Governor Jim Doyle this week announced a new group aimed at improving access and affordability of health insurance. The Healthy Wisconsin Council is charged with developing an action plan to reduce the number of uninsured Wisconsin residents in half by 2010 and reduce health insurance premiums by as much as 30 percent for businesses.

In his January 17 State of the State address, Governor Doyle proposed a new initiative called Healthy Wisconsin to help lower health care costs by offering catastrophic care insurance in Wisconsin to offset the high cost of health care for those individuals who suffer serious illness or injury. It is estimated that 50 percent of Wisconsin’s health care costs are incurred by five percent of the people. New York has a similar program that insures more than 100,000 workers and has reduced premiums by 50 to 70 percent for individuals and 15 to 30 percent for small businesses. The program is subsidized through New York’s tobacco tax.

Governor Doyle will appoint an 18-member Healthy Wisconsin Council to design the statewide action plan to reduce the number of uninsured people and make insurance premiums less expensive. In addition, the Council is to identify ways to strengthen the individual and small group insurance market and increase the number of businesses that offer comprehensive, affordable health insurance. The Council must submit its action plan to the Governor by December 1, 2006.

“WHA will be actively involved with the Council, helping to shape an initiative that can improve access and coverage for the individual and small group insurance market and find ways to not only preserve, but strengthen employer-based health care coverage,” said WHA President Steve Brenton. “This will also be an opportunity to involve our new WHA Task Force on Access and Coverage in helping to shape the direction of health care reform in Wisconsin.” The WHA Task Force on Access and Coverage will be chaired by Leo Brideau, president/CEO, Columbia St. Mary’s, Milwaukee.

The Healthy Wisconsin Council will be co-chaired by Michael Weiden, Partner at Quarles & Brady, LLP and Dr. David Kindig, Emeritus Professor of Population Health Sciences at the University of Wisconsin-Madison School of Medicine. The Council will include health care industry leaders, health insurance executives, small businesses, major employers, community leaders and government agencies.

Michael Weiden is an expert in health law. He is a member of the American Association of Hospital Attorneys and the National Health Lawyers Association.

Dr. Kindig spent two years as Senior Advisor to Donna Shalala when she was Secretary of the U.S. Department of Health and Human Services. He is the Senior Advisor to the Wisconsin Public Health and Health Policy Institute, and is a member in the Institute of Medicine and National Academy of Sciences.

A divided Wisconsin Supreme Court today overturned its two-year-old decision in Maurin v. Hall, which had held that all non-economic damages arising from a medical malpractice case in which the patient dies are subject to Wisconsin’s wrongful death cap. While a majority of the Court agreed to overturn Maurin, there was not a majority opinion as to how Wisconsin’s cap on non-economic damages in medical malpractice cases should apply when the patient dies as a result of the malpractice.

The deceased in this case was Helen Bartholomew who suffered a heart attack that led to additional injuries. As a result of those injuries, she remained in a nursing home for five years until her death. A jury awarded $850,000 in pre-death non-economic damages - $500,000 to the estate of Ms. Bartholomew for her pre-death pain and suffering and $350,000 to Robert Bartholomew for his loss of his wife’s society and companionship prior to her death. The jury also awarded $350,000 to Mr. Bartholomew for his non-economic damages for the post-death loss of his wife’s society and companionship.

Three justices, in an opinion written by Chief Justice Abrahamson, found that the statute provided two caps in medical malpractice actions, one for pre-death non-economic damages ($422,632 at the time of this case) and one for post-death non-economic damages (a wrongful death claim, which is capped at $350,000) and that those caps were to be stacked, meaning the plaintiffs would have access to both capped amounts. The Chief Justice’s opinion concluded that because the cap on non-economic damages was found unconstitutional in Ferdon, the plaintiffs in this case should receive all $1.2 million awarded by the jury.

In a concurring opinion, Justice Butler agreed with the result in the Abrahamson opinion, but found that the statute provides for a "cap within a cap" rather than two separate caps. In other words, the statute provides for a global cap on all non-economic damages (in this case $422,632) arising from the medical malpractice and within that cap, wrongful death damages are capped at $350,000. This is the position advocated by the defendants and WHA in Maurin.

Three justices, in an opinion written by Justice Roggensack and joined by Justices Prosser and Wilcox, concluded that Maurin was correctly decided, but that plaintiffs in medical malpractice actions are not prevented from selecting whichever cap on non-economic damages the plaintiffs prefer. In this case, the plaintiffs would have been able to choose to be under the non-economic damages cap of $422,632 or the wrongful death cap of $350,000, whichever would be the most beneficial to the plaintiffs.

The Bureau of Quality Assurance has proposed revised rules regulating testing of nurse aides, the Nurse Aide Registry, feeding assistants and medications aides. WHA has commented on the proposed changes and has requested that the nurse aide registry contain a notation if a complaint has been filed against a nursing assistant.

WHA’s comment to the department read: "WHA feels strongly that information on complaints and investigations against persons listed on the Nurse Aide Registry should be made more available to employers. As you know, employers check the registry for misconduct prior to hiring any nurse aide. Unfortunately, the fact that complaints have been made and that investigations have or have not been completed is not available to employers (the Registry affirmatively states that the person is eligible for hire even when BQA has received serious complaints against the individual). This has resulted in nurse aides with more than one complaint and serious misconduct being hired by Wisconsin hospitals. Protection of the public, specifically vulnerable patients, is the responsibility of BQA."

The Bureau is proposing that courses that prepare Nurse Aides be at least 125 hours in length (current requirement is 75 hours) include at least 40 hours of clinical experience (current requirement is 16 hours). WHA has commented that these changes will increase the cost of the program to both the educational facility and to the learner and could have the effect of reducing the number of courses available and the number of nurse aide candidates interested in and willing to take the course.

WHA has also commented on the elements of supervision of students, posting of student assignments, and the number of nurse aide programs that any clinical facility may host.

Judy Warmuth, WHA vice president of workforce development, is a member of a public advisory group that has been convened to review issues with the Nurse Aide Training and Testing process. Please contact her at 608-274-1820 or jwarmuth@wha.org if you have questions about the proposed rule, or concerns relating to the training and testing of nurse aides in Wisconsin.

Bob Metzig joined WHA Information Center this week as its new database administrator.

"We’re pleased to have Bob join our team," said WHAIC Vice President Joe Kachelski. "We are now collecting about eight million records a year, about three times our original volume. Bob’s knowledge and experience is exactly what we need to help us manage it all."

Metzig, of Lodi, most recently served as an independent consultant. He has extensive experience in database administration, including with Bone Care International of Madison.

The first chapter of WHA Information Center’s (WHAIC’s) history is about to reach a successful conclusion.

Department of Health and Family Services (DHFS) Secretary Helene Nelson has announced she will recommend that WHAIC retain its contract for collection and dissemination of Wisconsin hospital data.

The contract requires DHFS to review WHAIC’s performance after two years. The DHFS Secretary must either recommend to the Department of Administration (DOA) that WHAIC should retain the contract for another two years or, if performance is unsatisfactory, that DOA should solicit proposals from other organizations.

We fully expect DOA Secretary Stephen Bablitch to accept Secretary Nelson’s recommendation.

Better, Not Just Different

In changing the law to privatize hospital data collection, the Legislature and Governor Doyle challenged WHAIC to do more than merely maintain the status quo. We were asked to collect more data, process and release it more promptly, and do so with a tighter budget. In short, WHAIC was to be accountable.

Secretary Nelson’s announcement is evidence that we have delivered:

• WHAIC made substantial investments in Web-based technology to facilitate the efficient submission of data, replacing the state’s outdated bulletin-board system. Improvements at the beginning of the data collection cycle have allowed WHAIC to produce quarterly data sets an average of 65 days faster than BHI did during the last two years of its tenure.
  
• From the beginning, WHAIC recognized that hospitals are partners, not adversaries, in the effort to collect and report data. Surveys in 2004 and 2005 documented that WHAIC is perceived by data submitters as an organization that is committed to customer service and problem-solving. In each year, WHAIC received an average overall score of 4.4 on a 5-point scale, where 3 represented average performance and 5 represented excellent performance.
  
• WHAIC’s operational costs this year are about half of BHI’s costs three years ago. The law that privatized hospital data collection eliminated the $1.4 million assessment under which hospitals had to pay for the privilege of submitting hospital data to the state, and pay again if they wished to make use of the data.
  
• WHAIC is now collecting data relating to nearly all hospital outpatient services, a key part of our promise to make hospital data collection more relevant to today’s health care environment.
  
• WHAIC developed the ground-breaking PricePoint Web site, which makes up-to-date, service-specific pricing and utilization information accessible through the Internet. Hospital associations across the country see PricePoint as a model initiative for addressing pricing transparency issues.

WHAIC’s efforts, along with other WHA initiatives like CheckPoint and community benefits reporting, have established WHA as a leader in health care transparency. It has been an extremely rewarding experience working with hospitals from every corner of the state over the last two-plus years to achieve a common goal. Far from "the fox guarding the henhouse," as the critics feared, WHAIC’s privatization of hospital data collection is an outstanding example of an effective partnership delivering real results.

Sean Schultz, St. Vincent Hospital in Green Bay, submitted a story idea to the Green Bay Press- Gazette on a community benefit that St. Vincent’s supports called the San Damiano House. St. Vincent offers the three-bedroom house rent free for one year to families like the Escandells who are parents with three young children and recent immigrants who are in transition. St. Vincent owns and maintains the house located a block away from the hospital. Before the Escandell family, a family of seven occupied it rent-free for one year and then paid minimal rent - $200 per month – for six more months before they left to rent another home. Value of the rental is approximately $700 per month. Attached is a column that was generated from her submission, which ran on the front page on July 4.

Tony Walter Column: Pursuit of a better life brings family to Green Bay
The Green Bay Press Gazette, July 4, 2006

Independence? You want to talk about freedom today?

Take a look at it through the eyes and lives of Jose Antonio Escandell, his wife, Luceth Rincon, and their family. Then see if the phrase "certain unalienable rights, that among these are life, liberty and the pursuit of happiness," wasn’t intended for them as it was for those of us who will wave flags and attend parades on this holiday.

Escandell is a 47-year-old Cuban native, an ophthalmologist. His wife, Colombian-born, is a 37-year-old general-practice physician. They have three daughters — ages 2 through 10 — and are living at the St. Vincent Hospital-sponsored San Damiano House in Green Bay.

They have work permits, but no green cards, Social Security cards or necessary U.S. medical licenses yet. They have no jobs yet either. They have medical skills but not enough English proficiency.

And they are absolutely convinced that they are in paradise. "All the people smile at me," Jose said. "I feel free. More important, I feel safe."

Jose and Luceth met in Havana where she went on a scholarship to study medicine. They married, and she became pregnant. But the living conditions in Cuba under the communist regime were miserable, so they moved to Cali, Columbia, in 1995 to set up their practices, and raise their family.

It was a comfortable life, for a while. But this was a Columbia of guerrilla fighting, drug trafficking, a paramilitary movement and violent crime.

The family spent five hours of one day huddled under a mattress in their bathroom as bombs exploded nearby and the blood of victims ran past their house. Then there was the time that Jose was driving 8-year-old daughter Luceth Beatriz to school and they pulled up to a stop sign. Gunmen suddenly opened fire on the car next to them, killing a local politician and his bodyguard.

Another time, thieves leaped over the wall of their gated community in an attempt to steal two bicycles, and began shooting at security guards, the bullets racing past the heads of Luceth Beatriz and her younger sister, Sthephany.

But the final straw came when a stranger came to the door and asked Luceth Beatriz if her parents were physicians and how much money they made, a prelude to what Jose knew was a kidnapping.

"I said, ‘no more Columbia.’" he said.

It was another remarkable story that brought them to Green Bay. Luceth Rincon’s father, Balthazar, left Columbia when his daughter was six months old in hopes of finding work in the United States and bringing his family here. He landed in Sheboygan but was never able to relocate his family and lost touch.

So, in 2001, Luceth Rincon got on the Internet and found her father. This led to a reunion in 2002 in Wisconsin with Balthazar and his new family here, and, finally, the resettling of the entire family in Green Bay in early 2005.

But without all the proper paperwork, Jose and Luceth had to fend for themselves. They volunteered at Howe Elementary School, which brought them to the attention of Principal Ed Dorff. Dorff contacted St. Vincent Hospital officials, and the San Damiano House, formerly Altrusa House, was offered rent-free for a year.

In the meantime, Jose and Luceth are learning English at Northeast Wisconsin Technical College, and Luceth Beatriz is playing basketball and the violin.

Having pursued and found happiness, Jose and Luceth now pursue employment.

JoAnn is a 40-year-old mother of three who works a Mequon dairy farm with her husband. Farm life has been hard on her body, but like many women, JoAnn tends to put the health care needs of her family before her own – that is, until she attended a special health event in Wausau complete with screenings, education, and a little pampering.

"I have not seen my doctor on a regular basis since my youngest child was born nine years ago," JoAnn said. "I’ve been dealing with my health on a reactive basis, and the health screening sessions I attended gave me a wonderful chance to reconnect and take ownership of my health. Information and education are powerful tools."

Rural women came to Wausau from as far as Pulaski, Phillips and Whitewater to participate in the program, which was organized by Aspirus and the Wisconsin Rural Women’s Initiative. Aspirus Community Relations Consultant Nadine Grusnick helped marshal the resources of Aspirus, the Women’s Community, the Wisconsin Well Women’s Program, and Wausau businesses such as the State College of Beauty Culture and Health Touch Spa. JoAnn and the other participants had access to free depression screening, plus blood pressure, cholesterol, glucose and bone density screenings. Perhaps more important than the results of these screenings was the on site interpretation and advice provided by health care professionals.

"One of the unexpected benefits of the screenings was the person to talk to, right there, about the results," JoAnn said. "I asked her questions I don’t think I ever would have asked my own health care provider."

The experience has improved JoAnn’s health in two tangible ways:

• Her doctor had previously prescribed her a medication to help control high blood sugar. Through discussions at the event with a registered nurse, she gained additional exercise and diet tips.
• With some simple massage therapy, Joann gained relief from the low-back pain that had plagued her. "As a farm woman, I had lived in pain for the last 10 years. That weekend showed me that pain doesn’t have to be a constant, and that was freeing."

The innovative partnership between Aspirus and the Wisconsin Rural Women’s Initiative helped fill an important health need for JoAnn and other women. Because the event was so successful, the Wisconsin Rural Women’s Initiative is looking to replicate the partnership with other health care providers throughout Wisconsin.

Memorial Health Center through the years has been very active in diabetes education. In November 2005, MHC was awarded the Ernest Codman Award by the Joint Commission, which is a prestigious quality award demonstrating use of outcomes data to drive improvements in the treatment of diabetes. MHC also received another national award for diabetes management from the National Rural Health Association. Below is a short excerpt from the Ernest Codman Award application explaining the process improvement that MHC initiated:

The goal of our small, rural healthcare organization goal was to improve hemoglobin A1c outcomes among patients with type 2 diabetes and to improve frequency of testing hemoglobin A1c levels. We adopted the International Diabetes Center’s Staged Diabetes Management (SDM) Practice Guidelines to improve diabetes care practices among our providers. We also implemented an American Diabetes Association (ADA) Recognized Education Program including Medical Nutrition Therapy (MNT) by Registered Dietitians to improve diabetes self-care knowledge, skills and behaviors among our patients. After 5 years of adherence to SDM guidelines and algorithms, and offering patients comprehensive diabetes self-management education including dietitian services as well as implementing process improvements consistent with SDM including the creation and use of a diabetes flow sheet, the implementation of a diabetes registry, the formation of a diabetes care team, and the incorporation of visit planning and standing orders, our organization has achieved an average hemoglobin A1c level under 7.0 for our nearly 500 diabetic patients, and is the number one in our state for frequency of hemoglobin A1c testing.

Memorial Health Center also donated $6,797 to various community non-profit groups in 2005.

Harvard Business School Professor Michael E. Porter, Ph.D., co-author of the recently released book "Redefining Health Care: Creating Value-Based Competition on Results," will be in Milwaukee and Appleton on July 12. During these half-day seminars, he will challenge businesses to purchase health care only from providers that deliver the best outcomes at the lowest cost. According to Porter, "value-based competition" will stem the tide of double-digit increases in costs.

Porter will speak at two half-day seminars:

• 9 a.m. to noon in Appleton at the Fox Cities Performing Arts Center, 400 W. College Avenue
• 2-5 p.m. in Milwaukee at the Italian Community Center, 631 E. Chicago Street