Assembly Majority Leader Mike Huebsch (R-West Salem) and DHFS Secretary Kevin Hayden gave the WHA Board of Directors two sharply different views of the hospital tax proposed in Governor Doyle’s budget at the June 21 meeting in Madison.

"The hospital tax is the wrong way to go," according to Huebsch, while Hayden believes, "The assessment is the only vehicle to get additional dollars for Medicaid."

The battle lines are clearly drawn as the two houses prepare to begin crafting their budgets. Huebsch said the initial process of each house passing a budget will go fairly quickly, and then both versions of the budget will go to a conference committee to hammer out a compromise budget that will be sent back to both houses for a vote. From there, it moves to the Governor’s desk for approval and vetoes.

Huebsch said his caucus recognizes that merely stopping the hospital tax is not enough because the state’s underfunding of its health care programs is truly at the heart of the problem. "One of the biggest problems we have in health care today is that we over-promise on our health care programs and underpay our providers," he said. Huebsch reiterated that the hospital tax would not be in the Assembly Republican’s budget.

There will be two funding priorities in the state budget, according to Huebsch: K-12 education and providing for those who cannot provide for themselves. "We will work for other areas, but not at the expense of our two priorities. That is good news for you as Medicaid providers," he said.

Huebsch admitted that they have a "long way to go" to complete the state budget, but, in the end, he said, the job will get done. Commenting on the raid on the Injured Patients and Family Compensation Fund, he had this to say: "You should sue us immediately if we take that money. I feel strongly that we should not do it. It is not our money. It is, quite frankly, one-time money. You don’t take money that isn’t yours," he said. "It’s going to be a huge battle, just like the hospital tax."

The fact that Wisconsin was rated #1 by the Agency for Healthcare Research did not escape the Speaker’s attention. "You should all be congratulated on the status of health care in this state. We can be very proud of the quality of care we provide and the type of care that is available because of our care providers," he said. "We don’t want to go in a direction that erodes that status."

Hayden Terms Hospital Tax "Practical"

Just as strongly as Representative Huebsch opposes the tax, Department of Health and Family Services Secretary Kevin Hayden supports it. And he urged the WHA Board to reconsider its position of opposing the tax.

"It is clear there is a prescriptive approach to be successful in an assessment. It is also clear that the use of the assessment is the only vehicle we have for additional Medicaid reimbursements this biennium," Hayden cautioned. "If we have a cigarette tax and designate it to go to Medicaid payment increases, I strongly believe that the Governor will veto it. The Governor thinks drawing down federal dollars is critical, and I think an assessment is the only vehicle available to get additional dollars," Hayden said. "It is practical."

Hayden was confident that the hospital tax will be approved by CMS. "We think our methodology will pass CMS. We have a broad based tax, and the payments are redistributive. We think we have the technical capacity and political will to pass it. We are in discussions with CMS on the design of assessment; we are confident that we can do the math to get this done," Hayden said.

However, when Board members asked Hayden about the future of the hospital tax, and how he could ensure that the tax will not create additional losers in the years ahead or be raided to fund other spending, he was less certain. WHA Executive Vice President Eric Borgerding asked how much discussion there has been on long-term issues associated with passing a hospital tax. "Just like the nursing home tax, this is a long term policy that, if enacted, will be here to stay. With our state’s history of raiding segregated funds, there are significant issues associated with building safeguards in for protecting these dollars over the long run. How will the administration address that issue?"

Secretary Hayden encouraged WHA to accept the "inevitability" of the hospital tax and work with Administration officials to address specific issues associated with the proposal; issues which he suggested are addressable by the Administration.

Following the guest speakers’ presentations, the Board agreed to maintain its current position of opposing the hospital tax while seeking meaningful and necessary payment increases. Board members encouraged staff to continue dialogue with Administration officials and Legislative Leadership to accomplish the dual objectives. WHA President Steve Brenton said a considerable portion of the WHA Board Planning Session, slated for July, "will be devoted to a continuing discussion of the hospital tax and Medicaid budget issues."

Advocacy Chair Mary Starmann-Harrison reported good progress in meeting the 2007 fundraising campaign goal of $195,000. To date, $93,000 has been raised, which is $20,000 more than was raised at this same time last year.

In his report, WHA President Steve Brenton recognized Chuck Shabino, WHA senior medical advisor, and Dana Richardson, vice president, quality initiatives, for their roles in the development of Wisconsin’s CheckPoint (www.wicheckpoint.org) program. Brenton noted that the landmark public reporting program was instrumental in improving clinical performance at Wisconsin hospitals and contributing to the recent recognition that Wisconsin providers rank first in the nation in measured quality performance.

A poster size print of the ad that WHA ran in 18 newspapers across the state was on display in the Board Room. "We made an investment in sending a message to the public and to public officials. When AHRQ ranked us #1 last week, it represented a significant amount of dedication to improving quality," he said. "We have received a tremendous response to this accomplishment by our colleagues, and we wanted to recognize hospital caregivers and leadership for accomplishing this Wisconsin health care milestone," Brenton added.

Brenton also noted the almost universal hospital participation in WHA’s Hospital Billing and Collection Guidelines, Confirmation of Commitment initiative, an effort embraced by Wisconsin Attorney General Van Hollen. "Wisconsin hospitals have voluntarily stepped up to commit to this important effort," Brenton noted.

Finally, Brenton indicated progress in opposing a Workers Compensation (WC) provider payment cut proposal that was being led by management representatives to the Workers Compensation Advisory Committee, a group tasked with recommending legislative changes to the WC program. He noted strong staff work by Senior Vice President George Quinn and General Counsel Laura Leitch in managing the issue.

Ask physicians and nurses across the nation what they need most to improve the efficiency and quality of health care, and the most frequent answer is instant access to reliable information about their patients. But the implementation of electronic systems for the exchange of information among emergency departments and community clinics has been lagging.

Now, thanks to the collaborative efforts of the Wisconsin Health Information Exchange (WHIE), the Milwaukee Health Care Partnership, the State of Wisconsin Department of Health and Family Services, and Microsoft Corporation, a unique system is being established to secure and share medical information and to facilitate care coordination protocols that will assist in caring for patients, providing for better continuity of care, and improving patient safety. A formal kick-off meeting for the project, called the ED Linking Project, was held June 20 at Children’s Health Education Center.

"Emergency clinicians are often faced with very ill patients and a complete lack of past medical history that limits our ability to provide optimal care," stated Edward Barthell, MD, a local emergency doctor and one of the founders of WHIE. "Within two years the ED Linking Project will have all Milwaukee County hospital emergency departments and the local FQHCs (federally qualified health clinics) linked so that information can be shared instantaneously. This will allow us to coordinate, and will improve both quality and efficiency of the care we deliver."

The project will support the work of the Milwaukee Health Care Partnership, a public/private collaborative to improve health care for the medically underserved in Milwaukee County. The Partnership is governed by CEOs from local hospital systems and FQHCs, state and county government representatives, and the Wisconsin Hospital Association.

Leo Brideau, CEO of Columbia St. Mary’s and chair of the Partnership, notes that one of the basic challenges in the Milwaukee health care delivery system is that many people do not have a primary care physician or what is termed a medical home. "The new information exchange network will facilitate care coordination between area hospitals and the community clinics. Better continuity of care should result in better outcomes for patients."

The WHIE system is designed to be useful for all patients, with an initial focus on safety net providers and emergency departments. WHIE has obtained commitments for $5 million in funding to implement the ED Linking system in Milwaukee, including funding from the Wisconsin Department of Health and Family Services. Patients enrolled in Medicaid will be among the first group of patients with data available through the system.

Now WHIE will be working with Microsoft Corporation, which will provide its unique Azyxxi software platform to implement the local information exchange system. Azyxxi, which was developed by doctors for doctors, aggregates and enables analysis of all relevant data across disparate systems, for a single integrated emergency department view of patient information. The software allows health care workers to maximize the value of information and make the most informed decisions. The WHIE system will be the first application of the Azyxxi software in this type of health information exchange.

The WHIE ED Linking system is expected to roll out this summer with initial hospitals connected before year-end, and 10 hospitals connected to the network over the next two years. An evaluation of the ED Linking health information exchange will be performed by academic researchers from the University of Wisconsin and the Medical College of Wisconsin.

For more information, contact Elana Rotter, Wisconsin Health Information Exchange at 414-290-6725 or erotter@whie.org, or Bill Bazan, Wisconsin Hospital Association, at 414-431-0105 or bbazan@mailbag.com.

Department of Health and Family Services Secretary Kevin Hayden presented WHA Chair Bob Fale a Certificate of Commendation during the WHA Board meeting on behalf of Governor Jim Doyle, recognizing the high quality of patient care provided in Wisconsin hospitals. Hayden said both the Department and Governor Doyle were pleased to hear this week that the federal Agency for Healthcare Research and Quality (AHRQ) data 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.

The Commendation states: "Wisconsin hospitals provide the highest quality health care in the nation. Wisconsin’s health care providers (give) high quality care to patients presenting with a wide range of medical needs and conditions. Through their efforts, Wisconsin leads the nation in many important indicators of patient health."

"I commend Wisconsin’s hospitals and primary care providers for their commitment to providing health care of the highest quality to the people of Wisconsin." - Wisconsin Governor Jim Doyle

We have been reminded over the past two weeks just how important it is to demand that value be the foundation of all health reform discussions. In addition to expanding access and coverage to Wisconsin’s relatively small uninsured population, and improving provider payments to assure access to government programs and reduce cost shifting, the value equation must be the core principle for designing strategies that address the health care cost conundrum which is arguably the primary driver of the health reform debate.

Importantly, Wisconsin’s delivery environment is primed for advancing an agenda that promotes the value equation. Consider these recent developments:

+ AHRQ Scorecard - According to the federal agency considered to be the "gold standard" for measuring provider performance, Wisconsin ranks #1 in the nation when it comes to provider compliance with evidence-based clinical measures that are designed to measure health care quality. Contributing to this ranking are environmental factors that include a high level of delivery system integration and pace setting capital investments in IT systems that enable improved clinical performance. The fact that hospitals and physician groups embraced public reporting early via WHA’s CheckPoint and the Wisconsin Collaborative for Healthcare Quality (WCHQ) performance measures also contributed to this top ranking.

+ Commonwealth Report Card - Among the several positive findings in the recent Commonwealth Foundation study is Wisconsin hospitals and physicians demonstrated value to the Medicare program. When costs are measured in terms of annual per capita spending....the state is a true bargain to MEDICARE. In fact, the study claims that Medicare could save $22 billion annually if per capita spending nationally would align with Wisconsin spending. And the study doesn’t even factor in the added bonus associated with our high quality rankings. Maybe Medicare Pay for Performance should factor in this proven performance!

+ Workers Compensation - The recent attempt to enact massive hospital and physician payment cuts in the WC program allowed us to promote the fact that WC outcomes in Wisconsin are consistently among the best in the nation. When one focuses on the cost of episodes of care, as opposed to per unit payments, Wisconsin results demonstrate value. When you add outcomes to the equation (number of days until return to work) you have terrific value.

For much of the past five years, the public policy spotlight has been on hospital and physician prices. Much of that focus has included a disappointingly incomplete analysis of available but ignored information. The fairly recent GAO Study that was interpreted to identify high physician costs in most Wisconsin metro markets is a recent example. And unfortunately, none of the comprehensive health reform initiatives/solutions being discussed in Madison address value as a driving principle.

Let’s demand that the health reform debate recognize the value equation. When policymakers look at actual spending on episodes of care combined with real outcomes, the Wisconsin results will be hard to match. Improving health care quality and value is health reform.

Steve Brenton
President

The Hospital Quality Alliance (HQA), which includes AHA, this week added to the Hospital Compare Web site (www.hospitalcompare.hhs.gov) mortality data for heart attack and heart failure patients. The data shows consumers how heart attack and heart failure patients fared 30 days after admission to a hospital, including time after discharge. Hospitals are grouped as the same, better, or worse than the national mortality rate for the two conditions. The rates are calculated using sophisticated risk-adjustment that takes into account one year of billing history for each patient. Also added to the Web site on June 21 were additional data on steps hospitals have taken to prevent surgical infections and pneumonia. Since 2002, HQA has given consumers useful information about hospital quality through Hospital Compare. "Through this important effort, hospitals are voluntarily making more information about quality publicly available," said AHA President and CEO Rich Umbdenstock. "That’s good for patients and families."

The eHealth Care Quality and Patient Safety Board voted on June 21 to "fully endorse" Governor Jim Doyle’s proposed budget provisions related to the creation of an eHealth Care Quality and Patient Safety Council, provision of grants to fund adoption of e-health technology and creation of an electronic medical records tax credit.

During the Board’s debate on the resolution, Gary Bezucha, administrator, Boscobel Area Health Care, expressed concern that the language of the originally proposed resolution could be construed as referring to funding sources, which include the Governor’s proposed hospital tax. He also objected to the inclusion of a reference to a budget provision that would have prohibited WHEFA from providing financial assistance unless the requesting facility demonstrates progress in improving medical information systems technology, as determined by the Secretary of DHFS. Bezucha told the Board that he could not endorse the application of yet-to-be-determined criteria for "progress" to WHEFA bonding decisions.

The Board ultimately passed a resolution on an 8 – 3 vote that omits any reference to WHEFA and makes clear that the Board is not endorsing any proposed funding mechanisms.

The Board also received an update on issues related to privacy laws. Full implementation of e-health technology will require specific changes to privacy provisions of chapter 51 (mental health) and chapter 146 (general health care) of the Wisconsin statutes. The Board is expected by the end of this year to recommend specific statutory changes for consideration by the Legislature.

Now is the time to honor one of your hospital’s community health projects, by nominating it for a 2007 Global Vision Community Partnership Award, presented by the WHA Foundation.

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.

Nominations must be received no later than 5 p.m. on July 13, 2007. Included in this week’s packet is the final call for nominations for this year’s award. Any WHA member hospital 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 20, 2007. Nomination forms can also be found on the WHA Web site at www.wha.org. For more information about the Award, contact Jennifer Frank at jfrank@wha.org or 608-274-1820.

Last week, the Board of the Wisconsin Health and Education Facilities Authority (WHEFA) met to consider a health system’s application for bond financing. In a stunning development, the application was denied, failing on a 3 to 3 tie vote. What is most disturbing about the vote is that the denial appears to have been for other than financial reasons.

Since its creation by the Legislature in 1973, WHEFA has provided bond financing to hundreds of hospitals and other health facilities, amounting to billions of dollars. In fiscal 2007 alone, WHEFA provided over $850 million in financing for both new capital expenditures, such as new buildings, as well as refinancing of existing debt. Over its history, WHEFA has been instrumental in helping Wisconsin’s health care organizations provide the most modern and technologically advanced facilities to their patients.

But the latest decision by the WHEFA Board appears to jeopardize the access to capital that have benefited the patients of Wisconsin’s health care providers. Observers at last week’s meeting noted that there was considerable discussion surrounding "impact on other health care providers in the community" rather than the feasibility of the financing.

"This decision smacks of Certificate of Need-type policymaking rather than WHEFA’s traditional role of assessing whether the bonds being financed are credit worthy," said WHA Senior Vice President George Quinn. "One has to wonder whether the change in the makeup of the Board – which now includes a SEIU union representative, together with the 2002 change in WHEFA statutory authority – which allowed broad authority in denying bond issuance, is resulting in decisions that are more policy-related than what has traditionally been strictly fiscal in nature. Let’s hope that this is not the case as a drift in that direction has the potential of undermining WHEFA as a vital health facility financing tool."

As reported in last week’s issue of The Valued Voice, the Internal Revenue Service recently released for public comment a revised Form 990 that includes a new Schedule H to be completed by hospitals or other organizations that provide medical care. The AHA has released a Regulatory Advisory concerning the revised Form 990, which is available on the WHA Web site. AHA is seeking comments and concerns from hospitals.

AHA is hosting an AHA members-only call with key IRS personnel on June 28. Additional information concerning this call is available in the AHA Regulatory Advisory.

Does your hospital work with a great country doctor? If so, he or she may qualify as the 2007 Country Doctor of the Year. The Country Doctor of the Year Award honors the spirit, skill and dedication of America’s rural medical practitioners, and is sponsored by Staff Care, Inc., a national temporary physician staffing firm. Part of the MHA Group of health care staffing firms, Staff Care is a corporate champion of the Wisconsin Hospital Association.

Nominations for the 2007 Country Doctor of the Year Award will be accepted for physicians who practice in communities of 30,000 or less and who are engaged in such "primary care" areas as general practice, family practice, internal medicine, and pediatrics. Anyone can nominate a physician, including friends, patients, co-workers or family members, and all stories or anecdotes about the physician’s practice are welcomed.

Nomination forms can be downloaded from the Country Doctor of the Year Award Web site at www.countrydoctoraward.com, or you may call Staff Care for a nomination form at 800-685-2272. Completed nominations must be received no later than September 5, 2007.

To get people in the community moving, La Crosse-based Gundersen Lutheran Health System, in collaboration with supporting community partners, created Minutes in Motion. This was an exciting community-wide, six-week activity challenge designed to get people of all ages engaged in more physical activities. Participants of all ages were encouraged to challenge themselves to move at least 30 minutes every day for six weeks. More than 3,500 Gundersen Lutheran employees and community members participated in Minutes in Motion, including 400 teams from area businesses. Five million minutes of activity were reported by the end of the six weeks!

The Minutes in Motion challenge was a fun, innovative way to promote regular physical activity. Physical activity is one of the best and easiest ways for people to improve health, morale and productivity, as well as lower health care costs for patients and the organization.

As incentive to get people excited about Minutes in Motion, Gundersen Lutheran gave free pedometers to the first 1,000 community members and first 600 employees that signed up. All participants received weekly wellness tips by e-mail and a free copy of Prevention Connection newsletter. Cash and other prizes were awarded at the celebration party, held on May 16, Employee Health and Fitness Day.

The Premier Healthcare Alliance, a national alliance of 1,700 not-for-profit hospitals and health systems, recognized Aurora with eight 2007 Premier Awards for Quality for excellence in the care of patients. Aurora’s eight awards are the most one health system has ever achieved in one year. The eight awards are among 49 quality awards presented by Premier to hospitals and health systems across the country.

The hospitals honored include:

Aurora BayCare Medical Center
Heart failure

Aurora Medical Center Kenosha
Obstetrics

Aurora Lakeland Medical Center
Pneumonia

Aurora Memorial Hospital of Burlington
Acute myocardial infarction
Heart failure

Aurora Sheboygan Memorial Medical Center
Heart failure
Hip and knee replacement
Obstetrics

The Premier Award for Quality is based on quality and cost data regularly submitted to Premier by the nation’s top hospitals. Premier maintains the nation’s most robust database on health care quality. The database is the foundation for the pay-for-performance demonstration project undertaken by the federal government’s Centers for Medicare & Medicaid Services.

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