In budget action this week, the State Assembly voted to entirely remove the harmful tort provisions included in Governor Doyle’s budget proposal and left largely intact by the Joint Finance Committee. Their removal is a victory for WHA, health care providers and patients, and the 70 organizations voicing opposition to the changes.

A motion from Representatives Louis Molepske (D-Stevens Point) and Mary Hubler (D-Rice Lake) deleting the provisions was approved in the Democratic Caucus and is expected to be approved by the full Assembly.

The provisions, which are heavily supported by trial attorneys, would drastically change Wisconsin’s litigation landscape. WHA has made their removal from the budget a priority and has asked the Legislature to consider them outside of the budget process to allow for a more thorough consideration of possible unintended consequences for the medical liability system, Wisconsin health care providers, and patient care in Wisconsin.

The list of organizations opposing these provisions is diverse. Beyond hospitals and health care providers, businesses as varied as tourist attractions, cooperatives, farmers, local chambers of commerce, taverns, timber producers, and retail stores have all asked that these liability changes be removed from the budget.

The three liability provisions removed included:

• Allowing a person as little as 1 percent at fault to be forced to pay 100 percent of a lawsuit claim, known as "joint and several liability."
• Allowing, for the first time in Wisconsin, a person to be sued and forced to pay a party more at fault than themselves.
• Requiring juries to be told how to manipulate the determination of fault in order to maximize awards to plaintiffs.

It remains to be seen if the Senate will reinsert the negligence language in their version of the budget. The Senate is slated to begin debating the budget next week.

Copy fee language remains

Unfortunately, troubling language also supported by trial attorneys that sets a limit on the amount that can be charged for copying medical records below the cost of making the copies was retained by the Assembly Democratic Caucus. WHA is lobbying to remove or change the fee language, which will impact not just hospitals, but also clinics and physicians.

Among other provisions, the language sets the per page fee health care providers can charge to a person other than a patient at 35 cents per page and provides no index to inflation for future increases to account for increased costs of making copies.

The language also expands the definition of "Personal Representative" in a manner that conflicts with state privacy laws and federal HIPAA regulations. Under the provision, anyone possessing informed consent, including plaintiff attorneys and insurance companies, would be able to obtain copies of medical records at fees far below the actual cost of producing the copies.

This "stealth" provision means anyone would have access to records at the reduced fee reserved for patients because no one can access medical records without informed consent. This provision would be the only one of its kind in the country and is in direct conflict with federal HIPAA laws that preserve access to low-cost copies for patients themselves or those designated to make health care (not courtroom) decisions on their behalf.

A WHA-backed amendment to address the onerous language was offered by Representatives Jennifer Shilling (D-La Crosse) and Jim Soletski (D-Green Bay) during a closed Democratic Caucus. The motion, which would have among other things increased the allowable per page fee and indexed it to inflation, was defeated when it became caught in the timing of the contributory negligence vote referenced above.

Efforts to remedy the copy fee language or remove it entirely from the budget now shift to the Senate where budget debate is scheduled next week.

Watching out for Medicaid

WHA also continues to closely monitor the budget deliberations related to Medicaid. The increase in the hospital assessment negotiated between WHA, the Doyle Administration and legislative leaders remains intact. Expansion of basic health coverage to low-income, uninsured childless adults also remains on track at this stage in the budget process.

Both the Senate and Assembly will need to concur on an identical state budget before it can be forwarded on to Governor Doyle for his consideration and line item veto authority. The entire process is expected to be completed by the end of June.

Wisconsin Senators Feingold and Kohl are asking colleagues to "keep states in mind" that are already efficient and high quality providers of Medicare services as Congress prepares to take up health reform legislation.

In a letter (www.wha.org/financeAndData/pdf/medicareDisparity6-3-09.pdf) to Senate Finance Committee members, Feingold and Kohl along with counterparts from Minnesota, New Hampshire and other states, said they are "proud to represent states and regions that have demonstrated true leadership in lowering costs….and increasing quality outcomes for patients. They note that Medicare could save $100 billion annually if the nation could replicate the experience of the "high efficiency" areas of the nation.

The Senate letter indicates growing recognition that regional disparities are a health care cost driver that should be addressed in the health reform discussion. Just last week President Obama specifically mentioned Mayo’s track record in producing outstanding patient outcomes while being cost-effective for payers, including Medicare. He opined that Mayo could be a national model. His budget director has indicated similar thinking in recent media briefings.

Speaking to a capacity crowd at Southwest High School in Green Bay, President Barack Obama praised the Green Bay area and Wisconsin for providing "high quality, low cost" medical care.

"In Green Bay, you get more quality out of fewer health care dollars than many communities across the country," Obama said. "Our goal is simple: The highest quality health care at the lowest possible cost."

"The real cost savings will come from changing the incentives of a system that automatically equates expensive care with better care," Obama said.

WHA President Steve Brenton said Wisconsin’s reputation as a high quality, low cost state is a model that the President certainly would like to see replicated in other areas of the country. In the Medicare program, the cost per beneficiary varies widely across the nation. In 2006, Medicare spent an average of $8,304 per beneficiary. In Louisiana, the average cost in 2006 was $9,401 while in Wisconsin it was $6,978, 16 percent LOWER than the national average. At the same time, Wisconsin consistently ranks at the top for health care quality by the federal Agency for Healthcare Research and Quality (AHRQ).

Just over a month into the 2009 Campaign, the Wisconsin Hospitals State PAC and Conduit fundraising campaign has raised nearly $60,000 from 90 individuals.

Last year, the campaign raised just over $212,000, which was a record total. In 2008, more than 600 individuals contributed and average contributions increased by an average of nine percent.

This year the campaign goal is $213,000 and aims to increase the number of participants by 10 percent, hoping to gain at least another 65 new individuals.

Watch for individual contributors’ names to be published in the next edition of The Valued Voice. For more information or to see if you have made your 2009 contribution yet, contact Jodi Bloch or Jenny Boese at 608-274-1820.

WHA members have expressed serious concern about the time it takes to license health care professionals new to Wisconsin. WHA conveyed these concerns to the Department of Regulation and Licensing (DRL), and they have been working to address them. But while progress has been made, WHA continues to work closely with DRL on lingering issues, particularly those related to delays in physician licensing, which can present an obstacle when recruiting physicians to Wisconsin.

WHA made a specific request of the Medical Examining Board (MEB) asking them to create an expedited process for licensing physicians who hold a current license to practice medicine in Minnesota and wish to obtain a Wisconsin license to practice here.

The MEB has reviewed the request and is now examining all potential issues and concerns. To ensure that this proposal would not result in lower standards for licensure to practice medicine in Wisconsin, the Board directed staff at the DRL to compare the licensing requirements in the two states. The result was that the two states licensing standards are comparable, with Minnesota’s slightly higher.

A question was raised as to the impact or potential impact the proposal would have on the Injured Patients and Families Compensation Fund. Because WHA wanted to make sure that the proposal would not affect the fund, its members or Wisconsin patients, Laura Leitch, WHA senior vice president and legal counsel, and Judy Warmuth, vice president of workforce, shared the WHA proposal at a meeting with the Fund’s staff at the Office of the Commissioner of Insurance (OCI). WHA received confirmation both verbally and later in a letter from OCI Commissioner Sean Dilwig. In a letter to MEB Chair Dr. Gene Musser, Commissioner Dilwig stated:

The fund currently covers many physicians who practice in both Wisconsin and another state. WHA’s proposal does not change any processes within the Fund, nor is anticipated to have any significant impact.

It is expected that WHA’s proposal for expedited physician licensure will be on the June agenda of the MEB. WHA is optimistic that the MEB Board will take action on the proposal at that meeting.

WHA members have also been concerned about the time required to license new health care professionals during spring and summer months. The very high volume of requests for new licenses by health care students that graduate in May and June has historically resulted in longer-than-usual delays in receipt of licenses and permits during this time. These delays mean that hospitals cannot predict when new graduate employees will be able to provide direct patient care. This year, DRL added two temporary staff members as part of their ongoing efforts to address the waiting time problem raised by hospitals anxious to employ these new health care professionals. DRL believes that these positions will significantly improve licensure times for new graduates.

Issues related to licensure continue to be a WHA priority. In its continuing effort to assist members in this important area, WHA would like to know if you have seen improvements over the past few months in the licensing process, or if you continue to have concerns that have not been addressed. Share your experience with Judy Warmuth, vice president, workforce at jwarmuth@wha.org or at 608-274-1820.

Over the past several years, we have all seen the disturbing headlines about the explosion in incidents of identity theft and data security breaches. The number of reported incidents of privacy breaches in the U.S. has grown from 22 in 2004 to 525 in 2008. During that same period, the cumulative number of compromised records exceeded 300 million.

Failing to protect data can have a large financial impact on a company. According to the U.S. Cost of Data Breach Study conducted by the PGP Corporation and The Ponemon Institute, the average total per-incident cost of a data security breach was $6.65 million, compared to an average $6.3 million in 2007. The same study found that data security breach events cost U.S. companies $202 per compromised customer record in 2008. The cost of lost business is the most costly effect of a breach, averaging $139 per record compromised.

Wisconsin’s data security breach laws are delineated in Wis. Stat. § 134.98. If your facility serves patients outside Wisconsin, you must comply with the law where they reside. Therefore, the laws in numerous jurisdictions may apply.

In the event of a data security breach, the Wisconsin law requires:

A business or governmental entity to provide notice whenever personal information held by the entity is acquired by an unauthorized person. No notice is required if the unauthorized acquisition does not create a material risk of identity theft or fraud, or if the information was acquired in good faith and is used for a lawful purpose of the entity.

Any entity that is required to give notice of the unauthorized acquisition of personal information must provide notice of the breach within a reasonable time, not to exceed 45 days after the entity learns of the breach. The notice must be given by mail or by a method that the entity has previously used to communicate with the subject of the information.

In cases where the personal information of more than 1,000 individuals is acquired at one time, the entity must also give notice to all consumer reporting agencies that compile and maintain files on consumers on a nationwide basis. This would include the major credit reporting agencies.

Agnesian HealthCare is reinforcing its commitment to future generations by partnering with the Fond du Lac School District on its TeenScreen program.

A longstanding collaboration that involves several community partners, TeenScreen promotes a healthy student body by providing emotional health screenings for students—all at no cost.

TeenScreen is completely voluntary, confidential and requires parental consent. The program, developed by Columbia University, is used in many schools throughout Fond du Lac County. To date they have screened nearly 4,000 students at risk for depression, anxiety and alcohol/substance abuse, referring 700 for treatment.

Agnesian HealthCare’s support includes a medical expert on the advisory board and a funded staff position, Michelle Neill, RN, to help conduct screenings, provide education and serve as a resource. Neill stresses the importance of her work.

"If these issues went unidentified, students may not be able to finish school, go on to college and succeed in life," Neill says. "But by screening them now and catching concerns early, we are able to refer them to the appropriate resources they need and ensure they are physically, socially and emotionally healthy."

When it opened in June 2008, the new free Shalom Holistic Health Clinic in Stoughton had a relatively slow start; however, appointments are now fully booked and staff are adding extra appointment times to accommodate the demand.

Because the services offered by Shalom are holistic in nature, the appointment process differs quite a bit from a conventional doctor’s visit. Patient care is conducted using a multidisciplinary approach that addresses the "whole" person, including the physical, psychological, social and spiritual aspects of health.

After the patient has seen each provider, the health care team sits down without the patient, looks at all the information and puts together a treatment plan for the patient, who is then invited back to sit down with their care team and hear their recommendations. At that point, the patient will make an agreement regarding which aspects of the plan they feel they can comply with.

Education is the key to Shalom’s holistic process. Patients must be willing and able to be responsible for their own care, and willing to learn to help themselves through actively participating in their health care plan, which focuses on wellness and disease prevention.

Shalom Holistic Health Services is a non-profit organization whose mission is to provide quality health care to low-income and uninsured residents within the Stoughton Area School District.

Patients can be referred through another agency such as START (Stoughton Area Resource Team), Dane County Public Health Department, the Stoughton school system, or the Women’s Wellness Program in Madison. Patients are also seen by self-referral. Prospective patients must fill out an application to prove their financial eligibility before they can schedule an appointment.

The clinic is staffed on an entirely volunteer basis. There are currently 12 credentialed staff members, as well as non-credentialed members including housekeepers, grant writers, etc.

Dr. Jim McGrogan is one of the clinic’s volunteer physicians. He is a board certified emergency medicine physician who works for Southern Wisconsin Emergency Associates, a company that staffs emergency rooms and urgent care facilities in Stoughton, Beloit and Oregon. Although he finds primary care to be much different from emergency care, he fully enjoys his work with Shalom. "It’s good to know you’re helping someone who really needs it," he says. "It’s a really exciting opportunity."

Margo Dilocker, an RN at Stoughton Hospital, is another volunteer who loves her work with the clinic. "It’s been a really good experience. I’ve never worked with anything like this before; it’s a really different nursing role. There is much more of a team approach. It’s a totally different way of approaching patient care, and I think it’s truly an awesome system."

Stoughton Hospital also provides support to the free clinic through donations of equipment and offering discounted laboratory and medical imaging testing. Additionally, hospital staff members serve on Shalom’s Board of Directors. The hospital’s public relations department also donates their time and assistance in developing marketing and education materials related to the free clinic.

"I think things have been living up to our expectations," says Lamarr Gibson, pastor of the United Methodist Church in Stoughton and president of the Shalom board of directors. "We are very happy to be serving the community, and greatly appreciate all the support from Stoughton Hospital, local churches and businesses."

Submit hospital community benefit stories to Mary Kay Grasmick, editor, at mgrasmick@wha.org.

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