This week the Assembly passed AB 246, WHA-backed legislation establishing a five-year deadline for Wisconsin technical colleges to adopt a common curriculum and common admission standards for each of the health occupations. The bill also requires the Wisconsin Technical College System (WTCS) to report annually on progress toward alleviating massive waiting lists for its health care programs. All three provisions in AB 246 are components of "Healthier Choices," the health reform package developed by WHA, Wisconsin Manufacturers and Commerce, and the Wisconsin Association of Health Plans.  AB 246 is authored by Rep. Steve Wieckert (R-Appleton).

"The severe workforce shortages in health care are a significant contributor to rising health care costs," said WHA’s Eric Borgerding. "WHA supports this legislation because it will help streamline the process for the most important participants in the education system – the students. It is by no means the only answer, but we believe it is a significant step towards making our technical college system work more like a system."

On March 22, WHA’s Judy Warmuth testified in front of the Assembly Colleges and Universities Committee.

"The advantage to common admission standards and common curricula is that a learner who may have begun an application process or a program in a technical college district but who must leave a program, or who moves, has the flexibility of resuming that process without penalty, loss of credit, time or money," Warmuth told the committee.

"We feel strongly that relocation, changes in life situations and waiting lists cause students to move among districts," Warmuth continued. "Dramatically different standards from one school to another, like those that exist now, discourage learners – perhaps to the point that they never complete a program, never become a health professional."

Other organizations joined WHA in supporting AB 246, including Meriter Hospital in Madison, the Wisconsin Manufacturers and Commerce, and the Wisconsin Health Care Association.

"We need to continue working on streamlining our entire health care education system, and we look forward to working with legislative leaders to do that," Borgerding said.

Patients in Wisconsin may face increasing barriers to access care if plaintiffs’ attorneys are successful in invalidating Wisconsin’s over ten-year-old medical liability noneconomic damage caps. On April 23, the Wisconsin Supreme Court will hear oral arguments in Ferdon v. Wisconsin Patients Compensation Fund, in which the plaintiffs are asking the Court to declare Wisconsin’s noneconomic damage caps unconstitutional.

Owed in great part to Wisconsin’s medical liability noneconomic damage caps, Wisconsin has some of the most stable medical liability insurance premiums in the country, and that has been a significant tool that hospitals, particularly in underserved areas of Wisconsin, have used to recruit new physicians to their communities.

"Wisconsin’s medical malpractice caps have been a significant recruiting tool in bringing new physicians to Wisconsin hospitals," said George Quinn, senior vice president, WHA. "As one of only a few states not experiencing a medical liability insurance crisis, Wisconsin has become an attractive place for physicians to practice."

In states without established noneconomic damage caps, physicians and hospitals have seen medical liability premiums increase at a rate of up to 15 times greater than the average premium increase in Wisconsin. As a result, many physicians are leaving these states to practice in states such as Wisconsin that have long established noneconomic damage caps and stable medical liability premiums.

"Without Wisconsin’s noneconomic damage caps and the stabilizing effect they have on medical liability premiums, we would have a significantly more difficult time recruiting and keeping physicians in rural communities in Wisconsin," explained Sandy Anderson, president, St. Clare Hospital & Health Services in Baraboo. "The experience of states without established caps has shown that rural hospitals have had scores of physicians leave due to skyrocketing insurance premiums."

A 2004 study by WHA and the Wisconsin Medical Society entitled "Who Will Care for Our Patients?" reported that stagnant growth in the physician workforce, combined with a growing – and aging – population means Wisconsin will be facing a physician shortage that worsens with each passing year. The report also noted that the problem will be most challenging in medically underserved areas of Wisconsin, such as rural areas and inner city Milwaukee. The report concluded that one way to fill the need for physicians in underserved areas of Wisconsin and throughout the state is to maintain Wisconsin’s noneconomic damage caps in medical liability cases as one component to attracting physicians to Wisconsin from [other] states.

"Rural physicians typically don’t make the same income or have the same patient volume as their urban counterparts, rather they often choose to practice in a rural community for lifestyle reasons," added Anderson. "However, because of lower volumes, rural physicians have less financial ability to absorb dramatic increases in medical liability premiums. Consequently, the experience of states without established caps has shown that skyrocketing premiums have forced rural physicians, and OB-GYNs in particular, to leave their rural communities.

"Ultimately, if small communities in Wisconsin are unable to attract physicians, it will be the community’s patients that suffer as rural patients would face longer distances to seek care and longer waits to receive care, or because of these barriers, not seek care at all," continued Anderson.

"Hospital CEOs throughout the state recognize that if Wisconsin were to lose its noneconomic damage caps for medical liability, the result would be devastating for Wisconsin and rural communities in particular," concluded Quinn. "It has always been difficult to recruit physicians to serve rural areas; the loss of the caps would cripple Wisconsin’s ability to recruit new physicians and, ultimately, to provide timely, convenient care to the people of rural Wisconsin."

Major dailies all across Wisconsin are embracing an increase in the cigarette tax as a top priority to fund Medicaid and prevent kids from starting to smoke. This Milwaukee Journal Sentinel story is but the latest opinion piece that makes the case for hiking the tax by $1.

Editorial: Cigarette tax hike is wise
From the Milwaukee Journal Sentinel, April 10, 2005

In Madison these days, there is no more foul word than the one that starts with "t" and ends with "x." We understand that, and so do eight state lawmakers, five Republicans and three Democrats, who have proposed that the state raise its cigarette tax by $1 to cover a $590 million deficit in the Medicaid program over the next two years.

Fortunately, those eight legislators are willing to risk being labeled pariahs - unlike many of their fellow legislators and Gov. Jim Doyle - to do the right thing. And the $1 hike is right, not just because of the revenue it would generate but because it will save lives and alleviate unnecessary suffering from smoking-related diseases as sure as the sun rises every morning. And consequently, it will save tens of millions of taxpayer dollars now being spent each year to treat the victims of firsthand and secondhand smoke.

We understand the political climate in this state when it comes to taxes, even the so-called "sin taxes." But a detailed poll conducted in late January by the Wisconsin Hospital Association and American Cancer Society showed 78% of state residents favor the $1 cigarette tax hike, and that support even crossed over to many smokers.

If the cigarette tax is raised $1, the tax per pack would be $1.77, one of the highest in the nation and higher than most neighboring states.

Yes, that would be a financial hardship for smokers, but that's the point. Evidence shows that raising cigarette taxes not only persuades some smokers to stop but, more important, helps persuade many others, particularly kids, not to even start.

Critics of the $1 tax hike point out - quite legitimately - that some people don't quit when the tax gets that high and either grudgingly pay it or turn to sources other than retail outlets, including the black market and, increasingly, Internet suppliers. But even they do not dispute that many people do quit and kids are less likely to start.

Critics say cigarette taxes seldom produce as much tax revenue as supporters predict. But even if the $1 hike produces about $250 million a year, a conservative guess, that would go a long way toward relieving the state's Medicaid deficit. It also makes perfect economic sense since treating smoking-related illnesses, including cancer and heart disease, account for just under 15% of the state's annual $4.2 billion Medicaid budget.

Unfortunately, the dreaded "t" word has so rattled politicians in this state, including Doyle, that they are unwilling to seriously consider a hike in the cigarette tax, despite the compelling arguments for it.

Rather than skating around this issue, Doyle should be taking the lead, especially since he has proposed cracking down on Internet cigarette sellers, which would undermine one of the arguments that critics are using to oppose a tax hike.

ThedaCare took advantage of a golden grassroots opportunity to testify before Rep. Dean Kaufert (R-Neenah) and other area legislators at a listening session held in Menasha this week. Rep. Kaufert serves as one of the co-chairs of the state legislature’s powerful Joint Finance Committee.

"As a community owned not-for-profit health care provider, we understand our responsibility to help take care of the uninsured and the underinsured….Part of that commitment is to help those whose care is paid for through Medicaid, BadgerCare and other programs," began John Gillespie, ThedaCare’s manager of public and government relations.

"There is little disagreement that the reimbursement provided by Medicaid for the care delivered is inadequate. In many cases, it falls hundreds – even thousands of dollars short of the actual cost of delivering care [and] causes ‘cost-shifting’ to commercial payors to make up the difference," Gillespie told legislators.

According to WHA, the cost shifting equaled $450 million in 2004 alone – a "Hidden Health Care Tax" estimated to pay Wisconsin hospitals just 55 cents for every dollar it cost to provide care to Medicaid patients.

"Many have proposed addressing the Medicaid funding shortfall with a cigarette tax," testified Gillespie. "Our hope is that members of both parties realize that with three-fourths of all state residents supporting such a tax, the stakes are just too high to be squandered…."

Gillespie was referring to the joint WHA/ American Cancer Society poll which found that 77 percent of Wisconsin residents support a $1 per pack cigarette tax increase and using it to fund health care related programs like Medicaid.

His testimony also highlighted ThedaCare’s support for the Governor’s budget proposal providing $10 million for a new Health Care Quality and Patient Safety Board.

WHA is committed to reducing this "Hidden Health Care Tax" by advancing payment improvements and securing a "down payment" on restoring the devastating cuts from the last budget. In the 2005-2007 budget bill, WHA’s downpayment priorities are:

• Increasing Outpatient Reimbursement for hospitals across the state
• Enhancing Disproportionate Share Hospital (DSH) payments for hospitals that care for a high number of uninsured and government patients
• Restoring Graduate Medical Education (GME) funding for teaching hospitals

The Joint Finance Committee is currently reviewing the state budget and will begin voting on individual budget items on April 19.

The Hospitals Education & Advocacy Team (HEAT), WHA’s free grassroots program, launched a one-stop shopping Web page to help you email your legislators on important issues like Medicaid funding in the state budget bill.

The Web page is as easy as 1, 2:

Step 1: Find your legislators.
Step 2: Email them.

Voila, you have become a grassroots advocate!

Access "Email My Legislators" online at www.wha.org/speakUp/emailLegislator.aspx. Join HEAT online at www.wha.org/speakUp/heat.aspx.

For information or questions contact Jenny Boese at 608-268-1816.

WHA’s 2005 Advocacy Day agenda is packed with interesting speakers, an address by Governor Jim Doyle (invited), and most importantly, time to visit with your state legislator.

Visiting with your lawmaker is the most important part of Advocacy Day because your voice needs to be heard on Medicaid, the cigarette tax, and other related issues pending right now in the state budget bill.

Bring your grassroots team, key leaders, volunteers, auxilians, and trustees to this important event. It’s easy to register, and Advocacy Day is a free event to all participants. The brochure and registration form are included in this week’s packet. They are also available on-line at www.wha.org. Registrations are due by May 2.

For questions about registration, contact Sherry Rabuck at WHA at 608-274-1820, or email srabuck@wha.org.

For assistance in scheduling your legislative appointments, please call Angela Miloszewicz directly at 608-268-1801 by Monday, May 2.

2005 Advocacy Day: Learn about the issues that impact your hospitals and then do something about them. Register today!

Wisconsin Congressman Ron Kind (D-La Crosse) has introduced a bill that would require Medicare Advantage (MA) plans to pay Critical Access Hospitals (CAH) at least as much as the Medicare program pays them for their services. It is expected that Medicare Advantage plans will become significant factors in rural areas – for covering Medicare beneficiaries and paying providers.

Under current law, MA plans are not required to pay providers what they would receive under Medicare fee-for-services; instead, payment rates will be negotiated. This could mean that the cost-based payment that rural hospitals have fought for could be eroded if MA plans dominate in rural areas.

"Congressman Kind’s legislation preserves cost-based payment, thus helping to ensure the continued financial viability of Wisconsin’s 55 Critical Access Hospitals," said WHA President Steve Brenton. "We applaud introduction of this important rural health initiative, which is a key WHA legislative priority."

A highlight of this year’s 2005 Rural Health Conference is the participation of Senator Dale Schultz (R-Richland Center), Senate Majority Leader, in a panel discussion focused on current public policy issues affecting rural health care.

This panel discussion, which will also include WHA President Steve Brenton and Tim Size, executive director of Rural Wisconsin Health Cooperative, will wrap up a conference full of interesting topics and speakers focused on the theme of "Our Changing World of Rural Health."

This year’s event is scheduled for June 22-24, 2005, at the Kalahari Resort & Convention Center in Wisconsin Dells. Keynote speaker Leland Kaiser, PhD, renowned health care futurist, will open the conference by examining new challenges and opportunities for rural health care providers and the vital skills, attitudes and behaviors needed to survive and succeed. Attendees can choose from a variety of interesting and pertinent concurrent sessions throughout the event, including an education track devoted specifically to rural hospital board of trustee members.

Hospital administrators, chief financial officers, management staff, nurse leaders, physicians, and trustees are encouraged to attend this conference. The 2005 conference is approved for 7 long-term care administration continuing education credits, and for 7 ACHE category II (non-ACHE) credits. Additionally, the Wisconsin Medical Society designates this education activity for a maximum of 7 category 1 credits toward the AMA Physician’s Recognition Award.

The full conference brochure, with registration information, is included in this week’s packet and is available on-line at www.wha.org.

A new presentation that is designed to attract middle and high school aged students to health careers is available through the Healthcare Workforce Network, a program of the Northwest Workforce Development Board through CEP (Concentrated Employment Program). The content is fast paced, with music and graphics to hold the attention of that audience. A teen age moderator interviews employees in local health care facilities, asking what they like about their job and why they pursued a career in health care. The presentation encourages students to enroll in math, science and English courses in high school in preparation for a health career.

The message delivered at the Wisconsin Forum for Healthcare Strategy Spring Conference from Malcom Baldrige Award winner, Baptist Health Care, was clear—employee satisfaction is directly tied to patient satisfaction. To improve patient satisfaction scores, raise employee satisfaction ratings.

Kelly Rozier, RN, from the Baptist Health Care Leadership Institute, discussed how Baptist improved the quality of the care and service on the way to joining the list of other industries named to Fortune Magazine’s "Best Places to Work" four years in a row. Awards aside, Rozier emphasized that it is the journey to excellence that is important.

"You create a no secrets, no excuses environment in your hospital and find that everything begins to fall into place," Rozier said. "You can always find the differences—excuses—for not doing something, but the reality is we all care for patients. We have that in common, and that is where you start."

Rounding, that is, senior leaders visiting every unit in the hospital on a regular schedule, is advocated by Rozier as a way to encourage communication between administration and employees. Having a defined purpose while on rounds, and consistency in the visit schedule are important factors in maintaining credibility with employees.

Phillip Wright, CEO at the Mary Black Memorial Hospital in Spartanburg, South Carolina, said he uses rounding, and has found that it works very well. On the road to excellence, Wright said, "Rounding will get you to the next level."

Whether you’re an old pro or a little bit green, "Analyzing and Negotiating Better Reimbursement Contracts" is one seminar you can’t afford to miss this year. This powerful in-depth, hands-on workshop is designed to assist you in understanding the managed care contracting process, guiding you through the demystification of traditional contract language and the impact on provider operations and costs.

Learn to identify and dismantle the vagueness of complex managed care contracts with many of the classic and not-so-classic problem terms, conditions and "gotchas" frequently encountered in HMO, PPO, Silent PPO, and other managed care agreements. Also, learn practical solutions, as well as a technique to address negotiation jitters through non-confrontational methods of negotiation. Upon completion, attendees will feel more adept at the conversion of the boilerplate terms into clearly negotiated objectives, expectations and measurable actions.

This seminar is for business office managers, reimbursement managers, contract specialists, chief financial officers and others, both new and experienced, charged with managed care contract evaluation and negotiation.

The conference will be held on May 24, 2005, from 9 am to 4 pm at the Radisson Paper Valley Hotel in Appleton. A brochure and a registration form are included in this week’s packet and on the Web site at www.wha.org. Easy, on-line registration is available as well.

Ministry Health Care, Milwaukee, and Good Samaritan Health Center, located in Merrill, Wisconsin announced that Good Samaritan Health Center will become an affiliate of Ministry Health Care. The affiliation is intended to preserve and enhance the delivery of health care to area residents.

"Good Samaritan is a welcome addition to the Ministry system because of our similar mission and values," said Nick Desien, president and CEO of Ministry Health Care. "We share a Catholic heritage, and both organizations have had a significant and longstanding presence in northern Wisconsin."

"We are pleased with the affiliation with Ministry Health Care, and where our future is headed," said Michael Hammer, president and COO of Good Samaritan Health Center. "We have always been very committed to our community, and we believe this affiliation will help us to serve the community even better. Ministry Health Care holds a strong commitment to local communities, which is evident within the communities they have a presence in throughout Wisconsin and Minnesota."

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