As promised, less than 12 weeks after it was launched, CheckPoint^SM has already expanded and updated the hospital quality data found on the initiative’s Web site, www.wicheckpoint.org. CheckPoint is Wisconsin’s comprehensive source for consumers and employers to access statewide health care information related to the quality and safety of hospital care. A total of 122 hospitals, representing 99% of Wisconsin hospital admissions, participate in CheckPoint.

"We made a promise to Wisconsin consumers and employers when CheckPoint was launched in March that we will make data available on a timely basis that will assist them in making informed decisions about their health care," according to Wisconsin Hospital Association President Steve Brenton. "CheckPoint is delivering on the promise to increase the amount of data that is shared with our communities and among hospitals."

Many hospitals in Wisconsin promote the use of CheckPoint in their communities by linking it to their own Web sites. In addition, they encourage their physicians and staff to share the information in CheckPoint with patients. For those without access to a home computer, medical library resource directors are available to help residents look up and print out the information.

Vicki Becker, RN, quality staff coordinator at Southwest Health Center in Platteville, said they use the hospital data in CheckPoint to benchmark their own progress in quality improvement with that of other hospitals across the state.

"We have found the CheckPoint program to be of great value, as it provides a way for us to compare our own quality information with that of other hospitals," according to Becker. "This comparison helps us initiate internal change with greater support, which is critical to any quality improvement effort."

CheckPoint provides consumers and employers reliable, valid data on five error prevention goals and ten key clinical interventions that medical experts agree should be taken to treat heart attacks, heart failure and pneumonia, the three most common causes of hospitalization in Wisconsin. The clinical intervention data was updated on June 15. The safety data will be refreshed in September. New measures will also be added in September.

The Web site, www.wicheckpoint.org, helps consumers understand progress individual hospitals are making in improving patient safety and quality of care using clinical interventions that are scientifically shown to improve outcomes.

I believe that health care has been a priority and will continue to be a priority. We actually began to address the shortfall in medical assistance (MA) because we knew it was vitally important that we not let senior citizens and people with disabilities go without the services that they need. One of the challenges we know we will face is the issue of increasing costs within the MA program. We must consider reforms to the MA program to ensure that these critical services are sustainable.

Reimbursement levels are a key issue that we must address to ensure that we have providers available to serve this population, and that has been an on-going challenge. We need to encourage a constructive dialogue on the program to ensure that it continues to be a viable program for those who need the services.

The budget challenges Wisconsin has faced over the past three years, and will face in the future, obviously make the funding decisions very difficult. It is a matter of balancing the needs of the people of the state, while recognizing the unique needs of rural Wisconsin. We don’t want to create a situation where we pit urban vs. rural. We need to meet the needs of our citizens no matter where they live. I will continue to support policies that enable hospitals to serve and remain in rural communities.

There is growing shortage of health care professionals in rural areas, including physicians. What incentives can Wisconsin provide to the two medical schools that will create more training opportunities in and for students from rural communities?

The Legislature has utilized loan forgiveness programs to encourage individuals to practice in underserved areas. We need to take a look at how those programs have worked and how they could be expanded. I think it is very important that we look at how regulations affect retaining workers within the health care industry. While a certain level of regulation is necessary to ensure quality care, excessive regulation only serves to discourage people from entering or staying in their health care practice. We have to have regulations to ensure quality care, but we don’t want burdensome regulations that discourage people from working in health care.

As the population ages and the older population grows, it is essential that we work with the university and technical colleges to ensure that there is the capacity to train those who are interested in entering a health care occupation. It is important that we have the capacity that is needed to train health care workers and have as many graduates from health care programs as we can to keep up with the demand, given the lengthy waiting lists. This last session, I voted to protect the Patient’s Compensation Fund to ensure we maintain protection for patients and doctors with regard to medical liability.

While there are programs that have been formed to encourage healthier lifestyles, such as alcohol, drug, tobacco, and wellness programs, we can work on facilitating the sharing of ideas and initiatives among communities. Employers have started to recognize the value and benefit of their efforts of incorporating information and incentives in the work place to encourage healthy practices among their employees because they know a healthy employee misses less work and enjoys a better life outside of the workplace, too. The important thing is that we don’t underestimate what can be accomplished in our workplaces and within our communities. Preventive health care is beneficial and cost effective. I think that is why options like Health Savings Accounts, similar to Medical Savings Accounts, will enhance the opportunity for people to make good choices. Services are there for prevention and we need to encourage people to make wise decisions with regard to their health care.

Other thoughts?

Health care is a very important issue because it affects people on a daily basis. We have some tremendous challenges in controlling costs while ensuring that we don’t erode the quality of health care in Wisconsin. These issues are impacted by both state and federal policies, which adds complexity to the solutions. It is important that providers recognize the important role they play in bringing ideas to the legislature on how we can reform a system that in some respects is badly broken. Providers play a critical role in helping us find workable and effective solutions in maintaining the quality of health care as we work to control costs.

The Wisconsin Quality Steering Committee, which oversees the development of CheckPoint^SM, met in Madison on June 17. WHA President Steve Brenton reported that, as promised at the launch of CheckPoint, the data was refreshed on schedule as of June 15. Brenton said the data, both clinical and safety, along with four new clinical measures will be added when the Web site is refreshed again in September.

WHA Vice President Dana Richardson said the process of refreshing the Web site is nearly automated. Four new hospitals were added in this Web site update. WHA Senior Vice President George Quinn said a news release was issued June 17 that advised the media of CheckPoint’s updated data.

Richardson presented a draft of the next measures selection process. She said input regarding the measures would be solicited from multiple groups. Several members commented on the importance of obtaining consumer input since, ultimately, the consumer is an important end-user of the data.

Nancy Nankivil-Bennett mentioned that the Wisconsin Employee Trust Fund (ETF) is requiring health plans to include CheckPoint links on their respective Web sites. She also said that ETF will display CheckPoint data in their "It’s Your Choice" employee benefit handbook. Nankivil-Bennett said they have included information about CheckPoint in newsletters and various other publications.

Chair Chuck Shabino and committee member Terri Potter said both Wausau and Meriter Hospitals have linked their respective Web sites to CheckPoint and have educated their employees on the use and value of CheckPoint.

Committee member Pat Remington, MD described a tiered audience for CheckPoint, which includes consumers, purchasers, and hospitals. Of these, hospitals will likely be the first to use the measures since they have the greatest control over the processes related to the measures.

The Steering Committee also reviewed a high level preliminary list of measurement areas identified by the Measures Team and discussed a draft set of selection principles to be applied in the next measure selection process.

Cheryl Demars from The Alliance, and others provided an overview of the national pay-for-performance seminar sponsored by AHRQ and the Alliance in May. Several committee members were in attendance and commented on the complexity and speed by which these types of demonstration projects are occurring across the county.

Last week, the Wisconsin Supreme Court accepted Lagerstrom v. Myrtle Werth Hospital – Mayo Health System for review. In Lagerstrom, the plaintiffs and the Wisconsin Academy of Trial Lawyers argue that the statute that permits the abrogation of the collateral source rule in medical malpractice cases is unconstitutional. In other words, the Supreme Court has agreed to determine the constitutionality of the Wisconsin statute that permits the defendant in a medical malpractice case to provide the jury with evidence that the plaintiff has received compensation for his or her injuries from another source. The jury may offset any damages based on the evidence, but is not required to offset. The statute can prevent plaintiffs from receiving windfall recoveries in medical malpractice cases.

The Court of Appeals did not issue a decision in the case, but rather asked the Supreme Court to hear the case directly. In its certification to the Supreme Court, the Court of Appeals argued that it is appropriate for the Supreme Court to decide the issue for several reasons, stating, "It is appropriate for the Supreme Court to determine whether the legislature has impermissibly interfered in the functioning of the courts by allowing the jury to determine the measure of damages with no guidance and no meaningful review, and by improperly delegating to the jury its authority to establish public policy." Briefs will be filed in this case over the next two months.

[This column ran in the Milwaukee Journal Sentinel on June 6, 2004 and is reprinted as a guest column with permission of John Torinus, CEO of West Bend-based Serigraph, Inc.]

Wisconsin business executives don’t have to sit around and wait for health care reform to come out of Congress or the Legislature. There’s a lot they can do right now in their own shops.

That’s the view of a half-dozen Wisconsin health care experts in candid one-on-one sessions during which they came up with seven building blocks for any organization’s health program.

The reforms on the government side are not going to solve the double-digit inflation any time soon anyway.

Given the unrelenting price increases, employers/payers are clearly doing a poor job of purchasing health care. We wouldn’t let any other vendor get away with such out-of-control inflation. Nor would our customers let us get away with such performance.

In a recent article, Harvard University professor Michael Porter wrote: "In buying health care services, companies have forgotten some basic lessons about how competition works and how to buy intelligently. Ignoring differences in quality, companies have bought health plans based on price rather than value."

Specifically, companies have been focused more on discounted prices than on total cost of care, which revolves around quality as well as price.

Here are corrective actions for CEOs to drive through their organizations, drawn from the Wisconsin experts and Porter:

Involve employees financially.

Implement consumer-driven systems of incentives and disincentives. The employer still pays most of the health bill, but the employee is engaged through higher deductibles and co-pays. The employee portion is then offset through lower premiums, health reserve accounts, flexible spending accounts and health savings accounts. Menasha Corp. is leading the way on this reform.

Make pricing transparent.

Several Wisconsin firms are moving to supply accurate pricing by procedures, hospital and doctor. Prices need to be easily accessible on company Web sites.

Make quality transparent.

Vendors like Health Grades, and initiatives like CheckPoint and the Wisconsin Collaborative for Health Care Quality, are rating hospitals and doctors for quality. Once employers add that dimension to their Web sites alongside the price matrix, employees can become real shoppers.

Hire on-site health professionals.

Johnsonville Sausage is going that way, as have Quad/Graphics and Briggs & Stratton. Smaller companies can band together to hire a nurse practitioner.

Get aggressive on disease management.

More than 50% of costs come from chronic conditions like diabetes, asthma and depression. Some companies have virtually mandated annual health screenings and then coach at-risk employees on consistent treatments. Humana in Wisconsin and Aurora Health Systems offer programs for managing such diseases.

Get serious about wellness and prevention programs.

These programs save big money. Highsmith and Lands’ End have knocked back increases with holistic initiatives. On-site professionals can lead these efforts, as well as disease management.

Use auditors on drug plans.

Oversight of pharmacy benefit mangers by sharp auditors can bring large savings. Incentives for generics are another piece.

To create health competition, Porter would turn 180 degrees from a trend toward narrower networks and deeper discounts. He would like to see lots of choices, informed by transparency.

Few, if any, Wisconsin employers have all of these reforms in place. Some have some. Many have none. All of these reforms can be implemented relatively quickly, with the possible exception of the consumer-driven plans, which may require bargaining, without waiting for politicians to act.

If put into place by enough businesses and health plans, these changes could create a marketplace for cheaper, better health care.

As Porter concluded in his article: "The system can be fixed."

The Wisconsin Hospital Association Board of Directors met in Madison June 16. Senior Vice President George Quinn presented an overview of the May financial statements and budget and reported that both are on target. Quinn asked the board to approve two new positions, a computer programmer and a director-level position for the Maryland Project, which has grown 20% over the last year. The latter position would also assist with the growing workload in the CheckPoint^SM program. The Board approved both positions.

WHA President Steve Brenton previewed the agenda for the WHA Board summer planning session. Brenton emphasized that Medicaid is one of the major issues that will be addressed during the planning session.

Brenton reported that he has been contacted by a coalition consisting largely of Minnesota-based health systems and health plans that is staffed by former Minnesota Senator David Durenberger.  The coalition argues that states in the upper Midwest have health care delivery systems different from the rest of the country and use a more integrated approach with large multi-specialty clinics and hospital systems. The Board agreed with Brenton that WHA might want to be more involved in the coalition efforts in the future.

The Board approved the creation of the Wisconsin Council on Medical Education. Quinn reported that one recommendation of the Physician Supply Task Force was to establish a council that would be an ongoing vehicle to advance the goals of the Task Force. The council would have representation from medical education, providers and the public. It would develop an annual agenda and obtain funding to carry out the goals through the organizations represented on the council.

With the Legislature now finished for this year, WHA Senior Vice President Eric Borgerding outlined WHA’s current, or "off season," preparation for the 2005-2007 legislative session. Issue priorities for 2005-07 include Medicaid and the issues of health information (aka "transparency"). Borgerding also described WHA’s plans to significantly beef up grass roots and fundraising activities. Healthy Wisconsin PAC/conduit is on track to exceed its 2004 goal of $125,000. Healthy Wisconsin is also sponsoring more legislative fundraisers than ever before and will double its involvement in independent expenditures (primarily newspaper ads) during October and November. He indicated that the number of individuals in hospitals who are participating in grassroots support activities has increased markedly over the past year, with a goal of at least 600 "Healthy Wisconsin Advocates" by the end of this year.

Ned Wolf, chair of the newly formed Medicaid Task Force that met recently, noted that the Medicaid situation has worsened over the past five years because funding has not kept pace with the 100% enrollment increase. At the first meeting, Task Force members reviewed various other states’ efforts to deal with Medicaid deficits, which include reducing eligibility and benefits for Medicaid recipients, as well as cutting payments to providers.

The Board approved a plan forwarded to them from the Medical & Professional Affairs Council that is designed to increase access to dental care. In presenting the plan, Bill Bazan, WHA vice president Metro Milwaukee, said emergency rooms are in crisis because they have become the primary source of dental services for those who lack dental access.

Rural Health Council Chair Bobbe Teigen noted that council members have had an ongoing discussion on the cardiac rehab issue and will bring recommendations to the board at a future meeting. She said WHA has been in communication with the Bureau of Quality Assurance regarding the survey process and a meeting with BQA will be scheduled once the information from them is analyzed. Teigen said the Rural Health Conference next week will be at least as large as last year’s and that the number of vendors who have requested exhibit space is up over last year.

The July 14 seminar "Current Modifier Reporting Requirements… Are You Keeping Up?" will use actual coding examples, physician documentation illustrations and corresponding UB-92 claims forms to demonstrate the correct application of CCI edits, in relation to the use of modifiers. Coding and billing staff, chargemaster and APC coordinators, business office managers and other financial managers should consider attending this event.

The Wisconsin Hospital Association is offering an educational session, "The Public Relations Primer," on July 15 for public relations professionals and others who have communications responsibilities in hospitals and health systems. The seminar will be held at the Hotel Mead in Wisconsin Rapids from 9 am to 4 pm. It will focus on three important aspects of communications in today’s health care environment:

- developing positive press relations,
- developing a crisis communications plan, and
- communicating during a disaster.

Two well-known communications experts will share their expertise with seminar participants. Scott Fagerstrom, communications manager at Northwest Airlines, is an award-winning communications professional whose experience includes serving as a vice president at Hill and Knowlton, one of the world’s top five PR firms. He also served a business editor at several of the nation’s largest newspapers, and as a professor of PR at Chapman University in Southern California. Fagerstrom will teach participants to effectively write for and communicate effectively with the press to develop good relationships.

Fred Bagg, ABC, APR, Fellow PRSA, will lead the group through the process of developing a crisis communication plan. Bagg is one of most sought-after speakers on this topic in the country. Immediately following Bagg’s session, three tabletop disaster scenarios will allow participants to put their knowledge into action. Officer Larry Kamholz, Madison Police Department spokesperson, will participate and help hospital communicators understand law enforcement’s role in the release of information. Officer Kamholz most recently served as the spokesperson in the case of the Audrey Seiler disappearance, which garnered national media attention.

The July 30 seminar "Health Care Budgeting & Financial Management for Non-Financial Managers" will provide health care managers without a financial background the working knowledge of planning and budgeting, financial analysis, and performance management. All department managers with any responsibility for budgeting and financial management should consider attending this important event.

The HCSS certification program will require certified staffing firms to use a standardized set of measures, which will allow for comparability among all certified staffing firms’ performance measurement activities. Therefore, JCAHO is seeking performance measures that pertain to the Key Performance Areas, which JCAHO’s Health Care Staffing Task Force and Advisory Council have identified as being key factors in the performance of health care staffing service firms. Anyone who wishes to submit performance measures pertaining to the Key Performance Areas can access all instructions and submission materials at www.jcaho.org/dscc/hcss/pm.htm.

The deadline for submission is Friday, July 9, 2004. If you have any questions about this call for performance measures or any of these materials, please contact Linda Kusek, Associate Project Director, at 630-792-5616.

The Association of Peri-Operative Registered Nurses (AORN) is sponsoring National "Time Out" Day on June 23 to raise awareness of the Joint Commission on Accreditation of Healthcare Organizations’ (JCAHO) Universal Protocol for Eliminating Wrong Site, Wrong Procedure, Wrong Person Surgery. The protocol, which accredited hospitals and other surgery facilities must adopt by July 1, calls on surgical teams to take a "time out" before surgeries to verify the patient’s identity, the procedure and the surgical site. National Time Out Day also is intended to demonstrate to the public providers’ commitment to patient safety. With the 5-year anniversary of the IOM report on medical errors just around the corner, there could be extra interest in this initiative.