On May 15 the Senate overwhelmingly approved an amendment offered by Senate Finance Committee Chairman Charles Grassley, R-IA, and strongly supported by Senator Herb Kohl and Senator Russ Feingold, that provides significant relief for Wisconsin’s hospitals. By a vote of 86-12, the Senate added to the economic stimulus/tax cut bill language that adjusts the "labor share" for the wage index; permanently equalizes the standardized rate; equalizes Medicare disproportionate share hospital (DSH) payments; and increases flexibility and improves payments for critical access hospitals. WHA will provide a detailed analysis of the impact of these changes next week, but we estimate the overall impact to be over
$30 million per year.

By another overwhelming vote, 95-3, also supported by Sens. Kohl and Feingold, the Senate included in the economic stimulus bill $20 billion for state fiscal relief, including $10 billion to improve the federal share of Medicaid payments through Federal Medical Assistance Percentages (FMAP) under an amendment offered by Senators Susan Collins, R-ME, Ben Nelson, D-NE, and Jay Rockefeller, D-WV. WHA estimates the impact on the total Wisconsin Medicaid budget to be $174 million in the next two years, with the impact on hospitals at $18 million. In addition, the Senate passed an amendment authored by Sen. Jeff Bingaman, D-NM, which provides a temporary increase of the Medicaid DSH "floor" from 1% to 3%. If matched with state dollars, this could increase DSH payments to hospitals by over $80 million. At press time, the time frame for the temporary provision is unclear.

"The provisions within the Grassley, Collins and Bingaman amendments mirror WHA Medicare and Medicaid payment priorities and will provide enhanced payment for virtually ALL Wisconsin hospitals. We’re looking at tens of millions of new dollars annually in higher Medicare payments if these provisions are included in the final bill," said WHA President, Steve Brenton.

These provisions, tucked into the Economic Stimulus/Tax bill, will now be considered by the House- Senate conference committee, which is slated to begin work early next week. In conference, the Senate and House leaders must iron out differences between their versions of the stimulus/tax cut bills. The House bill does not contain any hospital payment improvements or state fiscal relief.

The Quality Initiative Steering Committee held its first meeting on May 14 in Madison. WHA President Steve Brenton told the group that the steering committee is responsible for working on the implementation of the public reporting effort, as well as charting the evolution of the project.

"We are committed to having a significant and expeditious evolution of this important project," Brenton told the group. "Your role is to help us define and shape that evolution."

Brenton said the purpose of the project is to encourage consumerism as it relates to the selection of health care services and to serve as benchmarks to improve quality within community hospitals. The project is an outgrowth of a WHA Board Planning session held almost a year ago when the Board heard from health care purchasers and learned what they are interested in having hospitals and health systems do in the area of providing information related to cost and quality.

Consumer input will be important, according to Dana Richardson, WHA vice president of quality, and one of the important tasks of the steering committee and the two subcommittees will be to find a clear way to incorporate that into the reporting and data products that are results of this project.

Nick Turkal, MD, medical director for Aurora Health Care, asked the committee to "seek feedback from consumers, and design the (reporting) with the consumer in mind so people get what they really need from us."

Greg Simmons, president of MetaStar, is enthusiastic about his organization partnering with WHA on collecting the data necessary to generate the report. "Getting these measures in front of the public is a good way to spur improvement. It seems to me that for Medicare, the public and for WHA members, this project is a winner all the way along," Simmons said. "We have substantial resources that we can use to help out on this project, and we are excited about collaborating on this with WHA."

Simmons said the Centers for Medicaid and Medicare Services will eventually mandate reporting on hospitals and it was smart to focus on indicators that are already out there. CMS has already released public reports on the quality of nursing homes and home health care (see related article in this newsletter).

The quality of the data is of the utmost importance, not only to consumers, but also to providers. Terri Potter, CEO, Meriter Health Services, and Glen Grady, CEO, Memorial Medical Center, Neillsville, both Steering Committee members, emphasized this point.

"I believe we want to be a reliable source of clinical and safety information for purchasers, providers, and consumers. To accomplish this, we need to include these four characteristics in our data; integrity, timeliness, relevance and accessibility," said Potter. "Of these four, accessibility is critical."

Sheila Jenkins, president, Network Health Plan, Menasha said, "What you measure is what people tend to focus on. The measures chosen should be those that really have an impact on quality so we can continue to improve the quality of care in the state."

Quality and leadership are important to James Mueller, president, Frank Haack and Associates, Milwaukee. "We (Wisconsin) want to be a leader in the country in our measurements and be the resource of choice. That is one way that we can measure the success of our own reporting effort," according to Mueller.

Turkal echoed Mueller’s comments, noting, "We can become the resource of choice for all groups, with the result being that consumers and providers are on the same page as to what they are looking at."

Educating the public on the use and value of measurements will be a task assigned to a subcommittee of the steering committee. The Education and Communication subcommittee will start their work this summer to find the best way to reach consumers with the information, determine how the information will best be distributed so it is easily accessible, and to build consumer input into the system so their feedback is received and incorporated into the project as it evolves.

Eric Stanchfield, secretary, Wisconsin Department of Employee Trust Funds, said his group is already sending information about the WHA quality reporting program to their 500,000 members. "Building up this initiative is an important thing. What positive reinforcements can we provide as purchasers to help ensure that we get close to 100% of the hospitals participating in this effort?" Stanchfield asked the group.

Charles Shabino, MD, chief medical officer at Wausau Hospital and Steering Committee Chair, said one of the tasks assigned to the Measurements Team is to continue to evaluate measures and to bring their recommendations back to the steering committee to ensure that the measures are current and appropriate for the end use. "If we are going to be a national model, the measures need to keep pace," Shabino said.

"In three years, when we look back on this initiative, it is my hope that is it not viewed as a ‘WHA initiative,’ but as a project that all of our organizations own. That was our intent in pulling this steering committee together, that it is a collective," Shabino concluded.

The Steering Committee will initially meet quarterly, more often if needed. For more information about the quality project contact Steve Brenton, sbrenton@wha.org , George Quinn, gquinn@wha.org  or Dana Richardson, drichardson@wha.org , or call 608-274-1820.

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This week, member hospitals received the materials necessary to participate in WHA’s Quality Initiative. Participation in the first phase of the public reporting program is an important step towards WHA’s goal of making quality information available to the public. The Quality Initiative has received an overwhelmingly positive response from WHA members, purchasing organizations, and other health care groups, including support from the Wisconsin Medical Society.

In this effort, WHA will collect and report hospital data on ten measures related to quality of care and five others associated with safety. An agreement between WHA and MetaStar will allow Wisconsin hospitals to submit data to MetaStar for the ten (10) clinical measures included in the WHA public reporting program. MetaStar will aggregate the data and supply it to the WHA for use in both Web and print-based applications. In addition to the clinical measures, hospital progress toward five safety goals will also be gathered directly from hospitals and reported.

A key objective of the public reporting program is consumer education. WHA has formed a subcommittee on education and communication that is charged with developing materials for consumers that will educate them on the use of the information, and show them how the information can be used to help them participate in decisions concerning their own health care.

The following diagram shows how data and information flow will support the first phase of the public reporting program.

We strongly encourage members to participate by completing and returning the agreements to WHA. For more information on the Quality Initiative, contact Dana Richardson, drichardson@wha.org , or George Quinn, gquinn@wha.org or call 608-274-1820.

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Last week, WHA’s PRIDE program dinner recognized employees from Wisconsin hospitals for their incredible essay testimonials on their reasons for being in health care and the personal experiences that keep them there. For those present, it was the pinnacle of proud moments recognizing the work we do.

Also last week, Senator Judy Robson announced that she intends to introduce legislation creating mandatory staffing ratios in Wisconsin hospitals. After hearing of the wonderful work done by employees and the special sentiments they feel about being health care workers, it was shocking to hear that staffing could and should be reduced to mere numbers.

Numbers arbitrarily created by the legislature are not the way to staff the patient care areas of Wisconsin’s community hospitals! There are too many factors that contribute to the shift-by-shift complexity of staffing. Patient needs (both the patients we already have in-house and those that may present), skills and knowledge of the available staff, seasonal issues such as flu-like problems in the winter and sports related injuries in the summer are examples. The idea that a single, correct number of staff can be legislated or that every staff member is equal to every other staff member is just incorrect. It’s also an insult to health care professionals.

Every hospital puts much time, effort and planning into patient staffing. Decisions are made continuously based on acuity tools, constantly varying patient need, unique attributes of the staff, and expert judgment of management staff. This leads to date and time specific answers to complicated questions, not the pre-set, pre-determined ‘one-to-six’ answer of a legislated mandate. I have spent much time making sure that the right number and mix of professionals were available to care for patients. Arbitrary staffing ratios might be easier. But they just wouldn’t be good for the patients, or the right thing to do.

Wisconsin is blessed with a great health care environment, an enthused and committed group of health care workers (I know, I read their essays) and hospitals voluntarily committed to quality and safety. I can’t imagine that an impartial, mandated staffing ratio could do anything but get in the way of providing outstanding patient care.

WHA developed a position paper on mandated staffing ratios, which is attached to this issue of The Valued Voice.

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"The budget is not even close to being Jello yet," Erpenbach said. "What do we do? We have a $3.5 deficit; we can’t nickel and dime this problem away."

Regarding the elimination of the Rural Hospital Supplement, Erpenbach made it clear that rural hospitals are important to Wisconsin, saying, "I don’t care where you are, you should have access to health care. Economics dictate where we work. We don’t want to strangle rural areas so they have to close their hospitals."

Donna Sollenberger, CEO, UW Hospital and Clinics, told Erpenbach that the elimination of Graduate Medical Education (GME) means that the entire first year of physician training at UWHC would not be funded. "We are spending $25 million a year to train residents. If GME is eliminated, 90 out of 322 resident positions would not be funded," according to Sollenberger.

He said he hopes that money can be restored to both the Rural Hospital Supplement and to the Graduate Medical Education program. Erpenbach also said that the cuts to the technical school "make no sense…they have jobs waiting and taking those cuts is counterproductive. The Republicans want more jobs, and getting students through the technical school and onto nursing is in line with that." He said this will be addressed as it goes through the legislature.

Erpenbach mentioned the Patient Compensation Fund and explained Gov. Jim Doyle’s plan to take money from this "huge fund" to fill part of the budget gap. Erpenbach said the state then has a responsibility to later replenish the fund. He noted that there has been discord over this proposal, "Legally, how do you do this? Well, the Governor is a lawyer and if it can’t be done, it won’t."

"I can tell you this: Once this budget is done, your staff at WHA will let you know what it means to your hospital, and if it adversely affects patients, let us know right away," Erpenbach told the group.

Within the next few days, the Joint Committee on Finance will decide whether to restore at least a portion of funding for the Medicaid Rural Hospital Supplement and the Graduate Medical Education. Governor Doyle’s budget proposal eliminated both the Rural Hospital Supplement in the 2003-2005 biennium - about $2.2 million all funds (state and federal) annually and the Graduate Medical Education 2003-2005 biennium - about $28 million all funds annually. Affected WHA members received two action alerts this week urging legislative contact on these issues.

The Wisconsin Hospital Association testified May 13 and 14 before the Senate Homeland Security, Veterans and Military Affairs Committee, as well as the Assembly Health Committee, in support of removing the "sunset" provision in state law regarding the State Trauma Advisory Council (STAC).

In 1997, WHA worked with the State Legislature to create Wisconsin Act 154 that established STAC as advisory to the Secretary of the Department of Health and Family Services. The purpose of STAC is to gather hospital, EMS, trauma physicians and public health officials together to develop a conceptual framework to create a trauma plan for the state. This plan was completed in 1999. Currently, STAC is working on implementing a regional trauma plan consisting of seven Regional Trauma Advisory Councils (RTACs) that are in the process of developing local protocols based on the resources found in each region. The work of STAC is ongoing and its work is far from being completed. Trauma systems throughout the state, when fully implemented, will enhance community health through an organized system of injury prevention, acute care and rehabilitation that is fully integrated with the public health system within a community and region. Trauma systems will have the distinct capacity to identify risk factors and related interventions to prevent injuries, and will maximize the integrated delivery of optimal resources for patients who ultimately need acute trauma care.

WHA thanks Sen. Ron Brown (R–Eau Claire) and Rep. DuWayne Johnsrud (R–Eastman) for their sponsorship of this legislation. Both the senate and assembly committees will hold an executive session on AB 281 and SB 115 in the near future.

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Hospital staff curious about the Centers for Medicare and Medicaid’s (CMS) plans for publicizing quality data may want to check out how the agency is handling data on home health agencies. CMS last week began publishing quality data on Medicare-certified home health agencies in eight states.

The data grades the agencies based on 11 quality measures covering issues such as patients’ improvement in walking and moving around, abilities to transfer in and out of bed, pain, bathing capabilities, dressing, and taking medication orally. CMS is publishing the data over the Internet, and is placing advertisements containing some of the data in 16 newspapers within the states.

Florida, Massachusetts, Missouri, New Mexico, Oregon, South Carolina, West Virginia, and Wisconsin are piloting the quality measure program, which will expand to all 50 states in the fall. 

Diane Peters, vice president, MetaStar, is in charge of nursing home and home health quality programs at MetaStar, Wisconsin’s peer review organization.  Peters said more than half of the home health agencies in Wisconsin participated in the first voluntary reporting effort.  After it was publicly released, Peters said the participants were pleased with the results, and the only calls that she received were from home health agencies that were not a part of report "and wished that they were." 

The program is part of a broad plan to give consumers better access to information in a variety of health care settings. CMS launched a similar program for nursing homes last year and is working more tentatively towards developing public quality measures for hospitals. Currently, the organization is working with a variety of organizations to encourage hospitals to voluntarily release data on 10 quality measures. WHA included information about the AHA quality effort materials that hospitals should have received this week to participate in WHA’s quality program.  If you did not receive participation materials, contact Dana Richardson,  or call 608-274-1820.   

Go to http://www.medicare.gov and scroll down to "Search Tools," then click on "Home Health Compare" to see the home health quality measures in the pilot states. Go to http://www.aha.org and click on "Quality and Patient Safety" to read the letter to hospitals.

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The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) released on May 9 for public review and comment a proposed new leadership standard that would address overcrowding in hospital emergency departments. The standard is part of JCAHO’s ongoing effort to seek solutions to what they term "a growing crisis, which puts patients at a high risk of experiencing treatment delays or inadequate care."

The draft standard calls on hospital leaders to develop and implement plans to identify and mitigate situations that result in emergency department overcrowding. Specifically, the proposal would call on hospital leaders to:

• Plan how to efficiently move patients through an organization, regardless of patient volume.

• Incorporate emergency department overcrowding into performance improvement activities.

• Use performance indicators to predict and monitor the capacity of individual support services and areas that receive emergency department patients.

• Plan for the care of patients who are placed in temporary bed locations.

• Coordinate community resources, such as long term care facilities, home health agencies and other hospitals, to expedite discharges from the emergency department.

• Coordinate with pre-hospital resources, such as emergency medicine services and air ambulances, to minimize diversions.

The draft standard is posted on the JCAHO Web site, www.jcaho.org, and has been sent to stakeholders for comments. The deadline for receiving comments on the proposed standard is June 2, 2003.

JCAHO’s Hospital Professional and Technical Advisory Committee and the Standards and Survey Procedures Committee (SSP) of the Board of Commissioners have reviewed the draft standard; the SSP will review and consider comments JCAHO receives regarding the draft standard before it takes final action to approve the standard for implementation. If approved, implementation of the standard is expected to be January 2004.

Emergency department overcrowding is the third in a series of key issues JCAHO is addressing through its public policy initiative. This initiative is designed to focus on critical areas related to patient safety and health care quality where JCAHO has established standards; but the desired impact cannot be realized until broader issues are successfully addressed. JCAHO brings together health care experts to discuss issues that are of greatest concern to health care leaders and workers and identify workable solutions. Roundtables on emergency department overcrowding were held in June and December 2002, in Boston, Massachutes, and a national symposium, Condition Critical: Meeting the Challenge of ED Overcrowding, was held February 24-26, 2003, in Boston.

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Health care professionals make a diffence in the lives they touch. This message comes through in all the essays that were submitted in this year’s 2003 Healthcare Employee Pride Program. Thank you to the 61 health care employees who took the time to write an essay that describes why they are in health care, and thanks to the 61 hospitals who participated this year. As you read the essays, notice that employees who tell their stories, also provide the answer to what inspires people to join health care, and what motivates them to stay. We look forward to even greater participation next year. The booklet is also available as a pdf at wha.org in the Workforce Section.

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Fitch Ratings, an internationally known financial rating agency, reports that the shortage of nurses and other personnel continues to present one of the greatest challenges for health care providers nationwide. Fitch says that while many hospitals are developing innovative strategies for workforce development, and federal, state and local governments are creating programs and providing financial support to help alleviate shortages, the benefits of many of these initiatives may not be realized for years.

Fitch believes recent legislative initiatives aimed at alleviating the nursing shortage are due largely to the success of hospitals drawing attention to the crisis. While most legislation that provides additional funding to health care providers is viewed favorably, Fitch believes restrictive laws aimed at quality, such as mandatory overtime restrictions and mandated nurse-to-patient rations, could negatively affect providers by requiring hospitals to employ more costly temporary nurses to meet standards.

The credit rating agency expects providers to continue to experience inflating salary and benefit expenses with growing use of temporary staffing and competitive pressure to increase overall compensation. Fitch expects labor cost inflation to offset any improvement in other areas from operational efficiencies or favorable rate increases from managed care payers, prolonging credit quality improvement for many hospitals.

Key statistics found in the report include:
6% -National Nursing Vacancy Rate, All Providers
13% - National Nursing Vacancy Rate, Hospitals
29% - Predicted National Nursing Vacancy Rate by 2020
16% - Highest National Nursing Vacancy Rate found in Florida, Maryland, Arizona
50% - National Turnover Rate of Staff Nurses, Nursing Homes
15% - National Turnover Rate of Staff Nurses, Hospitals
5.4% - Percent of Nurses Who are Male

National Vacancy Rates for Key Professionals
21% - Pharmacists
18% - Radiological technicians
18% - Billing coders
12% - Laboratory technologists

According to the Department of Health and Human Services, the demand for health care services will likely climb 40% from 2000-2020 versus a projected 6% growth in the number of nurses. Fitch believes that rising vacany rates are an early indication of future financial pressure. Not only are staffing costs likely to grow but volume may also be affected as capacity is constrained. In the meantime, they point out that revenue at the top five temporary staffing agencies is expected to increase 20% and earnings to rise 40% in 2003.

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Early contributors to the 2003 Healthy Wisconsin campaign have set a brisk pace for 2003. Leading the pack in early contributions are Aurora Health Care leadership and Covenant Healthcare System leadership. Already hitting 30% of the $125,000 goal, the brisk pace of giving sets the tone for another breaking year for hospital advocates.

This year’s goal includes reaching the $26,000 AHAPAC target for federal support. AHAPAC supporters are noted in bold on the honor roll below.

• Tim Size Rural Wisconsin Health Cooperative

• Steve Brenton Wisconsin Hospital Association, Inc.

• Ed Howe Aurora Health Care

• Jon Vice Children’s Health System, Inc.

• Ann Lucas Wisconsin Hospital Association, Inc.

• Eric Borgerding Wisconsin Hospital Association, Inc.

• Mary Starmann-Harrison SSM Health Care of Wisconsin

• Laura Leitch Wisconsin Hospital Association, Inc.

• Jodi Jensen Wisconsin Hospital Association, Inc.

• Paul Nannis Aurora Health Care

• Mark Ambrosius St. Luke’s Medical Center/Aurora

• Loren Anderson Memorial Hospital of Burlington/Aurora

• Paul Dell Uomo Covenant Healthcare System, Inc.

• Judy Warmuth Wisconsin Hospital Association, Inc.

• Susan Ela Aurora Health Care

• George Quinn Wisconsin Hospital Association, Inc.

• Lief Erickson Memorial Hospital of Burlington/Aurora

• Eliot Huxley Aurora Health Care

• Patricia Schroeder Covenant Healthcare System, Inc.

• Charles Shabino Community Health Care, Inc.

• Jack Steinman Aurora Health Care

• Joy Tapper Covenant Healthcare System, Inc.

• Rexford Titus, III ProHealth Care, Inc.

• Paul Spaude Community Health Care, Inc.

• Jon Braddock WHA Financial Solutions, Inc.

• Daniel Bonk St. Joseph Regional Medical Center/Covenant

• Kenneth Buser All Saints Healthcare System, Inc.

• John Goodenow Covenant Healthcare System, Inc.

• William Grundler Covenant Healthcare System, Inc.

• Raleigh Bruce James St Michael Hospital/Covenant

• George Johnson Reedsburg Area Medical Center

• Dean Kaster Covenant Healthcare System, Inc.

• Thomas Koehler Aurora BayCare Medical Center

• Gerald Lefert St. Marys Hospital Medical Center/SSM

• Daniel Manders Mile Bluff Medical Center

• Fred McGee Meriter Hospital

• Raymond Myers St. Joseph’s Hospital/HSHS

• David Olson Bay Area Medical Center

• Dana Richardson Wisconsin Hospital Association, Inc.

• Craig W.C. Schmidt Partners Health System, Inc.

• David Smith Covenant Healthcare System, Inc.

• Debra Standridge St. Francis Hospital/Covenant

• Bobbe Teigen Sauk Prairie Memorial Hospital

• Nick Turkal Aurora Health Care

• Charles Runge Froedtert Memorial Lutheran Hospital

• Karen Lautermilch St. Nicholas Hospital/HSHS

• Jeffrey Martin Ministry Health Care

• David Fish St. Joseph’s Hospital/HSHS

• Glen Grady Memorial Medical Center

• Rosemary Anton Covenant Healthcare System, Inc.

• Kimry Johnsrud Elmbrook Memorial Hospital/Covenant

• Mary Brenton Wisconsin Hospital Association, Inc.

• Mark Schwartz Aurora Medical Center Washington County

• Jennifer Frank WHA Financial Solutions, Inc.

• Roberta Riddle Wisconsin Hospital Association, Inc.

• Stephen Ronstrom Sacred Heart Hospital/HSHS

• Pat Dagnon Priairie du Chien Memorial/Partners of WHA

• Anne Ballentine Covenant Healthcare System, Inc.

• William Bestor Community Memorial Hospital/Froedtert

• Gary Bezucha Boscobel Area Health Care/SSM

• Lynn Carey Covenant Healthcare System, Inc.

• David Harper Covenant Healthcare System, Inc.

• George Hinton Aurora Sinai Medical Center

• Michael Karuschak Amery Regional Medical Center

• Jack Lockhart, MD Gunderson Lutheran

• James Malicki WHA Financial Solutions, Inc.

• Daniel Mattes Covenant Healthcare System, Inc.

• Eugene McMahon St. Francis Hospital/Covenant

• Jake Nunn St. Luke’s Medical Center/Aurora

• Greg Roraff Memorial Health Center, Medford

• Janet Schriner Covenant Healthcare System, Inc.

• John Kestly Shawano Medical Center

• Ed Harding Columbus Community Hospital

• Mary Kay Grasmick Wisconsin Hospital Association, Inc.

• Stephen Young WHA Foundation Board

• Patrick Brandel Holy Family Memorial

• Cynthia Eichman Victory Medical Center/Ministry

• Wendy Damm Columbus Community Hospital

• Richard Range Baldwin Area Medical Center

• Michelle White WHA Financial Solutions, Inc.

• Dave Cutler WHA Financial Solutions, Inc.

• Mary Brasseaux St. Nicholas Hospital/HSHS

• Matt Sande Wisconsin Hospital Association, Inc.

• Johni Stout WHA Financial Solutions, Inc.

• Bill Bazan Wisconsin Hospital Association, Inc.

• Michael Connor St. Luke’s Medical Center/Aurora

• Sean Cote WHA Financial Solutions, Inc.

• David Grundstrom Flambeau Hospital/Ministry

• Jeffrey Hine J. Hine & Associates, Inc.

• Jane Hodnik Covenant Healthcare System, Inc.

• Bradley Murray Covenant Healthcare System, Inc.

• John Riegler St. Luke’s Medical Center/Aurora

• Heather Schroeder WHA Financial Solutions, Inc.

• Kari Schmidt Aurora Health Care

• Michael Jaeger Aurora Health Care

• Dennis Pollard Community Memorial Hospital/Froedtert

• Marne Bonomo Aurora Metro Region

• Brian Potter Wisconsin Hospital Association, Inc.

• Dana Borgerding Wisconsin Hospital Association, Inc.

• Larry Matthews St. Vincent Hospital/HSHS

• Daniel Adams Memorial Medical Center

• Mark Thompson Aurora Health Care

• Timothy Allen Sacred Heart Hospital/HSHS

• Jim Hemes Affinity Health System, Inc.

• JoAnn Jones Sacred Heart Hospital/HSHS

• Jean Needham Holy Family Hospital

• Sharon Whelan River Falls Area Hospital

• Gail Piper WHA Financial Solutions, Inc.

• Rob Myers Vernon Memorial Hospital

• Dawn DeSart Wisconsin Hospital Association, Inc.

• Shelley Weiler Wisconsin Hospital Association, Inc.

• Mandy Kalepp Wisconsin Hospital Association, Inc.

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The Wisconsin Department of Health and Family Services is charged with promulgating a new administrative rule to prescribe uniform fees for copies of medical records. It is anticipated that the DHFS proposed rule will be released in the very near future and that this new rule will include a new per page fee for copies and will permit a fee for record certification. Persons following the work of the rule advisory committee also expect the proposed rule to include a flat fee for each record request, except for records requested by the patient.

Once DHFS makes its final decisions on the fee levels, DHFS will hold public hearings on the rule and, finally, the rule will be sent to both houses of the legislature for review by the appropriate standing committees. WHA submitted written comments on the work of the advisory committee to date that can be viewed on the WHA Web site. Many Wisconsin hospitals contract with health information specialists for their medical record activities and, therefore, have a strong interest in maintaining reasonable fees that enable these services. The Association of Health Information Outsourcing Services provided excellent comments on the rules that also can be viewed on the WHA Web site, under Legal and Regulatory.