On May 4 the State Senate soundly rejected two versions of the Taxpayer Protection Amendment (TPA), a proposed amendment to the Wisconsin Constitution to limit state and local government spending. By a vote of 20 to 12, Senators rejected Assembly Joint Resolution (AJR) 77, which would have placed spending limits on state government only. By another vote 21 to 11, Senators rejected a similar proposal (SJR 63) to limit state and local government spending. All 14 Senate Democrats voted against the proposals and were joined by six Republicans against AJR 77 and seven against SJR 63.

Both versions were strongly opposed by WHA, and the votes came as welcome news.

See below to learn how your Senator voted.

"The TPA is not a partisan or philosophical issue for us," said WHA Senior Vice President Eric Borgerding. "The TPA is about making sure the state keeps and improves its commitment to its own health care programs, namely Medicaid. The TPA would have made it even more difficult for the state to keep those commitments, and more difficult to stem the massive shift of unpaid program costs to employers. We are very pleased with these bipartisan votes."

According to WHA, Wisconsin hospitals were paid just 49 cents for every $1 they spent treating Medicaid patients in 2005. The underpayments resulted in some $550 million in unpaid hospital Medicaid costs being shifted to the private sector employers and their employees in 2005.

WHA was one of the leading health care organizations opposing TABOR in 2004 and TPA in 2006, and worked closely with Democrats and Republicans to defeat the proposals.

"We spent a lot of time in Capitol offices, and our members spent a lot of time on the phone expressing their concerns and urging Senators to vote ‘no,’" said WHA lobbyist Jodi Bloch. "We are glad legislators from both sides of the aisle heard that message, and quite resoundingly it seems!"

Opposition to the TPA was bipartisan and wide ranging. Many of those voting against were philosophically opposed to using the Wisconsin Constitution to do a job they were elected to do themselves.

"The voters go to the polls every two years to elect their representatives," said Senator Luther Olsen (R-Ripon), one of the early Republican opponents of the TPA. "The ultimate TPA in my book is going to the voting booth and voting for a Republican. We can limit spending ourselves."

Other legislators echoed WHA’s concerns over how the TPA would impact the Medicaid programs.

"The TPA will not lower taxes as promised," said Sen. Bob Jauch (D-Poplar) earlier this week. "What it will do is seriously and gravely damage the state’s ability to meet the needs of Wisconsin’s Medicaid program."

The votes bring to an end the debate over placing limits on state spending in the Wisconsin Constitution, at least for the time being.

"For all practical purposes TPA is dead for this session," Todd Allbaugh, a spokesperson for Senate Majority Leader Dale Schultz recently told WisPolitics.

President George W. Bush this week called upon the nation’s hospitals to provide more information on prices and quality measures as part of an effort to become more transparent for consumers. "We need informed consumers," the President said, praising the American Hospital Association Board’s new position on hospital price disclosure and ongoing efforts to share quality improvement data.

The President’s remarks came at the AHA Annual Meeting in Washington, D.C., May 1-3. President Bush appeared before close to 2,000 participants at a special Monday afternoon program. Earlier in the week, the AHA Board unanimously approved a new Policy Statement on Hospital Pricing Transparency. The Statement noted that, "people deserve meaningful information about the price of their hospital care" and that hospitals should be "committed to sharing information that will help people make important decisions about their health care."

The AHA Policy Statement provides a roadmap to hospital price transparency that includes support for a federal requirement for states, working with state hospital associations, to expand existing efforts to make hospital charge information available to consumers.

In comments at the meeting, AHA Senior Vice President for Government Relations Rick Pollack specifically cited WHA’s PricePoint as "an innovative initiative that provides meaningful information to the public about hospital inpatient prices and services." Pollack said that state-based initiatives like PricePoint should serve as national models to make hospital charge information available to consumers and public policy makers. Much like WHA’s transparency position, the AHA policy also calls upon insurers to make available in advance of medical visits information about an enrollee’s expected out-of-pocket costs.

The issue of hospital pricing transparency was prominently featured during AHA’s Washington meeting as one of the "community accountability" themes that were then featured in meetings in Capitol Hill visits with members of state Congressional Delegations. In addition to pricing transparency, issue papers pertaining to hospital billing and collection policies and community benefit reporting were also strongly emphasized.

Twenty-five Wisconsin hospital leaders participated in program activities during the AHA meeting. On Tuesday and Wednesday, Wisconsin hospital leaders met with all members of the Wisconsin Congressional Delegation and their health staff to discuss special initiatives being undertaken by Wisconsin hospitals to promote the public accountability agenda. Special issue papers regarding CheckPoint, PricePoint, the new Community Benefits Reporting initiative and Medicare Part D implementation concerns were discussed with Delegation members.

"AHA’s community accountability agenda featuring hospital pricing transparency, responsible and transparent billing and collection policies, and community benefits reporting using common definitions aligns perfectly with WHA’s commitment to showcase hospital community accountability," said WHA President Steve Brenton. "Members of the Wisconsin Congressional Delegation are strongly supportive of these initiatives and understand how they are benefiting the health and well-being of Wisconsin communities."

The American Hospital Association (AHA), in partnership with the Wisconsin Hospital Association, awarded Brad Neet, president of Saint Michael’s Hospital-Ministry Health Care in Stevens Point, the Partnership for Action Grassroots Champion Award. As a 2006 Grassroots Champion, Neet is being recognized for his exceptional leadership in generating grassroots and community activity in support of a hospital’s mission. The award was presented at a breakfast held during the AHA Annual Meeting in Washington, D.C. on May 2, which was also attended by 26 Wisconsin Hospital Association members (see article on page 1).

"WHA congratulates Brad for his outstanding grassroots efforts this past year," said WHA President Steve Brenton. "His assistance was instrumental in conveying to local legislators the impact that legislative issues, such as increased Medicaid reimbursement rates and restoring a cap on non-economic damages, have on his hospital and hospitals statewide."

Having spent just two short years in Wisconsin after relocating from Illinois, Neet plunged headfirst into grassroots activities on behalf of his hospital and the patients it serves. Neet is in regular communication with area lawmakers on major advocacy issues for Ministry Health Care and the Wisconsin Hospital Association. He has met, emailed and written legislators as well as utilized letters to the editor and more to galvanize the community around important public policy. His efforts have dramatically impacted the way his area lawmakers see hospital-related issues.

"I am pleased to have the privilege to work with Brad Neet on our grassroots advocacy efforts," said Jenny Boese, WHA VP of external relations & member advocacy. "The power of grassroots is seen when hospitals like Saint Michael’s make the connection for their area legislators about the impact that legislation being debated in Madison will have on their local community hospital. Brad knows how to do this perfectly. WHA couldn’t ask for more."

WHA is proud to see one of its members recognized as a Grassroots Champion by the American Hospital Association and views this as yet another example of the commitment by WHA and its member hospitals to grassroots advocacy. Each year WHA itself recognizes a Wisconsin hospital that best represents a grassroots partnership with WHA through our All-Star Grassroots Advocate Award. This award is given out at WHA’s Advocacy Day held each spring in Madison.

"Your leadership and dedication to promoting the mission of hospitals has added a strong voice on a local and national level," said Dick Davidson, president, American Hospital Association. "The compassion and hard work you have demonstrated has made a difference for your patients and your community and has earned you this special recognition."

It appears the Legislature will soon adjourn the legislative session, retire to respective corners, and prepare for battle in the November elections. I said "appears" because it was about this time two years ago the Legislature also "appeared" to have wrapped up the two-year session, capped-off with the defeat of the Taxpayer Bill of Rights (TABOR). But just as my musky rods were coming out that June, TABOR clawed its way back from the grave. The 2004 resurrection of TABOR ultimately failed, and took Senate Majority Leader Mary Panzer down with it.

In the closing days of the 2005-06 session, TABOR made its promised comeback. It had a different name (Taxpayer Protection Amendment/TPA) a different approach (limiting revenue rather than spending), but met the same fate – last night it failed. But this time, TABOR’s biggest casualty appears not to be a legislator, but TABOR itself.

The version narrowly adopted by the Assembly was deemed "too weak" by leading TABOR advocates because it exempted local governments from spending limits. But even this "watered down" version could only muster 12 of 33 votes last night in the Senate.

Despite its previous resuscitations, the entire notion of controlling state spending via constitutional amendment is clearly in disarray, if not dead, in Wisconsin. In fact, the divide over TABOR is greater than ever before, and for good reason.

Many legislators are simply uncomfortable punting their duties and obligations to a constitutional amendment. "It is not the job of the Constitution to control taxes, it is the job of elected officials," Senator Sheila Harsdorf (R- River Falls) said last night on the Senate floor, just before voting down TABOR.

Others share WHA’s concern with the impact TABOR will have on Medicaid. Wisconsin already shifts over $550 million in unpaid Medicaid costs onto the backs of employers. TABOR surely would make that worse.

Even those sympathetic towards the "TABOR notion" were disturbed by the magnitude and permanency of amending the Constitution. "I am not going to vote for any of these (versions of TABOR)," Senator Luther Olsen (R-Ripon) said just before voting ‘no.’ I don’t believe this should be in the Constitution, because I don’t believe any of us can craft fiscal policy that won’t have implications in the Constitution. We just can’t go back and change it if there are unintended consequences."

Olsen’s concerns were warranted. The frantic flurry of last minute amendments, hearings, and meetings aimed at piecing together an amendment to the Wisconsin Constitution produced a flawed product. One version would have included federal matching revenue in the overall spending cap and had dire consequences for Medicaid.

My sincere advice to the hard working folks in the Capitol is that it’s time to move on. Come back in January 2007 with a "TABOR mind in a legislator’s body" and get about the business of setting priorities.

We saw a promising glimpse of this last spring when the Joint Finance Committee unanimously rewrote Governor Doyle’s flawed Medicaid budget. It was a historic, bipartisan feat that rejected one time funding tricks, rejected new or expanded provider taxes, included some of the first hospital reimbursement increases in years, and MADE MEDICAID A BUDGET PRIORITY – no TABOR necessary. This accomplishment was hailed by WHA and it can be done again, sans constitutional amendments.

TABOR the Cat has now lived and died three times. With all due respect to its well-intended supporters, lets spare the next six and let this cat rest in peace.

"It’s a great feeling to look at the end of your day and know you helped make a difference in someone else’s life in some way, even if it was a very small task. Deep down, they appreciate everything you do; even if they don’t say it or show it, you just know."  — Keri Jo Schmidtke, CBRF Facilitator, St. Clare Hospital, Baraboo

It was an evening to remember. For about 250 people who attended the Fifth Annual Pride Program recognition dinner on May 4, it was an opportunity to honor the 60 persons who were being recognized for their dedication to a career in health care. Bob Fale, president of Agnesian HealthCare, Fond du Lac, welcomed the 60 people who were chosen to represent their hospital, their department, and their career. It was a well-deserved evening in the spotlight.

"Health care employees rise to the challenges before them every day with care, competence, and compassion. Thanking you all for what you do is such a small gesture when we consider how important the work that you do is to our patients, our employees and our communities," said Judy Warmuth, WHA vice president of workforce development in her message to the honorees during the program. "You can have the best technology in the world, but what our patients remember about being in a hospital is meeting you, seeing how much you care about them and their families. You are the face of health care."

The audience at the Blue Harbor Resort in Sheboygan listened intently as short vignettes were read from each honored employees’ essay as they were congratulated by Warmuth, Faye Deich, Wisconsin Organization of Nurse Executives (W-ONE), and Holly Fredrickson from the Wisconsin Society of Healthcare Human Resources Administration (WSHHRA). WHA, W-ONE, WSHHRA, and the Wisconsin Healthcare Public Relations and Marketing Society sponsor the Pride Program.

The Pride Program is designed to celebrate the health care workforce and the factors that distinguish it from other careers. Employees wrote passionately about the importance of their career to them, and how all the talents, skills and dedication of each employee in a health care setting is related to the same goal—delivering high quality patient care.

"I love the health care field, and feel I can now give back the love and compassion to our patients that I received throughout my many years as a patient. It’s been and continues to be a very rewarding field to grow and work in." — Jan Leischow, Rehabilitation Technician II, All Saints Healthcare, Racine

Below is a list of the 2006 Pride Program honorees.

Agnesian HealthCare, Fond du Lac
Kathleen Gardipee, CNA

All Saints Healthcare, Racine
Jan Leischow, Rehabilitation Technician II

Amery Regional Medical Center, Amery
Samantha MacDonald, RN

Aspirus Wausau Hospital, Wausau
Lynn Yaeger, RN

Aurora Medical Center of Manitowoc Co., Two Rivers
LeeRae Coenen, Certified Massage Therapist

Aurora Medical Center of Washington Co., Hartford
Kathy Roethle, RN, BSN, CEN

Aurora Sinai Medical Center, Milwaukee
Tricia Jene, RN

Aurora St. Luke’s Medical Center, Milwaukee
Leslie Biernat, Cancer Care Coordinator

Beloit Memorial Hospital, Beloit
Amy Brandenburg, RN

Black River Memorial Hospital, Black River Falls
Lois "Chipper" Wyss, Health Unit Coordinator

Boscobel Area Health Care, Boscobel
Dawn Stephenson, Certified Medical Assistant

Burnett Medical Center, Grantsburg
Brenda Rachner, LPN

Columbia St. Mary’s Hospital, Milwaukee
Eric Goin, Patient Care Assistant

Community Memorial Hospital, Oconto Falls
Tina Melnarik, CNA

Community Memorial Hospital, Menomonee Falls
Dale Scherbert, Director of Facility Services

Divine Savior Healthcare, Portage
Lorelei Karcz Vincent, Audiologist

Eagle River Memorial Hospital, Eagle River
Alicia Rouse, Medical Technologist/Microbiologist

Elmbrook Memorial Hospital, Brookfield
Julie Scheibe, RN, Registered Nurse III

Flambeau Hospital, Park Falls
William Westphal, RN, Registered Nurse

Fort HealthCare, Fort Atkinson
Shirley Brown, RN, Registered Nurse

Good Samaritan Health Center, Merrill
Angela Acker, RN, Registered Nurse

Gundersen Lutheran Health System, La Crosse
Cindy Vieth, RN, Care Manager

Howard Young Medical Center, Woodruff
Roddi Franck, Housekeeper

Lakeview Medical Center, Rice Lake
Sarah Schaefer, RN, Registered Nurse

Langlade Memorial Hospital, Antigo
Carol Philipps, RN, Surgery Nurse

Memorial Health Center, Medford
Sharon Vesnefsky, Environmental Services Aide

Memorial Hospital of Lafayette County, Darlington
Cindy Humphrey, Materials Management Supervisor

Memorial Medical Center, Neillsville
Marie Heck, CNA, long-term care

Memorial Medical Center, Ashland
Laurie Carlson, Health Unit Coordinator

Mercy Health System, Janesville
Pamela Schubring, Physical Therapist, Lead

Monroe Clinic, Monroe
Catherine, Seffrood, LPN, Pediatrics

Moundview Memorial Hospital & Clinics, Friendship
Linda Charles, Director of Senior Services

Oconomowoc Memorial Hospital, Oconomowoc
Jennifer Andler, RN, Registered Nurse

Orthopaedic Hospital of Wisconsin, Glendale
Amy Mueller, RN, Registered Nurse

Our Lady of Victory Hospital, Stanley
Becky Herman, Health Information Management Supervisor

Reedsburg Area Medical Center, Reedsburg
LaReta Dischler, CNA , Restorative Aide

Sacred Heart Hospital, Eau Claire
David Mortimer, Communications Assistant

Sacred Heart-St. Mary’s Hospitals, Rhinelander
Pamela Lohmeier, Environmental Services Aide

Saint Clare’s Hospital, Weston
Sarajane Moucha, RN, Registered Nurse

Saint Joseph’s Hospital, Marshfield
Nancy Joch, CNA, Exercise Assistant

Saint Michael’s Hospital, Stevens Point
Randal Wojciehoski, DPM, DO, Emergency Department Physician

Sauk Prairie Memorial Hospital, Prairie du Sac
Beth Ann Zick, Respiratory Therapist

Shawano Medical Center, Shawano
Lynn Spiegel, RN, Registered Nurse

St. Clare Hospital & Health Services, Baraboo
Keri Jo Schmidtke, CBRF Facilitator

St. Joseph Regional Medical Center, Milwaukee
Jamie Phillips, RN, Ambulatory Nurse

St. Joseph’s Community Health Services, Hillsboro
Marita Shaker, RN, Director of Nursing – long-term care

St. Joseph’s Hospital, Chippewa Falls
Nancy Fastner, Registered Dietetic Technician

St. Luke’s South Shore, Cudahy
Bonnie Henneman, Patient Access Representative Lead

St. Marys Care Center, Madison
Ce Ce Olson, LPN, Team Nurse

St. Marys Hospital Medical Center, Madison
Janet Bergum, RN, Registered Nurse

St. Mary’s Hospital Medical Center, Green Bay
Marge Vande Hei, LPN, Licensed Practical Nurse

St. Michael Hospital, Milwaukee
Erin Schulte, Patient Advocate

St. Nicholas Hospital, Sheboygan
Cori Salchert, RN, Registered Nurse

St. Vincent Hospital, Green Bay
Mary Pliner, Human Resources Specialist

Stoughton Hospital Association, Stoughton
Sarah Corbett, CNA , Health Unit Coordinator

Tri-County Memorial Hospital, Whitehall
Paulette Fox Beardsley, Insurance Clerk

University of Wisconsin Hospital & Clinics, Madison
Carrie Sparks, Sr. Administrative Secretary

Upland Hills Health, Dodgeville
Toni Rochon, Activity Coordinator, Nursing & Rehab Center

Vernon Memorial Healthcare, Viroqua
Janet Stalsberg, Renal Dialysis Care Manager

Waukesha Memorial Hospital, Waukesha
Ellen Marie Anders, Medical Technologist

Three new information pieces related to the WHA transparency agenda were just added to the WHA Toolkit. The full color brochures describe WHA’s key programs, CheckPoint, PricePoint and the newest reporting project, community benefits.

First used during meetings with the Wisconsin Congressional delegation in Washington DC earlier this week, the publications will also be helpful as handouts at community meetings, legislative visits, employee or employer meetings, and with the media.

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 2006 Forum.

A project submission brochure for the 2006 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 organization-wide 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 2006 Wisconsin Quality & Safety Forum Showcase CD and published in the December issue of the Wisconsin Medical Journal focused on quality and patient safety.

As in 2005, Showcase projects submissions will only be accepted via completion of the online submission form at www.wha.org/QSFshowcase. The online form is available as of Friday, May 5, and all submissions are due to WHA, via the online form, by Friday, June 30, 2006. 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 the December issue of WMJ. The deadline to submit manuscripts is October 9, 2006. To view "Instructions to Authors," visit the Wisconsin Medical Society Web site at www.wisconsinmedicalsociety.org/health_news/wmjauthorinstruct.cfm.

CMS has published a notice of proposed rulemaking (Federal Register, Vol.71, No.65, page 17052) that would revise the discharge notice requirements for the inpatient hospital setting by establishing a standardized notice for all discharges. The proposed rule would implement a two-step process, which more closely follows practices currently in place for other, non-hospital Medicare providers. Under the proposed rule, hospitals would be required to provide all inpatient Medicare beneficiaries with a standardized, generic notice of non-coverage the day before discharge. The generic notice informs the beneficiary when Medicare coverage ends and explains their appeal rights. If a beneficiary disagrees with the notice and contacts the Quality Improvement Organization (QIO) to appeal, the hospital would be required to issue a second, more detailed notice, which would include more specific information about the hospital’s decision to discharge the beneficiary.

The timeline for the new discharge notices is as follows:

1) One day prior to discharge the hospital provides the beneficiary with the standardized, generic discharge notice.

2) When notified by the QIO that a beneficiary has requested an expedited determination, the hospital must deliver a detailed notice to the beneficiary by close of business of the day of the QIO’s notification.

3) Upon notification by the QIO, the hospital must supply the QIO with all information the QIO needs to make its expedited determination as soon as possible, but no later than close of business the day the QIO notifies the hospital of the request.

4) At the beneficiary’s request, the hospital must furnish the beneficiary with a copy of or access to any documentation it sends to the QIO.

CMS has estimated the cost to hospitals of delivering the new generic notices at $5,200 per provider annually and the cost to hospitals of delivering the new detailed notices at $1,875 per provider annually. This is based on projections that two percent of all Medicare fee-for-service beneficiaries will request expedited determinations as well as two percent of Medicare Advantage beneficiaries. (An estimated 218,000 FFS beneficiaries and 32,000 Medicare Advantage beneficiaries nationally.)

Hospitals can provide comment on this notice of proposed rulemaking by going to www.cms.hhs.gov/eRulemaking. Refer to file code CMS-4105-P. Comments can also be mailed with one original and two copies to Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-41050-P, P.O. Box 8010, Baltimore, MD 21244-1850.

Comments must be submitted no later than 5 pm on June 5, 2006.

Included in this week’s packet is the call for nominations for the WHA Foundation’s 2006 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.

The Award will be presented at the WHA Annual Convention on September 28, 2006. Nominations are due June 30, 2006. Nomination forms can also be found on the WHA Web site at www.wha.org under the "About" tab. For more information about the Award, contact Jennifer Frank at jfrank@wha.org or 608-274-1820.

It’s the issue that enters the doors of every hospital in America, every day – the uninsured. And a new report analyzing government data confirms that there is a significant gap in the amount of health care accessed by people who do and do not have health care coverage in every state and the District of Columbia. Nationally, uninsured adults are nearly four times more likely not to see a doctor when they need to, compared to people who have health coverage.

The Coverage Gap: A State-by-State Report on Access to Care (http://covertheuninsured.org/media/research/CoverageGap0406.pdf) identifies the extent of disparities in access to health care between insured and uninsured Americans. The findings confirm that not receiving needed medical care is taking a toll on the millions of Americans who do not have health coverage. Across the nation, a far greater percentage of uninsured adults report being in ‘poor’ or ‘fair’ health, compared to adults who have insurance.

The report was released May 1 by the Robert Wood Johnson Foundation (RWJF) to kick off Cover the Uninsured Week, a nonpartisan, nationwide effort to urge U.S. leaders to make health coverage for Americans their top priority.

Activities designed to bring attention to the issue were held in Wisconsin. Specifically:

At St. Mary’s Hospital in Green Bay, CEO Jim Coller urged employees to write "a message to our elected officials in Washington on the need to make this a top priority. The uninsured are people like your neighbor who is out of work, the cashier at the grocery store or the older student who has returned to school."

Further, Coller said, "At St. Mary’s we provide a number of health care programs and services through grants and other programs to help the uninsured or underinsured. Because of these programs, people in our area receive life-saving screenings for illnesses such as colon and breast cancer. We offer community care for those in need. As part of our ministry of care and social accountability, we continually offer new ways to address unmet needs."

Monroe Clinic hosted a Town Hall Meeting on the issue of the uninsured on May 2.

"Health care is the single most important issue of our time," said Representative Brett Davis at Monday evening’s meeting.

Davis, along with Congresswoman Tammy Baldwin, State Senator Jon Erpenbach’s office, and U.S. Senator Russ Feingold’s office stressed the importance of finding a solution for the country’s uninsured and underinsured population.

The elected officials emphasized that a partnership is necessary between the local and national governments. Baldwin is excited about the bipartisan approach to solving this issue. "Because we are discussing this in a bipartisan manner, we hopefully won’t experience the gridlock we’ve suffered before," said Baldwin.

In addition to the comments by the elected officials, other people in attendance were invited to voice their concerns about the health care system including prescription drug coverage and insurance costs for small business owners. The Town Hall meeting was broadcast by Scott Thompson and The Big Easy 93.7 Radio Station.

St. Joseph’s Hospital, Chippewa Falls, set up displays near their cafeteria depicting state and population comparisons of the consequences of being uninsured. They also had an information sheet that provided action steps employees could take, including contacting their elected representatives. St. Joseph’s worked with their local media to develop stories on how lifestyle choices make a big difference in wellness levels that could lower an individual’s (uninsured, underinsured or insured) health care costs.

In Milwaukee, hospitals combined efforts and collaborated on a number of events during CTUW. A new collaborative effort among free health clinics in the Milwaukee area was announced at a reception on May 4. The collaborative will take a comprehensive approach to addressing barriers to health care, leveraging community resources and networking.

"The free clinics are being organized under the banner of the Primary Care Alliance, a collaboration between Milwaukee’s health systems and federally funded community health centers, in order to increase the coordination of activities and fund-raising to better assist those patients most in need," said Bill Bazan, vice president of the Milwaukee metro region, Wisconsin Hospital Association.

Special guests at the reception included Helene Nelson, secretary, Wisconsin Department of Health and Family Services; Scott Gelzer, executive director, Faye McBeath Foundation; and Dennis Brown, president and CEO, Delta Dental of Wisconsin.

Also in Milwaukee, academicians from local universities and health care executives from the community engaged David Riemer, director of Wisconsin Health Project, on the topic of "Healthcare Reform: Addressing the Symptoms or Addressing the System?"

Speakers on the health care panel were: Paul Nannis, vice president of government and community relations, Aurora Health Care; Dianne Kiehl, executive director, Business Health Care Group of Southeast Wisconsin; and Dr. Tito Izard, chief medical director, Martin Luther King Heritage Community Health Center.

The Centers for Medicare & Medicaid Services (CMS) on May 4 issued the long-term care hospital (LTCH) final rule, which takes effect July 1, 2006. While CMS made significant improvements to the proposed rule, issued in January, the AHA is still concerned with some sections of the regulation. While WHA is particularly pleased that the final rule contains a short-stay outlier (SSO) provision that is far less severe than initially proposed, we are disappointed that CMS failed to include a market basket update. This omission, in combination with the regulation’s other provisions, will cause a net reduction in rate year (RY) 2007 of 7.1 percent, a major improvement over the proposed 14.7 percent cut.

The final rule includes the following key provisions:

• LTCHs will not receive a market basket update for inflation. CMS states that it is omitting the 3.4 percent market basket update to offset coding increases. As a result, the LTCH prospective payment system (PPS) standard rate will remain at $38,086.04.
• Final changes to the payment formula for SSO patients are substantially less severe than originally proposed and, as a result, mitigates the negative fiscal impact. The SSO provision is estimated to reduce Medicare payments to LTCHs by $156 million in RY 2007, rather than the originally proposed $362 million, thanks to input from the AHA and other national LTCH organizations.
• CMS made important improvements to the SSO policy, adopting two key changes. The new SSO policy will base payments on the lesser of:
• 100 percent of patient costs (reduced from 120 percent of cost);
• 120 percent of the per diem of the LTCH-DRG payment;
• the full LTCH-DRG payment; OR
• A blend of the general hospital inpatient PPS (IPPS) per diem and 120 percent of the LTCH PPS per diem. As a patient’s length of stay increases, the LTCH-DRG portion of the blend increases. The IPPS per diem amount will be adjusted for low-income populations, teaching institutions, wage index, and other adjustments excluding high cost outlier payments. A sample calculation using the blended payment is available in Table 10 of the final rule (page 311 of the display version).

• LTCHs will begin using a new market basket – the rehabilitation, psychiatric and long-term care (RPL) market basket – to estimate the inflationary increases experienced by LTCHs and other providers. Adopting the RPL market basket will also increase the labor share from 72.885 percent to 75.665 percent.
• The outlier loss threshold will increase from $10,501 to $14,887, far lower than CMS’ proposed increase to $18,489. This means more cases than initially proposed will be eligible for outlier payments.
• As proposed, the exception to the three-day or less interrupted-stay policy will be terminated.

The final rule can be found at www.cms.hhs.gov/LongTermCareHospitalPPS/Downloads/CMS-1485-F.pdf, and will be published May 12 in the Federal Register. WHA will prepare a more detailed summary of the rule soon.

Reducing the risk of back injuries among caregivers is one way to address workforce issues. Many member hospitals are introducing new strategies and equipment to make turning, lifting and transferring patients safer for both patients and staff.

Last week, Governor Jim Doyle announced assistance from the Department of Workforce Development for health care institutions embarking on a lift-free or low-lift program. The Governor reported on the availability of $325,000 in competitive grants to promote this job safety initiative. Demonstration grants will assist health care providers, in partnership with local Workforce Development Boards, which are investing in new safe-lifting equipment by supporting the training and education needed by health care workers. The new Safe-Lifting Demonstration grants, funded through the Department of Workforce Development (DWD), have been established to advance the Governor’s "Grow Wisconsin" initiative.

Highlights of the grant:

• The grant applications are due June 2, 2006.
• The grants will run from July 1, 2006 - June 30, 2007, or until the grant funds have been spent.
• DWD plans to fund 10-12 grants in the range of health care settings including hospitals, clinics, nursing homes, community-based settings, and home based settings.
• Each grant will be limited to no more than $25,000, $1,000 per employee, and will require a minimum of 50 percent match from the health care provider.

The RFP can be found on the DWD Health Care Workforce Development Web site at http://dwd.wisconsin.gov/healthcare/

Health care providers that embarking on a no-lift environment may be interested applying for grant money and may also be interested in other information found on this Web site.

Two hospitals in Wisconsin were named to Solucient’s annual list of performance-improvement leaders for 2005. Gundersen Lutheran Health System, La Crosse, was included in the Teaching Hospital Category (200 or more acute care beds), and Holy Family Memorial Hospital, Manitowoc, was listed in the small community hospital category (25-99 acute care beds).

The most improved designation "recognizes a management team and board that are able to instill an organization-wide culture of performance improvement," according to Jean Chenoweth, a senior vice president at Solucient.

To select hospitals for the list of 100 most improved performers, Solucient analyzed Medicare cost reports for federal fiscal years 2000-04, Medicare Provider Analysis and Review data from federal fiscal years 1999-04 and CMS Standard Analytical File Outpatient Data Set for calendar years 2000-03. A total of 2,744 hospitals were included in the study.

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