Make your plans now to attend WHA’s 2006 Annual Convention September 27-29 at the Grand Geneva Resort in Lake Geneva.

This year’s convention kicks off with a fascinating and entertaining exploration of the "end of health care as we know it" by Joe Flower. Flower will offer an amazing examination of some of the newest technologies affecting health care, from genomics, bioinformatics, and nanotechnology to the latest in robotics and imaging, and will discuss what they mean for the future of health care. A variety of important and timely breakout sessions will be offered, as well as the distribution and discussion of the results of Wisconsin’s first voluntary community benefits reporting initiative.

Be sure to stay for Friday’s closing session by Dr. Lowell Catlett, a fascinating speaker who is sure to be the highlight of this year’s event. Catlett, a professor of economics, agriculture, and genetic engineering for New Mexico State University, will discuss how affluence is segmenting the health care market, how the three major drivers in health care can affect strategic planning, and the innovative research that is leading to the development of new tools and opportunities for the overall improvement of our health.

Hospital administrators, chief financial officers, management staff, nurse leaders, physicians, and trustees are encouraged to attend this convention. Applications for long-term care administration continuing education credits and continuing nursing education contact hours have been submitted. Additionally, the Wisconsin Medical Society designates this education activity for a maximum of 5.8 category 1 credits toward the AMA Physician’s Recognition Award.

Department of Health and Human Services (DHHS) Secretary Michael Leavitt spoke in Madison on

July 21. Hosted by the Wisconsin Manufacturers and Commerce, Leavitt identified one of his purposes for visiting Wisconsin was to learn more about the innovative work that Wisconsin health care organizations are doing to bring quality, cost, and safety information to consumers.

Leavitt said that he does not believe that Congress has the political will to redefine health care. Instead, he suggests that successful change will be led by the private sector impacting the market through collaborative efforts among payers, providers and patients. According to Leavitt, the federal government’s role should be to enable change through Congressional action and regulation, and to leverage the buying power of CMS, the largest health care purchaser in the world with 125 million covered lives. He suggested that three key changes need to occur:

1. As a condition of doing business, organizations should require the adaptation of the electronic medical record standards that will be available in the fall of 2006. This will be a requirement of the federal government.
   
2. The right definition of quality, with its corresponding measures, needs to be defined in a way that encompasses value. CMS currently provides quality and cost information on several components of the health care industry, and continues to pilot other options.
   
3. Financial incentives are needed for providers and consumers because people need a reason to care. CMS is now basing a percentage of provider reimbursement on performance and quality of care, not just quantity of care.

Leavitt stated that historically, health care has been viewed from the perspective of the individual needing care. Although this is still an important focus, today there is also an economic component as the rising cost of health care is affecting U.S. businesses’ ability to compete in the global marketplace. Rising health care costs are beginning to erode funding for medical research and force state government to spend less on other public goods like education. According to Leavitt, "The vast majority of Americans don’t know what they pay for health care or what they are getting," because we live in a culture that has trained us not to ask. "We need to change that culture by defining what health care quality means, and then identify the forces for change that will create a focus on quality," he said.

Leavitt suggested that consumers need to have access to a broader array of cost and quality information, similar to the information available in Wisconsin. "Until people know the cost and quality (of their health care), they can’t use consumer incentives," he concluded.

Leavitt’s visit also featured a meeting with leaders of the Wisconsin Collaborative for Healthcare Quality (WCHQ), and WHA Board Chair Mary Starmann-Harrison and WHA President Steve Brenton.

"Secretary Leavitt clearly views Wisconsin as a national leader in ongoing private sector transparency initiatives," Brenton said following his meeting with Leavitt. "He made it clear that HHS is looking forward to closely working with current Wisconsin projects as a way to advance the quality, safety and cost agenda."

Melissa Markey, an attorney with Hall Render and a consultant to WHA, has raised an important issue regarding emergency departments and the "boarding" or "parking" of patients brought to the hospital by EMS providers. This issue has surfaced nationally and is not specific to any violations reported regarding Wisconsin hospitals.

ISSUE: As over-crowded emergency departments struggle to cope with the increase in patients and the increased occurrence of "boarding," some emergency departments have been refusing to permit EMS personnel to off-load patients from ambulance stretchers to hospital beds in an attempt to delay assuming patient care responsibilities. This is commonly referred to as "parking" emergency patients, and delays of over an hour have been reported nationally.

CMS RESPONSE: CMS and the State Operations/Survey and Certification Group recently issued guidance to State Survey Agency Directors noting that the "parking" of emergency patients may violate EMTALA and/or the Conditions of Participation for Hospitals and Emergency Services, as well as cause quality problems. Noting that the obligation of a hospital to provide a screening examination and stabilizing treatment attaches when an individual presents and requests care (or has a request made on his or her behalf), CMS states that "(a) patients who arrive via EMS meet this requirement when EMS personnel request treatment from hospital staff…"

CMS also stated that EMTALA may be violated if a patient "appropriately transferred" from another hospital arrives and care is delayed, on the basis that "…the expectation is that the receiving facility has the capacity to accept the patient at the time the transfer is effectuated…" Although CMS acknowledges the "enormous strain and crowding many hospital emergency departments face…" use of parking is not permitted, as CMS notes that "parking patients in hospitals and refusing to release EMS equipment or personnel jeopardizes patient health and impacts the ability of the EMS personnel to provide emergency services to the rest of the community."

WHA’s online Toolkit has been updated with a new white paper describing the dental access crisis and its impact on Wisconsin’s hospitals. Dental decay is the most common chronic disease in children, yet 70 percent of Medicaid-eligible children cannot find a dentist who is willing to take them as a new patient, a representative of Wisconsin’s Department of Health and Family Services has said. That means many of the individuals who cannot find a dentist for their dental health care needs utilize the emergency room setting, and hospital emergency departments become the providers of last resort when dental pain becomes overwhelming for the patient. Unfortunately, this treatment in emergency rooms comes at a much higher cost than preventative dental treatment, and typically only after dental health needs have progressed significantly.

WHA has been active on this issue and successfully worked with the Legislature in 2006 to support an administrative rule change to allow dental hygienists to be certified as Medical Assistance providers and to be reimbursed for services they already provide. WHA will continue to advocate for approaches that address this issue at the front end.

• Health and Human Services (HHS) Secretary Michael Leavitt in Madison last week said that lowering health care costs will be "almost impossible" to accomplish via legislation alone. Instead, Leavitt maintained that moderating health care costs can best be accomplished through proactive, collaborative efforts involving payers, providers and patients. Leavitt said that he will support these three global initiatives to foster health care cost efficiency: promoting the rapid implementation of universally compatible health information technology; advocating that health care be purchased based on value; and providing consumers with a financial stake to care about their purchasing decisions instead of buying into the notion that "it doesn’t really matter because your insurance covers it."
  
  Finally, it was obvious that Leavitt’s focus on Wisconsin, in large part, is driven by this state’s embrace of private sector initiatives that align with his message. That means that we have a real opportunity to continue making an impact on the national scene.

• Two members of Wisconsin’s Congressional Delegation promptly responded to WHA’s call for "help" this week on a late-arriving and very troubling initiative. Representatives Paul Ryan (R-Janesville) and Mark Green (R-Green Bay) actively engaged House leadership urging for the removal of a provision inserted at the last minute in H.R. 4157, the Health Information Technology (HIT) bill that would have required hospitals to report to HHS the "range of prices actually received from private payers and insurers for specific services." In other words…the mandatory disclosure of negotiated payment rates. 
  
  This provision, apparently added at the last minute by House Ways and Means Committee Chair Bill Thomas, would have been hugely problematic for a number of reasons, not the least of which was the fact that hospitals not complying with the new mandate would lose their 2007 Medicare inflation payment increase! Also, the provision had neither been debated nor approved by any Congressional committee and would have applied only to hospitals, not insurers or other providers of health care services.
  
  Kudos to Representatives Ryan and Green for their help in removing this puzzling amendment from an important piece of legislation. WHA’s call to action noted that the marketplace—as opposed to government regulation—should facilitate transparency necessary to assist consumer decisions.
  
• Much of the discussion at last week’s WHA Board Planning Session focused on WHA’s current strategic plan and new areas of special emphasis as identified in the recent member survey. Probably the most significant area of interest and discussion targeted the need to beef up program activities designed to relate to and engage physicians in WHA program priorities. Session participants agreed that the evolving health care delivery model and the increasing demand for physician services requires closer alignment of physician and hospital agendas. The rewrite of WHA’s strategic plan will specifically address this member need.
  

Steve Brenton
President

To bring decision-makers to the people, state government traveled to Crawford and Grant Counties on July 25. Included in the series of meetings and events were visits by several Department Secretaries to area hospitals.

At Southwest Health Center in Platteville, CEO Anne Klawiter welcomed Department of Regulation & Licensing (DORL) Secretary Celia Jackson to a listening session with close to 25 hospital staff. Klawiter provided a brief overview for the Secretary on the new facility, which was completed in 2005. With the new building, Southwest Health Center nearly tripled its available space. It is now working in collaboration with others in the community to turn the previous hospital building into an Alzheimer’s unit. Secretary Jackson responded, "You have to be proud of what has been accomplished here."

During the remainder of their time together, Sec. Jackson discussed the role DORL plays in licensing and regulating over 50 professions, including health care professions, and invited attendees to ask questions of the Department. Questions ranged from how liability for hospitals will be addressed under the new midwifery regulations, to the length of time it takes to license out-of-state doctors or others relocating to Wisconsin, to the difficulty many have in reaching an individual at the Department.

In responding, Secretary Jackson indicated she has heard concerns about reaching DORL staff and said she tries to do the most she can with the 112 staff she has. She also indicated DORL follows the regulations set up for the various professions by their respective oversight Boards, and if there are areas of concern, she invited attendees to bring those before the Boards.

Southwest Health wasn’t the only hospital to host a cabinet secretary on July 25. Prairie du Chien Memorial Hospital hosted Department of Health & Family Services Secretary Helene Nelson during a lunchtime meeting. She was asked about priority issues for hospitals, such as Medicaid reimbursements, nursing home funding and rehabilitation services.

Upwards of 70 people attended an informative Attorney General candidate forum held at Aurora Health Care on Thursday, July 27. All four candidates for AG participated: Paul Bucher (Republican), Waukesha County District Attorney; Kathleen Falk (Democrat), Dane County Executive; Peg Lautenschlager (Democrat), Wisconsin Attorney General; and J.B. Van Hollen (Republican), U.S. Attorney for the Western District.

Each candidate was allotted two minutes for opening remarks. Candidate forum moderator Michelle Mettner then posed three questions of each. The three questions were: 1) What is the proper role for the AG in addressing ethics scandals in Wisconsin? 2) What is the role of legal action in the charity care debate? and 3) Is UW-Madison professor Kevin Barrett’s theory protected under the first amendment?

The candidate forum also allowed for candidates to take several questions from audience members. Each candidate was asked for their position on medical liability caps, the role the AG can play in addressing crime in the inner city of Milwaukee and concealed carry.

The Wisconsin Chapter of ACHE is presenting a workshop entitled "Walking the Public Reporting Systems Minefield" on September 29, following the adjournment of WHA’s Annual Convention.

The health care marketplace is inundated with quality and customer service rating systems jockeying for market recognition, while health care executives are confounded by how this information is gathered and its accuracy. Attendees will learn how successful organizations are navigating the public reporting systems, how payers and employers are utilizing this information today and in the future, and future trends with rating systems.

This program has been developed and is presented locally by the Wisconsin Chapter of ACHE. The American College of Healthcare Executives has awarded one (1) Category I (ACHE education) credit hour to this program.

The presenting panel will include Chris Queram, president/CEO of the Wisconsin Collaborative for Healthcare Quality, who will act as moderator; Larry Rambo, CEO of Wisconsin and Michigan markets for Humana, Inc.; Dana Richardson, vice president of quality initiatives for the Wisconsin Hospital Association; and Ford Titus, president/CEO of ProHealth Care, Inc.

The conference will be held at the conclusion of the WHA Annual Convention, on Friday, September 29, 2006, from 11 am to 12:15 pm at the Grand Geneva Resort in Lake Geneva. There is no cost to register for this event, but pre-registration is requested. A brochure with registration form is included in this week’s packet and on the Web site at www.wha.org. Easy, online registration is available as well.

George had been a caregiver his entire life. His two brothers agreed to support him as he filled the role of parental caregiver, first for his ailing mother and later for his father until his death. For the past 91 years, George has lived in the family home in Milwaukee. Unfortunately, his two brothers died and now that George is in need of caregiving support, he has no family to return the care that he had spent his life giving.

But George has a neighbor, Bill, who was more than happy to begin to help George meet his needs. As several years of Bill’s care have passed and George’s medical conditioned eventually worsened, Bill looked for help from a caring physician. He turned to Columbia’s Housecalls for the Homebound program for help. Since George had become increasingly frail, he had difficulty getting to any physician’s office. Housecalls for the Homebound agreed to come to George’s home to provide primary care. Nancy Leahy, the Housecalls nurse practitioner, visited George at home to help with a medication adjustment problem. While she was there she also discussed initiating a Power of Attorney for Health Care tool and scheduled a home visit by the physician. With Nancy’s intervention and Bill’s ongoing help, George was able to receive medical care to allow him to stay comfortably in his home, just as George had earlier supported both his mother and father.

José was waiting at the door when Midge Pfeffer, Madre Angela Dental Clinic’s (MADC) manager, arrived to unlock the clinic one morning. It had been a sleepless night for José. Driven by the pain of a badly infected tooth, he had gone to a hospital emergency room (ER), only to learn that the ER staff could assess him and provide pain medication, but could not provide dental care. They gave him the pain medication and referred him to MADC. He had been waiting in MADC’s doorway since before dawn.

José’s tooth was seriously decayed and had to be extracted – understandable since José had not had dental care in more than ten years. He had known for a while that he had this dental problem. However, as a father of three children with a job that paid minimum wage and no dental insurance, he could not get care at most clinics. He had had a long and difficult night, but the arrival of Midge was a ray of sunshine. José was pleasantly surprised to be welcomed at MADC. He appreciated the kind and gentle care he received, and soon the painful tooth was gone. With the support of corporate donations, United Way, and local foundations, MADC was able to continue his care to avoid future nights waiting in doorways for necessary dental care.

Sacred Heart Hospital patient Jeanne Erlandson writes, "When I read your letter I got tears in my eyes and my heart felt such relief, thank you so much." Erlandson is referring to her acceptance into Sacred Heart’s Community Care, a program designed to provide financial assistance for medical services provided by the hospital to those in need.

People like Angela Roth, who had a total hip replacement in January of 2005, have benefited from Community Care. "After my stay at the hospital, my husband remained home to care for me, and I was unable to work for several months," said Roth. "The initial bill we received would have left us financially destitute. Thank you for your help and for caring."

Sacred Heart Hospital cares for all patients, regardless of their ability to pay. Community Care is a hospital-based program to provide full or partial financial assistance for Sacred Heart services to patients. Guidelines have been established to ensure that our limited resources are used to treat patients who are unable to contribute to the cost of hospital services.

Patients may be eligible for Community Care if they:

• Have no health insurance coverage
• Are not eligible for any private or government-sponsored coverage
• Have health insurance coverage, but are responsible for co-insurance, deductibles, or other non-covered medically necessary services
• Meet certain income and asset eligibility criteria

"Our Community Care assistance is an example of the hospital’s mission to serve the poor," Assistant Administrator Patty Huettl commented. "It is a reassuring reminder to our patients that the Franciscan tradition of compassionate care continues after their discharge."

Community Care has changed the lives of thousands of patients in western Wisconsin. "I would like to thank the hospital staff and everyone involved in Community Care," says Sacred Heart patient Debra Shong. "It restores my belief that the world still has good people that listen, care, understand and have compassion in their hearts."

Sacred Heart Hospital Safe Sitter 2005
TRAINING SAFE SITTERS

For many adolescents, it’s a rite of passage, landing their first babysitting job. It’s a fun way for young people learn how to be responsible and earn spending money. But how do parents know if the babysitter they’ve hired has been properly trained to care for their children? Is the babysitter equipped to handle an emergency situation? Sacred Heart Hospital is working to make sure western Wisconsin babysitters have the skills they need to be successful by offering a Safe Sitter course.

Safe Sitter is a medically accurate, instructional program designed for young adolescents 11 to 13 years old. The training program provides an opportunity for participants to become confident and capable sitters. The program includes:

• How to care for a choking infant or child
• Basic first aid
• Personal safety for the babysitter
• How to care for children (feeding, diapering, etc)
• Preventing problem behavior
• Behavior management
• Babysitting as a business

"Sacred Heart Hospital has offered the Safe Sitter course for several years and has trained hundreds of babysitters in western Wisconsin," said Marcia Arneson, director of Sacred Heart Hospital’s Center for Healthy Living. "As a parent, I feel it is important to equip these young people with the knowledge and skill to properly care for the children in our community."

12 year-old Brianna Halvorson completed the one-day course. "I learned what to do if a child started to choke and they taught us some important first aid skills," Halvorson said.

"I’m glad Brianna had the opportunity to complete the babysitting course," said Brianna’s mother Kim Halvorson. "She impressed me with all that she learned and I know she will take that knowledge and become a confident and capable babysitter."

Participants are awarded a certificate of achievement upon completion of the course.

Sacred Heart Hospital 6th Annual Coat Drive, October 29-30, 2004
KEEPING THE COMMUNITY WARM

Imagine what it would be like not to have a warm coat to wear during the cold winter months in western Wisconsin. Thanks to Sacred Heart Hospital’s Center for Healthy Living’s Annual Coat Drive, thousands of residents in our region are able to bundle up and brave the elements. Each year the hospital collects and hands out more than 3,000 winter coats.

The Annual Coat Drive was started in 2000 and has grown every year. Coats are collected for people of all ages, from infants to adults. Collections take place during the month of October; the coats are handed out at the end of the month. The event took place on Friday, October 29 and Saturday, October 28. People start lining the sidewalk outside of the Center for Healthy Living an hour before the doors open.

"There is a huge need for this service in Eau Claire, and we are so blessed to be able work with our employees and the community to help keep others warm," said Kelly Lauscher, coat drive coordinator.

Throughout the collection process, other items like hats, gloves and scarves are also donated. People in need are welcome to take those items in addition to a coat. Hospital employees work the event helping residents find the proper size.

"Some people come in needing coats for their entire family," said Lauscher. "We enjoy helping them find colors and styles that will not only fit and keep them warm, but will also make them feel good about themselves."

This year a new project was added to the Annual Coat Drive; linens were also collected. Hospital employees and others in the community were asked to donate new or gently used blankets and sheets. Some of those items were given to area residents during the coat giveaway.

The linen drive also supported the Hospital Sisters Health System "Mission in Motion" program. The sheets and blankets were sent to areas in the world that are most in need, including Haiti and Tanzania. Hospitals that are part of the Hospital Sisters Health System (HSHS) all sponsor several "Mission in Motion" drives each year. HSHS operates 13 hospitals located in Wisconsin and Illinois.

SynergyHealth St. Joseph’s Hospital announced that Michael J. Laird will join St. Joseph’s Hospital as president effective August 28, 2006. Laird will report to Gregory A. Banaszynski, chief executive officer of SynergyHealth.

Laird joins St. Joseph’s Hospital from Ste. Genevieve County Memorial Hospital, Ste. Genevieve, Missouri, where he served as chief executive officer since January 2000. Ste. Genevieve County Memorial Hospital is a 53-bed acute care hospital affiliated with the BJC Healthcare System. Previously, Laird served as chief executive officer of Pana Community Hospital, Pana, IL, and held senior management positions at St. Joseph’s Hospital in Breese, IL, and St. Nicholas Hospital in Sheboygan, WI. Laird holds a bachelor’s of science degree in social work from St. John’s University, Collegeville, MN, and a master’s degree in hospital and health administration from Xavier University, Cincinnati, OH. He is a fellow of the American College of Healthcare Executives (ACHE) and serves on the ACHE Council of Regents, St. Louis, MO. Laird is also a member of the American Hospital Association’s Regional Policy Board.

"We are very pleased to have Michael join our organization," said Banaszynski. "He brings more than 18 years of experience in hospital leadership to St. Joseph’s and will play a key role in the strategic direction of the hospital."

Baldwin Area Medical Center (BAMC), a critical access hospital and a provider-based rural health clinic, is currently conducting a search for a highly skilled health care executive to assume the position of Chief Executive Officer (CEO). The current CEO, Richard Range, is retiring after 17 years of leadership.

For information about the hospital, visit www.baldwin-hospital.com.

The CEO is responsible for the management, direction, and coordination of all medical center operations and related activities for the purpose of attaining the goals and objectives as set forth by the Board.

• The ability to develop and maintain effective relationships with the clinic physicians, including the ability to achieve win-win solutions during contract negotiations.
• The ability to recruit new physicians to BAMC to meet the needs of the community.
• Capable of strategically guiding facility planning and understanding of how technology can improve patient care, business operations and productivity.
• The ability to effectively strategize and manage the direct approach of the integrated health systems from the Minneapolis and St. Paul area who are interested in expanding their influence into western Wisconsin.
• The ability to personally "champion" the strategic planning process and encourage the Board and physicians to actively participate in the planning process.

• Bachelor’s degree in business administration, health care administration, or accounting, or equivalent is required. Master’s degree in health/ business administration is strongly preferred.
• Ten or more years of hospital/medical/ambulatory health care senior-level administration experience required. Hospital experience in western Wisconsin or surrounding area is highly desired.

The BAMC Board of Trustees has retained the firm of Langan and Flynn, LLC to assist in this search. Interested candidates should forward their resumes to the attention of: Walter Flynn, Principal, Langan and Flynn, LLC, wflynn@langanflynn.com; 651-287-2370.

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