Three Assembly Republicans this week proclaimed their support for WHA’s Medicaid "Downpayment Plan."

Reps. Terry Moulton (R-Chippewa Falls), Scott Suder (R-Abbotsford), and Jeff Wood (R-Chippewa Falls) each sent a memo to members of the Joint Finance Committee this week urging passing of WHA’s three-part plan. Under the plan, payment improvements would be made in three areas of greatest need: Disproportionate Share Hospitals program (DSH); outpatient reimbursement rates; and Graduate Medical Education (GME).

"The WHA plan calls for the state to appropriate $25 million in each of the next two years," Rep. Moulton said in a memo to the co-chairs of the Joint Finance Committee. "Spending this money will bring an additional $74 million in federal revenues into the state over the next biennium. This additional funding is sound budgeting. Medicaid needs to be a priority in this budget, and I believe we can do it."

According to WHA, Wisconsin hospitals are paid just 55 cents by Medicaid for every dollar they spend providing care to Medicaid recipients. Some hospitals are paid as little as $94 for surgeries that cost thousands to perform.

"Over the past few weeks my office has been flooded with hundreds of letters, phone calls, emails and personal visits regarding our current Medicaid reimbursement rate for hospitals," said Rep. Jeff Wood. "I have come to a simple inescapable conclusion; continuing to under fund these reimbursements is unsustainable and will ultimately result in a catastrophe for our entire health care system. That is why I strongly support the ‘Downpayment Plan’."

"I am a lead sponsor of the Taxpayers Bill of Rights (TABOR) because I believe, as I am sure you do, in accountable budgeting," Rep. Wood continued. "It is essential to address this problem now in order to pay for the services we have promised Wisconsin citizens and ensure we are not in a worse financial mess two years from now."

According to WHA, in 2004, Medicaid paid hospitals approximately $450 million less than what it cost to deliver care. The results are higher health care costs for everyone, a situation Rep. Scott Suder well understands.

"Unpaid Medicaid costs are being shifted to employer health care premiums statewide – a situation many are calling the ‘Hidden Health Care Tax’," said Rep. Suder. "I believe it is the state’s responsibility to pay for the programs it creates … I believe we need to make this a priority in the 2005-07 state budget, and we can do this without raising any taxes. In 2005-07 we need to make this a priority."

The WHA plan also enjoys strong support from the state’s largest business lobby, the Wisconsin Manufacturers & Commerce (WMC).

"Wisconsin employers are paying artificially-inflated health care costs because the state is paying health care providers less than what it actually costs them to provide services to the Wisconsin Medicaid population," said WMC’s R.J. Pirlot in a May 13 memo to the Joint Finance Committee. "To begin repealing this hidden tax, WMC supports increasing Medicaid reimbursement rates."

He needs no introduction in health care circles. Leland Kaiser, Ph.D., is a dynamic, motivational speaker known for his ability to change the way organizations think. A recognized futurist and acknowledged authority on the changing American health care system, he is a provocateur and mentor to many hospitals and health care organizations in the U.S.

He’s a man who has worn many hats in health care organizations, as a hospital administrator, trustee, research and development director, graduate program director, and professional psychologist. He has Master’s degrees in clinical psychology and medical care administration and a doctoral degree in social psychology and higher education.

Kaiser will deliver the keynote address at the Rural Health Conference on June 23 at the Kalahari Resort in Wisconsin Dells. He will take a look at how the current health care environment will affect the delivery of health care in rural areas and offer his insights on the skills and behaviors that will be required to thrive in the new environment.

WHA is expecting record-breaking attendance at the 2005 Rural Health Conference. Conference registration materials are available at www.wha.org. Conference and golf outing registrations are due to WHA by June 8. The 2005 conference is approved for 7 long-term care administration continuing education credits, and for 7 ACHE category II (non-ACHE) credits. Additionally, the Wisconsin Medical Society designates this education activity for a maximum of 7 category 1 credits toward the AMA Physician’s Recognition Award.

Room reservations with the Kalahari Resort can be made by calling 877-253-5466 by June 1 and asking for a room in the WHA Rural Health Conference block. The group rate is $129 for a basic Hut room (two queen beds) /$149 for a Lodge Suite (one king bed/one queen sleeper sofa). Because the conference is during the busy summer season at the resort, the group rate will only be honored until June 1 OR until the room block fills, whichever occurs first. The special group rate will not be honored after the cut-off date of June 1, and no additional rooms will be held for conference attendees. The block is almost full as of print time, so make your reservations now!

In his continuing review of the charitable activities of the non-profit sector, Senator Grassley, Chair of the U.S. Senate Committee on Finance, asked ten of the country’s largest non-profit hospitals a series of questions concerning their charitable activities, patient billing practices, and joint ventures with for-profit entities. In addition to Grassley’s activities this week, the U.S. House of Representatives Committee on Ways and Means, held a hearing May 26 on the tax-exempt status of hospitals.

In a statement for the record of the House Ways and Means Committee hearing, AHA stressed that hospitals’ nonprofit status allows those hospitals to address vital health care needs in their communities. "Hospitals are open 24 hours a day, seven days a week. The women and men who work there – on the day shift, the swing shift or the night shift – provide compassionate care and help bring new life into the community. They provide medical care both within their four walls and in other community settings. Hospitals provide emergency department care to all, regardless of their ability to pay. Hospitals’ uncompensated care and Medicare and Medicaid payment shortfalls are costs that are absorbed so that communities can continue to receive the care they need."

In 2003, Wisconsin’s community hospitals provided $496 million in free or largely subsidized care to over 850,000 people. "Wisconsin hospitals are proud of their mission to provide high quality, around-the-clock care to persons in need, regardless of their ability to pay," said WHA Senior Vice President George Quinn. Quinn added, "Wisconsin is different from many states in that hospitals are required to report the amount of uncompensated care they deliver and their polices related to uncompensated care."

In addition, Quinn continued, "WHA issued guidelines on hospital billing and collection policies last year. Hospitals regularly review their policies to ensure that the specific needs of the uninsured and underinsured are taken into consideration." The WHA Billing & Collection Policies can be found at www.wha.org/financeanddata/collection.aspx.

A copy of Senator Grassley’s letter to the ten hospitals and a copy of AHA’s statement to House Ways and Means Committee are available on WHA’s Web site.

The Center for Medicare and Medicaid Services (CMS) recently published a proposed rule in the Federal Register (site listed below) that ties the FY2006 full annual payment update for acute care hospitals to the validation process for data sent to the CMS National Warehouse. This rule requires hospitals to:

1) Achieve a data validation score of at least 80 percent, and,
2) Provide data for 2 consecutive quarters (3rd and 4th quarters of 2004) on the 10 quality measures (AMI, CHF, CAP).

The proposed rule is in the 60-day comment period. Unless there is a change to the rule, CMS will use the results of validation from 3rd quarter 2004 discharges. These validation reports are expected to be released on June 6, 2005. Hospitals not passing this criterion after appeal will be able to request that their validation results from 4th quarter 2004 be used.

The Wisconsin Hospital Association will join the American Hospital Association to oppose the use of the validation score as part of the annual payment evaluation. The validation process, although a critical step to assure the accuracy of the data, is not yet perfected to the point that it should be used to determine a hospital’s market basket update.

If you have questions regarding this proposed rule, contact MetaStar at 1-800-362-2320 or Dana Richardson at drichardson@wha.org.

Federal Register: www.cms.hhs.gov/providers/hipps/frnotices.asp

CMS-1500 is a link that opens the federal register notice that was published May 4, 2005. The RHQDAPU information is on pages 23425-23427 of the document.

• Why is it that people who have never created a job are often first in line to criticize those who have?

That just might be the case with naysayers who are chortling about recent news stories that identify several major Wisconsin employers who have a handful of employees who, on their own initiative, enrolled in the BadgerCare program. National advocacy groups often demonize Wal-Mart as the focal point of what’s wrong with corporate America…and sure enough, about 800 Wal-Mart employees are enrolled in BadgerCare. But that’s 800 out of a workforce of 26,000! And the employees in question are either "new" hires or part-timers.

Looking back just a few years, the BadgerCare program was embraced by former Governor Thompson and the Wisconsin Legislature as a catalyst for providing temporary health coverage for a transitional workforce looking to "move up" the private sector employment ladder. And it’s working! As noted recently by Wisconsin Manufacturers and Commerce spokesman Jim Pugh, "It should not come as a surprise to anyone that low-wage (workers) and people who aren’t…working full-time would be enrolled in BadgerCare." That’s exactly who the program was designed to help.

• Two Wisconsin hospitals are featured in a story in this week’s Modern Healthcare (May 23, 2005) that effectively trashes newly proposed CMS rules that would prevent Critical Access Hospital (CAH) relocations. The rules state that CAHs relocating more than 250 yards from their current campus would lose CAH designation.

Jeff Meyer, CEO of Osceola Medical Center, notes that his 60-year-old hospital is planning to move about one mile from its current, land-locked downtown location. And St. Joseph’s Community Health Services (Hillsboro) CEO Bill Bruce says he won’t be able to build a replacement hospital even though it is impossible to accommodate necessary renovations at his land-locked (between a lake and a highway) facility.

WHA, the Rural Wisconsin Health Cooperative, the National Rural Health Association and the American Hospital Association are vigorously fighting the new CMS regulations, which are an unfortunate overreaction to one instance of a CAH relocating into a suburban area from a rural location 30 miles away.

One might also speculate that the new regulation is symptomatic of deep-seated CMS staff skepticism (and outright opposition) to the CAH program. But CAH advocates in Congress are likely to win this one given the overwhelming evidence that the CAH program has been a successful safety net for rural health care all across the nation…and at a cost of less than one percent of total Medicare spending…a veritable bargain!

Steve Brenton, President

Hundreds of legislative contacts by employees and a legislative forum show the importance of grassroots advocacy to Madison’s Meriter Hospital. Their most recent legislative forum was held on May 23, 2005 and featured local legislator, State Rep. Brett Davis (R-Oregon), whose district includes many constituents in Meriter’s service territory.

Rep. Davis spoke with employees of Meriter about the state budget bill, his commitment to funding Medicaid and other regional issues of importance. "So much of what goes on in Madison and Dane County spills over into neighboring counties, and Meriter is an engine for that," Davis said. "I see my role as helping bridge any gaps."

CEO Terri Potter provided background on how Meriter views its role in furthering regional development and growth. Potter is a member of the Collaboration Council, which is working towards building regional economic development through quality of life, technology, workforce, and other priorities. The Collaboration Council’s goal is to proactively bring businesses, institutions and governmental bodies into partnerships to move the region forward.

"Meriter is pleased to work in partnership with the Greater Madison Chamber of Commerce, local and regional businesses, and area elected officials to build on our existing strengths and to create new economic development opportunities. Working with policymakers and elected officials like Rep. Brett Davis will ensure a truly collaborative effort," Potter said.

Another issue discussed was the role information technology plays in the delivery of health care.

"What we need in this state is health information technology where clinical data is captured at the point of origin and shared with caregivers...this could significantly help us create more efficiencies," Potter said. "However, laws such as HIPAA, crafted for good reasons, have created unintended obstacles."

In response, Rep. Davis discussed ways government could partner with hospitals on this issue. "One thing the government can do is find ways to help, such as setting up pilot programs," he offered.

In recent weeks, Meriter employees have also sent hundreds of emails and letters to local legislators on the state budget bill urging legislators to support WHA’s Medicaid Downpayment Plan, which increases Medicaid outpatient reimbursement rates, enhances disproportionate share hospital payments and restores graduate medical education funding.

Valerie Endres is one Meriter employee who sent several of those emails to her legislators. Valerie works in Meriter’s GROW program, a program designed to assist the mentally ill as they transition from inpatient treatment to independent living. GROW, established 35 years ago by Meriter, provides services mostly to Medicaid patients and is impacted by the dismal outpatient reimbursement rates. She wrote, "Paying the current commitment in the Medicaid program will slow down the ‘hidden health care tax’," said Endres. "I am urging you to fully fund Medicaid for Wisconsin hospitals. The future mental health and well being of our patients depends on it."

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 the association.

WHA will recognize the award winners at the 2005 Annual Convention in September. You may know someone in your region, in your hospital or on your Board of Directors who deserves such an honor. You now have an opportunity to nominate them for one of these annual awards:

• Distinguished Service Award is presented to a senior health care executive who has made an exemplary commitment to WHA, his/her hospital, and the communities 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. Nominations for this award should be sent to Dan Bonk, FACHE, ACHE Young Healthcare Executive Award, Aurora Health Care, 1539 N. 33^rd Street, Sheboygan, WI 53083.

Nurse Educators for Tomorrow (NET) is a project of the University of Wisconsin School of Nursing that is designed to increase the number of advanced practice nurses and the number of nurses who would qualify as faculty in nursing schools. The program, funded by HRSA, is designed to create medical-surgical clinical nurse specialists and pediatric nurse practitioners who have an interest in teaching. The project is unique in that it offers all coursework online and holds clinical experiences within the learner’s community. The program has the dual goal of increasing teaching faculty and practicing clinicians without relocation or extensive travel. Information about the NET project can be found at www.son.wisc.edu/net/.

The project is making a concerted effort to attract minority and disadvantaged students who might be eligible for stipends or scholarships.

"We have supported increasing the number of advanced nurse practitioners, as detailed in WHA’s report, "Who Will Care for our Patients," says Judy Warmuth, WHA’s vice president of workforce. "This program also prepares more nurses as nurse educators, which is a profession where demand outstrips supply."

"This is exactly the innovative, flexible type of program that health care professionals need. The fact that the coursework can be completed online makes it ideal for nurses who are located in non-urban areas or who are unable to travel to classes," Warmuth continued.

Hospitals who know of potential enrollees or who wish to distribute program information can contact Project Co-Director Pam Scheibel at Scheibel@wisc.edu or 608-263-5199.

Three seminars will be offered in early June, focusing on a review of the newly published "Hospitals’ Guide to Mass Casualty Events," which documents the law as it is known and interpreted currently regarding emergency incidents.

The three seminars will be held from 10 am to 12 pm on the following dates at the following locations:

• Monday, June 6, at The Country Springs Hotel in Waukesha
• Tuesday, June 7, at The Plaza Hotel & Suites in Eau Claire
• Wednesday, June 8, at the Stoney Creek Inn in Mosinee

There is no registration fee for the seminars. You are encouraged to bring your disaster preparedness team to any of the three seminars, but WHA requests that each attendee is pre-registered.  Attendance is the only way to obtain a printed copy of the Guide, which lays out the foundation of present legislation and regulation to allow hospitals to begin to discover answers to questions in the law, as well as the gaps currently present. This Guide is the basis on which hospitals can begin to understand the law governing mass casualty events.

On July 14, WHA will offer a seminar design specifically for hospital staff who need to understand the fundamentals of the various Medicare hospital payment systems, including cost-based, prospective and fee schedule systems.

Attendance will be advantageous to your staff members who are new to the world of reimbursement, need help making the link between clinical and financial information, struggle to explain what the Medicare Prescription Drug Improvement Modernization Act of 2003 means to your hospital, or have difficulty explaining the importance of Medicare to the media and your community.

This may include staff in the areas of public relations and communications, government relations, health information management, finance, and board of trustee members.

Each participate will receive a 140-page reference manual, Medicare 101: An Overview of Medicare Payment Systems. This invaluable manual contains information on provider reimbursement rules for each Medicare program area, and examples of reimbursement. Additional manuals may also be purchased.

The seminar will be held on July 14, 2005, from 10 am to 2:30 pm at Stoney Creek Inn in Mosinee. A brochure and a registration form are included in this week’s packet and on the Web site at www.wha.org.

This year, the inpatient psychiatric prospective payment system (PPS) was implemented for reporting periods beginning on or after January 1. For psychiatric facilities and acute-care and critical access hospitals providing psychiatric services, this is a crucial time for preparing and converting to the new payment system.

A June 9 seminar, entitled "Prospective Payment System for Inpatient Psychiatry," will review several examples of inpatient psychiatry cases and learn how to accurately diagnose, code and treat patients to ensure adequate reimbursement. An overview of the PPS payment components, adjustment factors and transition period will be shared, as well as a case study examining an inpatient psychiatry unit before and after the implementation of PPS.

Participants will learn the PPS payment components and adjustment factors, patient assessment and evaluation procedures, and how to manage patients’ lengths of stay based on need and reimbursement.

This seminar is for psychiatric directors and managers, nursing directors and managers, medical records directors, health information management directors and coders, medical records directors, CFOs and finance analysts from all facilities offering inpatient psychiatry services.

The conference will be held on June 9, 2005, from 9 am to 3:30 pm at the Bridgewood Resort in Neenah. A brochure and a registration form are available on the Web site at www.wha.org, as well as easy, on-line registration.

ACHE’s 2005 Book of the Year Award recipient Fred Lee will present his service excellence and patient loyalty workshop, "If Disney Ran Your Hospital – Some Things You’d Do Differently," for WHA members on August 18.

Lee has the unusual distinction of having been both a senior vice president of a major medical center and a cast member at Disney University. Lee was recruited by Disney because of his expertise in helping hospitals achieve a culture that inspires patient and employee loyalty.

Lee’s health care experience includes five years as vice president of marketing and development for Shawnee Mission Medical Center in Kansas, where he won several national awards for innovative approaches to patient satisfaction and loyalty. He then took on the role of senior vice president at the 1,500-bed Florida Hospital, where he developed a nationally acclaimed guest relations program.

Based on his book, If Disney Ran Your Hospital – 9 ½ Things You Would Do Differently, this workshop will help you and your team gain the extraordinary competitive advantage that comes from being seen as "the best" by your employees, consumers and community.

The seminar will be held on August 18, 2005, from 9 am to 4:30 pm at Country Springs Hotel & Convention Center in Stevens Point. A brochure and a registration form will be available on-line and in the Friday packet on June 4, but mark your calendar today.

The Wisconsin Chapter of ACHE is presenting "Developing Mentoring and Coaching Skills" on June 24, immediately following the adjournment of the Wisconsin Rural Health Conference.

Data has shown that mentoring programs are an effective way to offer guidance and support for health care executives who are entering the field or who are seeking career advancement. A mentoring relationship provides a safe environment in which those with less experience may learn from experienced executives. Attendees will learn what mentoring is, how the process works and the benefits of a mentoring program. Additionally, attendees will learn how to identify individuals within their organizations to make the most of the mentor/protégé relationship.

This program has been developed and is presented locally by the Wisconsin Chapter of ACHE. The American College of Healthcare Executives has awarded one (1) Category I (ACHE education) credit hour to this program.

The presenting panel includes Francis Wiesner, FACHE, vice president and executive coach for Lee Hecht Harrison, who will act as moderator; Mark Hamilton, FACHE, vice president of ambulatory operations for UW Hospital and Clinics; and Frances Finley, FACHE, administrator for Aurora Medical Center of Oshkosh.

The conference will be held at the conclusion of the Wisconsin Rural Health Conference, on Friday, June 24, 2005, from 10:45 am to 12 pm at the Kalahari Resort in Wisconsin Dells. There is no fee to register for this event, but pre-registration is requested. A brochure with registration form can be found online at www.wha.org. Easy, online registration is available as well.

Included in this week’s packet is the call for nominations for the WHA Foundation’s 2005 Global Vision Community Partnership Award. This competitive grant award is presented to a community health initiative that successfully addresses a documented community health need. The Award, launched by the WHA Foundation in 1993, seeks to recognize and support ongoing projects that support community health.

Any WHA member can nominate a community health project. The project must have been in existence for a minimum of two years and must be a collaborative or partnership project that includes a WHA member hospital and an organization(s) within the community.

"This special award recognizes the many collaborative programs that our members are participating in within their communities, and continues the WHA Foundation’s commitment to WHA members meeting the needs of their communities," said Jennifer Frank, WHA Foundation director.

The Award will be presented at the WHA Annual Convention on September 22, 2005. Nominations are due August 26, 2005. Nomination forms can also be found on the WHA Web site at www.wha.org. For more information about the Award, contact Jennifer Frank at jfrank@wha.org or 608-274-1820.

In early 2005, three U.S. hospitals, (one in the Midwest), reported individuals posing as Joint Commission on Accreditation of Healthcare Organizations (JCAHO) surveyors, arrived at their facilities and asked to tour different areas of the hospitals. JCAHO administrators said the individuals were not associated with the Commission nor were there any planned inspections at the facilities. In all three incidents, when approached by security and asked for identification, the suspects fled from the hospital facilities.

For your organization’s safety, when Joint Commission surveyors arrive at your facility, it is imperative that you ask them to show their Joint Commission ID badge. Also, when Joint Commission surveyors arrive unannounced they will have a letter addressed to the head of the organization signed by Russell Massaro, M.D., executive vice president of Accreditation Operations for the Joint Commission, explaining who they are and why they are there. The Joint Commission suggests that any hospital experiencing a similar situation should notify their local authorities and the Joint Commission.

Health care providers can now apply for a National Provider Identifier (NPI) through an online tool available on the Centers for Medicare and Medicaid Services (CMS) Web site. The NPI is a standard unique identifier that health care providers must begin using when submitting electronic claims and other HIPAA standard transactions by May 23, 2007.

The NPI is a requirement from HIPAA; the final rule implementing the NPI was published on January 23, 2004, with an effective date of May 23, 2005.

The Green Bay Packers board has nominated six new directors to be voted on at the annual stockholders meeting July 27. Among those nominated was George Kerwin, president and CEO of Bellin Health of Green Bay. Go Pack!!

Sioux Valley Regional Health Services is currently accepting applications for the position of chief executive officer in Slayton, Minnesota. This CEO will be responsible for the operations of Murray County Memorial Hospital - a 25-bed Critical Access Hospital with attached medical clinic. The ideal candidate will have proven leadership success in the rural health care environment with a Masters Degree in health or business administration. This position offers a competitive salary and benefit program. Forward your resume/CV to: Sioux Valley Regional Health Services, Director of Human Resources, 1305 W. 18th St., PO Box 5039, Sioux Falls, SD 57117-5039, Fax: (605) 328-5501, email: kaltvedk@siouxvalley.org. EOE

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