This week the Senate and Assembly approved the compromise smoking ban agreement brokered by legislative leaders between the smoke-free coalition and the Tavern League of Wisconsin. Governor Doyle will sign the bill on Monday, May 18 at ceremonies being planned for Madison, Milwaukee and Green Bay.

The compromise, announced just last week after intense negotiation, sets a July 2010 effective date under which smoking would be prohibited in indoor workplaces across the state. Beyond the start date, several other changes led to the final agreement, including:

• Allowing outdoor smoking areas for private establishments.
• Revising penalties for individuals who violate the ban by smoking in prohibited areas to $100-$250.
• Revising penalties for establishment owners to a first offense written warning followed by a $100 fine for every subsequent violation. The changes also include language that allows business owners to demonstrate due diligence in attempting to stop their patrons from smoking.
• Providing an exemption for current cigar bars that generate 15 percent or more of their income from the on-site sale of cigars and pipe tobacco.
• Providing an exemption for current tobacco retailers that generate 75 percent or more of their income from the on-site sale of tobacco and smoking accessories.

During legislative floor debate, several amendments were introduced to modify the proposal, including those that would have exempted taverns, private clubs and veterans-only groups; applied the ban to casinos; and would have allowed hotels to designate certain percentages of their rooms for smokers. All of the amendments were defeated.

The bill was co-authored by Senators Fred Risser (D-Madison) and Michael Ellis (R-Neenah) and Representatives Jon Richards (D-Milwaukee) and Al Ott (R-Forest Junction), and included a bi-partisan list of over 30 cosponsors.

WHA joined several state and national advocacy groups, including SmokeFree Wisconsin, the American Cancer Society, the American Heart Association and several others in supporting a strong statewide smoke-free law.

Following a 2006 recommendation from the WHA Board that all hospitals go tobacco-free throughout their campuses, hospital leadership and staff across the state made the recommendation a reality. Today, 100 percent of Wisconsin’s acute care hospitals are already tobacco-free campus wide.

A fire at the Columbus Chemical Industries warehouse May 11 put the Columbus Community Hospital (CCH) disaster plan to the test as nearly 100 responders battled a blaze that eventually claimed the building. While the hospital did not evoke its full disaster operation, 19 firefighters and emergency responders required decontamination in the hospital emergency department’s negative air pressure/decontamination room. In addition to the 19, three firefighters were treated for injuries and later released.

CEO Ed Harding said the hospital set up a decontamination tent at the hospital, but because the initial decontamination process was started near the scene, the tent was not used at the hospital. Instead, it was determined after the initial decontamination at the scene that a much higher level of decontamination was required, so responders were transported to the hospital to receive the final, more thorough, decontamination. Harding said the decontamination process was completed in the hospital’s negative air flow decontamination room, which was installed in the new emergency department. That new room proved invaluable to the responders who could be thoroughly decontaminated in their own community without being transported outside of the area.

Harding explained the tent and partial funding for the decontamination room were provided through the Hospital Disaster Preparedness Program. The cost to install the decontamination room exceeded the dollars received from the program, but Harding said when the new emergency department was in the planning stages, the hospital felt it was an essential service to have in the community. Certainly, it proved true during this event.

More than 150 homes were vacated for more than a day due to the threat of the wind carrying the chemicals into the community. Environmental services employees monitored and adjusted the hospital’s air handling system throughout the night and into the next day to maintain air quality within the facility.

Harding said while hospitals practice disaster drills, it is difficult to tell how well everything will work during an actual emergency within the community. Everything went according to plan at CCH.

"I am exceedingly proud of the manner in which the staff of CCH responded to this event. We’ve trained hard to be prepared for disasters, but nothing can replace a real event," Harding said. "I witness staff living out our Mission and Values every day, but Monday evening we were tested, and we rose to the occasion."

For those who wonder if rural hospitals are capable of handing a disaster in their community, Harding said all doubt was removed in Columbus on Monday evening. "People tend to assume that urban areas are better equipped or more prepared to handle disasters than rural areas. The reality is that rural facilities know we have to rely heavily upon ourselves in these situations. We have to be self-reliant, and with this significant responsibility comes serious training and true preparedness," according to Harding.

Over the past several weeks Congress has been hard at work developing health care reform legislation. Right now all eyes are focused on the U.S. Senate Finance Committee, which has held three roundtable discussions focusing on Medicare payment reform options, insurance and coverage options, and health care financing options. The Wisconsin Hospital Association submitted a comment letter to the Senate Finance Committee on the Committee’s first options paper, Transforming the Health Care Delivery System: Proposals to Improve Patient Care and Reduce Health Care Costs.

WHA’s comment letter indicated belief that health care reform nationally should be a bipartisan process, should appropriately cover provider and physician payments, include necessary flexibility and build upon the current employer-based system. A few of the provisions WHA provided comment on are:

• Value-based purchasing – a logical next step on the quality frontier but not one to be used as a cost-cutting measure, must incorporate enumerated and consensus-based approved measures, and be done in a thoughtful manner
• Bundled payments – needs full vetting before implementation; current legal and regulatory restrictions must also be reviewed and/or removed.
• Hospital readmissions – a complicated issue with myriad factors involved, careful review and a targeted approach, if used, will be necessary
• Redistributing GME slots – support for strategies to ensure rural areas have access to primary care physicians
• Physician reimbursement fix – short-term fix is important but long-term fix needed
• Health information technology incentive payments to other health care professions – indicated concern with broadening the pool of recipients for HIT incentive payments when Critical Access Hospitals do not have full parity now.

The Senate Finance Committee released a second options paper after hearing from witnesses during their second roundtable discussion on health care coverage and insurance. The second paper, Expanding Health Care Coverage: Proposals to Provide Affordable Coverage to All Americans, included options related to:

• Non-group and micro-group reform
• Small group market reform
• Health insurance exchanges
• Low income tax credits
• Small business tax credits
• "Medicare-like" public health insurance option
• Changes to Medicaid, FMAP formula and DSH hospitals
• Temporary Medicare buy-in
• Personal and Employer coverage requirements (pay or play)
• Promotion of prevention and wellness

The flood of health care reform (national) and growing budget deficit (state) related headlines last week largely overshadowed what just might be the most important news of the week, maybe the year. That news was the Medicare Trustee’s Report to Congress that the Medicare fund will run out of money in 2017, 24 months earlier than last year’s forecast.

This new date has huge implications for health care reform. Never one to miss an opportunity to deploy a "crisis" to advance an ambitious domestic agenda, the new President and his senior advisors smartly jumped on the news to underscore the need to quickly advance the soon-to-be released reform initiative. Treasury Secretary Timothy Geithner, for example, said the only way to keep Medicare solvent is to "control runaway growth in both public and private health care expenditures." He added that the President intends to do just that in his reform plan. Details describing how the initiative will guarantee reduced spending is unclear but will be known soon.

On Capitol Hill, the usual group of sausage makers quickly responded to the gloomy news. One of the stranger quips came from Iowa Senator Chuck Grassley who opined at a legislative hearing that new funding might be found by eliminating the tax exemption currently enjoyed by the nation’s hospitals. The logic seems to be that since Congress will soon put an end to uncompensated care by covering everyone, just why would we need to continue the exemption? Grassley’s predictable poke at hospitals failed to take into account the fact that while charity care may go down a bit in the reformed world, bad debt and losses from government programs will almost certainly increase, probably a lot. And since when did charity care become the sole rationale for "earning" tax-exempt status? That certainly isn’t the case for other nonprofits.

It’s important to understand the intersection of Medicare’s mounting financial woes with the larger health reform issue. Why? Many Democrats support a "public plan alternative" as an essential component of comprehensive health reform. And a good many of those lawmakers (Nancy Pelosi, Harry Reid, Pete Stark, Henry Waxman, Dave Obey, John Dingell, Chuck Schumer, et.al.) readily offer up that "Medicare for all" should be the public/government option. So if Medicare is going broke, the "public alternative" (aka - Medicare), may seem to not be such a great idea.

Steve Brenton
President

This year’s conference is a great way for hospital executives, leadership staff and trustees to take advantage of great education, right in your backyard, at a fraction of the travel and registration costs of out-of-state events. And, make sure to take advantage of the "register 2, 3rd attendee free" special.

As part of the Robert Wood Johnson Aligning Forces for Quality (AF4Q) grant, quality improvement managers, nurse leaders, and others working in hospitals across Wisconsin are invited to participate in WHA’s Aligning Forces Sounding Board.

According to Stephanie Sobczak, WHA manager of quality improvement and project manager for AF4Q, "The purpose of the Sounding Board is to have ready access to a group of health care professionals that can provide timely feedback on the deliverables produced by our AF4Q Advisory Teams."

Two advisory teams are currently under way: quality improvement education & engagement, and nursing sensitive measures. Two more will be launched soon, one dedicated to helping hospitals improve HCAHPS scores, and another focusing on the needs of nurse leaders in engaging staff in quality improvement efforts.

The Advisory Teams will develop best practice information, along with many other resources related to quality improvement.

From time to time, the AF4Q Sounding Board will be asked to share their thoughts and ideas on Advisory Team products. Hospitals participating in the Sounding Board will be the first to see the outputs of the initiatives and will be on the ground floor for providing feedback on content and design. In the process, participating hospitals will have early access to education, strategies and lessons learned from state and national sources.

"The feedback we gather from our members will be vital to ensuring any outputs from this grant project are truly useful and valuable to hospitals in Wisconsin," said Sobczak.

Judy Murphy, RN, vice president of information systems at Aurora Health Care, was named by the Department of Health and Human Services on May 8 to the Health IT Standard Committee established by the recent American Recovery & Reinvestment Act. Murphy joins 22 others on the committee with technical expertise on health care quality, privacy and security, and on the electronic exchange and use of health information.

The Standards Committee is charged with making recommendations to the National Coordinator on Health Information Technology on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information.

In April, Judith Faulkner, president and CEO of Epic Systems in Verona, Wisconsin, was named to the Health IT Policy Committee by the Office of the Comptroller General. Also established by the American Recovery & Reinvestment Act, the 20-member Policy Committee is charged with making recommendations to the National Coordinator on a policy framework for the development and adoption of a nationwide health information infrastructure, including standards for the exchange of patient medical information.

For more information on the committees, see http://healthit.hhs.gov.

Pharmacists are among the most difficult health professionals to recruit, particularly in rural areas. But, hospitals can improve their chances of recruiting pharmacists by offering clinical rotations to pharmacy students.

In a recent column published in AHA News, Henri R. Manasse, Jr. executive vice president and CEO of the American Society of Health-System Pharmacists in Bethesda, Maryland, said hospitals that offer this training find they have enhanced recruiting opportunities leading to lowered vacancy rates and reduced recruiting costs.

Pharmacy students are required to complete 300 hours of introductory experiential education during the first three years of pharmacy school and 1,440 hours of advanced experiential education during the fourth year. About half of these experiential hours are to be obtained in hospital and health system settings. While many hospitals serve as student training sites for medical, nursing and other allied health professions, more hospital sites offering experiential training for pharmacy students are needed.

Wisconsin has for many years had only one school of pharmacy—the University of Wisconsin-Madison School of Pharmacy. Beginning in fall 2010, Concordia University–Wisconsin will open a second pharmacy school.

According to Judy Warmuth, WHA vice president, workforce development, there is no shortage of highly-qualified students eager to enroll, but a new school and more students create an even greater impetus for hospitals to consider hosting pharmacy students. She urges hospitals to consider offering a clinical rotation to pharmacy students.

"We can’t afford to stand back and watch what happens as pharmacy students seek training opportunities in other settings. We need to create relationships with pharmacists-in-training if we expect to be competitive in attracting them back to our hospitals," according to Warmuth. "I see setting up a pharmacy clinical rotation not only as an opportunity for hospitals, but also a responsibility, because of the critical role that hospital pharmacists have in our delivery systems."

According to Manasse, a recent national study revealed that about 25 percent of hospitals do not accept pharmacy students, and many of the remaining hospitals may only take students on an occasional basis. Other data show that 16 percent of hospitals that currently take students are planning to reduce the number of rotations that they offer.

"If we don’t take aggressive steps to adequately train the future workforce, the talent pool of qualified pharmacists available to hospitals will certainly suffer," according to Manasse.

WHA has not surveyed its members to obtain comparable data, but Warmuth says both pharmacy programs in Wisconsin are interested and actively looking for hospital-based clinical learning experiences. She suggests hospitals and hospital pharmacies explore creative ways to provide experiential education in an effort to meet the demand for clinical opportunities for pharmacy students while creating a pool of students that want to become hospital pharmacists.

Hospitals interested in exploring learning opportunities can contact the directors of Experiential Learning at either or both Wisconsin pharmacy programs:

• At University of Wisconsin Madison: Mara Kieser, makieser@pharmacy.wisc.edu or 608-262-6168
• At Concordia University of Wisconsin: Doug Meyer, doug.meyer@cuw.edu or 266-243-2757

If you have questions, concerns or a success story about your current pharmacy student experience, please contact Warmuth, at jwarmuth@wha.org or 608-274-1820.

Columbia St. Mary’s is seeking candidates for two top administrative positions:

• President and CEO of Columbia St. Mary’s Hospital, Milwaukee and Sacred Heart Rehabilitation Institute and Executive Vice President of CSM, and;
• President and CEO, Columbia St. Mary’s Hospital, Ozaukee and Executive Vice President of CSM.

The first position, President and CEO/ EVP of St. Mary’s Hospital and Sacred Heart Rehabilitation Institute serves as a member of the Columbia St. Mary’s Executive Council, the most senior strategic team of the health system. He/she helps shape the strategic direction of the health system. The president/CEO/EVP of St. Mary’s Hospital, Ozaukee is responsible for the overall administrative management and operation of the Ozaukee Campus and other system-wide responsibilities.

Losing a child through miscarriage, stillbirth or infant death is very emotional and can be hard to deal with for families. Upland Hills Health’s Obstetrics and Social Services Departments see the need for these families to be able to acknowledge and remember their losses.

A group of bereavement counselors specially trained in pregnancy loss organized "A Time to Remember," an event to honor those babies who have died through miscarriage, ectopic pregnancy, stillbirth or infant death.

The event highlights Pregnancy Loss Awareness Month, designed to bring awareness about what causes pregnancy losses and the emotional struggle they can be for families.

The event, held in October, is free to all and gives families the chance to remember their lost babies, network and socialize, and speak with bereavement counselors if they choose to.

Tomah Memorial Hospital staff, including Obstetrics Registered Nurse Teresa Wilkinson inspected the car seat of 10-month-old Matthew Copiskey of Tomah during "Seat Check Saturday" in the south parking lot at TMH on September 20. Copiskey is the son of Jeremy and Nicole Copiskey of Tomah.

Tomah Memorial, along with the Tomah Police Department, Monroe County Car Seat Coalition and Tomah Rotary Club sponsored the event, which included complimentary child safety seat inspections.

Three out of four child safety seats are improperly installed in vehicles according to research by the National Highway Traffic Safety Administration (NHTSA). That’s why Tomah Memorial Hospital, Tomah Police, Monroe County Car Seat Coalition and Tomah Rotary Club teamed up for the event.

"It’s the responsibility of every parent and caregiver out there to make sure their children are safely restrained – every trip, every time," Tomah Memorial Hospital Public Relations Coordinator Eric Prise said.

The Rotary Club also gave away four child safety seats.

During the past 30 years, NHTSA research also showed that 8,325 lives of children under age five have been saved by the proper use of child restraints.

Submit hospital community benefit stories to Mary Kay Grasmick, editor, at mgrasmick@wha.org.

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