Roughly 500 hospital advocates from across Wisconsin descended on Madison on May 11 to attend WHA’s annual Advocacy Day. Over 150 then turned up the heat by taking what they learned to the Capitol to meet with elected officials to tell them, "Make Medicaid a priority in the state budget!"

Advocacy Day is WHA’s premier grassroots event, bringing hospital administrators, employees and volunteers to Madison for a day-long program on WHA’s advocacy agenda. WHA Board Chair Ned Wolf kicked the event off by saying, "We greatly appreciate each of you for taking the time to come to Madison and participate in this important event and the legislative visits that follow."

Attendees heard from national political commentator Mark Shields on the state of politics today as well as from Washington, D.C. grassroots consultant Christopher Kush on effectively meeting with legislators. Governor Doyle addressed attendees over the lunch hour where WHA also gave out its top two advocacy awards. WHA’s Healthcare Leadership Award was presented to State Representative Sheldon Wasserman (D-Milwaukee) and its Advocacy All Star Award went to St. Vincent Hospital in Green Bay.

Advocacy Day 2005 couldn’t have been more perfectly timed, as the legislature is in middle of developing the state budget bill. Attendees learned about WHA’s budget priority, the "Medicaid Downpayment Plan," which seeks incremental increases in outpatient reimbursement rates, enhanced disproportionate share hospital payments and restoration of graduate medical education funding.

"Hospitals took an $80 million cut in Medicaid payments in the 2003-05 budget, and the worst is outpatient payments," Eric Borgerding, WHA senior vice president, told attendees. "Some hospitals are receiving $93 or less for intensive outpatient surgeries that costs thousand to perform. This cannot be sustained."

Medicaid is not just a hospital issue, as the underpayments to hospitals are having a growing impact on private sector employers. In 2004, $450 million in unpaid hospital Medicaid costs were shifted to employers, driving up the price they pay for health insurance. It is a situation labeled the "Health Care Hidden Tax" by the Wisconsin Manufacturers & Commerce (WMC).

"Wisconsin’s economy is on the rebound and growing, and the state is collecting more tax revenue than previously expected … the funding is there," Borgerding said. "Medicaid, and reducing the "Hidden Tax" must be made a priority, and we are ready to work with the Legislature and the business community to make it so."

For the third consecutive year, Governor Jim Doyle took time from his busy schedule to address the crowd.

"I want to thank you all for being here today," Doyle told the crowd. "And thank you for all that you do to make Wisconsin’s health care system the envy of the nation."

The Governor addressed several key issues in his remarks, including preserving Medicaid access and eligibility, long-term care cost and reforms, health care workforce, and heath care information technology.

"WHA has done a tremendous job operating the hospital data system since taking it over from the state two years ago," Doyle said. "It is a fine example of the government and private sector working together to make information more transparent and accessible to consumers."

The Governor also made it crystal clear that he strongly opposes regulation of health care, particularly in the area of hospital construction, expansion and renovation.

"I do not support certificate of need, or any other government regulation of hospital construction," Doyle said. "I have been there before, and it just doesn’t work. I believe in the free market for health care, where providers are competing on cost and quality and consumers and employers have transparent information to make smart choices."

Ford Titus, President and CEO of ProHealth in Waukesha, asked were the Governor stood on increasing the cigarette tax.

"I was burned a few years ago when the tobacco settlement was sold off to fill a one-time budget hole, because now that money is gone," Doyle said. "But as I have said in the past, if it (cigarette tax) is going to increase, it has to be a large number so kids will quit smoking. But I would only consider it if it were somehow walled off, placed in a lock box and used for preventing smoking and related illnesses."

"It seems to me the door is at least slightly open on the cigarette tax," said WHA President Brenton. "The Governor made it clear that he is reluctant to support an increase unless it is large and dedicated to health care programs. We couldn’t agree more, and believe the cigarette tax should be devoted to Medicaid – just like the gas tax is devoted to building roads."

Rep. Sheldon Wasserman (D-Milwaukee) was recognized for his outstanding efforts on behalf of Wisconsin hospitals by receiving the WHA 2005 Health Advocate Award. During his tenure in the Legislature, Wasserman, a physician, demonstrates time and again his strong commitment to health care policy.

In presenting the award, Paul Westrick, vice president of government & external relations at Columbia St. Mary’s, said of Wasserman, "As a legislator and physician, Sheldon is a leading advocate for health information and technology and has embraced its potential to improve the efficiency and quality of health care…[and] he has been one of the strongest proponents of letting the private sector lead in the development of new health care information tools."

As he accepted the award, Wasserman thanked the many volunteers and employees who make a difference in their communities every day because of who they are and what they do.

"You employ people in your community, you give people their future and you give people their health. There’s nothing more precious than health, and you give it freely and willingly…I salute you."

WHA’s 2004 Health Care Advocate of the Year was State Representative Curt Gielow (R-Mequon).

St. Vincent Hospital in Green Bay has been working hard to advance WHA’s Medicaid budget agenda in Madison. So diligently, in fact, they were named the WHA "Advocacy All Stars" for 2005.

At the helm is CEO Joe Neidenbach, who is committed to grassroots and provides leadership on its importance at St. Vincent.

"We had a Medicaid baby that spent 465 days in our hospital— Little Elizabeth, fat-faced kid, cute as a button. I went to her one-year birthday party in the hospital. We spent $1.3 million to get her to go home. We ended up with $250,000 in reimbursement from Medicaid. We need a better system. We’re going to fight for it; we’re going to keep working on it so we can continue to take care of the Elizabeths in the world," Neidenbach said in accepting the award.

Working closely with him is Sue Watts, who provides the resources to employees and volunteers. When asked, St. Vincent answered WHA’s grassroots call. They held important meetings with legislators, sent 100 letters and emails to those legislators and drove the issue of Medicaid funding powerfully home to those who are developing the state budget.

"WHA depends on hospitals like St. Vincent because there is no substitute for grassroots involvement," said Jenny Boese, WHA vice president of external relations & member advocacy. "They knew the issues, they worked with WHA, they engaged their elected officials, and they mobilized others to be involved. This is the heart of grassroots!"

WHA’s Advocacy All Star Award was first given out in 2002 to St. Joseph Hospital in Chippewa Falls, in 2003 to the Partners of WHA, and in 2004 to David Olson of Bay Area Medical Center in Marinette.

Almost 850,000 low-income patients received either charity care or had their debts "written off" by Wisconsin hospitals in 2003, the most recent year that information is available, according to data collected by the WHA Information Center.

On a daily basis, Wisconsin hospitals provide free or largely subsidized care to 2,315 patients, serving as the ultimate statewide health safety net. The community benefit comes at a significant price tag…$496 million per year, a 10 percent increase from 2002.

Importantly, Wisconsin is a national leader when it comes to publicly reporting information about hospital charity care and uncompensated care. And this just-released information demonstrates that despite an occasional news story to the contrary, Wisconsin hospitals are providing necessary care to all patients within the bounds of each patient’s ability to pay…which in some cases amounts to paying nothing.

Most Wisconsin hospitals have mission statements that discuss their commitment to serve and care for the poor and uninsured. This mission-driven, community-based commitment provides the foundation for charity care policies that strike a balance between serving the medically indigent and the hospital’s responsibility to obtain payment from those able to pay for their health care. As noted in our May 12 press release on this topic, financial aid in the form of billing and collection policies should not be viewed as a substitute for the responsibility of government to adequately fund coverage for patients in government health care programs like Medicaid and Medicare; nor should these policies eliminate personal responsibility for those able to pay. There is a balance here that Wisconsin hospitals clearly are recognizing and managing.

Steve Brenton
President

As a part of Saint Joseph’s Hospital/Ministry Health Care’s continued commitment to grassroots advocacy, legislators and hospital leaders gathered at Saint Joseph’s in Marshfield on April 29, 2005 to continue dialogue around budget issues and their impact on health care in Wisconsin.

Senator Julie Lassa, 24th Senate District (D), Representative Amy Sue Vruwink, 70th Assembly District (D) and Representative Robin Kreibich, 93rd Assembly District (R), were welcomed by Michael Blanchard, vice president of administrative services, who served as moderator for the forum.

Michael Kryda, MD, CEO, opened the discussion with the topic of the increase in the cigarette tax. He expressed concern for Wisconsin residents facing addiction to cigarettes, with recognition of the personal and societal cost incurred as a result of smoking. He reinforced the goal of reducing the number of smokers and increasing prevention efforts, while supporting the $1 cigarette tax increase, which could increase the state budget funding of the Medicaid program by over $300 million a year.

Each visiting legislator expressed a common concern for the health of Wisconsin citizens and shared some of the challenges faced in this upcoming budget period. As an example, Rep Vruwink discussed "Senior Care," a popular program with residents. She stated that federal dollars are being taken from Wisconsin, and as a result, the state will be required to provide additional funding to sustain the current level of service. Further discussion included a shared concern over the cost shifting from the Medicare and Medicaid Programs and the impact on employers and patients.

A discussion on addressing workforce shortages in health care took place. Sen. Lassa shared with the attendees that the UW system issues are very complicated, and the changes for them may take more time. Rep. Kreibich supported attempts to further integrate and allow additional credit transfers. On other health care staffing issues, Terri Richards, executive vice president, shared that Saint Joseph’s Hospital is currently in partnership with many institutions, serving as a clinical site for 800-900 students per year.

Dr. Kryda encouraged the restoration of Graduate Medical Education funding to the Medicaid Program, stating that "many residents who come to this campus stay here, and we need to sustain our commitment to this program." He also discussed the need to sustain a favorable medical liability environment to assist in recruiting and sustaining Wisconsin physicians.

Preceding a tour of the hospital facility featuring world-class technology and services, the forum members wrapped up the morning with a presentation on community benefits by Foundation Manager Ann Boson.

Board President John Nelson and Board Finance Chair Kathy Rhyner both concluded the discussion, stating, "finding the right balance between providing state of the art care and charity care can be extremely difficult, but Saint Joseph’s Hospital as a part of the Ministry Health Care System will continue to do both."

As a journalist, it was only fitting that Mark Shields stated his bias early to the large audience before him: "I have a great fondness for Wisconsin going back 40 years. There is no place that embodies the spirit and energy of America’s political system like the Badger State."

It is no wonder he appreciates Wisconsin—Shields cut his political teeth while working for Sen. William Proxmire, one of Wisconsin’s best-known senators, in Washington, D.C. Shields is a noted political analyst, a member of CNN’s Capital Gang, and a Washington Post columnist. He also is known for sharing his political wit and wisdom with audiences across the country.

Reflecting on the 2000 presidential election between George W. Bush and Al Gore, Shields said Americans entered the polls content with the direction of the country, but unhappy with the leadership.

September 11 had a profound influence on the 2004 election. Throughout history, Americans have chosen as their leaders those who have proven that they can lead in war times. Truman, Eisenhower, Kennedy, Ford and Bush, Sr. are all decorated war heroes. In 2000, the country believed that George W. Bush was the right person by a wide margin.

Shields said the USA is a country of contradictions. "We are first in gross domestic product, last in poverty. We are first in expenditures for education, last in student math and science testing," Shields said. "We are first in health care spending, last in health care coverage," he added.

"You know what that means. The cost and burden of health care has to be picked up, and too often, that means hospitals have to do it," Shields said. "That is a reality that has not seen political leadership. In my judgment, we need to grapple with it forcefully and honestly."

In closing, Shields said it is important to remember and reflect on what we have done as a people. "We have done great things, we have achieved remarkable accomplishments," Shields said. "We have a responsibility to work for and achieve greatness. We live with a truth: Each of us has been warmed by fires we did not build. We can do no less for those who come after," he concluded.

As part of the WHA Advocacy Day activities, in-house counsel, risk managers, compliance officers, and private attorneys gathered at the Madison Club for the WHA and the Healthcare Attorneys of Wisconsin Legal Issues Program for Health Care Providers.

The program featured attorneys Scott Taebel and David Snow, Hall, Render, Killian, Heath & Lyman; Guy DuBeau, Axley Brynelson, LLP; Colleen O’Connor Patzer and Julie Rusczek, Michael Best & Friedrich; Sarah Coyne, Quarles & Brady, LLP; and Alice Page, LaFollette Godfrey & Kahn, SC.

The presenters provided timely information concerning federal fraud and abuse investigations and self-disclosure, reimbursement for services provided to undocumented aliens, the implementation of electronic medical records, recent and pending health care litigation, and current challenges for hospital-based institutional review boards. WHA appreciates the generous support of the speakers for the program and their commitment to providing useful and timely information to WHA members. Photos and more details will be included in next week’s Valued Voice.

Hospital advocates used what they learned from Advocacy Day to go to the State Capitol and meet with their elected officials. Over 150 hospital employees and Partners of WHA volunteers met with legislators and told both personal stories about the need for increased Medicaid funding, as well as the financial impact of the hidden health care tax.

A meeting between hospital advocates from Northeastern Wisconsin and their legislator, Assembly Speaker John Gard (R-Marinette), demonstrated the effectiveness of hearing from constituents. During the meeting Speaker Gard acknowledged the powerful message hospital leaders and Partners had made regarding the need for Medicaid payment to be an important priority with legislators as budget decisions are made.

"We hear your message and will seek ways to try to accommodate hospital payment priorities in this difficult budget environment," Gard said.

Wendy Pelsis of Columbia St Mary’s drove her point home on the cigarette tax by telling a personal story. As she met with senior staff for Senator Alberta Darling (R-Menomonee Falls), she said, "I don’t care if raising the cigarette tax is politically popular or unpopular; it’s about saving lives. I see people come in every day who are diagnosed with lung cancer because of smoking, and there is nothing we can do for them. If I were an elected official, I’d think about that…."

At yet another meeting, St. Joseph Hospital’s (Chippewa Falls) 20-person contingent met together with Sen. Zien (R-Eau Claire), Rep. Wood (R-Chippewa Falls) and Rep. Moulton (R-Chippewa Falls). After that meeting, Deanne Rubenzer had this to say: "Many had never experienced such a legislative visit. People who never speak up - did. We feel now we understand the mind of our legislators and the Governor …we also feel they now have home-town stories that drove home the importance of getting that increase in Medicaid payments."

"We love that over 150 people put today’s grassroots training into action and met with their legislators. That equals meetings with about half of the legislature’s 132 members," said Jenny Boese, WHA vice president of external relations & member advocacy. "Next year, we’re aiming for visits to every one of those legislators!"

Grassroots advocacy is the heart and soul of an effective government relations program. The Hospitals Education & Advocacy Team (HEAT) gives you the information, the insight, the strategy and the assistance you need in order to be in touch with your legislators on issues of importance to Wisconsin hospitals. By joining HEAT, you partner with hundreds of hospital advocates across the state who want to make a difference on behalf of our hospitals and the communities we serve.

Join HEAT today and make a difference for Wisconsin hospitals!

Washington, D.C. grassroots consultant Christopher Kush educated and entertained the Advocacy Day crowd by providing practical tips on meeting with legislators and by involving attendees in interactive role-playing opportunities.

In preparing attendees for their legislative meetings, Kush told participants, "We have to stay on message. Each person can give a different story or statistic, [but] we all have to ask for the exact same thing." In WHA’s case, that message is to make Medicaid a priority in the state budget bill.

Kush provided insight into what he calls the "grassroots star of influence." In the first sphere, the electoral sphere, constituents have influence because they can vote, make political contributions to campaigns or volunteer on campaigns for candidates they support. Kush stressed that these actions put constituents in close proximity to people who influence public policy.

Kush told attendees by being at Advocacy Day they were in the second sphere, the legislative sphere. This sphere of influence revolves around communicating views to elected officials. "Personal stories work because they are compelling and motivating," said Kush, but added the other effective form of communication was the "formal argument."

Mark Schaefer of Froedtert Hospital in Milwaukee ended the day with this comment, "Christopher Kush showed us how to be an activist."

After attending WHA’s Advocacy Day, one attendee said, "You made us feel we could really make a difference." And Advocacy Day attendees did! Hospital administrators, employees and Partners made a huge difference by meeting with about half of the legislature’s 132 members or staff. Legislative visits were scheduled with:

Breske, Brown, Coggs, Cowles, Darling, Erpenbach, Hansen, Harsdorf, Jauch, Kanavas, Kapanke, Kedzie, Kerkman, Lassa, Miller, Olsen, Plale, Risser, Robson, Roessler, Schultz, Stepp, Taylor, Zien.

State Representatives:

Benedict, Davis, Fitzgerald, Freese, Gard, Gunderson, Hahn, Hebl, Hines, Hubler, Huebsch, Jensen, Jeskewitz, Kessler, Kleefisch, Krawczyk, Kreibich, Lamb, Lothian, Molepske, Montgomery, Moulton, Musser, Nass, Nerison, Petrowski, Pettis, Rhoades, Richards, Seidel, Sherman, Stone, Suder, Townsend, Travis, Vrakas, Williams, Young.

If you visited with your legislator or their staff, it’s always good grassroots etiquette to make sure to send him or her a thank you!

Senators Charles Grassley (R-IA) and Max Baucus (D-MT) introduced bi-partisan legislation, S.1002, coined "The Hospital Fair Competition Act of 2005," to address limited-service hospitals. The legislation will permanently extend the moratorium enacted by Congress, which is set to expire on June 8.

WHA President Steve Brenton has forwarded a letter to Wisconsin Senators Kohl and Feingold, alerting them to WHA’s support for the bill. "The Hospital Fair Competition Act of 2005 will prevent physicians from referring patients to hospitals they have sole ownership of – a practice that clearly creates a conflict of interest and prevents fair competition."

Brenton’s letter also pointed out that because physician owners tend to refer healthier, well-insured patients to the facilities they own, the full-service community hospitals are left to provide essential services that are seldom self-supporting, such as emergency services, burn units, trauma care and care for the uninsured. The potential result is less access to the care patients may need in an emergency.

S. 1002 would not apply to those limited service hospitals already in operation or under development before November 18, 2003, but would limit their growth and investor composition.

"Our Changing World of Rural Health" is the focus of the 2005 Wisconsin Rural Health Conference, scheduled for June 22-24, at the Kalahari Resort in Wisconsin Dells.

The event kicks off with an address by Leland Kaiser, PhD, renowned health care futurist, focusing on the conference theme, and is followed by a variety of interesting and pertinent concurrent sessions, including some devoted specifically to rural hospital board of trustee members. The conference will wrap with a discussion of current public policy issues affecting rural health, with a panel that includes Senator Dale Schultz (R-Richland Center), Senate Majority Leader; WHA President Steve Brenton, and Tim Size, executive director of Rural Wisconsin Health Cooperative.

Hospital administrators, chief financial officers, management staff, nurse leaders, physicians, and trustees are encouraged to attend this conference. The 2005 conference has been reviewed by the National Continuing Education Review Service (NCERS) of the National Association of Boards of Examiners for Nursing Home Administrators (NAB) and is approved for 16 clock hours and 7 participant hours. Additionally, for the first time, the Wisconsin Medical Society designates this education activity for a maximum of 7 category 1 credits toward the AMA Physician’s Recognition Award, so please encourage your physician leaders to attend as well.

The full conference brochure, with registration information, is included in this week’s packet and is available on-line at www.wha.org. Conference and golf outing registrations are due to WHA by June 8.

Conference attendees can make room reservations with the Kalahari Resort by calling 877-253-5466, and asking for a room in the WHA Rural Health Conference block, by June 1. The group rate is $129 for a basic room/$149 for a suite. Because the conference is during the busy summer season at the resort, the group rate will only be honored until June 1 OR until the room block fills, whichever occurs first. The special group rate will not be honored after the cut-off date of June 1, and no additional rooms will be held for conference attendees, so make your reservations early!

In an effort to play a part in improving the workforce crisis in Wisconsin hospitals, the WHA Foundation, Inc., has awarded 30 scholarships, worth approximately $38,000, to students obtaining health-related degrees from the state’s technical college system during the 2004-2005 school year.

This is the second year the WHA Foundation has provided scholarships to students in the final semester of a two-year, health-related degree program at any of the 16 technical college campuses in Wisconsin. Each scholarship winner is reimbursed for actual tuition and book expenses, up to $2,000.

Of the 30 scholarship recipients, 25 are pursuing associate degrees in nursing. Others are pursuing degrees in radiography, health information technology and physical therapy.

A unique twist to the Foundation scholarship program is that, unlike most scholarships, it covers tuition and book expenses for the final semester of the degree program, to assist and encourage students to make that one final push toward graduation and a career in health care. In a thank you letter to the Foundation, one scholarship recipient writes, "Your generosity at this particular point in time has alleviated the stress of additional educational costs for my family and for me."

Another recipient writes, "This scholarship will allow me to focus more fully on my studies and not on the cost associated with them and will help me to reach my goal of becoming a registered nurse… I will honor your investment in my education by my continued involvement in the community and the provision of professional, competent care to my patients."

During the 2003-2004 school year, the program’s first year awarding scholarships, a total of 26 scholarships, worth approximately $32,000, were awarded. Of the 26 scholarships, WHA Foundation is aware of 14 recipients who are now employed by Wisconsin hospitals. Efforts are now under way by WHA Foundation staff to gather employment information about all current, past and future scholarship recipients.

WHA’s Web site is now hosting the "Hospitals’ Guide for Mass Casualty Events." This 157-page document was created by the law firm of Michael Best and Friedrich through a grant given to WHA by the State of Wisconsin Hospital Disaster Preparedness Program. Attorney Shawn Guse and other attorneys from Michael Best, will be presenters at each of the three seminars sponsored by WHA. Hard copies of the legal manual will be given out at the seminars. WHA will not be mailing out copies of the guidebook, however, a printable, electronic version is available at www.wha.org. Pre-registration is required for participation in the seminars. To register, go to WHA’s Web site (www.wha.org) and click on Disaster Prep or find information in the education section. This will ensure that you will have a place at the seminar. The dates, times and locations are as follows:

• June 6, 10 am – 12 pm, Country Springs Hotel, Waukesha
• June 7, 10 am – 12 pm, Plaza Hotel and Suites, Eau Claire
• June 8, 10 am – 12 pm, Stoney Creek Inn, Mosinee

The Board of Directors of the Wisconsin Patient Safety Institute (WPSI) voted this past week to end current operations and transition ongoing functions to a new organization that will be administratively supported by MetaStar, the Madison-based health care quality improvement organization.

WPSI was founded in 2001 by a coalition of health providers, business and consumer organizations and individuals committed to enhancing, promoting and improving patient safety through education, research and collaboration.

"WPSI has been hugely successful in accomplishing its original mission to bring individuals and organizations together to identify best practices, share tools for change, and facilitate the exchange of knowledge and information that improves patient safety. Our commitment now is to build on the success we have enjoyed these past four years by transitioning to a new organization committed to carrying the mission forward," said WPSI Board Chair Chuck Shabino, MD, chief medical officer, Aspirus, Inc., Wausau.

WPSI Board members broadly supported the aim of the transition of WPSI from a freestanding agency to a forum supported by MetaStar. The new effort will maintain a convening role for current WPSI members, provide a continuing venue for communication among parties involved in patient safety, while focusing the majority of efforts on public education and consumer advocacy.

"WHA and many of our hospital and health system leaders were actively involved in the birth of WPSI and its formative years," said WHA President Steve Brenton. "We are now fortunate to have MetaStar as a new partner. MetaStar has a proven track record of improving quality and safety and is prepared to assume the lead role for the new organization."

A 1997 study noted that training alone can increase productivity in the workplace by 22.4 percent, while training plus mentoring can increase productivity by 88 percent. Increasing productivity and ensuring an effective return on your investment is important; however, equally important is the increase in job satisfaction and the accomplishments that employees report after participation in a mentoring program.

The overall goal of a mentor program is to assist risk management and patient safety leaders by enhancing their level of expertise and incorporating the critical elements related to a risk management foundation. Vision is clarified, organizational risks and/or opportunities for improvement are identified, specific goals are set, detailed plans are written, tangible products are developed, meaningful solutions are designed, and action is taken.

A mentor program should be flexible and individualized to an institution’s needs as well as cost effective. This is an investment and can be tailored for the new risk manager or the seasoned individual. The Risk Management and Patient Safety Institute has experienced mentors who are experts in the field and possess graduate-level education and/or risk management certification. If you would like additional information on a risk management mentor program for your facility, call 517-703-8464.

The U.S. Department of Health and Human Services’ Office for Human Research Protections and the Medical College of Wisconsin will host a full day Research Community Forum at the Medical College of Wisconsin in Milwaukee on June 2, 2005.

The forum, entitled "Human Research Protection: Striving for Excellence," will be open to anyone interested in human research protection. The target audience includes principal investigators, research coordinators and staff, IRB members, administrators and staff, institutional officials, research quality assurance and compliance professionals, medical personnel with an interest in human subjects research and medical and graduate students.