July 11, 2003
Volume 47, Issue 28

Hospitals Commit to WHA Quality Initiative

A significant majority of Wisconsin hospitals have committed to participate in the WHA Quality Initiative. The goal of publicly reporting 10 quality and 5 safety measures is to provide consumers and purchasers reliable and useful information that will allow them to check the quality of care in hospitals and to provide hospitals with benchmarking tools that will facilitate quality improvement.

"Wisconsin hospitals are stepping up to the plate and placing a high priority on providing information that will help people become more informed consumers of health care," said WHA President Steve Brenton. "This initiative comes at a time when consumers are being asked to shoulder more responsibility for decisions made about their health care, and we believe they will find information on quality and safety to be of value."

On July 8, the Quality Measures Team, charged with evaluating the measures used in the initiative, met in Madison to review the measurement model for the safety goals that will be included in the first set of information. Pat Schroeder, senior vice president and chief nursing officer for Covenant Healthcare System, and chair of the Quality Measures Team, described the initial work of the Measures Team as implementation of the first phase measures followed by determining the next generation of information to be collected from hospitals.

Listed below are hospitals that have completed the enrollment process, as well as those that have pledged to participate in the WHA quality reporting program. WHA staff are optimistic that the list will grow substantially over the next few weeks as staff assist hospitals by responding to technical issues associated with the reporting process.

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Hospitals Enrolled:

Pledged Hospitals

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Supreme Court Recognizes Peer Review Protection for JCAHO Material

In a decision filed last week, the Supreme Court of Wisconsin held that Joint Commission on Accreditation of Healthcare Organizations ("JCAHO") materials are immune from discovery during litigation based on Wisconsin’s peer review statute. The court stated that JCAHO reports and evaluations "enable hospitals to improve their services above the minimum levels set by the state" and that the evaluations "go to the core of why protection is afforded under the statute."

In its decision, the court recognized the importance of strong peer review statutes: "To permit discovery of these materials would subvert the central purpose of [the peer review statutes], which is to encourage hospitals to perform quality-control reviews aimed at improving, prospectively, their services." The court continued, "[Wisconsin’s peer review statute] is designed to encourage candid and voluntary studies and programs used to improve hospital conditions and patient care." The court agreed with a previous appellate court decision that "the statute clearly envisions entities beyond the health care provider itself participating in the review and evaluation process."

WHA is pleased that the court’s decision recognizes and protects a crucial element of hospitals’ quality improvement initiatives. The case is Hofflander v. St. Catherine’s Hospital, Inc., 2003 WI 77, 00-2467, which can be viewed in its entirety at www.courts.state.wi.us/html/sc/00/00-2467.htm. WHA will provide a complete analysis of the court’s decision soon.

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The Challenge Grows Bigger: Recruiting Health Professionals in Today’s Market

Valued Voice Editor Mary Kay Grasmick interviewed Kurt Mosley, vice president of business development at The MHA Group. The MHA Group is a valued supporter of WHA as a Corporate Champion.

What are the challenges in health care staffing today?

The American Hospital Association last year found that two issues occupy more than 80% of a CEO’s time—staffing and reimbursement. In 1993, the Council on Graduate Medical Education (COGME) predicted that by 2000, there would be a surplus of 160,000 physicians. The year 2000 has come and gone, and we are faced with a physician shortage. Why? Mainly because 75 million baby boomers are using more health care services than predicted, they see the doctor three times more often than their more youthful counterparts, obesity is driving up utilization, and boomers are having more elective surgery than ever before.

In 1997, the balanced budget amendment placed restrictions on residency slots in hospitals, and hospitals are still trying to recover from these cutbacks on their physician and other professional workforce. Further complicating the workforce issue in the country is the current medical malpractice crisis, which fortunately is not a big issue in Wisconsin.

Along with a shortage of physicians comes a shortage of allied professionals. Last year, radiologists were our #1 search, and because there is a lack of radiology technicians, it causes radiologists to leave to look for new practice opportunities. The good news is that people are living longer; the bad news is we currently don’t have enough health professionals in the pipeline to care for them.

WHA just initiated a new task force to study the issue of physician shortages.
I think this is a very good idea. As more and more state hospital associations tell Washington that they have severe shortages, some real solutions will begin to emerge. Dr. Richard Cooper and the team of researchers at the Health Policy Institute at the Medical College of Wisconsin in Milwaukee, has predicted a dramatic shortage of 200,000 physicians by the year 2020.

What do you think of staffing ratios for nurses and other health care professionals?
Staffing ratios are too vague and too hard to determine. Ratios do not take into consideration the available supply. The ratio may say you need X number of professionals but the supply is not available so everyone ends up not being in compliance anyway and you’ve done nothing to solve the real problem. Mandating ratios can put a small community against a larger competitor in a race to meet a ratio, and everyone ends up losing in the end.

Not only is supply an issue, but what two communities have the same health care needs? For instance, a community of 50,000 people with an average age of 35 will not have the same health care needs as a community of 50,000 people with an average age of 55.


How long can we expect current staffing challenges to continue?
It could be an issue for at least ten years. The problem is people are now responding to the problem, but you can’t, for instance, grow a physician in one year. Plus, for the first time ever, 50% of the primary care physicians coming out of residencies are female; the ratio is now about 76% male, 24% female, the highest it has ever been and getting bigger. Women work 7-10 hours less than their male counterparts, and they have other quality of life issues because they are often the primary caregivers for their own children or for aging parents. We might find we need to recruit more physicians to care for patients.

The problem is more physicians are retiring than are coming in. At this time, 28,000 leave each year, and about 28,000 come in. By 2004, we’ll see more leave than are coming in. The average age of a nurse in 1990 was 40; in 2002 it was 49. Among physicians, 38% are over 50.

What steps can hospitals take to improve their staffing methods?
It requires a full court press. Everybody has to be on board with agreeing that a staffing plan at the hospital is the #1 or #2 priority. People must represent the hospital accurately and positively in both informal and formal networks.

Keep in mind that when THE MHA GROUP surveyed physicians, 76% of them told their children NOT to be physicians. One of the concerns is when we asked physicians in residency training in 2001, if you were to begin again, would you pick medicine? In 2001 95% said yes, in 2003 only 76% said yes. Why? Because of things they are hearing from peers about malpractice, malfeasance, overly regulated, and bureaucratic. In the 80’s, medicine was associated with affluence, a great profession. In late 80’s to early 90’s, people were making more money in other professions with less education, and medicine began to be seen as "low tech." And worse yet, they are getting these messages from physicians who have left practice.

How is Wisconsin positioned relative to other states when it comes to staffing?
The good news, and I’ll repeat that, is your medical malpractice is not in a crisis. Compensation is good in Wisconsin in all specialties, including nursing. But, malpractice is really the key, because when you affect physician supply because they can’t afford the insurance, you impact the ability to attract all the other professions as well. You have a good quality of life. Physicians we place in Wisconsin say they like the family life and the outdoor opportunities.

How does the THE MHA GROUP assist clients in Wisconsin?
We use a national approach to staffing. In Wisconsin, 10,914 physicians are currently practicing medicine in the state. There are approximately 20,000 physicians born, trained or licensed in Wisconsin, but not working in Wisconsin. We developed a Web site specifically to provide information to physicians in resident training programs called newphysician.com and providing physicians with information that they never received while they were in medical school. In THE MHA GROUP survey, 50% of the residents we asked said they are not ready to handle the business consideration of practice, nor do they know what questions they should ask of recruiters, so they get very frustrated.

THE MHA GROUP has a relationship with more than 75 hospitals in Wisconsin, and in the last year, we brought 40 physicians to Wisconsin. Bigger doesn’t make you best, but when you are the best, you get bigger.

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President’s Column

Des Moines, Iowa is the epicenter of the Medicare reform debate…at least according to the Los Angeles Times. In a Sunday, July 6 front page article, Times staff writer Janet Hook noted "when presidential candidates fly into Iowa this month (Iowa is the venue for the first in the nation presidential caucus next year), they will be greeted with a message tailor-made for them. An enormous billboard at Des Moines International Airport tells them to ‘turn around and get back on your plane’ if they are not committed to increasing Medicare funds for the state."

Following years of struggling to get the message across…that Medicare payment and spending in rural America is a huge and growing problem…the Des Moines, Iowa billboard becomes a symbol for just how far some Iowans are willing to go to leverage Washington politicos in order that some level of meaningful Medicare payment change happens this year. And Iowa politicians, including Senators Grassley (R) and Harkin (D) and Congressman Jim Nussle (R), are well poised to advance provisions that will reduce the payment disparity…provisions that were included in both the House and Senate versions of Medicare reform legislation. Importantly, Democratic candidates seeking to line up support in the Hawkeye State will repeatedly be asked the question, "Where do you stand on correcting Medicare payment disparity?"

Hospital and health system support for the 2003 Healthy Wisconsin campaign is at an all-time high. The fundraising goal of $125,000 seems highly attainable, and the goal of increasing individual participation by 20% also appears achievable. Consider this, 45 managers and "friends" of Sacred Heart Hospital, Eau Claire have contributed $1,570 in individual, voluntary contributions. And Sauk Prairie Memorial Hospital’s first major campaign has netted almost $1,700 from a dozen individual contributors. What terrific efforts!

WHA board members, regional presidents and senior staff will gather in Lake Geneva next week to participate in the Board’s 2003 planning session. The focus will be on aligning the Association’s current strategic plan with member opinions and perceptions as identified in the recent WHA member survey. Breakout groups will focus on topics including the potential for enhancing WHA’s "commitment to accountability"; identifying "top five" priorities associated with the Association’s workforce agenda; and improving "targeted" advocacy programming and effectiveness strategies…especially as they relate to members’ expectations associated with the federal advocacy agenda.

Steve Brenton, President

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Wis. Nurses Association to Assess Emergency Preparedness Knowledge

The Department of Health and Family Services Division of Public Health has contracted with the Wisconsin Nurses Association (WNA) to determine the education and training needs of Wisconsin’s allied health care workers, including physicians, in responding to the issues related to bioterrorism. To do this, the WNA is asking all clinical, health care workers in Wisconsin to complete a survey, the Emergency Preparedness Information Questionnaire (EPIQ). The purpose of EPIQ is to assess how familiar clinical professionals are with large-scale emergency events, such as terrorism. The EPIQ measures familiarity with the emergency response system, NOT clinical competencies. The results of this voluntary and anonymous questionnaire will form the basis for the WNA and DHFS to prepare educational materials for the clinical workforce. EPIQ takes about 15 minutes to complete and is available on-line at www.publichealthplanet.org or by going to the WHA Web site where there is a link to the questionnaire. It is available on line from July 1 through August 19, 2003.

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WHA Weighs in on Emergency Responder Legislation
 Bill Complicates Staffing, Jeopardizes Public Health and Safety

As the Assembly Labor Committee held a public hearing July 9 on legislation creating a protected class under Wisconsin’s Fair Employment Act for volunteer emergency services personnel, WHA drew attention to the health care workforce shortage and the effects of staffing mandates on access to care.

Assembly Bill 45, introduced by Representative John Ainsworth (R-Shawano), requires hospitals to allow employees to arrive late, leave during the course of a scheduled shift, or miss a shift altogether if they are responding to emergencies. The bill covers volunteer fire fighters, emergency medical technicians, first responders and ambulance drivers. In a memo to Rep. Ainsworth and Labor Committee members, WHA recognized the critical role emergency services volunteers play, but argued that mandating their absence from work will jeopardize, rather than enhance, health and safety in many areas of the state.

According to the memo "to remove workers from duty without warning makes appropriate staffing of hospitals downright impossible, and endangers patient care. In many cases, the very destination of the volunteer emergency personnel would be unavailable. The health of the public will not be improved if emergency staff leave work to respond to calls causing the ER to close, reroute patients or defer care."

Rep. Ainsworth, who introduced the proposal for the third session in a row, expressed appreciation for WHA’s input. Having been made aware of the bill’s impacts on hospitals for the first time, he expressed a desire to avoid further complicating staffing difficulties. In addition to Rep. Ainsworth, supporters including the Wisconsin State Fire Chiefs Association and the Wisconsin State Firefighters Association, and many committee members said they hope to reach a compromise that protects existing volunteers, makes volunteering more attractive and does not disadvantage employers.

In testimony before the committee, Wisconsin Manufacturers and Commerce questioned whether this could be done without causing excessive litigation or discouraging the hiring of emergency services volunteers. WHA agreed with the concerns of WMC, but also pointed out that addressing these issues does not solve the problem, telling committee members "any mandate that removes hospital control over staffing and endangers patient care is unacceptable."

"WHA realizes the importance of emergency services volunteers in the health care system and is supportive of the goal to increase their numbers. WHA’s opposition to AB 43 should not be interpreted as a statement on the value these volunteers, but rather as a warning that this bill may well create more problems than it solves," said Jodi Jensen, WHA vice president of government relations. "We will continue working with Rep. Ainsworth and committee members to ensure that existing staffing challenges are not exacerbated and patient care is not jeopardized while recognizing the critical role emergency service volunteers play in many parts of Wisconsin."

The WHA memo will be available on the WHA Web site (wha.org). For more information about AB 43, contact Jodi Jensen or Judy Warmuth at 608-274-1820, or jjensen@wha.org  or jwarmuth@wha.org 

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New WAVE Award to Recognize Outstanding Volunteer Contributions

The Partners of WHA, Inc. is proud to announce a new statewide volunteer recognition program – the first annual Wisconsin Awards for Volunteer Excellence, or the WAVE Award. This program was established to recognize outstanding contributions of organized volunteer programs in Wisconsin, and is patterned after the AHA HAVE Award program (Hospital Awards for Volunteer Excellence).

Nominations are now being accepted for programs in any of the following categories:

Completed applications are due by September 5, 2003. Winners will be honored at the WHA Annual Convention luncheon on September 25 in Lake Geneva and at the Partners of WHA Annual Convention dinner on October 8 in Wisconsin Dells. A volunteer representing each award-winning program must be present at both events to receive the award.

The nomination packet for the first annual WAVE award is included in this week’s packet, and is available at www.wha.org under the Partners of WHA heading. Please be sure to pass it on to your volunteer or auxiliary group president or your director of volunteer services, and encourage them to nominate one of their successful projects. For questions about the WAVE Award, contact Jean Heniff, Partners’ WAVE Committee Chair, at 715-258-5453.

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State Certification Proposed for Foreign Language Interpreters

This week, the Assembly Labor Committee held a public hearing on legislation establishing state certification for foreign language interpreters. Assembly Bill 158, introduced by Representative Bob Turner (D-Racine), creates an optional certification through the Department of Regulation and Licensing. Under the bill, interpreters could represent themselves as a "Wisconsin certified foreign language interpreter" only after obtaining certification. The bill grants the Department authority to specify which languages certification will be available for, and to promulgate administrative rules establishing education, competency, or training requirements that must be satisfied to become certified.

Rep. Turner said he introduced AB 158 at the request of Spanish-speaking constituents who believe using unqualified interpreters has compromised their health care and legal rights. According to Milwaukee-based United Migrant Opportunity Services (UMOS), Inc., many interpreters are representing themselves as "certified" even though no certification exists either in Wisconsin or federally. UMOS argued that certification is required to ensure access to uniform quality of interpretation services throughout the state, and said this is crucial in the health care setting.

Concerns raised by committee members included driving up the cost of interpretation services and creating a new bureaucracy to certify approximately 100 interpreters. The Department sent committee members a letter opposing the proposal. At this time, WHA has not taken a position on AB 158.

For more information about AB 158, contact Jodi Jensen or Judy Warmuth at 608-274-1820 or jjensen@wha.org  or jwarmuth@wha.org.

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Credentialing Solution Offered by WHA, in Collaboration with WMS

The Wisconsin Hospital Association is pleased to announce a new partnership with the Wisconsin Medical Society, aimed at improving the credentialing process for both hospitals and physicians. The initiative employs communicative, web-based technology provided by Chicago-based CredentialSmart, Inc.

A hospital’s credentialing process can be streamlined via the menu of services offered through CredentialSmart’s on-line solution, electronically connecting a hospital to credentialing information provided by the physicians. The credentialing process is a common concern to both hospitals and physicians, and this new offering is intended to improve the reliability and efficiency of the credentialing process, while reducing frustration for those charged with managing this process in a hospital.

A unique feature of this service recognizes that some WHA members have invested in existing credentialing software systems. In these instances, the web-based tools will augment the hospital’s current software system – rather than replace it. This solution is not a software, so there are no traditional, costly, upfront licensing fees, Instead, it is transaction-based, so hospitals only pay for what they use, making it an appealing option to hospitals of various sizes. For those hospitals that do not currently have a system or are interested in evaluating other options, CredentialSmart can provide an affordable start-to-finish solution that goes beyond the traditional limits.

More information about this credentialing option will be sent to WHA member hospitals in early August, but if you’d like more information now, contact Dana Richardson at WHA at 608-274-1820 or drichardson@wha.org.

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HHS Launches Paperless Health Care System Effort
 Provides Medical Record Access Anytime, Reduces Errors, Reduces Costs

Health and Human Services (HHS) Secretary Tommy G. Thompson announced July 1 two new steps in building a national electronic health care system that will allow patients and their doctors to access their complete medical records anytime and anywhere they are needed, leading to reduced medical errors, improved patient care, and reduced health care costs.

First, the Secretary announced that the Department has signed an agreement with the College of American Pathologists (CAP) to license the College’s standardized medical vocabulary system and make it available without charge throughout the U.S. The CAP agreement will be administered through the National Library of Medicine (NLM), a component of HHS’ National Institutes of Health (NIH). NLM has issued a 5-year, $32.4 million contract to the College for a permanent license for their terminology, known as SNOMED (Systematized Nomenclature of Medicine) Clinical Terms. The licensing agreement includes the core database in both English and Spanish along with regular updates. This action opens the door to establishing a common medical language as a key element in building a unified electronic medical records system in the U.S.

Secondly, the Secretary announced that HHS has commissioned the Institute of Medicine to design a standardized model of an electronic health record. The health care standards development organization known as HL7 has been asked to evaluate the model once it has been designed. HHS will share the standardized model record at no cost with all components of the U.S. health care system. The Department expects to have a model record ready in 2004.

"Banks and other financial institutions all across the country can talk to each other electronically, which has streamlined customer transactions and reduced errors," Secretary Thompson said. "We want to do the same thing for the American health care system. We want to build a standardized platform on which physicians’ offices, insurance companies, hospitals and others can all communicate electronically, which will improve patient care while reducing the medical errors and the high costs plaguing our health care system."

The contract between the National Library of Medicine and the College of American Pathologists is an effort supported by all the agencies participating in the Consolidated Health Informatics initiative (CHI), which is working to adopt government-wide standards for clinical health data. CHI is the health care component of President Bush’s eGov Initiatives to make it easier for citizens and businesses to interact with the government, save taxpayer dollars and streamline citizen-to-government transactions. More information on CHI and the President’s eGov Initiatives may be found at: www.egov.gov.

Details of the SNOMED license arrangement as well as information on obtaining access to the SNOMED database may be found at:
www.nlm.nih.gov/research/umls/Snomed/snomed_announcement.html.

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IRS Ruling on Debit FSA

A report on medical plans and employee behavior found that participation in Flexible Spending Accounts (FSA) has increased 15% in the first quarter of this year compared with 2002. The success of FSA will only increase with the continued proliferation of the debit card as a way to access FSA funding and promote more effective spending. Recent IRS rulings confirm the debit card system is a tool for administrators to better serve their customers—the employers.

Read the entire article in Solutions Spotlight, included in this week’s packet or contact WHA Financial Solutions at 800-362-7121 for more information.

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Healthy Wisconsin 2003--Reached $85,000--Getting Closer!

PRESIDENT ($1,000 and above)

CHAIRMAN (500-999)

CAPITOL (250-499)

SENATE (100-249)  

ASSEMBLY (75-99)

CLERK (1-74)

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