At their April 3 meeting, the WHA Public Policy Council reviewed key aspects of the recently completed legislative session and ongoing budget repair bill discussions, affirmed Association principles guiding WHA’s position on licensing health care professionals and discussed several federal issues potentially impacting Wisconsin hospitals.

In beginning a review of the legislative session that ended on March 13, WHA Executive Vice President Eric Borgerding said that while their regular legislative work was completed, lawmakers now must find a way to deal with a shortfall to the state’s general fund, projected to be $650 million by June 30, 2009.

As previously reported, the size of the shortfall triggered a statutory requirement for Governor Jim Doyle to introduce a budget repair bill to address the deficit. Included in his proposal was the dramatically revised and improved hospital assessment, designed as a vehicle to draw down additional federal dollars while at the same time providing much-needed Medicaid payment improvements for Wisconsin hospitals.

The hospital assessment was included in the Senate Democrats budget repair plan, while Assembly Republicans did not include it, or any payment increases to hospitals, in their proposal.

In discussing the process surrounding the budget repair bill, Borgerding emphasized that agreement must be achieved by all negotiating parties.

"Governor Doyle, the Senate and the Assembly will ultimately need to agree on how to best address the projected deficit in the state’s general fund," Borgerding said. "To that end, there are some in the Legislature who may feel compelled not to find a complete solution to the budget deficit now, and instead only fill enough of the hole to get the state through to early next year," he added.

WHA President Steve Brenton also discussed the hospital assessment. He reminded Council members that the issue was taken back to the WHA Board in December, at which time the Board affirmed support for the revised funding mechanism as a viable approach to improving Medicaid rates for hospitals, contingent upon the proposal matching the Governor’s plan from last fall.

"The opponents of the assessment say it will increase health care costs, but the numbers clearly disprove those claims," Brenton told the Council. "What is certain, what is accurate is that continuing to do nothing about Medicaid payments, which is what the Legislature has done for over 12 years while at the same time expanding Medicaid eligibility, will ensure that health care costs continue to rise. No one needs to speculate about that."

WHA staff updated Council members on a number of specific proposals that were ultimately signed into law during this legislative session, including those related to: electronic medical records; granting state agency status to health care facilities in times of declared emergencies; remote dispensing by pharmacists; background checks for personal care workers; and requirements on hospitals for providing emergency contraception to sexual assault victims. (See article in the March 14 issue of The Valued Voice for a wrap-up of the legislative session.)

Staff discussed legislative proposals WHA was successful in modifying, but which ultimately did not pass, including those related to health care service pricing transparency. Also discussed was a proposal WHA opposed relating to a ban on mandatory overtime for nurses.

Also attending the meeting was Wisconsin Medicaid Director Jason Helgerson. Helgerson discussed Gov. Doyle’s BadgerCare Plus plan for providing affordable comprehensive health care coverage for all children in Wisconsin and eventually also for childless adults in the state.

According to Helgerson, BadgerCare Plus is part of Governor Doyle’s approach to health care reform – a targeted strategy that seeks to ensure that 98 percent of the state’s residents have access to affordable health insurance without a risky overhaul of the entire system.

"The Governor’s focus is on access," Helgerson said. "We have among the lowest uninsured rates in the country and this program builds on that…we are pleased to be working the WHA to achieve our shared goals."

Far from wanting to completely reorganize Wisconsin’s health care system, Gov. Doyle is instead focused on incremental health care reform, said Helgerson. He also acknowledged the Governor’s awareness of the many strengths of the state’s health care system, including Wisconsin’s recent number two national ranking in overall health care quality by the Agency for Healthcare Research and Quality (AHRQ) in their annual report. "The state on its own cannot solve all the problems in health care," Helgerson said.

The state continues to work on a federal waiver for the childless adults portion of BadgerCare Plus. Several WHA member CEOs will meet with Gov. Doyle to discuss the program and the waiver next week in Washington, D.C. while they are attending the annual AHA convention.

Brenton praised the proposal. "This is a terrific opportunity for Wisconsin to demonstrate something that is exactly what the federal folks in Washington are looking for," he said. "It uses innovation and a market approach to expand coverage to the uninsured."

WHA staff also requested feedback from Council members on legislative proposals from the recently completed session relating to the licensure of health professions. Citing ongoing problems and concerns with service levels at the Department of Regulation and Licensing (R&L), staff reviewed the Association’s guiding principles that would be used in determining WHA’s position on any proposals related to expansions of licensing or credentialing.

Comments from Council members affirmed that any proposals should not increase costs to hospital facilities or the professions, restrict access to health careers or compound the service level problems already plaguing R&L.

WHA staff provided updates on important Federal issues that could impact hospitals including recent CMS administrative actions, opposed by WHA, that make it more difficult for Critical Access Hospitals (CAHs) to relocate. Also discussed was the Critical Access Hospital Flexibility Act, supported by WHA, which would allow a CAH to choose between the current 25 bed count per day limit and a bed count based on an annual number of filled beds.

WHA staff also discussed the proposed cuts to Medicare in the federal budget, which were rejected by Congress and the Recovery Audit Contractor (RAC) program which is attempting to identify improper (over/under) Medicare payments (see related story). Both of these issues will be on the agenda when WHA members are in Washington, D.C. next week to meet with Wisconsin’s Congressional delegation as part of the AHA annual convention.

The next meeting of the Public Policy Council is scheduled for July 8.

Burnett County Circuit Judge Michael Gableman was elected to a ten-year term on the Supreme Court on April 1 beating incumbent Justice Louis Butler. Gableman became the first challenger to beat an incumbent Supreme Court justice in 40 years and is only the fifth challenger ever to unseat an incumbent justice.

Observers expect that Judge Gableman’s election to the Court changes the judicial ideology of the Court back to a 4-3 majority of judicial conservatives that existed prior to Justice Butler’s appointment to the Court in 2004.

"What most defines me as a candidate is I think I want to return the seat on the State Supreme Court currently occupied by my opponent to its more modest and restrained role of applying the law, not making it," Judge Gableman said in a March 7 interview describing his candidacy on Wisconsin Public Television’s "Here and Now" program. "I am a judicial conservative. The definition of a judicial conservative is one who gives a fair application to the plain language of the law. Put another way, we apply the law."

Justice Butler, who was appointed to the Court by Governor Doyle, sided with the majority on a number of Supreme Court cases that weakened Wisconsin’s favorable medical malpractice climate. Most notably, Justice Butler sided with the 4-3 majority in Ferdon v. Wisconsin Patients Compensation Fund to declare Wisconsin’s 1995 medical malpractice non-economic damage caps unconstitutional. Wisconsin passed a new medical malpractice cap in 2006.

The next election for Supreme Court will occur in April 2009 when Chief Justice Shirley Abrahamson’s current 10-year term on the Court expires.

WHA’s Recovery Audit Contractor (RAC) Task Force met this week to discuss how to prepare Wisconsin hospitals for the RAC program, which is slated to arrive here as early as January 2009. The RAC program is designed to find improper Medicare payments (both over and underpayments) and has been running as a demonstration in California, Florida and New York. RACs will roll out nationwide by 2010.

Divine Savior Hospital CEO Michael Decker began the meeting with introductions of the multi-disciplinary Task Force, which includes compliance, legal, controllers and government relations professionals. WHA Senior Vice President George Quinn provided an overview of the RAC program to date, including problems encountered in the three demonstration states.

Vice President of External Relations and Member Advocacy Jenny Boese updated the group on federal legislation, HR 4105, supported by WHA. HR 4105 would place a one-year moratorium on the RAC program and it is one of the issues WHA members will discuss with Members of Congress next week while in Washington, DC.

Brian Potter, WHA vice president of finance, updated the group on what other states and the American Hospital Association (AHA) have already done or are planning to do to help hospitals deal with RACs. WHA General Counsel Laura Leitch discussed the latest member advisory from AHA, which outlines ways hospitals should be preparing for RAC audits.

Task Force Chair Decker then led a discussion on how the group should proceed. After much discussion, the Task Force identified the following three consensus areas on which to concentrate its efforts:

1. Legislative Advocacy—The group felt it important to engage legislatively where appropriate. They indicated they would rely on WHA’s current grassroots program, HEAT, for notifications on how to help.

2. Preparation for RAC audits—The group felt communication and education as well as developing appropriate tools and/or guidance should begin immediately to assist hospitals now for the coming of the RAC.

3. RAC Relationship—The group felt it will be important to develop a strong relationship with the RAC when it is selected.

Watch The Valued Voice for regular updates on the work and outcomes of the RAC Task Force. If you would like to share ways your hospital is preparing for the RAC, please contact WHA.

This column has suggested on several recent occasions that for most voters, health reform means getting a handle on health care costs—not coverage for all. Given that reality, recent headlines provide yet another wake up call, especially for those proposing a massive legislative solution.

Government health care spending is expected to double in less than a decade, fueled by demographics and surging utilization of new drugs and medical technologies. In a just released study, CMS is projecting that the federal/state/local price tag will reach $2 trillion by 2017. Medicare spending alone will increase from $430 million last year to almost $850 million in 2017. Expenditures of that magnitude, combined with private health care spending, suggest that health spending’s take of gross domestic product may surpass 20 percent (the number is currently 16 percent) in just nine years.

Efforts to retard the growth of Medicare spending through managed care appears to have had limited, if any, success (other than being a boon to a handful of commercial insurers). The relatively new Medicare drug benefit is popular with seniors, although deemed "inadequate" by some advocates. The drug benefit is already costing more in federal outlays than originally predicted—a common phenomena with unchecked entitlement programs. Calls to enhance the benefit by eliminating "the donut hole" could cost Medicare billions in new spending that’s not factored into the CMS projections. And "fixing" the flawed physician payment formula will cost billions more.

To "address" the Medicare spending "crisis" the Bush Administration has offered up a plan to radically reduce annual payment increases to hospitals and other providers. The plan, breathtaking in its magnitude, was rejected by Congressional budget committees a few weeks ago. But few are betting that payment reductions will not be part of a short-term budget deal that will be inked later this year. And that will be a two-year budget plan, not a multi-year, comprehensive approach necessary to address Medicare’s future. Inadequate provider payment has always been a hallmark of government health programs, and that won’t change anytime soon.

Among the lessons to be learned here is that even with provider "price fixing," the government’s second largest but fastest growing entitlement program has failed to address the "cost problem." Those promoting anything that looks like "Medicare for all" as their health reform platform owe us an explanation of their plan to pay for that approach.

Steve Brenton
President

Register for this free event by visiting www.wha.org. For registration information, contact Lisa Geishirt at 608-274-1820 or lgeishirt@wha.org.

Reminder: The deadline for making a hotel reservation at the Hilton Hotel in Madison is Monday, April 14. Call 608-255-5100 to reserve a room today.

The WHA Employee Pride Program set a new participation record this year. On May 1, WHA will recognize 75 health care employees at a special reception, dinner and ceremony at the Kalahari Resort in Wisconsin Dells.

Below 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 to WHA, or if your hospital has not submitted this information but plans to participate, contact Shannon Nelson or Mary Kay Grasmick at 608-274-1820 or email snelson@wha.org or mgrasmick@wha.org immediately. The deadline to submit the employee’s name to WHA was March 28, so ACT NOW if you plan to participate in this very special event.

Affinity Health System/St. Elizabeth Hospital

Aspirus Wausau Hospital

Aurora Medical Center Washington Co.

Aurora Medical Center Manitowoc County

Aurora Medical Group

Aurora Sheboygan Memorial Medical Center

Aurora Sinai Medical Center

Aurora St. Luke’s Medical Center

Aurora St. Lukes South Shore

Baldwin Area Medical Center

Beaver Dam Community Hospitals, Inc.

Bellin Health Systems

Berlin Memorial Hospital

Black River Memorial Hospital

Boscobel Area Health Care

Burnett Medical Center

Children’s Hospital and Health System

Columbia St. Mary’s

Community Memorial Hospital

Divine Savior Healthcare

Door County Memorial Hospital

Flambeau Hospital

Fort HealthCare

Franciscan Skemp Healthcare, La Crosse

Franciscan Skemp Healthcare, Sparta

Froedtert Hospital

Good Samaritan Health Center

Gundersen Lutheran Health System

Hayward Area Memorial Hospital

Howard Young Medical Center

Hudson Hospital

Lakeview Medical Center

Langlade Memorial Hospital

Luther Midelfort Chippewa Valley - Mayo

Memorial Health Center, Medford

Memorial Hospital of Lafayette County

Memorial Medical Center, Ashland

Memorial Medical Center, Neillsville

Mercy Health System

Monroe Clinic

Our Lady of Victory Hospital

Red Cedar Medical Center

Reedsburg Area Medical Center

Ripon Medical Center

Rogers Memorial Hospital

Sacred Heart Hospital

Sacred Heart-Saint Mary’s Hospitals

Saint Clare’s Hospital, Weston

Saint Joseph’s Hospital, Marshfield

Saint Michael’s Hospital

Shawano Medical Center

St. Clare Hospital & Health Services

St. Joseph’s Community Health Services

St. Joseph’s Hospital

St. Mary’s Care Center, Madison

St. Mary’s Hospital, Madison

St. Mary’s Hospital Medical Center, Green Bay

St. Mary’s Hospital of Superior

St. Nicholas Hospital

St. Vincent Hospital

Stoughton Hospital

SynergyHealth St. Joseph’s Hospital

The Richland Hospital, Inc.

The Wisconsin Heart Hospital

Tomah VA Medical Center

UW Hospitals and Clinics

Vernon Memorial Healthcare

Watertown Memorial Hospital

Waupun Memorial Hospital - Agnesian Healthcare

West Allis Memorial Hospital

Wheaton Franciscan Healthcare - All Saints

Wheaton Franciscan Healthcare - Elmbrook Memorial

Wheaton Franciscan Healthcare - St. Francis

Wheaton Franciscan Healthcare - St. Joseph

William S. Middleton Memorial Veterans Hospital

Register today for the Wisconsin Society for Healthcare Human Resource Administration (WSHHRA) annual conference, scheduled May 7-9 at the Kalahari Resort in Wisconsin Dells. The conference is open to all health care human resource professionals. Attendance is not limited to current WSHHRA members.

The registration deadline is April 16, but more importantly, the WSHHRA hotel room block deadline is Monday, April 14. No hotel rooms will be available at the Kalahari after this date, due to other large events taking place at the resort during that time. If you plan to attend the WSHHRA annual conference, it is recommended that you make both your hotel reservation and submit your registration form as soon as possible.

For local teenagers in Watertown and their friends at Watertown Area Health Services, the benefits of volunteering are a two-way street. This fall, Watertown Area Health Services introduced its new VolunTeen program. "The program provides a structured volunteering opportunity for those teens who want to give some of their time and learn more about health care careers," says Mary Schultz, volunteer program coordinator. "Because teenagers are so busy these days with activities and work, we structured the program in a way that hopefully minimizes scheduling conflicts and maximizes the benefit that the teens get from volunteering."

VolunTeens make a one-semester commitment to volunteering at Watertown Area Health Services. Every VolunTeen works from 4 – 6 p.m. each Tuesday night. Throughout the semester, the VolunTeens rotate their assignments in different areas of the hospital. This fall semester, Watertown High School senior Kallie Henze spent about six weeks in the hospital’s Inpatient Center, then rotated to her current assignment in the hospital’s OB department. After that assignment is complete, Henze will move on to working in the Rehab department. "I’m planning to attend UW-Oshkosh for nursing next year," says Henze. "This experience is a good way to learn about working in health care. I’d definitely recommend it to other students."

In addition to getting a good look at the way various hospital departments function, the teens are also finding it rewarding to bring a little something extra to their volunteer responsibilities. After spending several weeks with the residents at the Highland House assisted living facility in Watertown, Rachel McManama, a senior at Lakeside Lutheran High School, asked some of her talented friends from school to entertain the residents one evening. "They’ll be playing the piano and singing for the residents," Rachel says.

The fall 2006 school semester was the first opportunity for teens to be part of the VolunTeen program. According to Schultz, the mission of the VolunTeen program is, "Through volunteerism, we provide the enhancement of health care services at Watertown Area Heath Services, ensuring a quality health care experience for the greater Watertown community."

The VolunTeen program is for students 16 years and older who are willing to commit to working one night per week for one school semester to assist professionals at Watertown Area Health Services in enhancing patient care. Benefits to the students include the chance to explore health care opportunities, make new friends and valuable contacts, enhance opportunities for future employment, and earn academic and employment references. "I’ve always been interested in going into physical therapy," says VolunTeen Colette Swenson, a Watertown High School sophomore. "As a VolunTeen, I’m glad that I’ve had the chance to see how a physical therapy department works on a daily basis."

Areas of Watertown Area Health Services that have benefited from VolunTeens this semester include: radiology, Watertown Highland House (assisted living), inpatient center, obstetrics, and Rehab and Sports Medicine. "The teens who have volunteered in our department have been very helpful to us," says Carol Otto, of Watertown Area Health Services’ Rehab and Sports Medicine. "They take care of a lot of behind-the-scenes tasks and are very willing workers who ask what else they can do to help out."

Spanish-speaking individuals and families in Northeast Wisconsin have the option to visit a health clinic where excellent care will not be impeded by a language barrier. That’s because Bellin Health’s Clínica Hispana opened in early September.

All doctors, nurses and assistants at the clinic speak fluent Spanish. Dr. Jean Riquelme is the lead physician. Joining Dr. Riquelme at the clinic is Karen Sanchez, nurse practitioner. Dr. Clark Stevens, a Bellin Health Partner at OB/GYN Associates of Green Bay, provides obstetrical care at the clinic.

"Clínica Hispana is a great asset to those looking for medical care in the area," Riquelme said. "Being ill, or having a child that is ill, is often a taxing situation, even without a language barrier. Those who speak Spanish can now get the help they need without the stress of unfamiliarity with the language."

Spanish-speaking medical professionals are just the start of the Hispanic focus at the clinic. All forms and brochures within Clínica Hispana are printed in English and Spanish so patients will fully understand their tests, illnesses, treatments and other services. Signs also feature universal symbols to direct patients to additional services such as the lab and X-ray department at Bellin Hospital, located next door.

The initiative behind this clinic began because of the struggle many Spanish-speaking families faced in communicating their need for medical attention.

"Language should never be a deterrent from proper medical care," Riquelme said. "Northeast Wisconsin is home to a large Hispanic population, and the new Clínica Hispana is one way for Bellin Health to adequately provide the services they need."

Family members of all ages can be seen at the new clinic, including newborns in the hospital. Services available at Clínica Hispana include routine check-ups, Pap smears, immigration physicals and school physicals.

George Kerwin, president/CEO of Bellin Health Systems, will receive the Free Enterprise Award from the Rotary Club of Downtown Green Bay on May 5. The award recognizes people and organizations in Brown County that demonstrate American free enterprise. Kerwin is the 26^th recipient of the Free Enterprise Award. He joined Bellin Health in 1971, moving up throughout the organization and becoming CEO in 1992. Kerwin will receive a $1,000 donation to the charity of his choice as part of the Free Enterprise Award.

St. Joseph’s Hospital, Chippewa Falls, Gundersen Lutheran Health System, La Crosse, Aurora Sheboygan Memorial Medical Center, Sheboygan, and Aurora West Allis Memorial Hospital, West Allis, have been named Top 100 Hospitals for 2007 by Thomson Healthcare. Thomson Healthcare is a national provider of information and solutions to improve the cost and quality of health care. The award recognizes hospitals that have achieved ongoing excellence in clinical outcomes, patient safety and financial performance.

The study used by Thomson to determine the top performing hospitals compares short-term, acute care, non-federal U.S. hospitals that treat a broad spectrum of patients. The data comes from public sources including the Medicare Provider Analysis and Review (MedPAR) data set, the Centers for Medicare and Medicaid Services (CMS), Standard Analytical File (SAF) outpatient data set and the Medicare Cost Report. Balanced organization-wide performance reflects a hospital’s ability to provide highly reliable, efficient health care services and great value to patients, local employers, payers and the entire community.

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