA president Steve Brenton said in testimony on April 11 before members of the Senate Select Committee on Health Care Reform, meeting in Milwaukee.

Brenton’s testimony came at a public hearing designed to gather information and ideas designed to improve access and lower health care cost inflation. Invited speakers were specifically asked to comment on the 2005 General Accounting Office (GAO) study and health care cost and access issues "in the Milwaukee area." Senator Alberta Darling (R-River Hills), the Committee’s co-chair, requested that speakers provide "input that will identify the factors behind the rising costs of care and coverage and recommendations for policy changes at the state level that will lower the cost of coverage and improve the quality of care."

Brenton told Committee members that the GAO study has unfortunately been "widely discussed without actually being widely read." He noted that the report’s focus on physician and hospital prices, as opposed to actual health care costs, has created "a hugely misleading snapshot of overall Wisconsin health care spending." Brenton noted that the GAO report concludes that when the focus is on actual spending, "no Wisconsin metropolitan area is found among the top 20 highest spending regions in the nation." Brenton also cited Medicare data that demonstrates, "that compared to most of the nation, Wisconsin is a veritable bargain when it comes to Medicare spending per average beneficiary."

The WHA testimony also examined unique and problematic characteristics of the health care environment in southeastern Wisconsin. "There should be no debate over the fact that access to primary health care services in the greater Milwaukee area is in a state of profound crisis," Brenton told the Committee. "The time has come to shine a bright spotlight on the specifics of this crisis and the fact that identification of solutions must be a statewide public policy priority that requires engagement by the Doyle Administration and by the Wisconsin Legislature." The testimony noted that just a handful of Milwaukee hospitals and Racine’s sole hospital system absorb 40 percent of annual statewide hospital Medicaid losses amounting to $200 million. "Fixing this crisis will require targeted new state funding that focuses on at least two initiatives – expansion of additional primary care infrastructure – and enhanced Medicaid DSH funding for hospitals that have become de facto safety net providers of primary care services."

The WHA statement also suggested that lawmakers embrace health care transparency as the corner-stone of health reform efforts. "There is agreement by virtually all stakeholders in the health, delivery and financing environment that measuring and reporting performance will lead to greater efficiencies and improvements in patient outcomes," WHA’s statement suggested. The written testimony encouraged lawmakers to allow current and future transparency initiatives to "blossom and evolve."

Brenton also encouraged legislators to closely examine Governor Doyle’s BadgerCare Plus initiative and the Healthy Wisconsin program initiative as "two promising proposals that can advance access and affordability of health care services for ‘at risk’ populations." Brenton also said that Wisconsin must recognize income tax deductibility of Health Savings Account (HSA) contributions. "HSAs are not the entire solution to access and coverage issues, but they represent a real opportunity, especially for individuals and small groups," Brenton observed.

The Senate Committee heard from representatives of the Wisconsin Medical Society and the Milwaukee area business community. Much of that testimony also focused on the need to advance quality, safety and pricing transparency as priority health reform initiatives.

The Senate Select Committee on Health Care Reform will hold additional public hearings this spring and early summer. Public hearings are likely to be scheduled for Madison, west central Wisconsin and a Fox Valley venue.

On April 12 the Assembly Ways & Means Committee narrowly approved a Taxpayer Protection Amendment (TPA), Assembly Joint Resolution (AJR) 77 by a 7-6 vote. Republican Steve Nass voted with all Democrats on the Committee against the proposal.

TPA amends the Wisconsin Constitution by putting in place strict limitations on the growth of governmental expenditures by capping the revenue that government can take in. Unlike legislation that must be signed or vetoed by the Governor, a constitutional amendment must pass both houses of the Legislature twice before it is then put to the voters for their final approval and the Constitution is amended.

The current TPA proposal (AJR 77) is likely to be voted on in the State Assembly during the week of April 24. If passed, it would then go to the Senate later on that same week or the following week.

Due to the importance of the issue, two legislators – Senator Bob Jauch (D-Poplar) and Rep. Gary Sherman (D-Port Wing) – recently held a hearing in Ashland to hear from their constituents regarding the proposed TPA. Dan Hymans of Ashland’s Memorial Medical Center testified at the hearing against the TPA.

"I am here to express strong opposition to this proposed amendment to the Wisconsin constitution," Hymans began. "While I can understand some of the rationale for such an amendment, now is not the time for such a radical alteration to our constitution."

Hymans joins with the Wisconsin Hospital Association and others in the health care industry, such as the Wisconsin Association of Health Plans, Wisconsin Medical Society, Wisconsin Health Care Association, in expressing serious concerns about the negative impact a TPA will have on the delivery of health care in Wisconsin. Hymans provided testimony at the hearing on how Wisconsin hospitals have been a partner with the state on the delivery of that health care to residents.

"In an effort to help the state meet its annual budget-balancing needs…[and] realizing we are partners in the process to ensure all Wisconsin residents have at least a minimum in health care coverage, we have agreed through the Medicaid program, the HIRSP program and any number of other health care programs to accept payment rates that do not cover the costs we incur to care for those patients."

This underfunding is commonly referred to as the "hidden health care tax." In 2005, it is estimated this hidden tax from Medicaid underpayments to hospitals alone resulted in $546 million being added to private sector health insurance costs.

Approval of a TPA would greatly exacerbate the hidden health care tax and lock in some of the worst Medicaid reimbursement rates in the country. If approved, a TPA would create an environment where payment rates will likely continue to spiral downward at an even more drastic rate, eroding access to high quality care.

"…experience in the only other state that has ever enacted such an amendment [Colorado] would suggest reimbursement rates would at best be forever frozen at their current levels or, even worse, would most likely spiral down at a dizzying rate," said Hymans. "Such a scenario would eventually force virtually every health care provider to consider whether they would need to follow the example of the dentists and arbitrarily limit the number of state supported patients we will see in a given year. Such a constraint would cause substantial deterioration in the quality of life we have all come to enjoy in this great state."

In closing, Hymans thanked the legislators for providing him the opportunity to present his concerns and for them to carry back his message to the full Legislature.

"Control and leadership at the local level has been a primary driver in making our local communities successful for many, many years. Now is not the time to imperil that legacy of success. I strongly encourage each of you to vote against any and all efforts to introduce this amendment to the Wisconsin constitution," he closed.

For questions, contact Jodi Bloch at jbloch@wha.org or Jenny Boese at jboese@wha.org.

Recently, many hospitals received a Notice of Proposed Settlement of Class Action, Certification of Settlement Class and Hearing Regarding Settlement that was sent to entities that purchased or rented Hill-Rom products from January 1, 1990 through February 2, 2006, as identified by Hill-Rom. A list of the Hill-Rom products involved is included in the notice. If you received the notice, then you have been identified as a class member and no further action is required at this time to preserve your rights.

Class members have a right to be excluded from the Settlement (and may then present a claim against Hill-Rom by filing their own lawsuit). If you choose to be excluded from the Settlement, you must mail a written request to Spartanburg Settlement Attn: Exclusion Department, PO Box 9000#6394, Merrick, NY 11566-9000. The request must be sent via first class mail and be postmarked no later than April 17, 2006. Additional information concerning this matter is available on the WHA web site.

• "This report has been widely discussed without actually being widely read by many pundits. The report’s focus on physician and hospital prices, as opposed to actual health care costs, has created a hugely misleading snapshot of overall Wisconsin health care spending."

• "Unless one factors in the volume of services consumed, there is an incomplete picture of dollars being spent on total health care services. Another way to look at it is, five widgets purchased at $5 ($25) is less expensive than seven widgets purchased at $4 ($28), even though the price of the individual widget may be less. Indeed, the GAO itself states that only about one-third of total cost differences are the result of unit prices."

• "From 1997 to 2005…just eight short years…Wisconsin Medicaid hospital reimbursement dropped dramatically from 82 percent of costs to 49 percent. Government’s role in health care reform should begin with paying the cost of its own program."
• "The Medicaid cost-shifting issue is particularly severe in the greater Milwaukee community where a handful of hospitals care for close to 40 percent of the state’s total Medicaid population. While the average Wisconsin hospital has about 10 percent of its patient base paid for by Medicaid, the Milwaukee average approaches 30 percent, and for two hospitals exceeds 40 percent!"
• "The ability of a handful of disproportionally burdened hospitals to manage the uncompensated care burden is not sustainable."

• "The Wisconsin Hospital Association’s CheckPoint and PricePoint initiatives, and the Wisconsin Collaborative for Health Care Quality’s health care performance reporting initiative are so well respected nationally that they are being discussed and replicated by organizations throughout the country."
• "We (WHA) firmly believe that transparency is the cornerstone of health care reform and a key ingredient in achieving a moderation in health care cost inflation."

Steve Brenton
President

Thank you to all who have completed the WHA leadership satisfaction survey. We have 50 percent response to date, but it’s important to hear from as many leaders as possible in order to get a true picture of member needs. Remember – this is your opportunity to rate WHA’s value and effectiveness.

If you have not yet completed the survey, using the following URL address, you can complete the survey on-line: www.satisfactionworks.com/WHA_Leadership_2006.htm

Otherwise, to get another copy of the written survey, contact Jennifer Frank at 608-274-1820 or jfrank@wha.org. The response deadline has been extended from April 17 to April 24 in order to accept some additional completed surveys.

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MADISON -- Advances in technology, population demographics and a rising demand for health care from an aging Wisconsin population are combining to create a future in which Wisconsin may not have enough health care workers to care for Wisconsin residents.

It is a problem that hospitals can’t wait for others to solve. That’s why Wisconsin hospitals are using their own resources to ensure that students are recruited, supported and provided sufficient facilities to receive the education they need to join the health care workforce.

In its most recent report on the status of the health care workforce, the Wisconsin Hospital Association (WHA) surveyed its member hospitals to determine what contributions they are making in their communities to create and maintain their own health care workforces. The report, "Building a Health Care Workforce for Wisconsin’s Future: Hospitals’ Contributions" is available at www.wha.org.

Hospitals Promote Health Careers

While some health occupation classes now have more students than they can accommodate for some careers, that has not always been the case. Interest in health careers fell in the 1990s, leading to lower enrollments in health care programs. As a result, technical schools and university campuses reduced or eliminated some health care training courses.

This trend alarmed health care providers in Wisconsin. In 2001, WHA launched a statewide media campaign to attract more students to health occupations. It was successful in creating renewed interest in health careers.

"Students have so many choices when they consider what career to choose; it is critically important that hospitals emphasize the fact that they offer family-sustaining jobs in a stable industry, along with a career ladder that doesn’t always exist in other industries," said WHA President Steve Brenton.

Hospitals promote health careers at all grade levels by:

- Sponsoring health career camps.
- Building career awareness through classroom presentations.
- Meeting with high school guidance counselors to build awareness.
- Creating job-shadowing opportunities in the workplace.

Hospitals Create Learning Environment

Hospitals help students receive the training they need to enter the health care workforce by bringing them into the clinical setting. Many hospitals provide both clinical and laboratory space for students in training. A shortage of faculty or faculty positions often limits schools’ ability to add capacity. So, hospitals pay their own qualified staff to serve as classroom instructors. By doing this, hospitals help educational facilities expand their capacity, which in turn, helps eliminate long waiting lists for key occupations, such as nursing and radiological technologists.

Hospitals Support Employee Advancement

Training is an ongoing process at hospitals as they adopt new technology and apply advances in medical treatment in caring for their patients. In addition to continuing education for their own employees, hospitals "build their own workforce" within the community by offering scholarships, tuition reimbursement and loan forgiveness to prospective and new employees.

"Many hospitals have a great ‘grow your own’ approach to workforce. Through reimbursement policies, they encourage employees to attain the next degree or credential which increases the depth and skill of the existing workforce, and often opens up an entry level position for a new employee. Everyone wins," Brenton said.

Hospitals are doing their part to address the forthcoming workforce shortages. It will take collaboration, cooperation and participation from educational, professional, policymaking and many other groups to meet the challenge of building tomorrow’s workforce today.

The Employee Pride Program will recognize health care employees at a special reception, dinner and ceremony on May 4 at the Blue Harbor in Sheboygan. Here is the list of hospitals that have sent WHA the name of the employee who will be honored that evening. If your hospital is NOT listed and your information WAS submitted, or if your hospital HAS NOT submitted this information to WHA but plans to participate, contact Mary Kay Grasmick at 608-274-1820 or mgrasmick@wha.org. The deadline for submitting the employee’s name to WHA was April 7, so ACT NOW if you plan to participate in this very special event.

Agnesian HealthCare, Fond du Lac - Kathleen Gardipee

All Saints Healthcare, Racine - Jan Leischow

Amery Regional Medical Center, Amery - Samantha MacDonald

Aspirus Wausau Hospital, Wausau - Lynn Yaeger

Aurora Medical Center of Manitowoc Co., Two Rivers - LeeRae Coenen

Aurora Sinai Medical Center, Milwaukee - Tricia Jene

Aurora St. Luke’s Medical Center, Milwaukee - Leslie Biernat

Beloit Memorial Hospital, Beloit - Amy Brandenburg

Black River Memorial Hospital, Black River Falls - Lois "Chipper" Wyss

Boscobel Area Health Care, Boscobel - Dawn Stephenson

Burnett Medical Center, Grantsburg - Brenda Rachner

Columbia St. Mary’s Hospital, Milwaukee - Eric Goin

Community Memorial Hospital, Menomonee Falls - Dale Scherbert

Community Memorial Hospital, Oconto Falls - Tina Melnarik

Divine Savior Healthcare, Portage - Lorelei Karcz Vincent

Eagle River Memorial Hospital, Eagle River - Alicia Rouse

Elmbrook Memorial Hospital, Brookfield - Julie Scheibe

Flambeau Hospital, Park Falls - William Westphal

Fort HealthCare, Fort Atkinson - Shirley Brown

Good Samaritan Health Center, Merrill - Angela Acker

Gundersen Lutheran Health System, La Crosse - Cindy Vieth

Howard Young Medical Center, Woodruff - Roddi Franck

Lakeview Medical Center, Rice Lake - Susan Schaefer

Langlade Memorial Hospital, Antigo - Carol Philips

Memorial Health Center, Medford - Sharon Vesnefsky

Memorial Hospital of Lafayette County, Darlington - Cindy Humphrey

Memorial Medical Center, Ashland - Laurie Carlson

Memorial Medical Center, Neillsville - Marie Heck

Moundview Memorial Hospital & Clinics, Friendship - Linda Charles

Oconomowoc Memorial Hospital, Oconomowoc - Jennifer Andler

Orthopaedic Hospital of Wisconsin, Glendale - Amy Mueller

Our Lady of Victory Hospital, Stanley - Becky Herman

Reedsburg Area Medical Center, Reedsburg - LaReta Dischler

Sacred Heart Hospital, Eau Claire - David Mortimer

Sacred Heart-St. Mary’s Hospitals, Rhinelander - Pamela Lohmeier

Saint Clare’s Hospital, Weston - Sarajane Moucha

Saint Joseph’s Hospital, Marshfield - Nancy Joch

Saint Michael’s Hospital, Stevens Point - Randal Wojciehoski, DPM

Sauk Prairie Memorial Hospital, Prairie du Sac - Beth Ann Zick

Shawano Medical Center, Shawano - Lynn Spiegel

St. Clare Hospital & Health Services, Baraboo - Keri Jo Schmidtke

St. Joseph Regional Medical Center, Milwaukee - Jamie Phillips

St. Joseph’s Community Health Services, Hillsboro - Marita Shaker, RN

St. Joseph’s Hospital, Chippewa Falls - Nancy Fastner

St. Luke’s South Shore, Cudahy - Doreen Parker

St. Marys Care Center, Madison - Cece Olson, LPN

St. Marys Hospital Medical Center, Madison - Janet Bergum

St. Mary’s Hospital Medical Center, Green Bay - Marge Vande Hei

St. Michael Hospital, Milwaukee - Erin Schulte

St. Nicholas Hospital, Sheboygan - Cori Salchert

St. Vincent Hospital, Green Bay - Mary Pliner

Stoughton Hospital Association, Stoughton - Sarah Corbett, CNA

The Monroe Clinic, Monroe - Catherine Seffrood

Tri-County Memorial Hospital, Whitehall - Paulett Fox Beardsley

Waukesha Memorial Hospital, Waukesha - Ellen Marie Anders

University of Wisconsin Hospital & Clinics, Madison - Carrie Sparks

Upland Hills Health, Dodgeville - Toni Rochon

Vernon Memorial Healthcare, Viroqua - Janet Stalsberg

As Wisconsin’s "safe haven" infant abandonment law turned five 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.

Bradley Manning, MD, of Monona, was elected the 153rd president of the Wisconsin Medical Society during the Society’s Annual Meeting at Madison’s Monona Terrace on April 7.

Manning said his presidency will provide him with an opportunity to reinvigorate the medical community’s dedication to improving the quality of care provided. "I am here to help us look at what we do every day and help us to find more effective ways to approach patient care," Manning added.

Manning noted that hospitals have taken a leadership role in collecting and reporting data to providers and the public through their CheckPoint and PricePoint Web sites. He currently serves on the Wisconsin Quality Steering Committee, the group that oversees the development of CheckPoint, and on WHA’s Medical and Professional Affairs Council. Manning has also facilitated the Society’s continued involvement in a number of key quality and safety improvement initiatives with WHA, including the Medication Reconciliation Statewide Improvement Team and Safe Care Wisconsin.

"Brad is a good friend of WHA and has been an active leader in the development and implementation of our quality and safety reporting agenda," said WHA President Steve Brenton.

Manning, a Madison plastic and reconstruction surgeon, will focus on health care quality issues during his presidential year because he says there’s potential for significant improvement. He is especially optimistic in light of the advent of electronic medical records.

"By studying patient data across providers and over time, we, as physicians, could begin to see the foundation for a more complete, accurate and timely picture of our patients’ care," said Manning in his inaugural speech. "We could see more of our patients’ state of health and better organize a more timely and comprehensive plan for treating them. We could compare the treatment of multiple patients by multiple physicians. The electronic record offered us a way to put the patient pieces together," he added.

I read an article in the paper about a free screening for abdominal aortic aneurysms with the attention-grabbing headline, "Aneurysm screening can save lives." It also caught my attention because my father had an abdominal aortic aneurysm in his 80s.

I was surprised to learn that as a man over the age of 60, with my family history and the fact that I’ve been a smoker for 50 years, I was five to six times more likely to develop an aneurysm. That was enough to convince me to call for an appointment.

As I left the house to go to the screening, I jokingly said to my wife, Barbara, "I’ll call you from the ER." While I had no symptoms to suggest I had a problem, I still had a nagging suspicion they might find an aneurysm…after all, I had all these risk factors.

I first suspected something might be wrong when the young man doing the screening called over a more experienced person to verify the results. They were concerned enough at what they found to suggest I go straight to the emergency room. They were very convincing. I called my wife and told her I’d meet her at Gundersen Lutheran…this time it wasn’t a joke.

Tests confirmed I had an enlargement in my abdominal aorta, the main artery that runs from the heart to the lower abdomen. The aneurysm was about the size of a lemon. Tests also showed I had a tear of the inner lining which is the first stage before an aneurysm bursts. Once an aneurysm ruptures, it usually means death.

Soon after the diagnosis, I had surgery to repair the aneurysm. Although it was my first time in the hospital, I wasn’t scared. As a retired dentist I’ve learned to remain calm. I also knew I was in great hands. The surgery went very well and I got out of the hospital nine days later…just in time to celebrate my 45th wedding anniversary.

I credit Gundersen Lutheran and the screening for saving my life. And to celebrate my new lease on life, I quit smoking after 50 years! I feel good that I did the screening. I certainly was fortunate.

We got the call from Dispatch around 4:30 p.m. on a Saturday in October. A small 3-year-old child was missing in a rural area. He had been missing about an hour. It would be dark soon making search efforts nearly impossible and temperatures were dropping.

I am a flight nurse for MedLink AIR, Gundersen Lutheran’s helicopter ambulance service. We receive calls a couple of times a month to help with an air search. We’re asked to assist with river searches for missing fisherman, and searches for missing hunters and farmers, too. But when a child is involved, we feel a particular sense of urgency.

Within minutes, our pilot, Marc Wuensch, had us in the air on our way to where the boy was seen last. While en route, Scott Larson, the flight paramedic, talked to search crews on the ground to get a description of the boy and what he was wearing.

Once the helicopter reached the search area, Marc began a standard search pattern. In particular, we were asked to fly over cornfields where it was difficult for teams on the ground to search. About 10 minutes into our search, we spotted the small boy on the edge of a wooded area about a mile from his home.

MedLink AIR typically helps with only the search, leaving rescue efforts to the specially trained and equipped teams on the ground. In this case, the boy was scared and started to run. So the decision was made: Marc landed the MedLink AIR helicopter in a cleared field nearby, and we recovered the child. We flew him home and reunited the boy with his very happy and relieved family.

It was a very positive experience for us all. We deal with a lot of tragedy in our work so we especially enjoy the happy endings. Assisting law enforcement and EMS agencies with search efforts is a very positive thing we do for our community and we’re glad to be a part of it.

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

Voluntary benefits, also called worksite benefits, have been around for decades. However, they are increasingly being added to employers’ menu of employee benefits.

The most popular benefits are still voluntary life and disability. The fastest-growing category of voluntary benefits consists of specialized medical coverage. Some types of coverage in that category are being expanded. For example, critical-illness insurance that once covered only cancer has been broadened in many instances to include heart attacks, major organ transplants, and other specific medical conditions or procedures. Typically, a lump-sum benefit of $10,000 or $50,000 is paid after a covered event occurs, and the money can be spent on medical or non-medical needs.

The Society for Human Resources Management’s 2005 Benefits Survey Report shows that 47 percent of employers offer supplemental health insurance, up from 42 percent in 2005, and 30 percent offer hospital-indemnity insurance, up from 26 percent. Critical illness insurance has risen every year since 2001, when it was offered by 26 percent of employers; in 2005 it was offered by 38 percent of companies surveyed.

Voluntary benefits not only can round out an organization’s total benefits package and offer employees discounted coverage for their specific needs, but can also aid in recruitment and retention.

The first step in setting up a voluntary benefits program is deciding which products to include. Some employers offer a broad menu, while others narrow the choices to those they believe best suit their workers’ needs and preferences. Consider having WHA Financial Solutions conduct an employee survey or prepare a benchmark report to help identify which products may make the most sense.

Contact Jon Braddock at jbraddock@wha.org or Michelle White at mwhite@wha.org for information about WHA Financial Solutions’ comprehensive worksite benefits program.

The Centers for Medicare & Medicaid Services (CMS) released its hospital inpatient prospective payment system (PPS) proposed rule for fiscal year (FY) 2007. Based on our preliminary read, here are some of the rule’s key provisions:

• Diagnosis-related Group (DRG) Changes: CMS proposes major changes in the calculation of DRG relative weights by using hospital-specific relative values and a modified version of costs instead of charges. CMS also discusses refinements to the DRGs to account for patient acuity, with implementation likely in FY 2008. WHA will analyze the data to determine the impact of the proposed changes on full-service community hospitals.
• Payment Update: The rule proposes a market basket update of 3.4 percent for those hospitals that submit data on the previously required 10 quality measures and pledge to report on 21 anticipated measures starting calendar year 2006. Per the Deficit Reduction Act of 2006, hospitals that do not report these measures will receive an update of market basket minus 2.0 percent, or 1.4 percent.
• Outliers: The rule would raise the outlier threshold from its current level of approximately $23,600 to $25,530, even though CMS did not spend all of the money set aside for outlier payments in FY 2006.
• Wage Index: The rule incorporates the expiration of Section 508 of the Medicare Modernization Act (MMA) of 2003, which was a one-time geographic reclassification opportunity for hospital that met certain criteria.
• Medicare Dependent Hospitals (MDH): The rule would implement the provision in the MMA that not only reauthorized the MDH program, but also added 2002 as an allowable base year, increased payments from 50 percent to 75 percent of the difference between the PPS payments and the hospital-specific rate, and removed the 12 percent disproportionate share hospital (DSH) cap.

Comments on the proposed rule will be accepted until June 12, 2006. The final rule will be released by August 1, 2006; policies and payment rates become effective October 1, 2006. The rule is available at: www.cms.hhs.gov/AcuteInpatientPPS/IPPS/itemdetail.asp?filterType=data&filterValue=2006&filterByDID=4&sortByDID=4&sortOrder=ascending&itemID=CMS061764. Look for a more detailed analysis of the proposed rule in the coming weeks.

Dick Davidson, president of the American Hospital Association (AHA) since 1991, will retire from the post, effective January 1, 2007. Davidson, 69, is the second longest-serving president in the association’s 108-year history.

The AHA also announced today that the Association’s Board of Trustees has chosen Richard J. Umbdenstock, a top executive with Providence Health & Services in Seattle as Davidson’s successor. Umbdenstock will be the tenth person to hold the chief executive position.

Umbdenstock will join the AHA as chief operating officer and president-elect in June before assuming the presidency next year. Umbdenstock recently served as the AHA’s Board chairman, a volunteer post from which he has resigned. The Board has asked AHA’s immediate past chair, George Lynn, president and chief executive officer of AtlantiCare in Atlantic City, N.J., to fill the remaining months of Umbdenstock’s term.

Davidson led the 4,800-member Association through one of the most tumultuous periods of change in hospitals and health care in America. It was early in his tenure that the nation debated comprehensive health reform under President Clinton. At the same time, many hospitals underwent a fundamental change in their structures, evolving into health systems with multiple sites and services, rather than the traditional hospital model. When the concept of "managed care" swept the health care field, causing major changes in health care delivery and payment, the AHA under Davidson’s leadership undertook a wide range of policy and legislative initiatives to help its members cope with the rapidly changing environment.

While at the AHA, Davidson helped establish the Institute for Diversity in Health Management and spearheaded the Hospital Quality Alliance – a public/private partnership that created publicly available information on hospital quality measurement nationally for the use of both consumers and internal hospital quality improvement. In 2004 and 2006, the association established two centers devoted to improving hospital and health system governance and quality and patient safety.

A nationally recognized health care leader, Umbdenstock has deep roots with the AHA. Early in his career, Umbdenstock served as special assistant to then-AHA President Alex McMahon. While on staff at the AHA, he created the Association’s outreach programs for hospital governing boards. He has remained active in the association serving on the Circle of Life Award Committee and joining the AHA Board in 2000. During his Board service, he was chairman of the operations committee and was on the Board’s executive committee. He became Chairman of the AHA Board of Trustees on January 1.

"This work is now more important than ever," said Kathryn Correia, senior vice president of ThedaCare™. "We are honored to receive this distinguished award for the second year in a row. Our staff is faced with the job of approaching family members who are experiencing the worst day of their life, and talking to them about the importance of the gift of life. This award recognizes our staff for successfully facing this difficult task with sensitivity and compassion."

With Doyle’s signature on the medical liability bill, that issue has hopefully been resolved. But Brenton notes in the article that WHA is focused on Medicaid as a long-term issue.

"We are simply leaving money on the table when it comes to Medicaid in Wisconsin," Brenton said. "The federal government provides $1.50 for every $1 we spend."

Both access and health care costs are also on his radar.

"In the long-range health care environment, costs have been the No. 1 issue for the past 25 years and will remain so for the next 25 years," he said. "Any steps we take to move forward to meet those costs are steps in the right direction."

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