The campaign is barely out of the starting gates, and already the total raised to date for the Wisconsin Hospitals Political Fundraising Campaign is at nearly $65,000. This year, the Campaign’s goal is to raise at least $185,000. This promises to be a hot election year in Wisconsin with the Governor’s seat up for grabs along with all 99 Assembly seats, 17 State Senate seats, all members of Wisconsin’s Congressional delegation in the U.S. House of Representatives, and one U.S. Senate seat.

And if that isn’t exciting enough, the Spring 2007 elections will provide voters a chance to elect a new Supreme Court Justice with the announced retirement of Justice Jon Wilcox. This coming year will make for a busy election year.

"Working to elect public officials who understand how important the hospital is to the community in terms of access to health care and as an economic development engine lays the foundation for good health care public policy making," said WHA’s Vice President of Government Affairs Jodi Bloch. "Candidates for elected office have to run extensive campaigns throughout the course of several months and need to get their message out early and often."

If you would like additional information, contact Jodi Bloch or Jenny Boese at 608-274-1820.

On May 31 the State Assembly reconvened to attempt to override Governor Doyle’s earlier veto of a bill (AB 4) that would have allowed Wisconsin residents with HSAs to claim an income tax credit for up to 6.5 percent of the allowable amount that the individual claims as a federal tax deduction. Falling five votes short of the two-thirds majority needed for an override, the veto override attempt failed 61-36.

"WHA supports the use of health savings accounts as part of a consumer driven solution to bring consumer rationale into health care purchasing decisions," says WHA Financial Solutions Senior Vice President Jon Braddock. Braddock also adds, "I am disappointed that the Governor vetoed this bill that would help many of the thousands of Wisconsin residents, including WHA staff that purchase health care through HSAs."

The federal government already allows account holders this credit on their federal taxes, and 39 other states have followed suit allowing the exemption at the state level as well with more expected to follow.

While WHA supports efforts to expand consumerism in health care, but along with that also recognizes the need to provide more information about prices and the quality of the services available to the public making health care purchasing decisions. According to WHA Senior Vice President Eric Borgerding, "That’s precisely why WHA has led the way in creating PricePoint and CheckPoint to provide the level of transparency that consumers need to help them become more knowledgeable, better consumers of health care." He added that, "While HSAs are not the only solution, they are part of the solution in encouraging consumers to understand they have a critical role to play in purchasing their health care."

The Centers for Medicare & Medicaid Services (CMS) has proposed two major changes to its DRGs (used in paying hospitals for inpatient services) that would be implemented over the next two years. WHA believes that these are the most significant changes in DRGs since the beginning of the inpatient PPS over 20 years ago. The proposed changes would significantly redistribute payments among the DRGs and among hospitals.

CMS proposes major changes to the DRG weights for Federal Fiscal Year 2007, referred to as the hospital-specific relative value cost center (HSRVcc) methodology.

Currently, CMS calculates the DRG weights by aggregating charges for all hospitals paid under the PPS and determining the average charge by DRG. CMS is proposing to change the weight calculation to a methodology that groups hospital charges into ten categories and then applies national average cost-to-charge ratios to eliminate the affect of differential charge markups.

The result of these changes will redistribute payments – away from surgery-related (for example, cardiac) DRGs and dollars toward medical DRGs. This means that those hospitals that have substantial numbers of cardiac patients will likely lose Medicare dollars, while those with relatively more medical cases will gain Medicare payment.

CMS also proposes changes to the classification system – with implementation likely in FY 2008 – refining the DRGs to account for patient severity. These are called consolidated severity adjusted DRGs (CS-DRGs). This change will greatly expand the number of DRGs, from the current total of 526 to 861.

WHA has been working with the American Hospital Association (AHA) to identify any problems in the methodology and to assess the impact on Wisconsin hospitals. Preliminary analysis indicates that Wisconsin hospitals will lose approximately $7.2 million per year from these proposed changes. WHA will be making detailed recommendations on the CMS proposal next week.

In early June, HRSA Region 7 (SE Wisconsin) will conduct a mass casualty management exercise using a new format which incorporates aspects of the newly revised JCAHO emergency management standards. The idea of a regional exercise is a relatively new concept and has not been attempted previously. It is, however, an important part of the evolving model of shared response on a regional level. While the new JCAHO standards do not actually go into effect until July 1, 2006, the exercise presents an opportunity to identify and evaluate methods of compliance.

The regional exercise concept was developed by the Region 7 Emergency Exercise Planning Group as a method to involve as many of the regional hospitals in the event they desire to participate. For this exercise, over 20 hospitals in southeastern Wisconsin have chosen to be involved. The following health care systems and their SE Wisconsin hospitals are involved: Aurora, Children’s, Froedtert Community Health, Wheaton Franciscan Health Care, Columbia St. Mary’s, Agnesian Health Care, Synergy Health Care. Other hospitals include: Kenosha Medical Center, Kindred, and St. Nicholas.

Participating hospitals receive a packet of 100 "paper victims," each one with a unique set of conditions. Hospitals can choose to test their surge capacity plans, decontamination processes, mass casualty plans, or any combination. EMSystem (which connects all hospitals via a 24/7 interactive website) will be used to control the exercise scenario through the release of specifically times messages.

The exercise process also includes a new assessment tool designed to evaluate the exercise based on the new core performance areas established by the JCAHO. A common set of objectives for the exercise demonstrates regional cooperation in the process. A regional debriefing session will be held to share best practices and to develop plans for future exercises.

This first attempt at a regional exercise will provide a foundation upon which to expand future community exercises. While compliance with JCAHO standards is an important element of these exercises, the major purpose is to prepare Region 7 hospitals to respond in a cohesive, effective, and efficient manner should a major incident occur.

A special thanks to Hugh Kirsh from Froedtert Hospital for chairing and providing leadership as chair of the Emergency Exercise Planning Group for Region 7, as well as providing the substance of this article.

On a routine basis our physicians in the emergency department, at our community clinics, and especially at the St. Clare Health Mission, see the results of inadequate access to primary dental care for the poor of our community. We are convinced that Wisconsin is in a crisis mode when it comes to children (and adults) having tooth decay because they do not have access to dental services. When preventive dental care is not provided early in the life of children, they often do not seek treatment until the pain is so bad that their parents take them to one of the few dentists who will care for low-income folks or the closest hospital emergency department. This is the venue of last resort for low-income families who do not have dental insurance or who are on Medicaid. Addressing the issue at the front end with proven preventive care is the most humane and cost effective approach.

An administrative rule (CR 05-033) is currently pending before the Joint Committee for Review of Administrative Rules (JCRAR). The rule would allow state licensed dental hygienists to bill Medicaid directly for services that they are already allowed to practice under current law. This administrative rule does not expand scope of practice nor practice settings for dental hygienists. The Wisconsin Hospital Association and Franciscan Skemp Healthcare strongly support this rule. The JCRAR meets on June 8 to deliberate on the matter.

Access to oral health services is critical, especially for our children. All across Wisconsin, low-income families have a challenging time finding a dentist who will serve them. Medicaid payments to dentists need to be adjusted upward as a financial incentive. The Governor’s Oral Health Task Force (of which WHA was a participating member) unanimously supported a "2 cents per can" tax on soda with the dollars earmarked for higher Medicaid payments for dental services. But until the entire oral health community begins to address the access issue, Wisconsin will be in a dental crisis…especially for our kids.

This is why WHA and Franciscan Skemp Healthcare so strongly support this administrative rule. Giving state licensed dental hygienists the ability to bill Medicaid for providing preventive services currently allowed under state law will go a long way in improving access. As a friend of mine keeps telling me: "If you are not part of the solution, you are part of the problem!" Dental hygienists are part of the solution. Why in the world would anyone be opposed to increasing access to the most vulnerable in our communities? This is why WHA is so heavily involved in supporting this administrative rule. Let’s all get on board. Let’s be part of a solution for our kids and their health.

Julie Greer is a special person. She doesn’t think she is, but those who know her would tell you differently.

When Julie was 46 years old, she suffered a brain aneurism which left her unable to talk, walk or function independently. She spent seven months in a rehabilitation hospital learning to do what she had always done naturally. When she finally returned home, she still traveled five days a week to Duluth, Minnesota for therapy. She was unable to work and had to rely on a government program for all of her living expenses.

It was during this time of relative inactivity that the asthma she had suffered since childhood became much worse. Weight gain from inactivity and breathing problems complicated her life. There were days when she couldn’t go outside because she couldn’t breathe in the cold air or the hot, humid air— both of which are part of the northern Wisconsin climate.

Julie, never one to despair or give up, learned about a program at Hayward Area Memorial Hospital through her local doctor. It was a program that changed how she lived.

Her doctor enrolled her in the ENERGY at Work program and she began taking a community bus to the hospital three days a week for supervised exercise. Hospital staff and volunteers monitor and supervise participants while they worked on individual pieces of exercise equipment.

Gradually, Julie lost weight and began breathing easier. She progressed to the point where she was able to work part-time at a local used clothing outlet and is now well enough to drive again.

Julie is always helping others. She cooks meals for shut-ins and works at her church cooking holiday meals. She is delighted that she can now drive and uses her ability to take others to church or shopping. Much of the credit for her improved health is due to Julie’s attitude and perseverance. Julie, however, credits her greater independence and better health to the ENERGY Program and the staff and volunteers who encouraged her to "keep going."

ENERGY is a collaborative partnership, subsidized by Hayward Area Memorial Hospital, the Hayward Clinic, Sawyer County Public Health Department and two area businesses. Its purpose is to educate, motivate and facilitate individuals who are at high risk for heart disease, diabetes and obesity, enabling them to become active participants in creating and/or maintaining healthy lifestyles. It has done that for Julie Greer and for many others.

The article’s headline on www.foxnews.com, "Fewer Doctors Providing Free Care to Poor," caught my attention immediately. Serendipity was at play, because that very day I was meeting with Linda Smith, a nurse practitioner and coordinator of Community Outreach Health Clinic.

Located in the Outpatient Care Center at Community Memorial Hospital, the clinic serves the working poor of our village and surrounding areas. According to John Wandschneider, chairman of the Community Outreach Health Clinic Task Force, it’s "the best-kept secret of Menomonee Falls."

I hope to change that with this column and future follow-ups. The work these people do is far too important, and the patients they treat far too vulnerable, to allow the clinic to go largely unnoticed any longer.

No one is turned away

According to the article mentioned above, a study recently released by the Center for Studying Health System Change suggests that "the percentage of physicians who provide free care to the poor has dropped over the past decade, signaling a growing problem for the uninsured."

In the mid-1990s, the study states, approximately 75 percent of physicians provided charity care. Today, the percentage has fallen to approximately 66 percent. Luckily for many people in our community, some of those wonderful physicians making up that 66 percent serve as volunteers at Community Outreach Health Clinic.

We’re just as fortunate to have nurse practitioners, nurses, nursing students and clerical staff who also donate their time. Smith, who has been with the clinic since it opened in 2000, oversees all their efforts.

Every Tuesday and Thursday evening from 5:30 to 8 p.m., the volunteer professional staff sees patients. Last year alone, the clinic had more than 1,700 patient visits.

"Anyone who walks in, we will see once. We do not turn anyone away," Smith said.

Parents bringing children, though, are made aware of BadgerCare; people 65 and older are directed to Medicare. Therefore, the clinic’s primary patient base tends to be people 18 to 65 years of age.

Patients must reside in Community Memorial Hospital’s service area, and their income from all sources cannot exceed 185 percent of the federal poverty guidelines. For example, the current poverty-level income for a two-person household is $13,200; 185 percent of that comes to $24,420.

"Most of our patients have chronic diseases, such as high blood pressure, diabetes and mental illness," Smith said, noting many of them need medication. "We get a lot of medication in the form of samples donated from drug companies."

What’s more, Smith applies for grants to purchase drugs and tries enrolling people in patient-assistance programs established by drug companies.

"I have tried my hardest to create an environment that is very friendly, very relaxed, because some patients might be embarrassed to be here. They feel horrible in their situation," Smith said.

Wandschneider observed that "there may be a certain level of guilt in taking free services from people."

"With health, you cannot allow that to happen," he said. "Follow-up care is needed."

Staff makes a difference

What helps immeasurably is the dedication of the clinic staff.

"The volunteers I have are absolutely fantastic," Smith said. "The physicians who come here are very, very committed."

Adding to her sentiments are the comments of Anne Krause, an Alverno nursing student.

"This is the best clinic experience I have had in school and the most rewarding," Krause said. "The people who work here want to help others. It’s a whole different way of working."

Fellow nursing student Becky Retzlaff from the University of Wisconsin-Milwaukee said she likes working at the clinic "because we are in a position to help people with preventative care as opposed to waiting until they are so sick they have to go to the emergency room.

"I am always searching for new volunteers—medical and clerical," Smith said.

She also encourages people who have something to offer to do just that. For instance, a local chiropractor has accepted a few of her patients. Anyone who has medical equipment they no longer need, such as knee braces or crutches, is asked to donate them to the clinic. Church groups have been kind enough to collect personal hygiene products and over-the-counter pain relief medication.

Depend on me to keep you current about Community Outreach Health Clinic. This column has merely opened the door. In the future, I’d like to bring you in, show you around and introduce you to more of the staff. Perhaps we can even get some insights from the patients.

To schedule an appointment at the clinic, N8085 Town Hall Road, call 262-257-3393. Linda Smith can be reached at 262-257-3394.

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