July 30, 2004
Volume 48, Issue 29

• Wasserman Wants Audit of Bureau of Health Information (BHI)
• TABOR: Gratefully Dead
• President ‘s Column - Health Care Transparency
• Make Plans to Attend WHA's 2004 Annual Convention September 15-17 in Lake Geneva
• State Licensing Fees: Who Pays How Much (and Why?)
• Board of Nursing Approves Bryant & Stratton College Nursing Program

The week of July 19, State Representative Sheldon Wasserman (D-Milwaukee) made a formal request of the legislature’s Joint Audit Committee to authorize an audit of the Bureau of Health Information (BHI).

In a July 16 letter to Audit Committee co-chairs Sen. Carol Roessler (R-Oshkosh) and Rep. Sue Jeskewitz (R-Menomonee Falls), Wasserman stated: “As you will recall, six years ago the Legislature passed a bill to expand Wisconsin’s data collection efforts to include information on physician office visits … It is my understanding that the Physician Office Visit Data (POVD) program has employed as many as eight full-time people and has spent over $5 million since its inception. Yet to date, no data has been released. Before the Legislature entertains any new government-run health care data programs, there are many questions that must be answered about POVD.” Wasserman is the Legislature’s only physician and the ranking member of the Assembly Committees on Health and Public Health.

“Given our successful experience with privatizing the collection of hospital data and what we have learned in that process, we think it could be a very enlightening examination,” said WHA President Steve Brenton. “We fully support Rep. Wasserman’s request and hope the Joint Audit Committee will approve it.”

Wasserman’s request includes a list of eight detailed questions about BHI, including: how hospital and physician assessment money has been spent; what has been the cost to providers to implement the programs; how has BHI processed data requests; how has BHI complied with strict state privacy laws; what has been the budgeting oversight role of the Board on Health Information; how were/are prices determined for data that is sold and has any information been given away. (To view a copy of Rep. Wasserman’s letter and press release, visit the WHA web site at www.wha.org)

“POVD was enacted by the legislature six years ago in a very contentious battle that many current legislators were not here to witness,” said WHA’s Eric Borgerding. “Some would rather forget about it, but given its history and with so much legislative interest in, and hearings on, health care information ‘transparency,’ this audit should be embraced. These are valid questions we should learn from.”

“In my opinion the POVD program has clearly not lived up to expectations,” Wasserman said in his letter. “The questions posed should have been answered long ago, and must be answered before the Legislature entertains any new government-run health care data programs. I believe the POVD program should be discontinued and any unused program revenue funds put into the general fund. At the very least, it and BHI should be subjected to an independent audit,” Wasserman wrote.

“If this audit is not approved, we would also support efforts to hold informational hearings in the Legislature,” Borgerding said.

WHA joins other health care groups in supporting the audit request.

Top

TABOR: Gratefully Dead
Eric Borgerding, WHA Senior Vice President

The first half of this week was, without question, one of the strangest, most tumultuous 72 hours recorded under the marble big top (aka the State Capitol). In the center ring was, once again, the “Taxpayers’ Bill of Rights” (TABOR), a proposed constitutional amendment to limit state and local government spending. The main act was a last ditch attempt to ram TABOR through the Legislature before the curtain (finally) draws on the 2003-04 legislative session. As with any amendment to the state constitution, TABOR requires passage by two successive sessions of the Legislature, followed by voter approval in a statewide referendum.

If you are thinking “Didn’t TABOR already die?” — well, yes it did, when the Legislature failed to adopt the necessary joint resolution in May. But on Monday, July 26, Senate Majority Leader Mary Panzer (R-West Bend) surprised everyone by bringing TABOR back to life, agreeing to reconvene in extraordinary session and try again to give the measure its first of two required votes in the Legislature.

This week, newspapers (and now editorials) statewide have been filled with excerpts from the not so happy “Tale of TABOR.” To make a long story short, it became apparent on Tuesday (July 27), and crystal clear on Wednesday (July 28), that there were not enough votes in the Republican-controlled Senate to pass TABOR. Senator Panzer confirmed this at a Wednesday afternoon press conference, and pulled the plug. TABOR was dead … again.

Senators Mike Ellis (R-Neenah) and Ron Brown (R-Eau Claire) were the first in the majority party to say no to TABOR at this time. They were followed by Senators Dale Schultz (R-Richland Center) and Carol Roessler (R-Oshkosh). It is believed all 15 Senate Democrats would have opposed TABOR.

WHA’s opposition to TABOR this week is exactly the same as it was during round one -- Wisconsin has some of the worst Medicaid reimbursement rates in the country without TABOR, how low would they go with TABOR? Last week, we reported MA payments to hospitals have dipped to 59 percent of cost, which translates into a $264 million “hidden tax” on health insurance premiums.

“This is not a partisan issue; we have no qualms with the notion of limiting taxes and spending,” said WHA President Steve Brenton on May 7. “However, TABOR comes at a time when the state is already chronically underfunding its own health care programs, particularly Medicaid, and passing those costs on to employers and employees.”

WHA lobbyists spent three solid days in the Capitol this week communicating that message. But as is ALWAYS the case, what we say cannot be heard without the help of our members.

Our gratitude goes to those who responded to WHA’s urgent requests for grassroots action and picked up the phone on literally a moment’s notice to personalize and deliver WHA’s message and reasons for opposition. Your targeted efforts, focused almost entirely on the four “NO” voting GOP Senators, paid off … Thank you!

Bottom line: Despite all the hoopla, hand ringing, TV cameras in the Capitol, and fist pounding speeches, the votes were not there to pass TABOR. They were certainly not there in the Senate, and we will never know if it would have passed the Assembly. (To see a list of those in the Assembly who said they would have supported TABOR, visit the WHA web site at: www.wha.org)

Will TABOR be back? Those who support it, guarantee it. But even if the Legislature’s high priests successfully raise TABOR from the dead next session (which begins January, 2005), it cannot go to a necessary statewide referendum until April of 2007 – and in politics, a whole lot can change in 33 months.

President ‘s Column

According to Webster’s New World Dictionary, something that is “transparent” is…”easily understood; clear; open; frank”…

Health information “transparency” was the topic of substantial debate and discussion at last week’s WHA board planning session. As WHA Senior Vice President Eric Borgerding noted, “Today, health care reform in Wisconsin is all about transparency.” For WHA, helping shape the transparency discussion by more clearly defining just what transparency means to the various stakeholders is an important task. And hospital leadership in advancing private sector initiatives that address transparency must be a top priority.

A number of planning session participants noted that many Wisconsin health care leaders are at an early stage of understanding what transparency is and why policymakers, purchasers, payers and consumers are asking for it. For purposes of this discussion, transparency can be defined as the public disclosure of information about the performance of the health care system. And that performance should include disclosure of meaningful information about quality, safety, service and pricing.

The reason transparency is being demanded in today’s health care environment is that major purchasers claim they need the information to facilitate purchasing decisions…and…consumers increasingly will require information to “shop” for health care due to the emergence of consumer-driven health insurance benefits that will feature high deductibles and personal medical savings accounts.

Transparency (perhaps we could re-label it necessary consumer health information) is a hugely timely issue. Recent editorials and guest columns in the Wisconsin State Journal and Milwaukee Journal Sentinel and two State Capitol legislative hearings are contributing to transparency’s new status as a current health reform issue. But we also must recognize the fact that Wisconsin’s private sector embraced transparency well in advance of recent media attention. CheckPoint and the Wisconsin Collaborative for Healthcare Quality’s performance measures are a terrific example of “transparency” accountability as it relates to measuring and reporting quality, safety and service performance. And the fact that those initiatives are committed to expanding current measurement sets provides strong evidence that the private sector is engaged.

It’s now the “pricing” aspect of the transparency issue that requires our focus. And it’s essential that the private sector once again rise to the challenge of proactively addressing stakeholder needs, as well as shut down ill-considered regulatory “ideas” that may be in play soon (see the WEA Trust opinion piece on page 1 of this week’s NewsSeen).

[Next week’s Valued Voice will take a stab at identifying potential new private sector actions that align with stakeholder needs.]

If you haven’t already, mark your calendar for WHA’s Annual Convention, which will be held September 15-17 at the Grand Geneva Resort in Lake Geneva. Hospital administrators, management staff, nurse leaders, volunteer leaders, and trustees are encouraged to attend this year’s convention, which offers many opportunities for education and motivation.

Board of Nursing Approves Bryant & Stratton College Nursing Program
Board tells two others schools to proceed with planning process