With the door closed on the tax relief bill, the Senate Finance Committee and the House Ways and Means Committee will begin markup of a Medicare Reform/Prescription Drug bill when Congress reconvenes from the Memorial Day recess. Arguing Medicare payment reform belongs in a Medicare bill, not a tax bill, Chairman Bill Thomas (R- California) has promised to include Medicare payment reform changes in his bill which begins markup June 2.

In a case of déjà vu, passage of a prescription drug bill through both houses of congress seems fraught with obstacles. Congressional leaders have agreed to a $400 billion over ten years price tag for the benefit and committed to completing work on the bill before fall 2003. The House has twice passed prescription drug legislation, only to meet deadlock in the Senate. Complicating factors for Medicare reform proponents, Congressional budget leaders will most likely insist any and all changes to the Medicare program will need to come in under the agreed upon $400 billion cap. Senate Finance Committee Chair Senator Chuck Grassley (R- Iowa) has made clear his intention to fight vigorously for passage of his Medicare amendments that were stripped out of the tax bill earlier this week. Armed with chairmanship of the committee and a letter of commitment from the president to address "concerns that rural Medicare providers need additional help," Senator Grassley is well positioned to succeed in including Medicare payment equity for rural providers in the prescription drug bill. Whether the bill will clear the Senate and stay within the budget cap will make for an interesting legislative summer.

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Connie Curran left no doubt in the minds of those who attended the May 20 meeting of the Wisconsin Forum for Healthcare Strategy that it is better to lead, than follow, when it comes to quality report cards. "As they say, if you are not the lead dog, the view is always the same," she quipped.

Curran, a noted health care consultant, said in addition to the benefit of providing information to the public, the WHA Quality Initiative provides data that can be used internally to benchmark not only against others, but against yourself. "It places the focus on getting better, not on making excuses that your hospital, your staff, your community ‘are different,’" she added.

"Take the lead. You define the terms, don’t play catch up," she advised when it comes to report cards. Curran labeled the WHA Quality Initiative as a very good effort because instead of having consumers go to "other" report cards, you drive them to a place where they go first, and that is what they will use as their key source for information about hospitals. Establishing the WHA report as a reliable and timely source of hospital data and consumer information is a major goal of the project, according to Dana Richardson, WHA vice president of quality.

Speaking at the same meeting in Pewaukee, Rep. Curt Gielow (R-Mequon), Vice Chair of the Assembly Committee on Health, told the group that he applauds the WHA Quality Initiative. "By WHA leading with this initiative, it pre-empts the need for government to exert regulatory control," Gielow said of the WHA quality effort.

"I have heard constituents complain about new health care facilties being perhaps ‘too grandiose,’ and that gets added to some bill," Gielow said. "I  believe that the free market, not government, should work that out."

At this time, WHA is collecting participation agreements and Richardson encourages members to contact her drichardson@wha.org  or George Quinn gquinn@wha.org ) if they have questions as they discuss the program and participation materials with members of their staff.

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The Joint Committee on Finance halted its deliberations on Wednesday night (May 21) after receiving new federal revenue estimates from the Doyle administration, but both Senate and Assembly leaders said the committee will complete its work by Friday, May 30.

As previously reported in The Valued Voice, the state’s Medicaid budget relies on $434 million of new federal revenues secured through a waiver application and intergovernmental transfer (IGT). On Wednesday, DHFS Secretary Helene Nelson notified the Finance Committee that it should continue to expect $434 million from the federal government – although only a portion of that amount from the IGT.

Secretary Nelson and Department of Administration Secretary Marc Marotta said Governor Doyle expects to reach the $434 million goal with about $280 million from the federal tax relief/economic stimulus legislation (see related articles on pages 1 and 3), $70 million from savings in the Medicaid budget, and $84 million from the proposed waiver and IGT.

Because some legislators feared this news means Wisconsin’s IGT proposal is in jeopardy, the committee delayed action on Medicaid and other major spending proposals. With final Congressional action on the stimulus package completed today (May 23), the committee hopes to have more reliable federal revenue estimates when it votes on the Medicaid budget next week.

"The Medicaid budget has been - and continues to be - up in the air as the committee makes spending and cutting decisions based on updated enrollment projections and revenue estimates," said Jodi Jensen, WHA V.P. of government relations. "The progress we’ve made in our efforts to restore funding for GME and the Rural Hospital Supplement hinge on this constantly changing revenue picture."

"Over the next few days, we will redouble our efforts to ensure that GME, the Rural Supplement, and other hospital-related issues continue to be part of the debate as the committee makes its final decisions on Medicaid funding," added Jensen.

Once the Finance Committee completes its work, both the Assembly and Senate must approve the budget before sending it to the Governor for his signature and vetoes. Legislative leaders say the budget will be completed by mid-June.

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Senate Finance Committee Chairman Chuck Grassley (R-Iowa) last week made a last-minute decision to add a major Medicare payment amendment to the tax relief/economic stimulus legislation. Although the Medicare amendment was eventually stripped from the bill during conference committee deliberations, Grassley’s move significantly improves prospects for address of Medicare equity issues in 2003.

Virtually no one in Washington, D.C. was predicting a Medicare "add-on" to the tax relief/economic stimulus bill. Conventional wisdom focused on Medicare payment issues being addressed as part of Medicare reform/prescription drug legislation that will be debated in Congress later this summer. A growing number of prognosticators are suggesting that major Medicare legislation that includes the trifecta of Medicare "reform," a new prescription drug entitlement and provider payment changes will be difficult to pass due to the politics associated with the prescription drug issue and the skepticism of "reforming" Medicare along the lines supported by conservative Republicans.

Nevertheless, prospects for the enactment of meaningful Medicare payment improvements as found within the Grassley amendment have improved significantly. Although stripped from the tax relief/economic stimulus bill due to germaneness issues, Senator Grassley extracted a reluctant commitment from House Republicans, including Ways and Means Committee Chairman Bill Thomas, that Medicare equity will be a significant priority in the new Medicare bill. A similar and even more specific promise was received from President George Bush.

The fascinating "inside the beltway" conflict that will emerge this summer will be Grassley vs. Thomas. A recent article in the Capitol Hill newsletter, Rollcall, described Bill Thomas as a "sometimes feared public presence on the Hill." The article suggests that the California Republican dominates discussion on tax and Medicare spending issues and is viewed as the leading architect "of a sweeping Medicare reform measure." It’s also well known that Bill Thomas is consistently unsympathetic with the notion of addressing longstanding Medicare payment equity problems. In fact, Thomas is known to support new Medicare provider cuts that he would use to fund his so-called Medicare reform package.

The leverage, however, now is on Grassley’s side. Events of the past few days, almost exclusively shaped by Iowa’s senior senator, have significantly improved the odds that Medicare legislation this year will include much of WHA’s federal advocacy agenda.

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President George Bush has sent a letter to Senate Finance Committee Chairman Chuck Grassley (R-Iowa) indicating support for increasing Medicare funding for providers consistent with improvements included in Grassley’s amendment that was removed from the tax relief legislation this week. The Bush commitment is viewed as a trade off for Grassley’s agreement to allow the amendment to be stripped from the bill.

Support from President Bush virtually guarantees that comprehensive Medicare reform legislation that will be debated by Congress will address improvements affecting the Medicare Wage Index, equalizing the Medicare base inpatient rate and the current Critical Access Hospital law, including enhanced eligibility flexibility. The combination of these payment improvements, along with an increase in the current Medicaid low DSH cap, has the potential of improving Medicare and/or Medicaid payment for virtually every Wisconsin hospital. The Medicare improvements alone total as much as $30 million annually.

Congress is expected to begin debate of comprehensive Medicare reform legislation, including prescription drug coverage, in June.

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As a way to improve the W-2 program and address specific workforce issues, the Governor’s budget included transitional jobs as a new option within W-2. The Department of Workforce Development (DWD) asked for input and support from WHA, as it is believed that the health care industry might benefit from transitional jobs.

WHA arranged a meeting between DWD Secretary Roberta Gassman and representatives from the Milwaukee hospitals on May 8 because more than 80% of the eligible recipients reside in the larger Milwaukee metro area. Hospital representatives at the meeting included: Peggy Neimer, Children’s Health System; Mike Holzum, Froedtert/Community Health; David Smith, Covenant Healthcare System; Nancy Grisdale, Aurora Health Care; Cheryl Hill, Columbia St Mary’s; Ed Malindzak, All Saints Healthcare; and Sally Brenner from Columbia St Mary’s. Secretary Gassman explained the program, requested support and responded to questions from the attendees. The hospitals impressed on the Secretary that their greatest workforce need is not entry level jobs, but rather clinical positions. She responded with a statement of the Governor’s commitment to the entire health care workforce.

A transitional job program would place workers in actual positions with real employers doing real work. The program would pay workers salary for a six-month period plus additional support for the cost of administration. Existing resources for education, access to health care, transportation and work place behavior/adaptation would continue. Participants would be better prepared for jobs than current programs, and employers could evaluate participants’ ability to meet all workplace expectations and be potentially successful employees.

On May 22, the Joint Finance Committee determined that the Transitional Jobs proposal should more appropriately be addressed as separate legislation and removed it from budget consideration. Judy Warmuth, WHA’s vice president of workforce development is a member of the Task Force on Transitional Jobs created by DWD that will continue to work on the operational components of a transitional jobs program. This task force will have an opportunity to offer recommendations to the legislative process. In addition to the task force work, WHA will also actively participate in the process to ensure that any transitional jobs program is structured to best meet the needs of Wisconsin hospitals.

On the overall workforce issue, WHA will hold a meeting in the near future of a small group representing our membership. The purpose will be to confirm or reorder the workforce priorities of our members. The ideas and issues raised at this meeting will help refocus WHA’s workforce plan. The ideas and issues will be shared with DWD Secretary Gassman at a meeting she plans to hold that will help identify appropriate administrative and legislative actions designed to continue the work of the 2002 Governor’s Task Force on the Health Care Worker’s Shortage.

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Nominations are now being accepted for WHA’s annual Distinguished Service Award and Trustee Award, as well as for the ACHE Young Healthcare Executive Award. These important awards recognize those who display leadership, dedication and professionalism to their community or their association.

You may know someone in your region, in your hospital or on your Board of Directors who deserves such an honor, and you now have an opportunity to nominate him/her for one of these prestigious awards:

• Distinguished Service Award is presented to a senior health care executive who has made an exemplary commitment to WHA and the community he/she serves.

• Trustee Award honors a trustee of a WHA member organization who has made an exemplary commitment to his/her community and to the organization on whose board he/she serves.

• ACHE Young Healthcare Executive Award is presented to a member of the American College of Healthcare Executives under the age of 40 who has shown exceptional professional development.

Administrators, trustees, senior managers, nurse leaders, volunteers and others are encouraged to review the criteria for the awards and nominate someone to receive one of the honors.