This week was marked by a flurry of activity surrounding a proposal to increase Wisconsin’s cigarette tax by $1.

In a Wednesday, April 16 interview with WIBA radio, Governor Doyle indicated he might consider a $1 per pack increase if it were "locked away" and used for anti-smoking and health care programs.

According to the Legislative Fiscal Bureau, a $1 per pack increase in effect on July 1, 2005, would generate $640 million GPR over the 2005-07 biennium. If used for the state’s Medicaid program, that revenue would capture approximately $960 million in federal matching revenue – a total of over $1.5 billion in 2005-07.

Doyle also made it clear that if such a proposal were to come to his desk as part of the state budget, it would have to be large enough to have an immediate impact on smoking.

"If you are going to a tax increase, you only should go for a major increase," Doyle told WIBA. "The purpose of this, and there is a good argument for it... is if there is a sudden large increase, it has a substantial effect on the number of teenagers who begin smoking."

It is estimated that Wisconsin’s taxpayer-funded, cash strapped Medicaid program spends $375 million per year to treat smoking caused illness. It is also estimated that $450 million in unpaid hospital Medicaid costs are shifted to Wisconsin employers every year (see WMC story below).

"The unavoidable fact is that the poor reimbursement rates from Wisconsin’s Medicaid program, which for hospitals have not been increased in years, are driving up health care costs for state employers," said WHA Senior Vice President Eric Borgerding. "We think the cigarette tax should be tied to Medicaid, just like the state gas tax is tied to road building programs– essentially a user fee earmarked for a specific, dedicated purpose."

In another significant development this week, a bipartisan group of legislators announced plans to introduce the $1 per pack increase as legislation. At a Capitol press conference, Rep. Hines (R-Oxford), Rep. Benedict (D-Beloit), Rep. Bies (R-Sister Bay), Rep. Gielow (R-Mequon), Rep. Gottlieb (R-Port Washington), Sen. Jauch (D-Poplar), Rep. Owens (R-Oshkosh), Sen. Roessler (R-Oshkosh), and Rep. Wasserman (D-Milwaukee) called on the Legislature to both raise the cigarette tax and dedicate the revenue to Medicaid and anti-smoking programs.

"Medicaid is Wisconsin’s largest health insurer," said Rep. Curt Gielow, a former hospital administrator and Chairman of the Assembly Medicaid Reform Committee. "This is like a co-pay on those who smoke."

"I am delighted to stand shoulder to shoulder with my Republican and Democrat colleagues to support this effort," said Sen. Jauch. "For our colleagues who are reluctant to support this, they only need look at recent polls that show overwhelming support for a $1 increase. Well over two-thirds of the state supports this."

Rep. Mark Gottlieb, whose wife is a registered nurse at St. Michael Hospital in Milwaukee, minced no words about the situation with Medicaid. "My wife works in a hospital that serves many Medicaid patients," Gottlieb said. "We see the costs and stress this places on facilities that serve high numbers of Medicaid patients. If we don’t provide them with the resources they need, these hospitals will close."

The Wisconsin Manufacturers & Commerce (WMC), the state’s largest and most influential business lobby group, this week launched a series of radio ads calling on legislators to fix Wisconsin’s "Hidden Health Care Tax" – the $450 million in unpaid hospital Medicaid costs that are shifted to Wisconsin employers every year.

"Businesses in Wisconsin need to understand that the state underpays hospitals $450 million a year in the Medicaid program alone," said James A. Buchen, WMC vice president of government relations. "Those costs get shifted to private businesses in the form of higher health care premiums and amounts to a hidden health care tax."

At the last few meetings of the WHA Foundation Board, we have focused on what direction we would take in the future. We have three funding priorities:

1. Workforce development. The question is what can the Foundation do to improve the workforce crisis that faces Wisconsin hospitals? The Foundation currently is in the second year of funding health careers scholarships for students enrolled in programs at each of the state’s technical colleges. Several students who graduated in 2004 are now working in Wisconsin hospitals.

2. Quality and patient safety. We are looking at what the Foundation can do to improve quality and safety initiatives in our hospitals by providing some funding for innovative initiatives. The Foundation provided funding for the WHA CheckPoint program, which was used for Web site development.

3. Global Vision Partnership Award. The GVA started in 1993. Since then, 13 awards have been granted. In 2002, the Foundation took a break to reassess to see how we can best improve that program, and decided that we should continue the GVA program. The call for 2005 GVA submittals will go out in May with a deadline in August.

The value to our hospitals is that through the award recognition we are able to reward initiatives that can be showcased to other Wisconsin hospitals, who can then benefit from the award-winning initiatives. I sat on the GVA selection committee for three years, and I was impressed by the quality of the ideas that are coming from hospitals. The importance of the award is really overshadowed by the value of sharing these ideas. Several notable programs over the past few years were:

• Waukesha Hispanic Health Initiative, nominated by ProHealth Care/Waukesha Memorial Hospital
• IMPACT Child Development Screening Program, nominated by Columbia St. Mary’s, Milwaukee
• Angel of Hope Clinic, nominated by St. Francis Foundation/St. Francis Hospital, Milwaukee
• Brown County Child Passenger Safety Program, nominated by St. Vincent Hospital, Green Bay

In the area of workforce, the Foundation started giving technical school students scholarships. How well is that working?

As mentioned earlier, we realize that by providing scholarships, we can make friends for life for those who receive them—and we learned that 13 of the 15 2003-2004 scholarship recipients, who responded to a WHA survey, stayed in Wisconsin to work. We have awarded 20 scholarships so far this year to 11 technical schools. Last year we gave a total of 25, for amounts up to $2,000 each. It truly does help us "grow our own" workforce. This is something we want to continue into the future because we know it works.

Nearly 100 health care leaders, physicians and managers representing 62 hospitals and health care systems participated in the first of four Executive Leadership Teleconferences on Hospital Emergency Preparedness. The next teleconference will be held on April 20, 2005, from 1-2 pm. No registration is required. The theme of this teleconference will be "Executive Leadership’s Role in the National Response Plan" and will feature discussion on how to collaborate in managing disasters. In addition, input will be given on the availability of federal, state, and local assets to assist your hospital.

A PowerPoint presentation will be available for download on WHA’s Web site about one week prior to the teleconference. The toll free call-in number for this and all the other teleconferences is 888-296-1938; the identification code number is 972184.

Mass casualty incidents present new and unique challenges in all aspects of mitigation, planning, response, and recovery for hospitals. The "Hospitals’ Guide to Mass Casualty Events" documents the law as it is known and interpreted currently regarding emergency incidents.

This new Guide lays out the foundation of present legislation and regulation to allow the reader to begin to discover answers to questions in the law, as well as the gaps currently present. This Guide is the basis on which hospitals can begin to understand the law governing mass casualty events.

The "Hospitals’ Guide to Mass Casualty Events" will be reviewed and distributed at three seminars around the state scheduled for early June. Attendance is the only way to obtain a printed copy of the Guide. There is no cost to register for one of the seminars. You are encouraged to bring your disaster preparedness team to any of the three seminars, but WHA requests that each attendee is pre-registered.

The three seminars will be held from 10 am to 12 pm on the following dates at the following locations:

• Monday, June 6, at The Country Springs Hotel in Waukesha
• Tuesday, June 7, at The Plaza Hotel & Suites in Eau Claire
• Wednesday, June 8, at the Stoney Creek Inn in Mosinee

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. The Guide will also be available on-line at www.wha.org in late April and can be downloaded.

The Centers for Medicare & Medicaid Services (CMS) released its new Hospital Compare Web site at www.hospitalcompare.hhs.gov on April 1. Unfortunately, this was no April Fool’s Day joke. It’s clear that this initiative, while well intended, is a very flawed first attempt.

The Rural Wisconsin Health Cooperative (RWHC) has long advocated for the need for rural providers to engage in the quality improvement and public reporting movement, believing in the proposition that rural communities deserve and demand the same high quality as all Americans. And the Wisconsin Hospital Association (WHA), through the CheckPoint initiative, is especially proud of the near universal participation of rural hospitals in this important public reporting initiative. But as currently constructed, we do not believe that Hospital Compare fairly serves rural patients and communities.

Hospital Compare separates out into a secondary category over 1,000 hospitals, those that serve most of rural America. While hopefully unintended, the resulting presentation is easily misinterpreted as a statement that these Critical Access Hospitals are not "real" hospitals.

We had thought that the long embedded federal bias against hospitals serving rural communities had finally expired, but apparently not. A hospital does not need to do brain surgery or heart transplants to be a hospital; it needs to address the medical needs of its community in the most appropriate manner, and that is exactly what these hospitals do.

The reported labeling of the two groups makes a bad situation worse; the first group is called mainstream "acute care hospitals" and the second "small, geographically remote facilities"—implicitly labeling them less than "acute care." We doubt if any of the over 50 Wisconsin hospitals in the latter category regularly recognize themselves with the "remote" description.

While the operative word in Hospital Compare is "compare," this separating out of hospitals serving rural communities significantly impairs the use of the site by rural consumers. This is not a surprise as the "consumer focus" group that apparently led to this decision had few-to-no rural participants and was held in Maryland, a state with few if any hospitals like those segregated into the separate group.

There are alternatives to this clumsy approach. Wisconsin’s CheckPoint (www.wicheckpoint.org) is a good example of a public reporting site that is user friendly and deals with the same data, the same technical challenges without having to fall back on a discredited "separate but equal" organizing principle.

Moving forward, both RWHC and WHA will work with federal lawmakers, national organizations like the American Hospital Association and the National Rural Health Association, and CMS leaders to help make Hospital Compare worthy of the name.

Steve Brenton                                     Tim Size
President                                            Executive Director
Wisconsin Hospital Association            Rural Wisconsin Health Cooperative

Sen. Ron Brown (R-Eau Claire) and Rep. Rob Kreibich (R-Eau Claire) spent several hours at Sacred Heart Hospital and its Regional Cancer Center on Friday, April 1. The pair of legislators sat down with hospital representatives to discuss the state budget bill, particularly Medicaid reimbursement, the hidden health care tax and the cigarette tax, as well as tour the new Regional Cancer Center, a joint venture with Marshfield Clinic.

At the meeting, Susan Peiffer of Sacred Heart’s Regional Cancer Center discussed the importance of partnering with the state to ensure continued quality of care. Peiffer told both legislators of her commitment to implement efficiencies and do what she could to reduce costs, but added, "We are trying to do more with less, but we still need a little help from the state," referring specifically to the Medicaid outpatient reimbursement rates.

As the Legislature’s Joint Finance Committee wrestles with funding the state budget, both Medicaid and a $1 cigarette tax increase have been topics of importance to hospitals across Wisconsin; both were brought up at the meeting.

While hospital inpatient reimbursement rates continue to slip relative to cost, outpatient payment rates are proving equally atrocious. In 2004, it is estimated that Medicaid paid Wisconsin hospitals 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; that is a "Hidden Health Care Tax" of approximately $450 million. Those costs are passed on to private payers in the form of increased insurance premiums.

During that discussion, Rep. Kreibich indicated his support for the $1 cigarette tax increase to be used towards health care related programs like Medicaid. Concerned with the detrimental health impact of smoking, Kreibich said, "I support the $1 cigarette tax increase. Price, especially among younger people, is going to make the difference in whether they smoke or not."

In January, WHA and the American Cancer Society undertook an independent poll to gauge support in Wisconsin for a $1 increase in the cigarette tax "user fee" and use those funds to support health care related programs like Medicaid. Statewide support was an overwhelming 77 percent.

We want to hear your grassroots stories. Contact Jenny Boese at 608-268-1816 or jboese@wha.org to report a recent meeting or conversation you have had with your state legislators!

Covenant Healthcare System President Paul Dell Uomo saw the Greater Milwaukee Business Foundation on Health (GMBFH) study and knew he needed to take grassroots action. He drafted a letter to Milwaukee business and community leaders outlining key findings of the recently released study on Milwaukee’s health care profile, and then provided two tangible actions they could immediately take.

The GMBFH study found that underfunding of government programs results in cost shifting to commercial payers – the "hidden health care tax," as it has been called. The report concluded, "Government health care programs need to pay their fair share. The disparity in the indigent/charity care and Medicaid cost shifting burden must be addressed."

"Business and community leaders often ask me if there is a role they can play in addressing this issue," Dell Uomo wrote. He answered that question in a March 4, 2005 Business Journal Opinion Editorial and then provided in his letter two additional ways business and community leaders can be involved.

To address the cost shifting, Dell Uomo’s letter proposes two recommendations:

• Lobby legislators to take measures to ensure adequate funding for Medicaid.
• Support the proposed increase to the Wisconsin cigarette tax.

To address the hidden health care tax issue, Dell Uomo urges business leaders to follow the lead of Wisconsin Manufacturers and Commerce and call 1-800-362-9472 to tell legislators to stop this cost shifting by securing adequate funding for Medicaid.

Dell Uomo went on to highlight that Wisconsin’s current cigarette tax is 77 cents per pack, far below the national average. Raising this tax by a dollar per pack would generate an additional $300 million per year plus $450 million in federal matching dollars to help address shortfalls in the Medicaid program. "Not only will the cigarette tax prevent further rate cuts and future cost shifting, but it will also improve health. Businesses are encouraged to communicate support for this proposal to elected officials," Dell Uomo closed.

Join Covenant and hospitals across Wisconsin in our collective grassroots advocacy on Medicaid funding in the state budget bill. Contact your legislators today.

We want to hear your grassroots stories. Contact Jenny Boese at 608-268-1816 or jboese@wha.org to report a recent meeting, conversation or grassroots action you took on behalf of your hospital and the communities you serve!

Seven new members to the Wisconsin Quality Steering Committee were introduced to the group at the April 7 meeting in Madison. New members joining the group were: Lisa Benson, MD, Marshfield Clinic; Mike Shoys, Wisconsin Manufacturers and Commerce; Susan Turney, MD, Wisconsin Medical Society; Greg Simmons, MetaStar; Dan Schwartzer, Wisconsin Association of Health Underwriters; Kevin McCabe, MD, S.C. Johnson; Meg Gaines, JD, University of Wisconsin Hospital & Clinics; and Mark Moody, Wisconsin Department of Health and Family Services.

WHA President Steve Brenton, and Dana Richardson, WHA vice president of quality, described the release of "Hospital Compare," the national public report (www.hospitalcompare.hhs.gov). Richardson also briefed the group on the National Quality Forum’s project to identify priority areas for hospital measurement, of which she and Tim Size from the Rural Wisconsin Health Cooperative are participants. This group is charged with overseeing the endorsement of potential new measures for mortality, as well as care coordination.

Greg Simmons, president of Wisconsin’s quality improvement organization, MetaStar, presented information about the Institute for Healthcare Improvement’s (IHI) 100,000 Lives Saved Campaign. MetaStar will work with several state-level organizations to coordinate communications and improvement projects. Simmons said 100,000 lives could be saved if hospitals implement these six interventions:

• Deployment of rapid response teams;
• Delivery of reliable evidence-based care for acute myocardial infarction;
• Standardization of medication reconciliation (a measure which will be added to CheckPoint in 2005);
• Prevention of ventilation-associated pneumonia;
• Prevention of central line infections; and,
• Prevention of surgical site infection.

Chris Queram, CEO, The Alliance, discussed the Purchaser Consumer Disclosure Project. This project recently published a set of guidelines on the selection of provider performance measurement that purchasers, consumer groups, and health plans can use to avoid confusing or wasteful measurement efforts.

The Committee also reviewed the prototype of a joint Web site that is being developed by WHA and the Wisconsin Collaborative for Healthcare Quality (WCHQ). This Web site will serve as a single source for consumer access to Wisconsin-based health care reporting Web sites. The site will open in early May with access to the CheckPoint and WCHQ Web sites. Each initiative will also maintain their current sites.

The HIPAA Collaborative of Wisconsin ("HIPAA COW") has released a new preemption analysis titled "Reporting and Disclosing Information to Law Enforcement Agencies."

The HIPAA COW preemption analysis compares the federal HIPAA Privacy Rule’s permitted disclosures of protected health information to law enforcement officials with Wisconsin’s permitted and required reports and disclosures. Reports and disclosures of patient information to law enforcement officials present difficult issues for health care entities, issues that were complicated by the federal HIPAA regulations. The HIPAA COW analysis should prove to be useful for Wisconsin health care entities. HIPAA COW prepared its analysis with the assistance of the Wisconsin Department of Justice.

Gather the health care and hospital supporters in your community and head to WHA’s Advocacy Day on May 11. Governor Jim Doyle has been invited to address attendees during the luncheon, and you will have the chance to visit your legislators in the afternoon.

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

"Can you imagine the impact we will have as hundreds of grassroots advocates storm the halls of the Capitol during Advocacy Day, urging their legislators to fund Medicaid and increase the cigarette tax by $1?" asked Jenny Boese, WHA vice president of external relations & member advocacy. "I can’t tell you how important it is for legislators to know that hospitals and their employees are legislatively aware and active."

During the morning session, attendees will hear the wit and wisdom of Washington correspondent Mark Shields. Shields, who has spent 30 years covering American politics, has the unique ability to make audiences laugh and think. He will share personal perspectives and stories about Washington, DC and the importance of grassroots advocacy at all levels of government.

Following the luncheon, Christopher Kush, author of The One-Hour Activist and president of Soapbox Consulting in Washington, DC, will teach attendees tried and true tips for discussing issues with your legislators during his interactive presentation.

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 one of two 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 608-274-1820.

For assistance in scheduling your legislative appointments, 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!

In the last week, two hospitals — one on the East Coast and one on the West Coast — have reported that individuals posing as surveyors arrived at their facilities at approximately 3 am asking to survey different areas in the hospital. In both cases, hospital staff questioned the impostors, who then left.

For your organization’s safety, when Joint Commission surveyors arrive at your facility, it is imperative that you ask them to show their Joint Commission ID badge. Furthermore, when Joint Commission surveyors arrive unannounced, they will have a letter addressed to the head of the organization signed by Russell Massaro, M.D., executive vice president of Accreditation Operations for the Joint Commission, explaining who they are and why they are there.

If you have recently experienced a similar situation or experience this type of situation in the future, call Joe Cappiello, vice president, accreditation field operations, Joint Commission on Accreditation of Healthcare Organizations, at 630-792-5757. If you have any questions about whether an individual is a surveyor, do not hesitate to call your account representative or Joe Cappiello.

Agnesian HealthCare, Fond du Lac
All Saints Healthcare, Racine
Amery Regional Medical Center, Amery
Aspirus Wausau Hospital, Wausau
Aurora BayCare Medical Center, Green Bay
Aurora Medical Center, Oshkosh
Aurora Medical Center of Manitowoc County, Two Rivers
Aurora Medical Center of Washington County, Hartford
Aurora Sinai Medical Center, Milwaukee
Baldwin Area Medical Center, Baldwin
Bay Area Medical Center, Marinette
Bellin Health, Green Bay
Beloit Memorial Hospital, Beloit
Black River Memorial Hospital, Black River Falls
Boscobel Area Health Care, Boscobel
Burnett Medical Center, Grantsburg
Columbia St. Mary’s, Glendale
Community Memorial Hospital, Menomonee Falls
Dr. Kate’s Convalescent Center, Woodruff
Eagle River Memorial Hospital, Eagle River
Elmbrook Memorial Hospital, Brookfield
Fort Healthcare, Fort Atkinson
Franciscan Skemp Healthcare, La Crosse
Froedtert Memorial Lutheran Hospital, Wauwatosa
Gundersen Lutheran, La Crosse
Kindred Hospital Milwaukee, Greenfield
Lakeview Medical Center, Rice Lake
Langlade Memorial Hospital, Antigo
Memorial Health Center, Medford
Memorial Hospital of Lafayette County, Darlington
Memorial Medical Center, Neillsville
Memorial Medical Center, Ashland
Mercy Health System, Janesville
Mercy Medical Center, Oshkosh
Monroe Clinic, Monroe
Moundview Memorial Hospital, Friendship
Myrtle Werth Hospital, Menomonie
Orthopaedic Hospital of Wisconsin, Glendale
Prairie du Chien Memorial Hospital, Prairie du Chien
Riverview Hospital Association, Wisconsin Rapids
Sacred Heart Hospital, Eau Claire
Sacred Heart-St. Mary’s Hospital, Rhinelander
Saint Joseph’s Hospital, Marshfield
Saint Michael’s Hospital, Stevens Point
Sauk Prairie Memorial Hospital, Prairie du Sac
Shawano Medical Center, Shawano
St. Clare Hospital & Health Services, Baraboo
St. Francis Hospital, Milwaukee
St. Joseph Regional Medical Center, Milwaukee
St. Joseph’s Community Health Services, Hillsboro
St. Joseph’s Hospital, Chippewa Falls
St. Luke’s Medical Center, Milwaukee
St. Luke’s South Shore, Cudahy
St. Marys Care Center, Madison
St. Marys Hospital Medical Center, Madison
St. Mary’s Hospital Medical Center, Green Bay
St. Michael Hospital, Milwaukee
St. Nicholas Hospital, Sheboygan
St. Vincent Hospital, Green Bay
Stoughton Hospital, Stoughton
The Richland Hospital, Richland Center
The Wisconsin Heart Hospital, Wauwatosa
Tri-County Memorial Hospital, Whitehall
University of Wisconsin Hospital & Clinics, Madison
Vernon Memorial Healthcare, Viroqua
Waukesha Memorial Hospital, Waukesha

Corporate Report Wisconsin (CRW), a statewide business magazine, will feature all winners of the WHA Pride Award in a special section in their July issue. CRW approached WHA with the idea of further promoting the Pride Program to a much wider audience, in particular, to the business community. At the Pride Program award dinner on April 28, WHA will take photos of all the winners that will be used in the WHA newsletter, The Valued Voice. In addition, WHA prepares a news release for each winner and sends the release and a photo back to the hospital PR department for distribution to the local press. This year, photos will also be sent to CRW for inclusion in the supplement, at no cost to the winner or the hospital.

An opportunity to advertise in this special issue of Corporate Report Wisconsin is available. The specifics for purchasing an ad will be sent to the human resources department that submitted a Pride winner to WHA. For more information, go to the WHA Web site at www.wha.org/workforce/pride_program.aspx.

WHA is sponsoring a teleconference focused on the administration of pneumococcal vaccine to hospitalized patients. The teleconference will be held Thursday, April 28, 2005 from 9-10:30 am.

According to Nancy Hoffman, WHA director of quality, "We know that pneumococcal disease kills more people in the United States each year than all other vaccine-preventable diseases combined. We recognized by watching the CheckPoint data that there are opportunities for improvement in the number of appropriate patients vaccinated. There are a number of ‘success stories’ in Wisconsin hospitals where there have been dramatic increases in patients vaccinated."

Dennis Maki, MD, an expert in the field of infectious disease, and head of infectious disease at University of Wisconsin Hospitals, will begin the program with information on the vaccine for pneumococcal pneumonia and guidelines for administration of the vaccine to hospitalized patients. A representative from the Wisconsin Immunization Registry will discuss how to access the registry if a patient doesn’t remember having the immunization. Additionally, representatives from Wisconsin hospitals will share their success stories.

If you have questions about the conference, contact Nancy Hoffman at nhoffman@wha.org or call 608-274-1820.

We anticipate a high call volume for this teleconference, so please respond if you think you will participate by contacting Brian Competente at bcompetente@wha.org or call 608-274-1820.

Hospital and clinic laboratory staffers are on the front lines during emergency response. At six regional meetings in May, these laboratorians will learn the latest about the Wisconsin Laboratory Response Network (WLRN) for preparedness and response to bioterrorism, chemical terrorism and other public health emergencies.

"In CDC’s language, hospital and clinic labs are known as ‘sentinel laboratories’ because they’ll likely be one of the first to know if a terrorism event or public health emergency is happening as patients start presenting to the hospital or clinics for treatment," explains Dr. Peter Shult, Wisconsin State Laboratory of Hygiene Communicable Disease Division and Emergency Laboratory Response director. "Their involvement in the Wisconsin Laboratory Response Network is key to ensuring the public health system responds appropriately in a real or suspected emergency."

This is the second year for the WLRN regional meetings, which are sponsored by the Wisconsin State Laboratory of Hygiene. This year, infection control practitioners and emergency department managers are also invited. Local health department staff also attend the meetings.

Dates and locations for the meetings are:

May 3 - St. Croix Casino Hotel in Turtle Lake
May 4 - Park Inn Wausau in Wausau
May 5 - Radisson Hotel and Conference Center in Green Bay
May 10 - Country Springs Hotel in Waukesha
May 11 - Crowne Plaza in Madison
May 12 - Radisson Hotel La Crosse in La Crosse

More information and on-line registration can be found at the State Lab of Hygiene’s Web site: www.slh.wisc.edu/outreach/index.php.

Three medical malpractice crisis states – Texas, Ohio, and West Virginia - that enacted noneconomic damage caps in 2003 are showing signs of positive improvements in their medical liability environment. These states are following Wisconsin’s 10-year-old lead in enacting meaningful noneconomic damage caps to provide a stable medical liability environment.

Wisconsin has enjoyed a stable medical liability environment since the enactment of its current medical liability noneconomic damage cap 10 years ago (currently at $410,322 and adjusted yearly for inflation), and, according to the AMA, is one of only six states that are not experiencing problem signs or a medical liability crisis. Wisconsin does not have a cap on economic damages.

The ability of Wisconsin hospitals to attract and retain quality health care professionals and, therefore, provide affordable health care to Wisconsin citizens is particularly linked to Wisconsin’s noneconomic damages cap. The overwhelming evidence, both nationally and in Wisconsin, demonstrates that in states with meaningful noneconomic damage caps, such as Wisconsin, medical liability insurance premiums are lower than in other states. Wisconsin’s noneconomic damage cap is currently being challenged in the Wisconsin Supreme Court in Ferdon v. Wisconsin Patients Compensation Fund. The plaintiffs in that case are asking the Court to declare the cap unconstitutional.

Fewer than two years after the enactment of caps in Texas, Ohio, and West Virginia, those states are seeing stabilizing liability insurance rates for health care providers, more insurers entering the market, and physicians returning to the market. The AMA declared all three states to be medical liability crisis states because of rising medical liability insurance premiums that were causing physicians to retire early, discontinue high-risk procedures, and move to states not in crisis such as Wisconsin.

In 2003, Texas voters approved a constitutional amendment capping noneconomic damages at $250,000. An American Medical News article on March 28 reported that access to care, including obstetrical services, seems to be building as a result. It also reported that this year, several medical liability insurers have reduced their premiums between 12 and 30 percent from last year. To see the entire article go to www.ama-assn.org/amednews/2005/03/28/prl10328.htm.

West Virginia enacted a $250,000 cap on noneconomic damages in 2003 and is also seeing improvement in its medical liability situation. According to the West Virginia Board of Medicine, West Virginia had licensed 28 percent more new physicians in 2004 than it did in 2000. The West Virginia Insurance Commission also reported late last year that although medical liability rates continued to rise, the increases were less dramatic than in previous years.

Ohio also enacted a $350,000 noneconomic damage cap in 2003. According to the March 28 article, the increase in medical liability premiums have slowed from around 30 percent per year prior to the cap to between 10-20 percent per year after the cap, and two new insurance companies offering medical liability insurance have entered the state.

Meanwhile, Missouri became the latest state to enact tort reforms when its governor signed into law medical liability reforms including a single $350,000 cap on noneconomic damages. Missouri is included as one of the 20 states listed by the AHA as a medical liability crisis state.

Born out of the victories and defeats of the past, consumer-centric health care has become an increasingly significant strategy. Employers consider consumerism a viable solution to their high health care costs. Consumerism is a movement that seeks to protect and inform consumers by requiring certain practices and standards. The four determinants of health are genetics, access to care, environment, and behavior. Behavior, by far, has the most significant impact on personal health status and medical costs. As consumers, employees will be expected to make decisions about provider costs and quality as well as treatment options and expenses.

Carey Jury, vice president of the health division at Principal Financial Group states, "The first step in bringing down health costs is perhaps one of the most challenging - getting people to change their lifestyle and make healthier decisions on a daily basis. Research shows that American workers are beginning to take ownership of the health care cost issue. By getting active, eating right, and taking other such precautions to stay healthy, people will notice a decrease in trips to the doctor and pharmacy - saving them money."

Although a significant percentage of employees are open to health care initiatives and incentives, they may experience some reservations or information overload. Employers who have a systematic approach will build credibility and assurance. Giving employees a reason to change behavior that adversely affects their health, rather than requiring them to change, will set the tone for success.

Read the entire article in Solutions Spotlight, included in this week’s packet. Contact Jon Braddock at jbraddock@wha.org or Fred Bounds at fred.bounds@kunkel-bounds.com for more information on consumer-driven health plans, HSAs, and HRAs.

Charles Shabino, MD, will assume all leadership responsibilities for the Aspirus system and its subsidiaries as president and chief executive officer. Shabino has served Aspirus for 12 years as the chief medical officer. Shabino is board certified in pediatrics and medical management and is a clinical professor in the Department of Family Medicine at the University of Wisconsin Medical School. Shabino is immediate past chair of the Wisconsin Hospital Association, chair of the Wisconsin Patient Safety Institute, and he chairs the Wisconsin Quality Steering Committee.

"We are very pleased to name Dr. Shabino as president and CEO," said Stuart Carlson, chair of the Aspirus Board of Directors. "He has been instrumental in the growth of Aspirus as the leading healthcare provider in our region."

Paul Spaude, the current CEO at Aspirus, has accepted a position as president/CEO of Borgess Health Alliance in Kalamazoo, Michigan. Borgess Health Alliance has 130 sites of care, 67 specialty clinics in 15 different communities, and includes seven owned or affiliated hospitals. Borgess is a member of Ascension Health. Spaude will be leaving his post on June 3, 2005.

Spaude joined Wausau Hospital as its executive vice president and chief operating officer in 1985. He became president of Wausau Hospital in 1994 and chief administrative officer of Aspirus in 1996.

"Paul has not only been an effective health care administrator, he has also been a strong contributor to our community," Carlson commented. "He will be missed by the whole community."

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