April 25, 2008
Volume 52, Issue 17

• Governor Doyle Confirmed Keynote at 2008 Advocacy Day
• Medicaid Director Helgerson Says Goal is to Insure 98% of Wisconsin’s Residents
• Call for Nominations: 2008 Global Vision Community Partnership Award
• Petasnick Participates in McCain Economic Summit Panel
• President’s Column: Hospital Volunteers Deserve Recognition and Thanks for Astounding Community Service
• 2008 Wisconsin Rural Health Conference
• CMS Releases Proposed Inpatient Rehabilitation Payment Rule for Fiscal Year 2009
• Milwaukee Coalition Hosts National Cover the Uninsured Week Events
• Member News: Hudson Hospital Nurse Leader Receives AONE Scholarship
• Member News: Menomonee Falls Nurse Leader Receives AONE Research Grant
• Stories From Our Hospitals: Gundersen Lutheran Medical Center, La Crosse
• Stories From Our Hospitals: Columbia St. Mary’s, Inc., Milwaukee

WHA is pleased to announce Governor Jim Doyle is confirmed as the luncheon keynote speaker for the 2008 Advocacy Day scheduled May 15 in Madison at the Monona Terrace. You won’t want to miss it.

Fred Barnes will lead off as the keynote speaker. He is co-host of The Beltway Boys on Fox News. Barnes is also the cofounder and executive editor of The Weekly Standard. A legislative panel will highlight priority health care issues facing Wisconsin. Confirmed legislators for this panel discussion include: Senators Mark Miller and Ted Kanavas and Representatives Jeff Stone and Sheldon Wasserman.

Following the luncheon, WHA’s government relations team will provide insight on legislative issues to prepare you for your legislative visits that afternoon. These visits help show legislators that you care about your hospital and are watching what the Legislature is doing. WHA strongly encourages you to participate.

Attendance at Advocacy Day is expected to top 600 this year, with registrations already coming in from hospital employees, trustees and volunteers from across the state.

If you have never participated in Advocacy Day, this is your first step into effective grassroots advocacy. If you’re a long time attendee, you already know the value of participation. Either way, make your voice heard by attending on May 15.

This event is free of charge. For a complete brochure, log onto www.wha.org/education/pdf/2008advocacyday.pdf. For questions specific to registration, contact Lisa Geishirt at lgeishirt@wha.org or at 608-274-1820. For all other questions, contact Jenny Boese at 608-268-1816 or jboese@wha.org.

Sen. Mark Miller (D-Monona), Co-Chair Joint Finance Committee
Rep. Jeff Stone (R-Greendale), Joint Finance Committee
Sen. Ted Kanavas (R-Brookfield), Senate Health & Human Services Committee
Rep. Sheldon Wasserman (D-Milwaukee), Assembly Health & Health Care Reform Committee

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Wisconsin’s Medicaid Director Jason Helgerson is clearly proud of recent changes made in the state’s Medicaid program. Changes that he says have now made it easier to enroll beneficiaries and simpler to administer.

"Far too many families were falling through the cracks, so we combined three programs into one, streamlined eligibility, and added 42,000 individuals, 60 percent of which were children, on day one when we launched the new Badger Care Plus program," Helgerson said. "We’ve seen enrollment rise by 72,000. The vast majority of these people are very poor. They were eligible in the past but didn’t sign up. Streamlining our processes helped them apply."

Helgerson described to WHA’s Access and Coverage Task Force on April 16 what he called, "the path to comprehensive health reform," as having three phases:

1. BadgerCare Plus Insurance for All Kids (effective 2/01/08)

2. BadgerCare Plus Childless Adults Expansion (effective 1/1/09)

3. BadgerChoice/Small Business Health Insurance Reform (in development)

Helgerson said Governor Jim Doyle’s goal is to see that 98 percent of Wisconsin residents are insured. "A number of things the Governor wants to achieve in health care reform are highly consistent with what WHA wants to accomplish," according to Helgerson.

WHA President Steve Brenton agreed with that assessment, calling the Doyle Administration’s initiatives "a rare opportunity to advance health reform with bipartisan support from stakeholders committed to expanding coverage with an eye to cost containment."

The Doyle Administration has met with CMS and is currently seeking authorization to expand BadgerCare Plus to childless adults. Childless adults in Wisconsin are chronically uninsured, high users of uncompensated care. In Milwaukee County alone, they account for one-third of all emergency department visits. The Childless Adults benefits would be delivered through a managed care model and would be less generous than the Benchmark Plan. A physical exam and the completion of a health needs assessment are required to maintain coverage.

Also under development is a plan to address issues in the small business health insurance market.

"What reforms can we make in the small group market to help these people access health coverage? Our goal is to achieve near universal health insurance coverage and address the cost element. Among large businesses with 50 or more employees, 90 percent offer health insurance. Only 50 percent of the employers with fewer than 50 employees offer health insurance," according to Helgerson.

WHA President Steve Brenton commended Helgerson and the Administration for taking a measured and targeted approach to health care reform.

"We have many things to be proud of about health care in Wisconsin, including the quality of care provided, and we do not want to jeopardize those strengths with a risky overhaul of our entire system," said Brenton. "The Governor’s approach identifies the most urgent weaknesses and targets them with specific, achievable solutions. We are very much in alignment with that approach and are looking forward to learning more about the Governor’s next step — addressing health insurance premiums for small businesses."

George Quinn presented a gap analysis, comparing the Task Force principles on access and coverage to the situation as it currently exists. The table summarizing the analysis can be found at www.wha.org/financeAndData/accessAndCoverage.aspx. Task Force Chair Leo Brideau suggested that the analysis be expanded to include recommendations on how to address the gaps.

Joe Kachelski summarized the three presidential candidates’ health care plans at the task force meeting.

All of the candidates’ plans envision a larger role for the federal government in regulating health insurance, although the Clinton and Obama plans call for much more government involvement than does the McCain plan. All three also propose subsidies for individuals to help them purchase health insurance.

Senator John McCain proposes to eliminate the "bias" toward employer-sponsored health plans in the tax code, and instead offer tax credits ($2,500 single, $5,000 family) to help them purchase their coverage. The McCain plan is the most market-oriented proposal. It does not involve a mandate on either employers or individuals to purchase health insurance. The McCain campaign has not provided a cost estimate for the plan, but it is certainly the least costly of the three.

Senator Hillary Clinton would mandate coverage for all. Employers, except the smallest businesses, would be required to offer and pay for health insurance coverage for their employees. If they did not do so, they would be required to pay into a government plan that would provide coverage (a "pay or play" approach). Senator Clinton would also make tax credits available to low-income small businesses and individuals. Her plan is the most detailed of the three, and the most costly. The campaign estimates the cost at $110 billion per year, half of which would be funded by increasing taxes on high-income families and half of which is said to come from reductions in provider payments.

Senator Barack Obama has a nearly universal plan that would cost between $50 billion and $65 billion per year. It is also a "pay or play" proposal, but would exempt the smallest businesses. All children would be covered. Like the Clinton proposal, a new public program would be offered along with private health plans. Funding would come from tax increases on high-income families and reductions in provider payments.

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Honor one of your hospital’s community health projects by nominating it for a 2008 Global Vision Community Partnership Award, presented by the WHA Foundation.

This competitive grant award is presented to a community health initiative that successfully addresses a documented community health need. The Award, launched by the WHA Foundation in 1993, seeks to recognize and support ongoing projects that promote community health.

Any WHA member can nominate a community health project. The project must have been in existence for a minimum of two years and must be a collaborative or partnership project that includes a WHA member hospital and an organization(s) within the community. The official call for nominations for the 2008 Award is included in this week’s packet.

The Award will be presented at the WHA Annual Convention on September 18, 2008. Nominations are due July 1, 2008. Nomination forms can also be found on the WHA website at www.wha.org. For more information about the Award, contact Jennifer Frank at jfrank@wha.org  or 608-274-1820.

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Bill Petasnick, President and CEO of Froedtert & Community Health and the newly appointed chairman of the American Hospital Association, was among Milwaukee business leaders invited to participate in an economic summit with Senator John McCain April 16 in Milwaukee.

Petasnick was joined on the panel by Curt Culver of MGIC (and a Froedtert Hospital Board member); Jon Hammes, the Hammes Company; Paul Jones, A.O. Smith; Mike Knetter, UW School of Business, and John Torinus, Serigraph Incorporated.

Responding to a question about preparing the workforce for 21st century jobs, Petasnick commented, "Many new jobs in health care will be created, and workforce development must be a part of any broader health care reform agenda. We are beginning to experience shortages and know that there will continue to be growth in the high-tech, high-skill jobs available in health care."

McCain commented to the audience, "Bill is the president and CEO of one of the major health care providers," then asked "Bill, why is it that every time there is a new technology in health care the costs go up? In every other sector of the economy — when new technology is introduced, the price goes down, but in health care, the cost goes up."

Petasnick responded, "We have seen some efficiency as a result of technology, and we need to see more. There are a couple of issues. We have to ask — is all of the technology really warranted? Studies have shown that as much as 25 percent to 30 percent of health care provided is not useful. We have to evaluate the application of technology to make sure it isn’t just a marketing tactic, but truly meets a need. We also have to recognize that the new technology is being applied to people — that is different than other businesses."

"I think technology is having an impact on health care cost. Length of stay has dropped across the country. Froedtert’s length of inpatient stay is around five days — this is low, especially considering the very complex patients we serve. When I started in health care, cataract surgery included a seven-day hospital stay. Now, we do this on an outpatient basis. Technology does reduce costs."

McCain responded, "Could part of that increase in health care costs be a form of defensive medicine?"

Petasnick replied, "Some of the cost reflects the need for tort and liability reform. These are not the only issues, but they are important ones."

McCain responded, "Life is full of anecdotes, but I was in Pittsburg yesterday and a young medical school graduate told me that he has more than $285,000 in debt from medical school."

Petasnick responded, "Medical students are coming out with significant debts — $100,000 to $200,000. We need to include a review of education financing in health care reform, especially graduate medical education as a piece of the puzzle. These costs and debts have ramifications on who goes to medical school and in what specialties and areas of the country they decide to practice when they are done. Notably, the costs have limited the diversity of medical school classes. We have made progress in some areas. Fifty percent of medical school graduates are women, and we are proud of that. But, we need to do more to make sure that we are attracting medical school students who reflect the diversity of the patients we serve."

In his closing statement, Petasnick said, "If I were advising you on health care reform, I would ask you to build it on the following principles.

· Focus on Wellness. We know that wellness has a direct impact on costs and quality of life.

· Information Technology (IT) development. IT is a portal to affordability, facilitating care coordination and reduced duplication, especially in the Medicare population. There is a role for the federal government here. We are all investing in IT, and, too often, the systems don’t talk to each other. We need the federal government to set standards for interoperability.

· Care Coordination. With the aging of America, we need better care coordination, especially of patients with chronic illnesses. IT development could have a positive effect here as it relates to medical records. Today, if you go to four different doctors, each will run some of the same tests because they don’t have access to the medical record. Care coordination can help reduce duplication, reduce costs and enhance quality.

· Coverage for all. We need coverage for all, paid for by all. We need a system that creates incentives to get everybody covered. There are too many people outside the system now. The level of uninsured is reflected as a hidden tax on business. We need to address this. Fundamentally, we need to refocus health care on health and wellness. The health care system isn’t just hospitals. In fact, we should have a goal of improving health and keeping people out of the hospitals. I believe that you will see that the health care community will align and support these strategies.

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President’s Column
Hospital Volunteers Deserve Recognition and Thanks for Astounding Community Service

Next week (April 27 – May 3) is National Healthcare Volunteer Week…a very special opportunity to recognize the yeoman efforts undertaken throughout the year by our community volunteers who oftentimes are the first faces that patients and families see as they enter our facilities. And let’s not forget the Directors of Volunteer Services who organize and manage the countless activities undertaken by these very special hospital "friends."

Of special note is the incredible work of the Partners of WHA, the statewide organization of hospital volunteers whose documented contributions include:

• Cataloguing 1.26 million volunteer hours in 2007! Since the value of one hour of volunteer service has been calculated at $18.77 per hour, this is a $23 million contribution to Wisconsin hospitals.

• Raising and donating $2.26 million to community hospitals in 2007.

• Awarding almost $500,000 in academic scholarships to students interested in pursuing health careers.

• Writing hundreds of letters and placing numerous phone calls to state and federal lawmakers regarding important legislative issues that directly affect the ability of hospitals to serve patients, families and communities.

It’s also important to note that Partners have been among the strongest supporters of the ADVOCACY DAY program (May 15 this year), attending in record numbers year after year. You’ll recognize them because they’ll be the ones wearing red, white and blue. Their strong participation has made this program a real showcase for statewide grassroots political education and action.

A BIG THANK YOU once again this year to our volunteers for all they do to help differentiate our organizations and demonstrate the importance of connecting with our communities.

Steve Brenton
President

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"Living Great Leadership"
Plan today to attend the 2008 Wisconsin Rural Health Conference
The Osthoff Resort, Elkhart Lake *** June 18-20, 2008
The Osthoff Resort Room Reservation Cut-Off: May 28
Conference, Golf & Sailing Registrations: Due June 4 to WHA
More information and registration form can be found at www.wha.org

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On April 21, 2008, the Centers for Medicare & Medicaid Services (CMS) issued a press release announcing the release of a display copy of a proposed rule (Proposed Rule) that would update the prospective payment rates for inpatient rehabilitation facilities (IRF) for fiscal year (FY) 2009. In brief, the proposed changes include:

• CMG Relative Weights. The current case mix group (CMG) relative weights are based on FY 2003 data. For FY 2009, CMS proposes to update the CMG relative weights and average length of stay values using FY 2006 data.

• Outlier Threshold. For FY 2009, CMS proposes an outlier threshold of $9,191, which is estimated to maintain outlier payments equal to 3.0 percent of the total estimated payments for FY 2009.

• Wage Index Adjustment. To determine FY 2009 rates, CMS proposes to continue using the pre- reclassification and pre-floor hospital wage indexes.

• Policy Clarifications. In the Proposed Rule, CMS also seeks to clarify policies regarding "New England deemed counties" and multi-campus hospitals to be consistent with IPPS and other post acute care settings. CMS will update the IRF wage index tables based on the OMB bulletins used to update the hospital wage data.

• MMSEA. The Proposed Rule would implement aspects of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) by setting the compliance percentage at 60 percent for cost reporting periods beginning on or after July 1, 2006 and by continuing to count comorbidities when determining IRF compliance with the threshold. CMS would also update the IRF payment rates by 0 percent for FY 2009.

According to CMS, the Proposed Rule is expected to result in a decrease in aggregate IRF payments of $20 million for FY 2009. The Proposed Rule is scheduled to be published in the Federal Register on April 25, 2008. CMS expects to publish a final rule on or before August 1, 2008.

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The Milwaukee Health Care Partnership, in collaboration with an array of health, human service and advocacy organizations, will host a series of public awareness and outreach events to coincide with national Cover the Uninsured Week, April 28 to May 2.

"In 2006 it is estimated that 297,000 people of all ages across the state, including 39,000 people in the City of Milwaukee were uninsured all year," said Leo Brideau, president and CEO of Columbia St. Mary’s and chairman of the Milwaukee Health Care Partnership. "Living without health insurance is a risk that no one should have to take. National Cover the Uninsured Week is a chance to bring awareness to the burden that people endure by not having insurance. As a community, we need to work together to help make sure that all Milwaukee County residents know about health care programs and services that are available and help them take the first step towards gaining coverage."

National Cover the Uninsured Week aims to draw attention to the growing number and needs of people who are uninsured, advocate for affordable insurance coverage for all and reach out and enroll those individuals who may be eligible for health care assistance and have not already applied.

The Milwaukee Cover the Uninsured Week coalition will host events to increase awareness about Milwaukee County residents that are uninsured and underinsured. These events will educate advocates, providers, and volunteers about health care programs and services that are available for people that are uninsured and underinsured and will help them enroll in the available health care assistance programs.

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Hudson Hospital Nurse Leader Receives AONE Scholarship
The American Organization of Nurse Executives (AONE) announced Deb Brisch-Cramer, RN, MA, hospital VP and chief nurse officer, as one of two winners of its 2008 AHA/AONE Leadership Scholarship, a scholarship for nurse leaders from critical access hospitals. The scholarship fully supports attendance at both the 2008 AONE Annual Meeting and the AHA/Health Forum Leadership Summit.

The AONE Institute for Patient Care Research and Education has awarded Lynn Dunn, Community Memorial Hospital, Menomonee Falls, a seed grant to facilitate research in workforce development, patient safety, cultural competence, and leadership development. Dunn is one of six recipients of the 2008 Research Seed Grant Awards, selected from grant proposals submitted by members of the American Organization of Nurse Executives. She will be honored April 25-29 at the AONE annual meeting in Seattle.

The specific aim of this study is to determine the level of nursing satisfaction with the nursing governance model at Community Memorial Hospital and its perceived importance to professional nursing practice. It is through this model that nursing is influencing patient outcomes, professional growth and development and satisfaction within the work environment.

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Physical activity is important to everyone, no matter the age or fitness level. Recognizing a need for an exercise program geared toward older and less active adults, Gundersen Lutheran Health System, based in La Crosse, Wis., created a moderate intensity exercise program called Swing Into Shape. In a fun, safe environment, the class teaches safe movements for flexibility, muscle strength and endurance. Postural awareness, balance skills and coordination are emphasized through seated, standing and low-impact movements.

Physical therapists, fitness experts and gerontology specialists developed this safe and effective exercise program. Swing into Shape is offered as a class in the community. In addition, the video is provided for local cable access networks so that it can be seen on public television on various days and times. It is also available for purchase on videotape and DVD.

Albert Schweitzer, the medical missionary to Africa, once talked about the challenge in staying motivated because the impact of our work is often difficult to see. He said, "Not one of us knows what effect his life produces, and what he gives to others; that is hidden from us and must remain so, though we are often allowed to see some little fraction of it, so that we may not lose courage." The story from a parish nurse’s routine health education helps to illustrate Schweitzer’s wisdom:

Once a month at each parish after all the Sunday Masses I offer blood pressure screening and health consultation. Each month I try to have on hand information on a health issue that is timely or relevant. In December I handed out information on grieving during the holidays; in January I made available some articles on New Year’s resolutions. As February is designated American Heart Month I set out brochures on a variety of topics related to cardiovascular health. I can’t always gauge the impact the information will have but I set it out nonetheless.

Sometimes there is a great deal of interest in the information; at other times very little. This month and at one parish in particular, the cardiovascular information and especially that on women’s heart health was very popular and there were only a very few pamphlets left at the end of the day. In March I returned to the parish for their monthly blood pressure screening. A woman approached me. We had never spoken before, but I recognized her as a member of the choir, and I remembered that she had been one of those who had picked up some of the heart health information a month ago.

"I want to tell you something," she said. "Last month I took some of that information you had on women’s health, and I ended up with an angioplasty and a stent (placement)."

I looked at her quizzically and invited her to go on. "I had been having chest pain and shortness of breath but was afraid to have a stress test because a friend of mine died after having one," she continued. She went on to relate that emboldened by the information from the pamphlet she called her physician the next day, made an appointment for the stress test and by the end of the week had undergone a successful cardiovascular procedure. Three weeks later, she stood before me beaming and reported that she was free of chest pain and shortness of breath. "I just wanted you to know," she said.

Sometimes, I have found that the routine things, the little things, can have a profound impact.

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