Late yesterday (May 21), Governor Doyle was joined by the co-chairs of the powerful Joint Committee on Finance—Senator Mark Miller (D-Monona) and Representative Mark Pocan (D-Madison)—at a press conference announcing an agreement on a package of measures aimed at addressing Wisconsin’s additional $1.6 billion budget deficit.

The Governor and Legislature were already struggling with the monumental task of solving a deficit projected at nearly $6 billion when news of a greater shortfall hit earlier this month.

"My priorities in addressing this historic budget deficit are clear—first, I am not proposing any new taxes," Gov. Doyle said during yesterday’s press conference. "Second, we must make deep cuts to state government spending. Third, we must preserve our essential services such as education and public safety."

An expanded hospital assessment is a key element of the plan. The assessment will increase by roughly 20 percent, while the distribution formula negotiated earlier this year remains complete and intact and allows hospitals to receive additional Medicaid payments to help address growing program enrollment. The initiative was negotiated with WHA late last week and approved by the WHA Board earlier this week. Information regarding the increased assessment was sent to members May 21.

The expanded assessment will also mean additional funding to help shore up the state’s Medicaid program and allow expansion of coverage to low-income, currently uninsured childless adults to move ahead statewide without delay.

"Some of the new assessment revenue will be used to help pay for health care programs that otherwise face the budget ax due to the impact on state revenues of the most extraordinary economic downturn in recent history," Brenton said. "These safety net health programs provide care for our most fragile patients and families. We believe that this agreement also lessens the exposure of hospitals and perhaps other providers to sharp payment cuts that are very much in play in our neighboring states. These positive outcomes are something we all should be able to support."

Protecting Medicaid and expanding coverage to uninsured, low-income childless adults has been a priority for WHA since news of the unprecedented budget shortfalls began to surface last fall. And as increasing numbers of people lose their health coverage due to the economic downturn, hospitals’ charity care and bad debt losses are also exploding. Hospital uncompensated care increased by 20 percent in 2008 at a cost of $85 million and resulting in the potential for increased cost-shifting. Moving ahead with the already approved coverage expansions should help alleviate the problem.

"(Cost-shifting) has often been called the hidden tax that all of us have to pay when there are high levels of uninsured people coming in to our medical facilities," Doyle said. "We have worked hard in Wisconsin to do away with that hidden tax by making sure people do have health insurance coverage so we are not paying for that through our own premiums and other ways."

Other deficit reduction priorities illustrate the magnitude of the state’s fiscal problem. These include:

The full Joint Committee on Finance is expected to meet today, tomorrow and next week to vote on these proposals and the remaining items left to address in Governor Doyle’s budget plan. Both houses of the Legislature must then pass identical versions of the budget before it is forwarded back to Governor Doyle for his consideration and line-item veto authority.

The entire budget process is expected to be completed by early to mid-summer.

A coalition of community organizations and businesses that together employ nearly two million people in Wisconsin held a press conference this week asking that any changes to Wisconsin’s liability laws be carefully considered and debated as separate legislation, not as part of the massive state budget.

Representing Wisconsin hospitals, Ed Harding, chief executive officer, Columbus Community Hospital, said, "We ask that the Legislature thoroughly consider any changes to joint and several liability, contributory negligence, and jury instructions. We are concerned that there would be unintended consequences for the Injured Patients and Families Compensation Fund, health care providers, and ultimately patient care in Wisconsin."

Ed Lump, president and CEO, Wisconsin Restaurant Association, explained, "[The bill means] the return of joint and several liability in which anyone here or at home can lose everything they have to pay 100 percent of the damages when they are only one percent at fault; a brand new provision allowing the liability of all defendants to be added together so the person most at fault can collect from the person least at fault; and new jury instructions that allow trial lawyers to give the jury a roadmap to defendants with deep pockets."

Harding emphasized the impact on access to health care, "Rural communities have an extraordinarily difficult time recruiting physicians. Upsetting Wisconsin’s currently well-balanced medical liability system by increasing uncertainty and costs would make it even more difficult to recruit physicians to already underserved rural and urban areas."

The Wisconsin Hospital Association opposes the proposed changes and has been asking legislators to remove the provisions from the budget.

More information and online registration is available at www.wha.org.

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.

This week the Wisconsin Hospital Association wrote to Wisconsin Members of Congress in opposition to proposed cuts under the FY 2010 Medicare Inpatient Prospective Payment System rule.

A significant portion of the cuts comes from what the Centers for Medicare & Medicaid Services (CMS) claims is a necessary reduction for the effect of coding or classification changes that do not reflect real changes in case mix. In other words, the cuts are a 1.9 percent behavioral offset. Across the nation, the cut will cost hospitals $22 billion over 10 years. In Wisconsin, this 1.9 percent reduction will total $34 million in FY 2010 and $390 million over 10 years. (District by district impacts are listed in the table below.)

District                     Impact of 1.9% behavioral                     Impact of 1.9% behavioral
                                offset (FY 2010)                                      offset (FY 2010-2019)

Statewide                     $34 million                                         $390 million

Rep. Baldwin                $5.9 million                                         $68.4 million

Rep. Kagen                  $3.4 million                                         $39 million

Rep. Kind                     $3.68 million                                       $30.7 million

Rep. Moore                   $8.4 million                                        $97 million

Rep. Obey                    $3.8 million                                        $44.5 million

Rep. Petri                     $2.6 million                                        $30 million

Rep. Ryan                    $2.9 million                                        $33.5 million

Rep. Sensenbrenner      $4.1 million                                        $47 million

WHA’s letter also highlighted the Medicare Payment Advisory Commission projection that hospitals will have a negative 6.9 percent Medicare margin in 2009—down from a positive 6.2 percent Medicare margin in 1999—the lowest level in more than a decade.

"The cuts pile on an already under-funded Medicare payment system, the President’s recently proposed hospital payment cuts… [and] the majority of our hospitals have seen decreased patient volumes, increased charity care and bad debt, and close to 75 percent have reported a decline in overall margins" during the economic downtown, the letter read. "With all of this in mind, the types of cuts proposed under the FY 2010 IPPS rule are unwise and unsustainable."

Please contact Jenny Boese at 608-268-1816 or jboese@wha.org for information on the impact of the IPPS proposed rule to your facility and/or how to contact your Members of Congress on the issue.

On May 18 the Office of the National Coordinator for Health Information Technology at HHS released an eight-page operating plan that outlines immediate actions HHS needs to take to fulfill its obligations under the health information technology provisions of the American Recovery and Reinvestment Act (ARRA).

Highlights of the document include:

• A table listing those dates specified under ARRA in which HHS must promulgate certain regulations and guidance.
• A timeline for HHS to adopt and publish standards, implementation specifications, and certification criteria for HIT exchange. It appears such standards and criteria would not be published before December 24, 2009.
• No definition of "meaningful use" of electronic health record systems was provided in the plan. "Meaningful use" is a key requirement that providers must meet to qualify for the Medicare IT incentive payments. Some expected this plan to provide some guidance.

HHS also released a separate overview of the Medicare and Medicaid IT incentives under ARRA and plans for implementing those incentives at HHS. In 2009 and 2010, HHS plans to:

• Develop the definition of meaningful use (2009).
• Develop rules to allow public input to the incentive program policies (2009).
• Plan systems and other requirements needed to support the incentive programs (2009).
• Plan a national outreach program (2009).
• Conduct outreach to eligible providers and to State Medicaid Agencies (2010).
• Develop systems to support the payment of incentives (2010).
• Develop final rules to establish policies needed to pay incentives (2010).
• Develop systems to monitor and evaluate incentive payments (2010).
• No sooner than October 2010, start to pay hospital IT incentives.

The two HHS plans can be found at www.hhs.gov/recovery/reports/plans/onc_hit.pdf and www.hhs.gov/recovery/reports/plans/hit_implementation.pdf.

Last month St. Elizabeth Hospital (Appleton) CEO Travis Andersen traveled to Madison to spend the day shadowing one of his area state legislators, Rep. Thomas Nelson (D-Kaukauna). The day provided Andersen with a bird’s eye view of life as a legislator.

Rep. Nelson serves as the State Assembly’s Majority Leader, the second most powerful position in the Assembly. In asking Nelson why he wanted to participate in this "shadowing" opportunity, he said: "With the very serious issues we’re facing as a state, it is critical for me and for all legislators to have input from people who are leaders in their communities. Health care is a top concern, and this was a great opportunity for Travis and me to learn something from each other."

Nelson added, "It was great to get Travis’ unique perspective when he was in Madison. He attended several events where I gave remarks and sat in on a number of meetings, including one with members of the Wisconsin Hospital Association. He gave me valuable feedback and made great contributions during the meetings. I also heard about the challenges Travis faces in his job, which helped me to see another side of the health care world."

Travis Andersen commented on the insight he gained from this experience.

"I really got an appreciation for the work ethic that Rep. Nelson brings to his office. He demonstrates a collaborative, inquisitive leadership style that seems to work well to bridge party lines as well as serve other legislators in his capacity as the Majority Leader," said Andersen. "Our day had a packed agenda beginning with the Madison Chamber of Commerce meeting in the morning, three or four different speeches and three to four meetings with constituents from those industries."

When both Nelson and Andersen were asked if they would recommend this experience to others, they had this to say:

"I absolutely think all legislators would benefit from this experience. When it comes to the issue of health care, it is very important to hear from all of the key players—doctors, nurses, patients, dentists, insurance providers and administrators—so we can make collaborative decisions based on the expertise of everyone involved. I will continue to go to Travis as a resource on health care issues in the future." - Rep. Tom Nelson

"Yes, I would definitely recommend doing this. As part of the original discussion of walking in each other’s shoes for a day, I am now looking forward to hosting Rep. Nelson at St. Elizabeth Hospital for a day." - Travis Andersen

"With the very serious issues we’re facing as a state, it is critical for me and for all legislators to have input from people who are leaders in their communities. Health care is a top concern, and this was a great opportunity for Travis and me to learn something from each other." - Rep. Tom Nelson

"I really got an appreciation for the work ethic that Rep. Nelson brings to his office. He demonstrates a collaborative, inquisitive leadership style that seems to work well to bridge party lines as well as serve other legislators in his capacity as the majority leader."
- Travis Andersen

Volunteers make many valuable contributions to your organization—they also create exposure for potential liability.

Volunteer insurance is a cost-effective option for insuring hospital volunteers and student nurses who are injured while performing authorized volunteer and student nurse activities – either on or off your organization’s premises. The program offers flexible benefit levels and premiums that meet the specific needs of health care organizations without the hassle of deductibles or co-payments.

There are four plans to choose from and each includes:

• Coverage for medical expenses that result from covered accidental injuries

• Coverage for accidental death and dismemberment

• $50,000 benefit for total paralysis

• Coverage for dental expenses resulting from accidental injuries up to the plan maximum

In addition to protecting against financial losses, this coverage protects other valuable assets – your volunteers and student nurses.

Short-Term Medical Plans

Facing the loss of health benefits due to either the loss of employment or eligibility can be stressful. If available, continuation of group coverage under COBRA can be extremely expensive. Short-term medical plans may offer a solution.

Short-term medical plans help "bridge gaps" in medical coverage by reducing the number of individuals who may risk going without coverage, which could result in financial hardships. Just one uncovered accident or illness can be financially devastating.

Short-term medical plans provide affordable health coverage for people who are between permanent health plans, whether:

• Between jobs or laid off

• Recent college graduates without coverage

• Waiting for employer group coverage

• A temporary or seasonal employee

• Recently retired and not yet eligible for Medicare

• A dependent falling off parent’s plan

An individual has the flexibility to design the plan by choosing the length of coverage, deductible and out of pocket maximums to meet his or her personal situation.

Contact a member of WHA Financial Solutions’ benefits team at 800-362-7121 or whafs@wha.org with any questions about Volunteer Insurance, Contact Fill, or any of our employee benefit solutions.

Prostate cancer, the most common non-skin cancer in the United States, kills one man every 19 minutes. As the baby boomer population ages over the next ten years, the number of men dying from prostate cancer will increase dramatically. For this reason, Memorial Health Center is dedicated to helping detect this cancer in its early stages when it is often curable.

Since 1996, Memorial Health Center has held an annual free prostate cancer screening for area men. This year, 222 men participated in the free screening, which included a prostate-specific antigen (PSA) test of the blood and a digital rectal exam (DRE). Results from the screening revealed 18 men (8 percent of those screened) had either abnormal PSA scores or abnormal DRE results.

"Prostate cancer screening is important to identify men at risk for prostate cancer as prostate cancer typically produces no symptoms until it is at an advanced stage," says urologist David Bluestein, MD, of Urology Specialists of Wisconsin.

Because early prostate cancer has no symptoms, screening tests like the PSA and DRE are the most common means of detecting the presence of prostate cancer. Abnormal PSA or DRE results indicate that additional testing is needed to determine if there is indeed cancer present.

The 18 men whose results were abnormal were contacted by phone within two days of the screening to inform them of their results and to encourage them to schedule a follow-up appointment with a medical professional. The remaining men received a letter within two weeks reporting and explaining their results. A copy of each man’s results was also sent to his medical provider, if so requested.

Memorial Health Center laboratory, emergency services, infection control, and marketing staff worked together planning, executing, and wrapping-up this year’s free prostate cancer screening, ultimately devoting hundreds of staff hours to ensuring its success. Especially important to the screening’s success was the generous participation of urologists Dr. Bluestein and Dr. Roy Brandell of the Urology Specialists of Wisconsin, who donated their time and patient care to the three-hour event, as well as the participation of several volunteers who kept the screening organized and running on time.