Make plans now to attend WHA’s 2008 Annual Convention September 17-19 at the KI Convention Center and the adjoining Hotel Sierra (formerly Regency Suites) in downtown Green Bay.

This year’s convention is the perfect opportunity for you, your hospital senior staff, and your Board of Trustee members to network with colleagues and share thoughts on the future of health care. The agenda has several important and timely topics, including:

• A keynote session presented by internationally-known health care futurist Ian Morrison will provide new insights on the future of health care and how the health care provider’s playing field will change, particularly following the 2008 elections.
• A CEO reactor panel will share their thoughts on the future of health care and the keynote presenter’s message, moderated by Leo Brideau, president and CEO of Columbia-St. Marys, and chair of WHA’s Task Force on Access and Coverage.
• A plenary session focused on AHA’s Health for Life reform initiative, presented by AHA Chair, and Wisconsin’s own Bill Petasnick, president and CEO of Froedtert and Community Health.
• An overview of the expected changes to Wisconsin’s Workers Compensation program.
• A discussion focused on the issues surrounding payment for on-call physician coverage.
• An examination of the revamped IRS Form 990 and the importance of making your hospital’s finances, billing/collection policies, and community benefits more transparent.
• A closing session focused on leadership, presented by Major General David Rubenstein, Deputy Surgeon General for the U.S. Army and 2008-2009 Chairman of ACHE.

Led by WHA Chair-elect Mike Schafer, the WHA Board Planning Session was held July 16-18 with a heavy focus on issues associated with health reform. In his presentation, AHA Chair Bill Petasnick, president and CEO of Froedtert and Community Health, described the role of hospitals as being one of stimulating ideas and developing frameworks for reform that are multidimensional and helpful in evaluating proposals.

The WHA Principles on Access and Coverage, along with a gap analysis that identifies key principles related to improving coverage of and access to health care, together provide a framework for evaluating health reform proposals in Wisconsin. (See both documents at www.wha.org/financeAndData/accessAndCoverage.aspx.

Petasnick said the American Hospital Association has identified several key issues around health reform, which align with the WHA Principles. These include defining the role of government, employers, employees, individuals and whether mandates should come into play in any discussion of coverage.

"Reform is much broader than just ‘coverage,’" according to Petasnick.

That point was also emphasized by WHA Task Force on Access and Coverage Chair Leo Brideau, president and CEO, Columbia St. Mary’s, who gave the example that Wisconsin’s Medicaid program "covers" dental, but the reality is that Medicaid patients have very limited access to those services.

In the final analysis, the Board agreed that WHA and its individual members should work at both the state and local level for rational and thoughtful improvement of the health care delivery and financing system. A summary of the Board Planning event is in this week’s packet.

Health care is the largest and fastest growing industry segment of Wisconsin’s economy. With that comes challenging workforce issues, especially with fewer workers available to replace older employees, and an increase in demand for medical services predicated on an aging population. That was the picture WHA Vice President of Workforce Judy Warmuth painted during her presentation at the first meeting of the Legislative Council Special Committee on Building Wisconsin’s Workforce held July 21 in Madison.

WHA’s Warmuth was appointed to the Special Committee by the Legislative Council. The Committee will study and make recommendations to the Legislature on how to best prepare, retain and retrain workers to meet Wisconsin’s future workforce needs in its major industries. Warmuth was one of the committee members who were asked to present industry-specific facts and statistics at the first meeting.

Warmuth emphasized that health care is the largest component of Wisconsin’s workforce, which continues to grow and create new jobs.

"More than half of the fastest growing occupations statewide are in health care. Preparing the workers we need in the future is a challenge that will require us to continue to create interest in the field, increase capacity in our classrooms, and retain the workers we recruit," Warmuth said. She said new ways must be developed to prepare these workers. Health care providers might also need to find ways to deliver health care with a smaller workforce.

"It is very appropriate that the Legislative Council appointed this Special Committee of workforce experts to study the issues now and make recommendations on steps we can take to avert a crisis in the future," Warmuth said.

Warmuth conveyed the sobering facts about the supply of and demand for health care workers in Wisconsin to the group. Major themes in her presentation were:

• An aging population requires more medical care with fewer workers to deliver it;
• An increased demand for workers well prepared in technical and medical specialties; and,
• A lack of ‘soft skills’ in new job applicants.

Department of Workforce Development Secretary Roberta Gassman reviewed the state’s current workforce initiatives while Dennis Winters, DWD Office of Economic Advisors, shared economic and labor data.

"We face a quality and quantity challenge," according to Winters, who provided data to demonstrate that while Wisconsin’s future population will be greater than today’s, the labor force will not keep pace with that growth.

Terri Newmier from the Marshfield Clinic outlined the most serious current occupational shortages in health care, which included: CRNA, physical therapists, specialty nurses, advanced practice providers and pharmacists. She described these shortages as affecting providers’ abilities to deliver care in a timely way to patients.

Presentations by other occupational groups and Wisconsin Manufacturers and Commerce President James Haney further emphasized the divergence between future supply and demand, the need to help new entrants in the workforce learn positive work skills, and the complexity of helping students make wise career selections.

The next meeting of the group will focus on the educational resources that are available at all levels in Wisconsin.

• When WHA launched the PricePoint Web site almost four years ago, we challenged Wisconsin health plans to embrace similar transparency initiatives in order to provide their customers with specific information necessary to make purchasing decisions. One health plan has finally answered that challenge—Anthem Blue Cross Blue Shield of Wisconsin. The plan recently unveiled a password-protected Web site that will allow customers to access net price information related to hospital, physician and clinic services. The site reportedly also provides potential pricing estimates related to entire episodes of care, at least for relatively common conditions. That information is much desired by patients who understand that their hospital bill doesn’t include separately billed physician services that are part of the overall treatment package.

Although Anthem should be applauded for this breakthrough, some might ask "What’s taken you so long?" WHA has consistently pointed out the limitations of PricePoint’s focus on retail charges as it relates to making real decisions based on actual costs. We have suggested that health plans marketing high deductible policies must provide "real price" and out-of-pocket cost information to their beneficiaries. It’s good to see that at least one plan has undertaken the heavy lifting necessary to help consumers shop for elective health care. Others need to follow this lead.

• The WHA Board and staff worked to set the stage for a pro-active Association role supporting health reform initiatives during last week’s Board Planning Session in Kohler, Wisconsin. Recent planning sessions have paved the way for a variety of important WHA programs including PricePoint, CheckPoint, ServePoint, various physician workforce initiatives and the Association’s current strategic plan. Last week’s efforts are an important starting point for defining and advancing the Association’s reform agenda.

Here’s a link to WHA’s board-approved health reform principles (www.wha.org/financeAndData/pdf/accessprinciples.pdf). Members will soon receive the GAP analysis that was the focus of Board deliberations. That analysis identifies current "gaps" that must be addressed in order to advance WHA principles while improving access, coverage and affordability—the primary desired outcomes—as we move forward.

• The WHA Annual Meeting is just two months away. Details and registration materials are included in this week’s Valued Voice. Programming will be heavily focused on health reform ideas and initiatives that will be "front and center" in 2009. Per usual, the meeting will also include several awards presentations, plenty of networking opportunities, and the Annual Business Meeting (September 18). Please plan on joining us in Green Bay for this important WHA program.

Steve Brenton,
President

In a back and forth tussle between Congress and the Bush Administration on Medicare funding, Congress ultimately prevailed. On July 15, Congress voted to override President Bush’s veto of H.R. 6331, the Medicare Improvements for Patients and Providers Act of 2008. President Bush vetoed this legislation earlier in the day, citing objections to provisions that would cut payments to Medicare Advantage plans, among other reasons. The U.S. House and Senate immediately voted to override the veto. The vote in the U.S. House was 383-41 and 70-26 in the U.S. Senate. All Wisconsin Members of Congress, except Rep. Sensenbrenner, voted to override the President’s veto.

The good news is the bill retroactively prevents a scheduled 10.6 percent cut to physician payments that went into effect July 1. The bill also provides a 1.1 percent increase for physicians in 2009 among other provisions.

The Wisconsin Hospital Association thanks our members of Congress who stopped the physician payment cuts by voting to override the President’s veto.

Hospitals Rally Against IME Cuts

Twenty-four of Wisconsin’s teaching hospitals will be negatively impacted under a proposed provision in the Inpatient Prospective Payment System rule. The provision phases-out indirect medical education (IME) capital payment adjustments. The phase-out impacts a cross-section of Wisconsin hospitals—from rural to urban hospitals—and results in a five year loss of almost $26 million.

In an effort to show the Centers for Medicare & Medicaid Services (CMS) the extent of opposition to these cuts, hospitals across the country are asking their Members of Congress to sign onto "dear colleague" letters that will be sent to CMS Acting Administrator Kerry Weems. WHA has asked each of Wisconsin’s members of Congress to sign onto these letters. Not only does WHA oppose the specific provision but believes it is yet another example of the continual payment/funding erosion our hospitals face.

Please make sure you thank your legislators if they voted to override the President’s Medicare veto or signed onto the IME dear colleague letters.

U.S. Senators
The Honorable (full name)
United States Senate
Washington, DC 20510
Dear Senator (last name):

U.S. House
The Honorable (full name)
United States House
Washington, DC 20515
Dear Representative (last name):

In the Medicare Modernization Act of 2003, Congress established the Medicare Recovery Audit Contractor (RAC) program as a demonstration in California, Florida and New York. RACs were to identify improper Medicare payments—both overpayments and underpayments. While the three demonstration states each encountered problems with their RAC, a complete evaluation of the program has just recently been completed by the Centers for Medicare & Medicaid Services (CMS).

In that report, CMS indicates that under the three-year demonstration, RACs found $1.03 billion in Medicare improper payments. Approximately 96 percent ($992.7 million) of the improper payments were overpayments collected from providers, while the remaining 4 percent ($37.8 million) were underpayments repaid to providers. The costs of the program include $187.2 million in RAC contingency fee payments, $8.7 million for claims processing contractors and $5.4 million for other expenses. CMS puts the total costs at 20 cents on every dollar collected. After subtracting out refunded payments and RAC operating costs/contingency fees, CMS states that the RACs returned a total of $694.6 million to the Medicare Trust Funds.

Of the roughly $1 billion collected by RACs, 85 percent of overpayments were collected from inpatient hospital providers, 6 percent from inpatient rehabilitation facilities and 4 percent from outpatient hospital providers. Of the overpayments collected, nearly 40 percent were based on a RAC determination that care provided was not medically necessary or provided in the correct setting, while 35 percent were denied for incorrect coding and 8 percent for no/insufficient documentation.

CMS reports that 4.6 percent of all RAC denials were overturned through the appeals process. Of the 14 percent of RAC denials appealed so far, approximately one-third were overturned in favor of the provider. However, many denials are still in the appeals process, and final figures will not be available for some time. CMS will issue report updates through summer 2008 on appeals that are still in process.

Wisconsin is expected to see the RAC as early as January 2009. In order to assist our hospitals, earlier this year the Wisconsin Hospital Association created a WHA RAC Task Force, which has already released a "white paper" on preparing for the RAC audits. The white paper summarizes the experiences from the RAC demonstration project, provides "best practices" for hospitals to use and outlines the areas/codes RACs have focused on to date. Access the white paper online at the WHA Toolkit or directly at www.wha.org/financeAndData/pdf/RACwhitepaper7-08.pdf.

WHA will also offer a one-day program August 6 on minimizing compliance and financial risk while preparing for the RAC. Details are in the following article or log onto www.wha.org to register.

Based on the recommendation of the WHA RAC Task Force, WHA and the Wisconsin Chapter of HFMA are offering a one-day program entitled "Minimize Compliance and Financial Risk While Preparing for the RAC" on August 6 in Wisconsin Dells.

Following the mantra ‘the best defense is a good offense,’ this program will help you learn to unite your Utilization Review committee, medical staff and financial departments to establish a proactive program to achieve audit preparedness and compliance success, which is especially important in light of the Recovery Audit Contractors, or RAC, audits that will be coming to Wisconsin in 2009. The one-day program will be presented by national experts Robert Corrato, MD, president and CEO of Executive Health Resources (EHR) and John Bartell of Bay Area Healthcare Consulting.

The U.S. Department of Health and Human Services (HHS) has entered into an agreement with a Seattle-based health care provider to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). In the agreement, the health care provider agreed to pay $100,000 and implement a detailed corrective action plan to safeguard electronic patient information from theft or loss.

HHS said that the provider, which provides home and hospice care services, left backup tapes, optical disks, and laptops, all containing unencrypted protected health information, unattended. The tapes, disks, and laptops were lost or stolen, compromising the protected health information of over 386,000 patients.

According to HHS, their Office of Civil Rights and Centers for Medicare and Medicaid Services have resolved over 6,700 HIPAA cases by requiring providers to make systemic changes to their privacy and security practices. In this case, in addition to the $100,000 payment, the provider must revise its policies and procedures regarding physical and technical safeguards governing off-site transport and storage of electronic media containing patient information; train workforce members on the safeguards; conduct audits and site visits of facilities; and submit compliance reports to HHS for three years.

Kerry Weems, the acting administrator of CMS, commented, "This resolution confirms that effective compliance means more than just having written policies and procedures. To protect the privacy and security of patient information, covered entities need to continuously monitor the details of their execution, and ensure that these efforts include effective privacy and security staffing, employee training and physical and technical features."

Former State Rep. Curt Gielow (R-Mequon) has been named as the executive dean and assistant professor of pharmacy practice for Concordia University’s planned School of Pharmacy, which is scheduled to begin classes in the 2010-2011 academic year.

Gielow, 63, who began his career as a pharmacist, will be in charge of the Pharmacy School’s external relations and funding development, according to a statement from the university. He will take his new job effective August 1.

Gielow said it is his hope that the new school will produce many graduates who "will return to their urban or rural roots where pharmacists are often at a real shortage."

Gielow holds a Master’s degree in health care administration from the Washington University School of Medicine in St. Louis and has a bachelor’s degree in pharmacy from St. Louis College of Pharmacy. He was a two-term state representative from 2003-2007.

Concordia also announced that Dean Arneson will be the pharmacy school’s academic dean and associate professor of pharmacy administration. Arneson was an assistant professor and associate dean for academic affairs for the College of Pharmacy: Clinical and Administrative Sciences at the University of Oklahoma-Tulsa. He holds doctorate degrees from the University of Nebraska.

"We are very happy to have found two extremely knowledgeable and talented individuals to lead our university in accomplishing our goal of creating a School of Pharmacy for the 2010-2011 academic year," said the Rev. Patrick T. Ferry, Concordia president.

Wisconsin Governor Jim Doyle visited Sacred Heart Hospital in Eau Claire to announce statewide "Buy Local, Buy Wisconsin" (BLBW) grant awards. Gov. Doyle chose Eau Claire as the city to announce the grants due to the innovative partnership between Sacred Heart Hospital and River Country RC&D Council.

The $41,660 BLBW grant awarded by the Governor to River Country RC&D Council will help launch a Chippewa Valley Buy Local Consortium to bring together farms and institutions who wish to sell and purchase food locally. River County has a decade of experience in helping farmers sell directly to customers.

Sacred Heart Hospital, a founding partner in the project, pledged 10 percent of its $2 million annual food budget to purchasing local food and committed in kind support of $15,000 in matching funds in the form of staff, supplies and support.

"We wish to provide patients and employees fresh food products with greater nutrition, a longer shelf life and reduce fuel/transport costs," said Steve Ronstrom, CEO of Sacred Heart Hospital. "Following our historic Franciscan Mission to benefit and support our community, we wish to further invest in the local economy to provide additional community jobs and encourage sustainable agriculture."

"The hospital’s commitment to purchasing local products provides a ready-made market that reduces the need for farmers to advertise and reduces the risk to farmers in expanding their production," said Rich Purdy, PhD, president, River Country.

Since February 1, 2008, all kids in Wisconsin have been able to get the health care they need at a price their families can afford through BadgerCare Plus. BadgerCare Plus allows every Wisconsin family, regardless of income, to have access to affordable, comprehensive health care coverage for their kids. In addition, BadgerCare Plus also offers coverage for additional pregnant women, self-employed parents, farm families, and youth aging out of foster care.

The Department of Health Services is offering training and information sessions to hospital staff members and others in the community that are interested in helping families apply for BadgerCare Plus. To arrange a training session, contact Outreach and Training Specialist Joanna Gurstelle at 608-261-7830 or Joanna.Gurstelle@wisconsin.gov. For more information about BadgerCare Plus, call 1-800-362-3002.

The Wisconsin Chapter of ACHE has organized its first ever six credit Category I seminar to take place on August 15 at The Glacier Canyon Lodge at The Wilderness Resort in Wisconsin Dells, entitled "Physician Relations—Achieving Physician/Hospital Partnerships: The Clinical Institute Model."

Program participants will learn to assess a range of physician/hospital partnership options, understand the strategic and tactical components necessary to create a clinical institute, discuss how clinical institutes can improve the quality of care, and describe the positive financial rewards for both physicians and hospitals in clinical institutes.

The quality of patient care delivered in Wisconsin continues to be nationally recognized. Currently, the federal Agency for Healthcare Research and Quality (AHRQ) ranks Wisconsin second in the nation in health care quality. Wisconsin nurses throughout the state play a vital role in achieving these outstanding outcomes.

In conjunction with WHA, Aspirus Wausau Hospital and Aurora Health Care Metro and Kettle Moraine Regions have collaborated in the development of a forum focusing on nursing-driven quality outcomes and related leadership topics. As Magnet-recognized organizations, they share a commitment to provide education opportunities like this for Wisconsin’s nursing community.

The September 9 conference, entitled "Over the River and Through the Woods: Excellence in Wisconsin Nursing" will focus on expanding nurses’ knowledge of the latest evidence-based care guidelines in key clinical categories; discuss critical leadership challenges facing nurse managers in the areas of retention, employee engagement and career planning; and identify how the American Nurses Association Magnet Recognition Program promotes the continuous growth of professional nursing practice and an optimal work environment.

The Health Resources and Services Administration announced this week that it will not move to finalize a proposed rule changing how it designates medically underserved populations and health professional shortage areas. In the notice, HRSA said it received many substantive comments on the proposed rule and will need to make a number of changes. The agency plans to issue a new proposed rule for review and public comment. In its recent comment letter, WHA, like many other organizations, urged HRSA to withdraw the proposed rule for further field testing, analysis and stakeholder input, noting that the proposed changes would have a significant impact on the providers, programs, and communities that depend on these designations for federal funding.

Out of 5,453 hospitals, only 170 made it into the U.S. News & World Report rankings in at least one of the 16 specialties. Below are the Wisconsin hospitals that made the list, by category, and in alphabetical order.

Cancer
University of Wisconsin Hospitals and Clinics, Madison

Ear, Nose & Throat
Ministry Health Care-Saint Joseph’s Hospital, Marshfield
University of Wisconsin Hospitals and Clinics, Madison

Endocrinology
Aurora St. Luke’s Medical Center, Milwaukee
Froedtert Hospital, Milwaukee

Gastrointestinal Disorders
Aurora St. Luke’s Medical Center, Milwaukee

Geriatric Care
Aurora St. Luke’s Medical Center, Milwaukee
Ministry Health Care-Saint Joseph’s Hospital, Marshfield

Kidney Disease
University of Wisconsin Hospitals and Clinics, Madison

Respiratory Disorders
Aurora St. Luke’s Medical Center, Milwaukee
Froedtert Hospital, Milwaukee

Urology
University of Wisconsin Hospitals and Clinics, Madison

Seven Wisconsin health systems have been named to the nation’s list of "Most Wired Hospitals," according to the results of the 2008 Most Wired Survey and Benchmarking Study published in the July issue of Hospitals & Health Networks magazine. The Wisconsin hospitals/health systems that made the list are below:

Hospital/Health System                                     # years on the list

ThedaCare, Appleton                                                  7
Aurora Health Care, Milwaukee                                   5
Ministry Health Care-Saint Clare’s Hospital, Weston     3
Spooner Health System, Spooner                               1

Most Wired - Small and Rural
Ministry Health Care-Saint Joseph’s Hospital, Marshfield
Watertown Memorial Hospital, Watertown

Most Improved
Door County Memorial Hospital, Sturgeon Bay

The 100 Most Wired hospitals show better outcomes in patient satisfaction, risk-adjusted mortality rates and other key quality measures through the use of information technology (IT), according to a new analysis. The Most Wired Survey is conducted annually by Hospitals & Health Networks magazine, the journal of the American Hospital Association, which uses the results to name the 100 Most Wired hospitals and health systems. It focuses on how the nation’s hospitals use information technologies for quality, customer service, public health and safety, businesses processes and workforce issues.

Ministry Health Care is partnering with Marshfield Clinic to create what will be the state’s largest patient database. Ministry Health Care selected Marshfield Clinic-CattailsMD™ to provide electronic health record support for Ministry Medical Group (MMG) and all of Ministry Health Care. By choosing CattailsMD™, MMG will automate its medical records and combine them with Marshfield Clinic, creating the largest patient database in the state. More than 1,000 providers at MMG, Ministry hospitals and Marshfield Clinic locations will share access to 2.5 million patient records in central and northern Wisconsin.

Having a baby is a memorable and joyous occasion. For the first-time mom and dad, though, it can be filled with anxiety as they "learn the ropes" of being new parents.

Wendy and Randy Clark were no exception when their son was born. But the Waupun couple has been especially thankful to learn they could lean on Waupun Memorial Hospital for support and guidance before, during and after their pregnancy.

The Clarks started planning for the big day with childbirth classes while Wendy was pregnant. Then, when her natural childbirth plans turned into a cesarean section, she found strength in the hospital’s physicians and staff, never losing faith. "Everyone was so supportive and encouraging. I believed in them completely and knew we all wanted the same outcome—a safe delivery," she says.

After their healthy baby boy was born, Wendy talked regularly with the lactation consultant to learn more about breastfeeding, joined a breastfeeding support group, and took the infant car seat class for instruction on properly securing her baby in a car seat.

"We are so impressed that Waupun Memorial Hospital realizes the importance of having these types of programs and offers them at no charge! It means they understand that childbirth and parenting are not as simple as just having a baby and sending you home. They really care about the community … it has been a blessing in our lives to have them so close to home."

Life took a downward turn for Joan Goff in 2003. While at a job she loved, a severe back injury occurred. She could no longer work. With no health insurance, no financial support, and her health declining, Joan fell into a depression. Shortly after that her 36-year-old son, Marc, died in a car crash. "I was devastated," says Joan. "If it wasn’t for Sauk Prairie Hospital and the Good Neighbor Clinic, I couldn’t have pulled through."

The Good Neighbor Clinic (GNC) in Prairie du Sac donates medical services to individuals who qualify, but GNC can’t do it alone. With that in mind, Sauk Prairie Memorial Hospital & Clinics (SPMHC) donates basic x-ray and laboratory services to all GNC patients in the hospital’s service area.

After a GNC appointment, Joan goes to SPMHC for basic x-ray or lab services, if needed. The clinic calls to confirm the referral, and she’s seen quite quickly. There is no application to complete. It couldn’t be easier.

In 2007, Sauk Prairie donated over $51,000 of basic x-ray and lab services to GNC patients. Office supplies are also donated to the clinic.