WHA staff is still reviewing the proposal, which took almost three months to develop. Staff has requested work papers and additional information in order to undertake a more comprehensive analysis of the plan. What is known is that the Administration proposes to exempt Critical Access Hospitals and psychiatric/behavioral health hospitals from the tax, mostly because of WHA’s earlier work that exposed legal problems with the first plan. That initiative attempted to flow supplemental Medicaid dollars through CAHs in order to prevent "losers" under the tax plan.

The new proposal uses two mechanisms to deliver higher payments to non-exempt hospitals: 1) higher fee-for-service payments that would be delivered via a new payment system designed to pay hospitals approximately 98 percent of hospital-specific costs; and 2) higher managed care payments that basically align with the increased fee-for-service payments. The payment model (spreadsheet) developed by the Administration suggests that aggregate HMO payments will be 200 percent higher than the HMO payments that were identified in the initial Administration plan unveiled in February. WHA staff expressed skepticism relative to that large number at the Wednesday meeting. "WHA raised legitimate concerns back in February about the notion that HMOs will pass-on, dollar for dollar, higher payment to hospitals. Those concerns remain and should now be magnified by the fact that the new plan essentially triples the amount of dollars delivered to hospitals via HMOs," said WHA President Steve Brenton.

The Administration’s new, hospital-specific, "Potential Distribution" spreadsheet identifies "winners and losers" among Wisconsin hospitals and suggests approximately 52 "winners" in FY 2009 and 21 "losers." Officials acknowledged that the spreadsheet is an approximation of "what may happen" and is based on numerous factors that can not be accurately predicted. "WHA staff is leery of how the payment model lumps together fee-for-service and HMO payment increases," Brenton said.

"We requested documentation of specific methodology used to arrive at the numbers, which are at best "guestimates" based on many moving and variable parts."

During the meeting, WHA staff initially noted that the Association’s position opposing the hospital tax is not exclusively tied to specific details associated with any specific tax and payment plan. Fundamental policy issues remain, including: 1) The insistence on taxing hospitals prior to CMS Plan approval; 2) The likelihood that HMOs will pass on the higher payments to hospitals…and the ability to "police" any HMO enforcement provisions; and 3) The ability to "protect" hospital tax revenues from future "raids" that are a virtual certainty as experienced by the Patients Compensation Fund and the Nursing Home Bed Tax.

The WHA Board will hold a special conference call to further discuss this latest development next week.

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When I was campaigning and knocking on doors and talking to people, school finance reform and more affordable and accessible health care coverage were dominant issues. We would like to roll up our sleeves and get at it in the State Legislature.

SeniorCare is a perfect example of a program that helped open up access. We had a good quality program that helped our senior citizens, and I have a lot of them in my district. Wisconsin Care will hopefully be on par with Senior Care. We need to expand BadgerCare to include more people, including farmers. There are three or four proposals out there that would cover a lot of people in some of the reform plans. We need to put the plans on the table and start a discussion. There isn’t one silver bullet, but we need to take this issue seriously.

I think one of the best ways to attract people to rural areas is to fund our schools — that will go a long way in attracting people to rural areas. They want to settle where there are good schools and good jobs. Southwest Technical College has a nursing program. We need to help get them what they need to continue and improve upon what they offer in their curriculum for nursing.

Overall, if the intention is solid, I support the concept.

No, not straight up. I know the Governor wants to use it to get more federal funds. Whether this is the right way to do it, I don’t know. I don’t have a lot of faith in the federal government to do what’s fiscally wise. They allowed SeniorCare to expire and it saved them money. They haven’t shown a commitment to fiscal responsibility. You hate to have so many unknowns.

Unless it is an emergency we shouldn’t be doing that. If you have a national disaster and need to find special funding, that is one thing, but to routinely do it is not a good budgeting strategy. General rule of thumb, I don’t like it.

Concept is ok, but whether it is a reality. Tobacco money was supposed to be used for smoking-related illness and for anti-smoking education. Instead, we used it to balance a budget. What is to say that we won’t do that again?

The best way to contact me is an email or phone call, but I also really appreciate personal visits. I encourage anyone to stop by and if we disagree, let’s sit down at the table and address the issue.

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The Wisconsin Hospital Association (WHA) and MetaStar, Wisconsin’s quality improvement organization, are members of an advisory panel co-led by The American Hospital Association and the Institute for Healthcare Improvement, supporting the development of the Hospital Leadership and Quality Assessment Tool (HLQAT). The goal is to provide hospitals with a road map for creating a culture of quality and patient safety that supports performance excellence. On May 17, the WHA Medical and Professional Affairs Council participated in a "Dialogue Group" at WHA headquarters, facilitated by Meg Horgan, MSN, of CareScience|Premier, to evaluate a draft of the HLQAT. Wisconsin Hospital Association was one of 13 hospital associations asked to evaluate the draft tool.

One characteristic high quality hospitals share is the active participation of the hospital board and administration. The HLQAT will be a standardized, self-administered hospital assessment tool that examines structures, processes, and leadership approaches demonstrated to be associated with high performance in clinical quality.

"Wisconsin hospitals are national leaders in quality and safety improvement, and as such, we were pleased to be asked to have a role in evaluating a tool that will be used by hospitals across the United States to better understand the role that hospital leaders play in improving quality and safety," said Dana Richardson, WHA vice president, quality.

The HLQAT will close a gap in the availability of tools to assess hospital leadership’s success in providing resources, programs, activities, and equipment to drive safety and quality of patient care in hospitals. Some assessment tools exist in the private domain, but urgency is increasing for identification or development of publicly available tools for this purpose. To date there has been no consensus among major stakeholders regarding a preferred tool.

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This year’s Wisconsin Rural Health Conference will focus on improving the many relationships that are vital to the successful management of a community hospital. Two of the four planned education tracks will focus on strengthening hospital relationships with physicians and the community.

The hospital/physician relationship track will feature three sessions focusing on dealing with common issues between administration and physician; the role advance practice providers can play in your community; and developing a physician compensation model that meets the goals of both the hospital and the employed physicians.

The hospital/community track will highlight best practices of bringing together hospital, business and public health in a community; ways to keep patients in town for local care; and review one community’s "healthy village" model, making health care and wellness a community destination.

This year’s conference will be held June 27-29 at the Kalahari Resort in Wisconsin Dells. Leadership staff members from small or rural hospitals, as well as board of trustee members, are encouraged to attend. The full conference brochure with registration information is available online at www.wha.org .

For more information on the program content, contact Jennifer Frank at 608-274-1820 or email at jfrank@wha.org . For registration questions, contact Lisa Geishirt at 608-274-1820 or email at lgeishirt@wha.org 

President’s Column
Hospital Tax

Wisconsin’s 60 government-owned nursing homes are hemorrhaging "red ink," running annual deficits that exceed $60 million according to a report undertaken by the Wisconsin Taxpayers Alliance. The primary culprit…inadequate Medicaid payment….despite a nursing home bed tax that was enacted in 1991 as a strategy to "boost" Medicaid payments by drawing down federal matching dollars. Sound familiar?

Although public nursing homes account for just one-fifth of the state’s total long term care beds, the bleak financial picture is shared by for-profit and not-for-profit counterparts, including hospital-owned facilities. It’s pretty much a given that if a nursing home’s patient mix is two thirds or more Medicaid, the organization is losing money. Wisconsin hospitals and health systems subsidize their nursing facilities with millions of dollars in much criticized hospital "profits" each year.

The Doyle Administration’s current budget proposes to increase Medicaid nursing home payments by 2 percent each year of the upcoming biennium. The funding would come by increasing the bed tax. The modest payment increase will not cover anticipated wage and benefit adjustments, let alone begin to drain the ocean of red ink facing long term care providers. Not one penny of the proposed tobacco tax increase has been slated to assist beleaguered facilities cope with the very real challenge of caring for the frail elderly. Want more money…then raise your bed tax….appears to be the rejoinder of elected officials when it comes to calls for redressing this crisis.

The WHA Board position opposing the hospital tax is not solely based on the hugely flawed current proposal – or – the fact that the tax would be assessed and collected in advance of federal approvals that are necessary to facilitate higher hospital payments. The current WHA Board position also recognizes that a provider tax is a troublesome idea over the long term and lets the State of Wisconsin "off the hook" for paying for health care with traditional revenue sources. The sorry experience of Wisconsin nursing homes, as documented by the Wisconsin Taxpayers Alliance report, strongly supports that position

Steve Brenton, President

The HFS 117 Advisory Committee met for the first time the week of May 14 to discuss the administrative rule that went into effect earlier this year setting limits on fees that can be charged for copying medical records. The fees now in effect are projected to result in millions of dollars of unreimbursed costs for hospitals.

At the meeting, health care providers outlined in detail how much the new limits are increasing their copy service costs that must be subsidized by other services, how much copying costs would increase if providers brought this service in-house, and in general, all of the costs that go into copying medical records.

Cathy Ptak, regional director, clinical information services for Aurora Health Care explained that overall, only a small percentage of registrations result in requests for copies and asked why the entire patient population should bear the cost of only a few making the requests. Meg McElroy, director, patient health information, Children’s Hospital of Wisconsin reminded everyone that any increase in costs is difficult for non-profit entities to absorb and that frequently costs go well beyond the actual cost of copies and include additional requests for copy certifications and attendance at depositions.

Trial attorneys countered that it is too soon for a review of copying costs since the new rule just went into effect earlier this year. It is important to note that DHFS developed the current rule in 2003 and based the fees on data that is now more than four years old. Trial attorneys also argued that the state statutes limit what the Department of Health and Family Services (DHFS) can look at in determining an approximation of the cost of copying medical records. They further maintain that providers have never shown evidence of these costs.

A large copy service provider generated the most discussion at the meeting when he produced a breakdown of his company’s costs for providing copies and a detailed company financial statement. He argued that his costs include all the costs that go into duplicating patient health care records. Trial attorneys countered that since his costs represented both billable and non-billable copying, the costs he presented were not an accurate measure of the actual cost of copying.

In the end, the committee members agreed it would be a good idea for DHFS to collect additional updated cost information. All committee members were given until June 15 to submit their cost data and assumptions relating to copying medical records. DHFS will analyze the information and prepare a document with alternatives for the committee to review at the next meeting, tentatively scheduled for late June or early July.

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Delivering health care during a mass disaster requires health care providers and others to make critical decisions with limited resources. A panel of experts, including representatives from WHA and the State Division of Public Health, are developing ethical guidelines that can provide guidance to health care workers when they are attempting to deliver scarce health care resources following a mass disaster.

A series of meetings will be taking place around the state beginning in June facilitated by Mueller Communications.  Those who attend will gain a better understanding of the ethical questions that confront all stakeholders during a mass disaster. Feedback will also be solicited at the meetings on how to best communicate the Guidance Document and its content, a draft of which is expected to be ready by September.

Meeting dates and locations are as follows: June 7, Hayward; June 21, Eau Claire; July 12, La Crosse; July 26, Stevens Point; August 9, Green Bay; August 16, Madison; August 23, Milwaukee.

Representatives of hospitals, health care systems, clinics, public health agencies, community organizations, and the media will be contacted about specific dates, times and locations of the meetings in their part of the state. To obtain additional information, contact Bill Bazan, 414-431-0105, bbazan@mailbag.com , or contact Phill Trewyn at 414- 390-5500 or ptrewyn@muellercommunications.com.

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The Wisconsin Hospital Association and Rural Wisconsin Health Cooperative will co-sponsor a PR Issues Forum June 29, 10 am-3:30 pm at the Kalahari Resort in Wisconsin Dells. The Forum is designed to prepare hospital communications experts along with spokespersons, quality professionals and others who are asked to speak on one or all of what have been identified by the sponsors as five of the biggest issues facing hospitals.

Kristin Baird, Baird consulting, and Kevin Stranberg, Memorial Medical Center in Ashland, will acquaint participants with the newest tools that can be used to develop a communications plan that has the flexibility to address about any situation. Using the tools from this session, participants will be prepared to address the following crucial topics with various stakeholders. These issues include:

Hospital Tax – "Taxing hospitals to pay hospitals." Find out what’s current; how to develop a local response.

Union Campaigns – There isn’t time to plan once a campaign on your hospital has started. Identify the early warning signs and get recommendations for internal and external communications that can be developed in advance to prepare for a union campaign in your community.

Billing and Collection Policies – The number of patients who have high deductible plans is growing, and with it, public concern about hospital costs and the billing process. Learn your pivotal role in ensuring that patients are aware of, and understand, this process.

CheckPoint will expand to include more than 70 measures by the end of 2007. Soon, mortality, volume and patient experience of care information will be publicly available on CheckPoint. Learn how information now available on CheckPoint can help the public relations professional address questions related to the current measures and how to plan for the new measures.

PricePoint is a valuable tool for public relations professionals to use when working with reporters on everything from hospital costs to discounts. What you don’t know about PricePoint can come back to you in the form of a question from a reporter or consumer. Learn how to put it to work for you.

The registration form is available at www.wha.org/education/pdf/2007IssuesForum6-29.pdf: The fee for this seminar is $95. For information on content, contact Mary Kay Grasmick, mgrasmick@wha.org  or 608-274-1820. For registration or hotel information contact Lisa Geishirt, lgeishirt@wha.org , 608-274-1820.

A continuing highlight of the annual Wisconsin Quality & Safety Forum, the Project Showcase will once again allow attendees to share information about their current quality and safety improvement initiatives, in a poster board format, as part of the 2007 Forum.

A project submission brochure for the 2007 Wisconsin Quality & Safety Forum is included in this week’s packet and on WHA’s web site at www.wha.org. Examples of projects eligible for submission include those that enhance organizationwide improvement culture and structure; are undertaken to improve quality or safety of care; and demonstrate how quality improvement practices are utilized in an organization. Submitted projects will be included on the 2007 Wisconsin Quality & Safety Forum Showcase CD and published in a future issue of the Wisconsin Medical Society’s Wisconsin Medical Journal.

Showcase projects submissions will only be accepted via completion of the on-line submission form at www.wha.org/QSFshowcase. The online form is available as of Friday, May 18, and all submissions are due to WHA, via the online form, by Wednesday, July 18, 2007. For questions about project submission, contact Brian Competente at 608-274-1820 or bcompetente@wha.org .

For those involved in research projects, you are also encouraged to submit a manuscript for peer review, to be considered for publication in a future issue of WMJ. To view "Instructions to Authors," visit the Wisconsin Medical Society Web site at www.wisconsinmedicalsociety.org/health_news/wmjauthorinstruct.cfm.

A full agenda and registration information for the 2007 Forum, scheduled October 22-23 at Country Springs Hotel in Waukesha, will be distributed in August. If you have any questions about the 2007 Wisconsin Quality & Safety Forum, please contact Dana Richardson or Jennifer Frank at 608-274-1820, or e-mail at drichardson@wha.org  or jfrank@wha.org

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At least 60 individuals attended a budget listening session held in Menasha and hosted by Sen. Mike Ellis and Reps. Dean Kaufert, Steve Wieckert and Roger Roth. Amy Sommerville and Mike Hert of Aurora Health Care attended.

The listening session provided an opportunity for individuals from the Fox Valley to express their opinions on issues in the state budget bill. Hert and Sommerville expressed views on important hospital issues, including the raid on Medicaid, the hospital tax and the cigarette tax.

We appreciate the commitment of our many hospital grassroots advocates who continue attending listening sessions across the state to express their views on important hospital and health care issues.

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Federal Issues
Stark Introduces Ban on Mandatory Overtime
Nursing Homes Exempted From Legislation

The U.S. House Ways & Means Health Subcommittee Chair Pete Stark (D-Calif.) introduced legislation prohibiting mandatory overtime for nurses. Under the legislation, H.R.2122, mandatory overtime is prohibited, except during a state of declared emergency, for any nurse who has already worked: 1) his or her scheduled work shift; 2) 12 hours in a 24-hour period; or 3) 80 hours in a consecutive 14-day period. The legislation also requires providers to post nurse schedules in a "conspicuous manner" for the department of unit involved. The legislation includes civil penalties up to $10,000 for each violation.

Several interesting exemptions are included in the bill:

• nurses who voluntarily work more than the prescribed limits are exempted

• nursing homes are exempted

The AFL-CIO and other labor organizations have endorsed this legislation.

Recently U.S. Senators Russ Feingold (D-WI) and Lindsey Graham (R-SC) introduced the State-Based Health Care Reform Act, S. 1169. The bill authors authored the legislation to help break the political stalemate in Congress over health care reform through a state-based approach.

"Our legislation provides the states flexibility to best extend health care coverage to all their residents. By helping states to try different approaches, we can figure out the best way to ensure all Americans receive the health care they need," said Feingold and Graham.

Among the key features of the legislation:

• Participating states would not be required to adopt a certain prescribed program. States would be given maximum flexibility to achieve coverage and must meet only certain basic standards.

• The pilot program would last for five years and is funded through a grant application program overseen by a Health Care Coverage Task Force. The Task Force would evaluate state applications, select projects for Congressional approval, oversee implementation and review progress.

• The Task Force would be authorized to select as many states as can be funded. They would make recommendations to Congress at the end of the grant period on which programs should be enacted into law. Congress would then take up the recommendations through an expedited procedure.

Access both bills online at http://thomas.loc.gov/.

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Rogers Memorial Hospital, a nonprofit behavioral health care provider with four locations in southeastern Wisconsin, is celebrating its 100-year anniversary with a series of educational events throughout 2007.

David L. Moulthrop, president and CEO, said, "Along with providing high quality treatment, our mission includes research and education. This speaker series is bringing nationally recognized behavioral health experts into Milwaukee to provide Wisconsin physicians, therapists, and social workers current information on a wide range of behavioral health concerns for children, adolescents, adults and older adults."

As the Rogers reputation has grown, so have its facilities, thanks to a Rogers Memorial Hospital Foundation capital campaign. The Oconomowoc hospital recently added a 37,000-square foot patient services wing to the original building. The Milwaukee hospital is scheduled to begin a 20,000 square foot addition in spring 2007. Plans also are in process for expansion of the Oconomowoc campus residential centers for chemical dependency and child and adolescent behavioral health.

For complete information, visit www.rogershospital.org.

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Wisconsin Hospitals Earn Environmental Awards

Seven Wisconsin hospitals and health systems received awards for their environmental stewardship at the Hospitals for a Health Environment (H2E) Environmental Summit on May 14.

Gundersen Lutheran Hospital in La Crosse and St. Mary’s Hospital Medical Center in Green Bay each received H2E’s 2007 Environmental Leadership Award. In addition, Affinity Health System in Appleton and Mercy Hospital-Mercy Health System Corporation in Janesville, received Sustained Environmental Leadership Awards. These awards are given by H2E to those health care facilities that are setting the highest standard for environmental practices in health care.

Luther Hospital in Eau Claire, Mercy Walworth Hospital & Medical Center - Mercy Health System in Lake Geneva, and Wheaton Franciscan Health Care - All Saints in Racine, each received a 2007 Partners for Change Award in recognition of their continuous improvement and expansion of their mercury elimination, waste reduction and pollution prevention programs. Mercy Walworth Hospital and All Saints Hospital also received the Making Medicine Mercury-Free Award for their elimination of mercury from their facilities.

H2E is an organization jointly founded by the American Hospital Association, the U.S. Environmental Protection Agency, Health Care Without Harm, and the American Nurses Association whose mission is to educate, motivate, and engage health care professionals to adopt best environmental practices that increase operational efficiency, and support an environmentally sustainable system that improves the health of patients, staff, and the community. 57 Wisconsin hospitals are H2E Partners. A list of all 2007 H2E award winners can be found here: http://cms.h2e-online.org/awards/2007winners/

When her daughter Noa was 18 months old, Kerry Hansen-Peller wondered why she was so timid at the playground. "She didn’t like being in a swing, and she was afraid to jump off a bottom stair like the other kids did," Kerry remembers.

"She had finally started to walk – several months after the national average – but she became agitated whenever her feet were off the ground." Both a physical therapist and Noa’s pediatrician said everything was OK. Still, Kerry had doubts.

One day, she and Noa were at the Sherman Park Family Resource Center, where occupational and physical therapists, and a nurse from Columbia St. Mary’s IMPACT Program were offering free screening of children for developmental problems. The goal of IMPACT – Initial Medical and Pediatric Assessment, Consultation and Training – is finding problems early and providing therapy so children will be prepared and confident when they reach school age.

Kerry signed up for a screening, and almost immediately, pediatric physical therapist Lisa VanderGeeten detected signs that Noa might have a problem: "I asked Noa’s mom if Noa didn’t like walking on grass or sand, or was bothered by movement and motion. Her mom said, ‘That’s Noa to a T.’"

Afterward, Kerry brought Noa to CSM’s pediatric therapy department. Lori Guszkowski, a pediatric occupational therapist, assessed her coordination and told Kerry that Noa had a disorder called sensory integration dysfunction, the inability of the brain to correctly process information perceived by the senses.

"Therapy was key," Kerry says. "Now, when Noa tries the swing, she’s confident." Noa also had intensive occupational therapy just before starting preschool. "She’s still behind, but she’s no longer afraid to get involved with the other kids."