It’s that time of year—the legislature is in full swing and so is the WHA Advocacy team, as the WHA Board of Directors learned at their April 21 meeting in Madison.

WHA Senior Vice President Eric Borgerding said Medicaid funding continues to be a top priority as the state budget is discussed in Madison. Coincidental with the budget discussions, the Wisconsin Manufacturers & Commerce (WMC) "hidden tax" campaign is up and running. Borgerding played one of the radio ads that is running in selected markets statewide, and he showcased several direct mail pieces that WMC developed and will send to their members. The campaign emphasizes the $450 million shortfall in Medicaid payments that occurs because government does not cover the costs of the program.

In an effort to provide legislators with facts about the Medicaid program, WHA developed "Wisconsin Medicaid Myths: Facts you need to know," which has been distributed at the capitol (find it on the Web site at www.wha.org/FinanceAndData/pdf/2005medicaidmyths.pdf).

"We recognize that long term changes are necessary in the Medicaid program, but the first step in ‘reforming’ Medicaid is to stem the rising levels of cost shifting necessitated by payment shortfalls and slowing down growth in the hidden tax," Borgerding explained.

Jodi Bloch, WHA vice president of government affairs, announced the new WHA fundraising campaign, which is detailed on page one in this issue of The Valued Voice.

WHA’s newest staff member, Jenny Boese, vice president of external relations and member advocacy, introduced the Board to WHA’s Hospitals Education & Advocacy Team (HEAT). Boese said the goal of WHA’s grassroots program is to recruit more advocates, communicate with advocates through newsletters and emails; educate; mobilize; and follow up with grassroots advocates, which could be as simple as a "thank you" or a quick survey.

Boese said the priority of grassroots action has been the state budget. She noted that many hospitals have activated their grassroots programs, generating hundreds of letters to legislators (see Grassroots Spotlight on pages 4 and 5).

WHA President Steve Brenton distributed WHA financial statements, which met with Board approval. He reminded Board members to sign up for the AHA Annual Meeting in Washington. Visits with the Wisconsin Congressional Delegation are scheduled, and Brenton gave Board members copies of the white papers that will be shared with Wisconsin’s elected officials in Washington (available at www.wha.org, click on Publications & Archives, Position Statements).

Task Force and Council Reports

Community Benefits Task Force – Chair Bob Fale said the group voiced an interest in creating an organized approach to community benefit reporting. He noted that the participation of a hospital trustee on the task force proved to be very helpful as the group discussed how best to address the issue.

Workforce Development Council – Chair Carolyn Friese reported that Rep. Steve Wieckert was a guest speaker at the last meeting. Friese asked the Board for approval of a survey that will be sent to all hospitals to gather demographic data about registered nurses that will be essential to determining how many nurses would be needed in the future (see article on page 2).

Wisconsin Council on Medical Education & Workforce – George Quinn and Chuck Shabino, MD, said at the second meeting of the group they discussed medical school admission policies. The question is how to identify and recruit medical students who have a high probability of practicing in a rural or underserved area.

Wisconsin Quality Steering Committee – Shabino said the Committee welcomed several new members from diverse backgrounds. Brenton pointed out that only one-third of the members of the group are from hospitals; the other two-thirds are from diverse backgrounds, including insurers, purchasers, business, and state government.

Council on Rural Health – Chair Bill Bruce announced the Rural Health Conference will be June 22-24 at the Kalahari Resort in Wisconsin Dells.

Council on Finance & Payment – Quinn asked the Board to approve guidelines and resources that provide information to help hospitals implement policies and procedures to collect payments at the time of service.

Brenton introduced Susan Turney, CEO/EVP of the Wisconsin Medical Society, who outlined the Society’s priorities in the current legislative session. Turney said the Ferdon case, which has been featured in The Valued Voice over the past several weeks, is a concern as it poses a challenge to the constitutionality of caps on non-economic damages. For more on Turney’s dialogue with the WHA Board, watch for an exclusive interview with her in the April 29 issue of The Valued Voice.

Last week, hospital CEOs and administrators received the 2005 annual fundraising solicitation for the newly renamed state PAC and conduit funds. Previously called Healthy Wisconsin PAC and Conduit, WHA senior vice president Eric Borgerding says, "The new name ‘Wisconsin Hospitals PAC and Conduit’ more aptly reflects to elected officials that these funds represent contributions coming from individuals who are employed by or affiliated with a Wisconsin hospital."

The name change is not the only change to the fundraising campaign this year. There are new recognition programs designed to spotlight contributors and hospital leadership that meet certain contribution goals. The first is an individual giver’s recognition program called the Silver "H" Club, which recognizes individuals who contribute $250 or more to either/or both the state PAC and conduit. Individuals who reach or exceed this threshold will receive a silver "H" recognition pin and will be invited to a members-only thank you reception. The second program, called the Gold "H" Club, is designed to recognize hospital leaders whose staff and volunteers meet a larger hospital staff-wide goal of raising 15 percent more than the previous year. Gold "H" Club members will receive special recognition in printed publications and at events throughout the year.

These recognition programs are designed to increase contributions to reach the campaign’s overall goal of raising $175,000 in 2005. Last year total contributions exceeded $152,000. According to Jodi Bloch, WHA vice president, government relations, "The cost of political campaigns is growing significantly; so must our contributions grow to make sure there are enough funds to assist all of our friends in their campaigns."

Solicitations for AHA’s federal PAC will be done separately as limitations on federal fundraising have spurred this decoupling. Watch for federal authorizations to go out shortly as an authorization to solicit must be signed in order to receive AHA federal PAC brochures. According to WHA’s Steve Brenton, "All of these funds, including contributions to AHA’s federal PAC, play a critical and necessary role in achieving success for WHA’s government relations efforts at both the state and federal level."

Bloch told WHA Board members this week, "Just as WHA needs a strong advocacy program and lobbying team, we also need a strong fundraising effort to ensure that WHA’s government relations program is effective." She also shared that WHA staff will be contacting hospital CEOs and administrators, especially those that have not contributed in the past, to discuss the progress of their campaigns and offer assistance including traveling to hospitals to talk to their staff and volunteers about the campaign.

For more information about this campaign, please contact Jodi Bloch or Jenny Boese at 608-274-1820.

Speaking at the WHA Council on Workforce Development, Rep. Steve Wieckert (R-Appleton) emphasized the importance of constituent contact with their legislators. He stated that far too often, constituents do not contact him regarding pending legislation.

He indicated, "If I receive five or six constituent letters on an issue then, wow, that’s a big issue." He encouraged members of the council to communicate with their elected officials, saying that, "You know health care; you don’t want the Legislature determining it."

Rep. Wieckert said calls are often more meaningful than emails, and the words, "I am a constituent" are "magic" to a legislator’s ears. He also shared his legislative interests with the Council, including Cody’s Law (organ donation), health savings accounts, and the Technical College Common Curriculum.

Will Wisconsin have an adequate supply of registered nurses? The consensus of the group was that WHA should continue to encourage entry into health occupations, as there will clearly be many job opportunities in the future. Several Council members said recruitment must start as early as middle school.

Future planning for nursing educational programs should center around planned growth to ensure that supply keeps up with demand. Council Chair Carolyn Friese, assistant administrator and CNO at St. Vincent Hospital, Green Bay, said while hospitals are saying they are "ok" right now as it relates to nurses, the situation will change soon.

"The projection is that the crossover year will be 2010, and at that time, we will begin to see a lot more nurses retiring from, rather than entering, the job market," Friese said. "We have to be careful with the messages that are returned to the nursing schools. While graduates might not find a position in exactly the department they want to work in, that does not mean that there is not a nursing position for them in Wisconsin hospitals."

The concern is that students may look for a job, not find the exact position that they were hoping for, and send a message back to the schools that there are not positions for them upon graduation. The danger in that message is that the schools could pull back on enrollment, only to find themselves trying to gear up quickly again in a very short period.

Connie Geier, immediate past president of the Wisconsin Society of Radiologic Technologists provided an overview of the projected supply and demand for the profession. There are 18 programs in Wisconsin that graduate about 275 technologists each year. "The average age of members in our profession is over 44, so our association has refocused on what we can do to ensure that we have an adequate supply of radiologic technologists in the future." In the past, Geier’s association focused on educational credentials.

WHA Senior Vice President Eric Borgerding reviewed the issues contained in the 2005-2006 Wisconsin Biennial Budget proposal. In addition to the Tobacco Tax and Medicaid, he mentioned WHA’s support of AB 246, relating to the technical college curricula and admission standards.

• Editorially, the Wisconsin State Journal and the Capital Times seldom agree on anything. That changed last week when both of the Madison-based dailies came out strongly supporting increasing the cigarette tax with new revenues devoted to funding health care programs like Medicaid, as well as anti-smoking initiatives. The Wisconsin State Journal referred to a higher cigarette tax as a user fee, noting that "just as gas tax revenue should pay for roads, so should cigarette taxes pay for health, prevention and cessation programs for smokers."

Both editorials chided Governor Jim Doyle and Republican leaders for their current reticence to embrace higher tobacco taxes, noting that "the public understands that raising the cigarette tax is much different than raising the sales, income, or property tax." The editorials noted deep and widespread public support, even from current smokers, for higher cigarette "user fees."

• Two dozen Wisconsin hospital and health system representatives will be in Washington, DC in early May attending the American Hospital Association (AHA) annual meeting and meeting with members of the state’s Congressional Delegation. WHA staff is developing Wisconsin-specific issue papers that will frame Capitol Hill office discussions. The position papers will focus on: Wisconsin hospitals’ commitment to transparency (public reporting of quality, safety, price and community benefit information); Wisconsin hospital physician and health profession workforce initiatives; Medicare and Medicaid payment issues and the growing "hidden tax"; and a developing Medicare audit issue that threatens essential family medicine residency funding.

Special kudos to WHA leaders who will help make this a meaningful advocacy activity.

• Our 2005 political fundraising campaign has begun with a hospital/health system-specific mailing last week. Our fundraising success over the past three years has been phenomenal…tracking well with WHA’s overall growth in advocacy effectiveness and stature.

We are no longer Healthy Wisconsin Political Action Committee. We’ve been renamed Wisconsin Hospitals Political Action Committee and Conduit to clear up confusion as to just who we are. Help us make the 2005 campaign the success required to match the growing expectations of elected officials and candidates who support our community hospitals.

Steve Brenton
President

To see a well-oiled grassroots machine, all you need to do is drive on over to Chippewa Falls and stop in at St. Joseph’s Hospital. The award-winning grassroots operation is always primed and ready to jump into action. In fact, WHA awarded St. Joseph’s with its first-ever advocacy award in 2002 because of their grassroots efforts and tremendous turnout during Advocacy Day.

When learning about the Medicaid priorities in this year’s budget bill, St. Joseph’s didn’t even blink before putting their grassroots machine to work. Using WHA’s Medicaid Grassroots Toolkit, St. Joe’s created a table display and placed it in a high traffic area outside the cafeteria.

"As I was setting up [the display] people were signing letters! I just love our colleagues - they are so engaged in this whole [process]," said Deanne Rubenzer, executive assistant to CEO David Fish.

The display allows employees to read about how low Medicaid reimbursement rates result in a "hidden health care tax," how increasing the cigarette tax by $1 could provide $640 million in new revenue to fund health care related programs and how St. Joe’s employees can play a positive role in impacting the state budget bill.

And they are making an impact…Over 400 letters are ready to be mailed to area legislators with hundreds more expected to go out!

"St Joe’s continues to serve as a benchmark for grassroots advocacy," said WHA President Steve Brenton. "We hope other hospitals will strive to match those efforts during the state budget bill process."

Good Samaritan Health Center in Merrill hosted Rep. Don Friske (R-Merrill) this week as CEO Mike Hammer and representatives from the American Cancer Society (ACS) sat down with Friske to discuss Medicaid issues in the budget bill and support for a $1 cigarette tax increase.

In discussing Medicaid, Hammer told Rep. Friske that Good Samaritan Health Center knows all about the "hidden health care tax." "For a procedure that costs $3,000," said Hammer, "we receive $80 in reimbursement."

In 2004 it is estimated that Medicaid paid Wisconsin hospitals, like Good Samaritan, just 55 cents for every dollar it cost to provide care to Medicaid patients—a total of $450 million less than what it cost hospitals to provide the care. Those costs are passed on to private payers in the form of increased insurance premiums.

To address the hidden health care tax, one of WHA’s budget bill priorities is increasing Medicaid outpatient reimbursement rates. The other budget priorities are enhancing Disproportionate Share Hospital (DSH) payments for hospitals that care for a high number of uninsured and government patients, and restoring Graduate Medical Education (GME) funding for teaching hospitals.

The Medicaid discussion also tied into talk of a $1 increase in the cigarette tax. In January, the WHA and ACS undertook an independent poll of Wisconsin residents regarding an increase in the cigarette tax. The poll found that 77 percent are in favor of increasing the tax by $1 per pack and devoting the revenue to health care programs. The poll also found that 79 percent said it would either make no difference in how they would vote or they would be more likely to vote for a candidate who supported the cigarette tax increase.

The $1 cigarette tax increase would provide $640 million in new revenue over the next two years, prevent 72,000 youth from ever starting to smoke and result in 44,000 current smokers quitting.

"Maybe this $1 increase would have stopped my mother from smoking," ACS volunteer Scott Doerr told Rep. Friske. "I hope that when you go to Madison, you let the Legislature know this is an important health issue."

Contact your legislators in support of Medicaid funding in the state budget bill and a $1 cigarette tax increase. To learn more, contact Jenny Boese at 608-268-1816.

We want to hear your grassroots stories. Contact Jenny Boese at 608-268-1816 or jboese@wha.org to report on your grassroots advocacy efforts.

Partners of WHA, Inc. (Partners), the non-profit, volunteer service organization affiliated with WHA, raised and donated a total of $3.39 million, through more than 400 fundraising activities, and volunteered 1.65 million hours of service to Wisconsin hospitals in 2004, as reported by Linda Fish, Partners President, at the April 21 WHA Board meeting.

Partners is made up of volunteer and auxilian groups at more than 80 Wisconsin hospitals. As of December 31, 2004, Partners had 13,523 adult members and 1,517 teen volunteers. Teen volunteers contributed an additional 73,733 hours of service to their hospitals in 2004.

Partners awarded 548 scholarships to students seeking health care-related degrees in 2004, amounting to almost $458,000. This is an increase of 48 scholarships and $50,000 over the scholarships awarded in 2004.

Fish thanked local hospital, along with WHA, for the support that they provide to the volunteers and auxiliary groups.

WHA Chair Ned Wolf said Partners is an essential organization in our state and added, "This report reflects the huge impact that Partners have in terms of hours they spend volunteering at, advocating for, and supporting our community hospitals with their time and dollars."

Founded in 1951 as Wisconsin Hospital Association Auxiliaries, Partners emphasizes volunteer service and participation in grassroots advocacy, public policy and community health education, and health career programs for Wisconsin hospitals. Additionally, Partners promotes leadership development offering resources and educational seminars to local hospital volunteer and auxiliary groups, and shares information on successful community health education initiatives, advocacy and fundraising activities and trends on volunteerism through a variety of channels, including its quarterly newsletter, Reaching Out.

FACT: More than 72,000 kids won’t start smoking if the cigarette tax is raised by $1 in Wisconsin.

FACT: More than 400 organizations in Wisconsin support raising the cigarette tax by $1.

FACT: When asked if they would support a candidate who votes for the increase, 58 percent of those who responded to a WHA/ACS survey said it would make no difference in their support of a politician.

All those facts, and more, are in the newest edition of "Your Doctor. Your Health," a magazine suitable for hospital and clinic waiting rooms published by the Wisconsin Medical Society. WHA contributed editorial content to this issue, and is working with Wisconsin Medical Society to distribute Your Doctor. Your Health to hospitals. A copy of the publication, along with a poster, is in this week’s packet. Both are available in quantity through WHA. To order, contact Shannon Nelson at snelson@wha.org or Mary Kay Grasmick, mgrasmick@wha.org, or call 608-274-1820.

The Wisconsin Chapter of ACHE is presenting a workshop entitled "Developing Mentoring and Coaching Skills" on June 24, following the adjournment of the Wisconsin Rural Health Conference.

Data has shown that mentoring programs are an effective way to offer guidance and support for health care executives who are entering the field or who are seeking career advancement. A mentoring relationship provides a safe environment in which those with less experience may learn from experienced executives.

Attendees will learn what mentoring is, how the process works and the benefits of a mentoring program. Additionally, attendees will learn how to identify individuals within their organizations to make the most of the mentor/protégé relationship.

This program has been developed and is presented locally by the Wisconsin Chapter of ACHE. The American College of Healthcare Executives has awarded one (1) Category I (ACHE education) credit hour to this program.

The presenting panel will include Francis Wiesner, FACHE, vice president and executive coach for Lee Hecht Harrison, who will act as moderator; Mark Hamilton, FACHE, vice president of ambulatory operations for UW Hospital and Clinics; and Frances Finley, FACHE, administrator for Aurora Medical Center of Oshkosh.

The conference will be held at the conclusion of the Wisconsin Rural Health Conference, on Friday, June 24, 2005, from 10:45 am to 12 pm at the Kalahari Resort in Wisconsin Dells. There is no cost to register for this event, but pre-registration is requested. A brochure with registration form is included in this week’s packet and on the Web site at www.wha.org. Easy, on-line registration is available as well.

For more information on the program content, contact Brett Norell, CHE, at 414-266-3137 or email bnorell@chw.org. For registration questions, contact Sherry Rabuck at 608-274-1820 or email srabuck@wha.org.

Gather the health care and hospital supporters in your community and head to WHA’s Advocacy Day on May 11 at Monona Terrace in Madison.

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.

The most important part of the 2005 Advocacy Day agenda is the visit with your legislator. WHA encourages you to make this a part of your trip to Madison on May 11.

This year’s Advocacy Day event is in the midst of the legislative effort to balance the 2005-2007 state budget, and a variety of health care related issues are involved. Now is the time to talk to your legislator about those issues that affect your hospital. During Advocacy Day, you’ll learn more about those issues and how to most effectively deliver your message to your legislator. Then, put what you’ve learned into action and share your thoughts at the Capitol.

We have set aside time at the conclusion of the Advocacy Day agenda to make your visit. You are welcome to make your own legislative appointments, and can find your legislator’s contact information in the Speak Up section of WHA’s Web site at www.wha.org/speakUp.

Also, WHA will gladly assist you in making your appointment. If you want WHA to schedule an appointment for you, call Angela Miloszewicz directly at 608-268-1801, by Monday, May 2.

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. You can register a variety of ways:

• Print the registration form from the Web site, complete and fax to 608-274-8554; or
• Email your registration information to Sherry Rabuck at srabuck@wha.org or call Sherry at 608-274-1820. Register today!

Join the organizations already registered.

Agnesian HealthCare, Fond du Lac
Aurora Health Care, Burlington
Aurora Health Care, Milwaukee
Beaver Dam Community Hospitals, Inc., Beaver Dam
Bellin Health Systems, Inc Auxiliary, Green Bay
Beloit Memorial Hospital, Beloit
Black River Memorial Hospital, Black River Falls
Boscobel Area Health Care, Boscobel
Children’s Health System, Inc., Milwaukee
Divine Savior Healthcare, Portage
Franciscan Skemp Auxiliary, West Salem
Franciscan Skemp Healthcare, La Crosse
Graef, Anhalt, Schloemer & Assoc., Inc., Madison
Gundersen Lutheran, La Crosse
Hess Memorial Hospital, Mauston
Hudson Hospital, Hudson
Lakeview Rehabilitation Center, Waterford
Luther Midelfort, Eau Claire
Marshall Erdman & Associates, Madison
Memorial Health Center, Medford
Memorial Medical Center, Ashland
Meriter Health Services, Madison
Meriter Hospital, Madison
Oconomowoc Memorial Hospital, Oconomowoc
Partners Health System, Inc., Berlin
Partners of Beaver Dam Community Hospital, Beaver Dam
Plunkett Raysich Architects, Milwaukee
ProHealth Care, Inc., Waukesha
Rural Wisconsin Health Cooperative, Sauk City
Sauk Prairie Memorial Hospital, Prairie du Sac
Shawano Medical Center, Shawano
St. Joseph’s Community Health Services, Inc., Hillsboro
St. Joseph’s Hospital, Chippewa Falls
St. Mary’s Hospital Medical Center, Green Bay
St. Michael Hospital, Milwaukee
St. Vincent Hospital, Green Bay
UW Hospital & Clinics, Madison
Upland Hills Health, Dodgeville
Wisconsin Hospital Association, Madison
Wm. S. Middleton Mem. Veterans Hospital, Madison

There’s still time to register for the May 11 "WHA/HAW Health Care Provider Legal Issues Program." Overviews and analysis of the current hot topics in health care law are the focus of the seminar, which will be presented by many of the top health care attorneys in our state, and will be submitted for 6 hours of continuing legal education.

Specific topics include:

• The Power and Art of Self-Disclosure
• What Happens When the Feds Come Calling at Your Hospital-What You Can Do About It
• Litigation Update
• Undocumented Alien Patients: Legal, Financial and Risk Management Challenges
• HIPAA Issues Inherent in Implementation of Electronic Health Records
• Institutional Review Boards: Current Challenges in the Protection of Human Subjects in Biomedical Research

The seminar will be held on May 11, from 9 am to 4 pm at the Madison Club in Madison. A brochure with registration form, as well as the option for on-line registration, is available at www.wha.org. As part of the agenda, registered attendees will participate in the luncheon and address by Governor Jim Doyle (invited) at WHA’s 2005 Advocacy Day, being held at the Monona Terrace that same day.

Performance-based contracting continues to show signs that it is gaining momentum within the Medicare program. Performance reports are now displayed on Medicare’s website. Also, the reduction in physician fee schedule conversion factors, which changes how physicians are reimbursed for Medicare services, is another sign that pay-for-performance is not going away anytime soon.

At this "dine and learn" workshop, learn how payment for performance operates and what hospitals and physicians need to know to get ahead of the curve and establish a means to evaluate these opportunities. Additionally, a case study of a provider-owned health plan’s pay-for-performance program will be presented, along with issues of concern by payers; points to evaluate in your agreements; and a look at the future of performance-based contracting.

Presenter Bill DeMarco has been working with both health plans and provider organizations in developing new incentive-based reimbursement and clinical improvement opportunities for more than 25 years. Co-presenter Maria Todd is a regular presenter for HFMA and specializes in analysis and negotiation of complex health care provider agreements, managed care contractual revenue audits and recovery projects.

The workshop will be held on May 23, 2005, from 6-8:30 pm at the Radisson Paper Valley Hotel in Appleton. The $60 registration fee includes dinner, the workshop and all materials. A brochure and 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.

Seven Wisconsin health care organizations have joined together to form what is referred to as a "node" in the Institute for Healthcare Improvement’s (IHI) 100,000 Lives Campaign. Organized by MetaStar, Wisconsin’s quality improvement organization, the node will disseminate improvement tools and provide support to health care providers throughout Wisconsin as they seek to improve the care provided to Wisconsin patients. Joining MetaStar in the node are the Wisconsin Hospital Association, Pharmacy Society of Wisconsin, Rural Wisconsin Health Cooperative, Wisconsin Medical Society, Wisconsin Nurses Association, and Wisconsin Organization of Nurse Executives.

The 100,000 Lives Campaign aims to enlist thousands of hospitals across the country in a commitment to prevent unnecessary deaths through the implementation of six changes in health care. These changes include: Deployment of Rapid Response Teams; Delivery of Reliable, Evidence-Based Care for Acute Myocardial Infarction; Prevention of Central Line Infections; Prevention of Surgical Site Infections and Prevention of Ventilator-Associated Pneumonia. The challenge put forth by IHI is to implement these changes in 18 months, from December 2005 to June 2006, to prevent 100,000 avoidable deaths.

The node will provide opportunities for hospitals to connect and share with one another through monthly conference calls and other activities. Technical assistance on quality improvement activities will be provided and supported by node members. MetaStar will provide interventions in support of AMI Care, Prevention of Surgical Site Infections, Prevention of Ventilator-Associated Pneumonia and Prevention of Central Line Infections. The Pharmacy Society of Wisconsin and the Wisconsin Hospital Association are conducting a Medication Reconciliation project, while Wisconsin Organization of Nurse Executives is taking a leadership role in a Rapid Response Team Initiative. Through the Rural Wisconsin Health Cooperative Roundtables, hospitals will have an opportunity to discuss interventions in various areas of the campaign.