The reports rated different aspects of Wisconsin’s health care system, but both the federal Agency for Healthcare Research and Quality (AHRQ) and the Commonwealth Fund Commission on a High Performance Health System ranked Wisconsin at the top. The AHRQ report looked at 129 measures that were indicators of hospital and health care provider performance, while the Commonwealth state scorecard used data that evaluated the overall health care system performance state by state.

AHRQ Ranks Wisconsin #1

Bolstered by hospitals’ quality rankings, the federal Agency for Healthcare Research and Quality (AHRQ) data released June 11 showed Wisconsin is number one in the nation for health care quality. Wisconsin had the top overall health care quality score among all 50 states based on 129 measures that AHRQ used to evaluate health care performance.

AHRQ ranks the quality of a state’s health care system from weak to very strong. Wisconsin’s strongest performance measures were: appropriate discontinuation of antibiotics after surgery; giving a beta blocker within 24 hours of admission to a hospital for heart attack; pneumonia patients receiving appropriate care; number of diabetics who receive a A1c hemoglobin test; and the lowest number of HIV-deaths per 100,000 people.

"Quality health care means doing the right thing, at the right time, in the right way, for the right person—and having the best possible results. Wisconsin hospitals are always working to improve quality and to sustain it. This report confirms what is well known in the area of quality improvement; if you can measure it, you can improve it," according to Dana Richardson, vice president of quality initiatives at the Wisconsin Hospital Association (WHA).

In 2004, WHA launched the first voluntary hospital quality reporting Web site in the nation, CheckPoint (www.wicheckpoint.org). The first 10 measures that were used in CheckPoint, and publicly reported by 98 percent of the hospitals in Wisconsin, focused on measuring the care patients receive who are hospitalized with pneumonia, heart attack, or congestive heart failure. Public reporting creates a focus on improvement by prioritizing improvement resources and helping consumers understand the type of care that they should expect to receive from their health care provider.

"Over the past few years, several reports have been released evaluating the quality of care at the state level. We recognize that rankings depend on the measures included in the score, but Wisconsin consistently ranks high among top performing states," said WHA President Steve Brenton. "Our status is clearly the result of private sector public reporting initiatives, like CheckPoint, that have been embraced by Wisconsin hospitals and physicians."

While public reporting creates a measurement tool for improvement, the next step is changing processes to assure that the best care is provided to each patient. MetaStar, Wisconsin’s Quality Improvement Organization (QIO), supports hospitals in their improvement efforts through projects that facilitate learning and sharing best practices among Wisconsin hospitals.

"Through shared learning Wisconsin hospitals can accelerate the pace of improvement. This assures that all Wisconsin residents have access to the highest quality of care," said Jay Gold, MD, JD, senior vice president at MetaStar.

According to AHRQ, its State Snapshots Web tool (http://statesnapshots.ahrq.gov) helps State health leaders, researchers, legislators and consumers understand the status of health care quality in individual states, including each state’s strengths and weaknesses. AHRQ’s annual State Snapshots is based on data drawn from more than 30 sources, including government surveys, health care facilities and health care organizations.

Wisconsin Ranks in Top Ten on State Health System Scorecard

A state scorecard released by the Commonwealth Fund Commission on a High Performance Health System ranked Wisconsin ninth in the country across key dimensions of overall health system performance, AHRQ was based on provider performance. According to the report, where you live in the United States does matter for health care quality and care experience.

The report shows that 13 states, including Wisconsin, emerge at the top quartile of the overall performance rankings, and these states generally ranked high on multiple indicators on the five dimensions assessed by the State Scorecard. The five dimensions included: access, quality, avoidable hospital use and costs, equity, and healthy lives.

Dana Richardson, vice president of quality initiatives at the Wisconsin Hospital Association, said hospitals here have a strong commitment to improving both the quality of the care they provide, as well as access.

"Better access is closely associated with better quality. That is why in Milwaukee, for example, and in many of our rural areas, it is a top priority to recruit and retain health care professionals, and then connect our patients to a primary care physician," Richardson said. "Having a ‘medical home’ is vitally important to patients who suffer from a chronic illness," she added.

Data in the report identifies Wisconsin as a high quality, low cost provider in the Medicare program. The report found that Medicare could save $22 billion a year if high cost states moved down to spending levels of the average states, such as Wisconsin and others in the Midwest.

WHA President Steve Brenton said, "Wisconsin hospitals provide good value and high quality care to Medicare program beneficiaries. We know that a large percentage of senior citizens who leave the state and retire elsewhere, move back when they need health care because of the quality of our care. The ability to provide high quality, safe patient care is a core value in our hospitals."

The striking variability across states adds up to substantial human and economic costs for the nation. The report estimates that if all states could do as well as the top states, 90,000 lives could be saved annually, 22 million additional adults and children would have health insurance, and millions of older adults, diabetics and young children would receive essential preventive care.

The report, Aiming Higher: Results from a State Scorecard on Health System Performance, compares each state to benchmarks that have already been achieved in states across the country. Although some states ranked highly on multiple indicators, the report finds that that no one or group of states scored top marks in every area.

"The differences we found between the top and bottom states were shocking, often a two-to three-fold variation or greater," said co-author and Commonwealth Fund Senior Vice President Cathy Schoen. "Where you live clearly matters: for access to care when you need it, the quality of care you receive, and opportunities to live healthier lives."

An overarching goal of the health care system, according to the Commonwealth report, is to contribute to long and healthy lives. The report ranked Wisconsin 27th in the percent of adults who are overweight or obese, and 28th in the percent of adults who smoke, two statistics that concern Wisconsin hospitals. In 2006, hospitals reached more than two million people in Wisconsin through their free clinics, health screenings, and nutrition and exercise classes, and a wide variety of other health programs designed to address specific public health concerns.

"Wisconsin hospitals, often in partnership with their local health departments, offer literally hundreds of free programs directed at improving the health and safety of the communities they serve, " Brenton said. "But their outreach efforts fall short without the support of the community. We encourage residents in every Wisconsin community to partner with their hospital and take advantage of the classes and programs they offer that are designed to reduce the rate of preventable diseases in our state. It is an investment in our own, and our children’s health, that we can’t afford to pass up."

The Internal Revenue Service has released for public comment a discussion draft of a revised IRS Form 990, Return of Organizations Exempt from Income Tax. According to the IRS, the form has been redesigned only on a piecemeal basis since 1979. The IRS based the proposed redesigned Form 990 on three guiding principles, which the IRS describes:

• Enhancing transparency. Enhancing transparency means providing the IRS and its stakeholders with a realistic picture of the organization and its operations, along with the basis for comparing the organization to similar organizations.

• Promoting tax compliance. Promoting compliance means the form must accurately reflect the organization’s operations and use of assets, so the IRS may efficiently assess the risk of noncompliance.

• Minimizing the burden on the filing organization. Minimizing the burden means asking questions in a manner that makes it relatively easy to fill out the form, and that do not impose unwarranted additional recordkeeping or information gathering burdens to obtain and substantiate the reported information.

The proposed redraft includes a Schedule H, which is to be completed by all hospitals and other organizations that provide medical care. Schedule H requires hospitals and other organizations to report aggregate community benefit information for all facilities and certain information regarding billing, collections, and joint ventures. On Schedule H, the IRS also is requesting general narrative information related to health care needs assessment, emergency department policies and procedures, and distribution of information about financial assistance.

AHA President Rich Umbdenstock commented on the proposed revised Form 990, "We welcome the addition of a number of questions that will allow tax-exempt hospitals to better communicate the important community benefit work that they do."

George Quinn, WHA senior vice president, noted, "Wisconsin hospitals are well-positioned for the transparency envisioned by the revised form and schedules. The form and schedules, however, must be clear and not create reporting burdens that are greater than the reporting benefits. We will work with AHA to address identified concerns."

283 individuals affiliated with 48 hospitals have to date raised $89,746. This accounts for 46 percent of the 2007 fundraising campaign’s $195,000 monetary goal. This is a 15 percent increase in dollars over this same time last year. In addition, at this time last year, 212 individuals had contributed as compared to 283 individuals currently. Additional campaign goals include identifying and implementing strategies to increase individual participation.

Persons who have contributed this year will be listed in The Valued Voice on a monthly basis beginning in July by name and their affiliated organization. Contributors will be listed by amount categories and in the order the contribution was received.

For more information, contact Jenny Boese at 608-274-1820 or Jodi Bloch at 608-217-9508.

WHA President Steve Brenton this week announced the promotion of Eric Borgerding to executive vice president. Borgerding, who returned to the Association in January of 2002 as vice president of government affairs, was named senior vice president in 2003. From 1997 until his return to WHA, Borgerding served as director of legislative relations for the Wisconsin Manufacturers and Commerce, Wisconsin’s largest and most influential business association. Borgerding directed WMC’s lobbying strategies in the areas of energy, transportation and health care.

Borgerding has also served as the chief state lobbyist for the University of Wisconsin-Madison under Chancellor David Ward. He was the director of legislative affairs for the Wisconsin Hospital Association from 1992 to 1994, and a legislative assistant to Wisconsin State Representative Tom Ourada.

Borgerding received a bachelor’s degree in political science from the University of Wisconsin-Madison in 1988.

"Eric’s leadership of WHA’s strong advocacy program is well understood and appreciated by WHA members and by those we work with daily to advance our advocacy agenda," said Brenton.

Wisconsin is fortunate to have a Workers Compensation (WC) system that allows open access to medical providers, has some of the best outcomes in mending worker injuries, and enables workers to quickly return to productive employment—all at a reasonable cost to employers.

A recent report by the Workers Compensation Research Institute (WCRI), an independent organization focusing on workers compensation in the United States, confirmed these points.

As a reminder, July 18 is the deadline to submit your quality and safety improvement projects for inclusion in the 2007 Wisconsin Quality & Safety Forum Project Showcase. Only those projects submitted by July 18 will be included in the 2007 Wisconsin Quality & Safety Forum Showcase, included on the CD-ROM of all submitted projects, and considered for a breakout presentation at the Forum, and published in a future issue of the Wisconsin Medical Journal.

Showcase projects submissions will ONLY be accepted via completion of the online submission form at www.wha.org/QSFshowcase. The online form is now available and all submissions are due to WHA by Wednesday, July 18, 2007. For questions about project submission, contact Brian Competente at 608-274-1820 or bcompetente@wha.org.

Projects that have not previously been submitted are eligible, as are new phases of a previously submitted project. A full project submission brochure, describing all submission criteria, is available on WHA’s Web site at www.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 a future issue of the Wisconsin Medical Journal. For more information on this opportunity, visit the Wisconsin Medical Society Web site at www.wisconsinmedicalsociety.org.

The three-year partnership between Froedtert and the University of Wisconsin-Milwaukee’s (UWM) College of Health Sciences brought learning alive for Wendy Yang. A summer internship at Froedtert through the UWM Minority Internship program led to a part-time position as a medical assistant in the cardiology clinic for the UWM senior. Now she’s considering going on to medical school.

"The information I read and study about in my books just clicks for me when I’m working in the clinic," Wendy said. "Simply being in the presence of so many people who were once in my position has pushed me to be more passionate about my studies."

As a medical assistant, Wendy is often the first point of contact for patients who visit the clinic. Before they see the doctor, she takes their blood pressure, checks other vital signs and reviews their medications with them. Working alongside Medical College cardiologists as well as Froedtert nurses and nurse practitioners, Wendy benefits from a variety of mentors who have different but intersecting roles in caring for a patient.

"Ultimately, it’s all about teaming up for the good of the patient, and my internship allowed me to see how everything comes together," she said.

The second annual Wisconsin Academy for Rural Medicine (WARM) Symposium will be held Wednesday, August 8, 2007, in Madison. The Symposium is for a broad array of individuals to learn more about the WARM program and its plans to address the shortage of physicians in rural Wisconsin, and improve the health of rural Wisconsin residents.

The event will take place at the University of Wisconsin School of Medicine and Public Health in the Health Sciences Learning Center. Dr. Roger Strasser, founding Dean of the Northern Ontario School of Medicine, is the keynote speaker. Dr. Strasser has played a valuable role in the development of rural medical education programs in Australia and around the world. Dean Robert Golden, MD, will also address the symposium, and the first group of WARM students will be introduced. The afternoon session will offer a choice of breakout sessions during a working lunch.

Register online at www.med.wisc.edu/education/md/warm/symposium.php by July 16. To learn more about the WARM program, go to www.med.wisc.edu/education/md/warm. Contact Alison Klein at alklein2@wisc.edu or 608-263-7082 for more information.

During the last legislative session, WHA supported a bill that would have broadened the requirements for nurses serving as faculty in schools of nursing. As a result of the introduction of that bill and subsequent input by many interested parties, a Task Force of the Wisconsin Board of Nursing (BON) and the Wisconsin Center for Nursing (WCN) was formed to examine issues surrounding the shortage of nurse faculty. WHA participated on that Task Force, along with Tim Size from the Rural Wisconsin Health Cooperative (RWHC), representatives of the nursing home associations, and individuals from the schools of nursing, the WCN and the Wisconsin BON. The report can be found on the Center’s Web site at: www.wisconsincenterfornursing.org/docs/EducatingNursingWorkforce.pdf.

Without an adequate number of prepared faculty, schools of nursing will be unable to grow or even maintain the capacity necessary to ensure an adequate nursing workforce. Today faculty are, in general, even older than the overall nursing workforce and nearing retirement. Additionally, nurses tend to attain graduate degrees and qualifications late in practice, so they have a limited career in teaching. The report offers recommendations that will encourage individuals to seek teaching careers, reward those who teach in public schools, and encourage sharing of clinical and human resources. Hospitals are mentioned as partners in several of the recommendations. The addition of a waiver for a nurse faculty member who does not hold a master’s degree in nursing, but is otherwise well qualified, is included as a recommendation.

WHA continues to be very concerned about the future supply of registered nurses in Wisconsin and is working with workforce coalitions, workforce investment boards and RWHC to collect retirement intention data that will help predict when and how many nurses are needed for Wisconsin’s future.

The three-year pilot program is designed to encourage the collaboration of private-practice medical, surgical, and radiation oncologists—with close links to NCI research and to the network of 63 NCI-designated Cancer Centers principally based at large research universities.

According to Dr. Carl Olson, medical director of oncology services at Columbia St. Mary’s, the program has ambitious goals for cancer treatment in Milwaukee. "We hope to attract more people into clinical trials, especially those in underserved areas in Milwaukee," said Dr. Olson. "Only three percent of adults with cancer participate in clinical trials. This pilot program will extend research offerings to patients in more diverse communities.

"Consistent with our mission, the pilot program will provide additional opportunities to care for cancer patients, many who are poor and vulnerable, who would otherwise not have access to the clinical care and cancer trials they need and deserve," said Leo P. Brideau, president of Columbia St. Mary’s health system.

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