The WHA Foundation approved $209,000 in grants to support statewide health care related priorities at its most recent meeting. The grants support key WHA initiatives of quality reporting, workforce development and access to health care services. "These grant awards align with the Foundation’s new strategic direction to promote the larger Association’s broad health reform principles of enabling consumerism, improving coverage and access for vulnerable populations and promoting accountability," said WHA President Steve Brenton.

The Foundation created a scholarship program that will be available to Wisconsin Technical Colleges to support scholarships for students in their last semester of a degree program leading to a health care career. "Our research indicated that while scholarship support is available for students at the beginning of their education cycle, many students need to suspend the pursuit of their degree midstream because of financial need. This scholarship program is designed to give student scholars that final push to complete their degree and enter the workforce in a timely manner," said Steve Young, Foundation Board Chairman.

Thanks to the generosity of the WHA Foundation, funding is now available to the Association to develop and implement a Web site that will provide on-line access to data and information from WHA’s new quality initiative. An important aspect of the quality initiative is not only to collect data from hospitals related to the ten clinical and five safety measures, but to make this information available to the public.

"The objective of our quality public reporting initiative is to put information in the hands of consumers to facilitate their decision making. It is essential that consumers have a friendly, accessible way to get this information," said Dana Richardson, WHA vice president of quality and the director of the quality initiative.

Chuck Shabino, MD, chairman of the Wisconsin Quality Steering Committee, welcomed the news of the Foundation grant. "This support will facilitate the development of the appropriate consumer focused web site to be sure the information is timely and accessible," he said.

The Foundation also issued grants to two Milwaukee initiatives to study the structure of the funding for the General Assistance Medical Program (GAMP), and for technical assistance to review and determine the feasibility of expanding the capacity of the city’s four Federally Qualified Health Centers to take advantage of new federal dollars available for FQHC expansion.

"Both of these initiatives will assist the Milwaukee health care system to respond to the growing demand for services by Milwaukee’s neediest populations," said Bill Bazan, WHA vice president, Metro Milwaukee.

State Rep. Dan Meyer (R-Eagle River) shared his perspectives on the just-finalized state budget and Wisconsin’s taxing and spending habits with members of the WHA North Central Region on July 28 in Minocqua.

Even with a $205 million positive balance created in large part by Governor Doyle’s line item vetoes (see July 25 Valued Voice article), Meyer expects the legislature to consider a budget repair bill once new revenue estimates are released later this year or early in 2004. As a member of the budget-writing Joint Committee on Finance, Meyer said his goal will be to hold the line on taxes and spending, just as it was during this summer’s budget debate.

"Wisconsin’s tax policies have reached a crossroads," he said. "Our $3.2 billion deficit didn’t happen because we don’t tax enough; it happened because we spend too much."

Meyer said with Wisconsin residents already paying over 33% of their income in taxes, government must cut expenditures to match revenues and focus on growing the economy.

"We can’t tax our way out of this," he said. "If we try to, people will keep leaving the state as they are taxed out of their businesses and homes."

Meyer said the Governor’s veto of the three-year property tax freeze for local governments, schools and technical colleges was misguided, and the legislature will attempt to override it. Meyer said exceptions to the freeze, including a 2.6% annual increase in technical college district levies, made the freeze fair and workable.

"Given the situation Wisconsin is facing, it’s not out of line to ask local governments to take a step back and to back off on raising taxes until the economy comes around," he explained.

Meyer said the legislature recognized the need for flexibility within the Wisconsin Technical College System (WTCS) and believed the role of WTCS in addressing the health care workforce shortage called for approval of the new $9.8 million Health Care Training Grant Program (see July 25 Valued Voice article).

WHA President Steve Brenton thanked Meyer for approving the funding and praised WTCS for its responsiveness to the demand for new health care workers and its willingness to partner with hospitals to train students.

"Most of our hospitals have job openings in well-paying, family-sustaining health careers, and WTCS has done an outstanding job expanding capacity to get people into those jobs - often in partnership with our members," Brenton said.

"The ability of the state to support the technical colleges as they step up to the plate during these tough economic times, directly helps us and the patients we care for," added Dave Grundstrom, chief administrative officer, Flambeau Hospital, Park Falls.

Meyer prefaced comments about the need to control health care costs by saying he doesn’t believe Wisconsin residents expect health care to be inexpensive, but they do expect it to be affordable. He recognized the pressures increasing costs are putting on the state’s Medicaid budget and Medicaid providers, pointing to an aging population in need of more medical services and rising prescription drug prices. He said one of the keys to stabilizing health care costs is encouraging responsible utilization by requiring co-pays for health care visits.

"Asking employees to pay a portion of the monthly premium won’t change their behavior, because their costs stay the same regardless of how often they utilize services," he said. "If people don’t know the cost – if someone else is paying for it – they won’t worry about."

Meyer was first elected to the State Assembly in 2000. An army veteran, he has also served as the mayor of Eagle River and the executive director of its Chamber of Commerce.

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Currently consumers use health care like people use an open bar at a wedding. They select the best, use half of it, and throw the rest away. We should not be asking for body scans for aches and pains. We have to give consumers incentives to chose wisely as they go through the process. Our consumers have high expectations for quality, and our providers have for the most part met their demand for quality. The price for receiving high quality care has gone beyond just the cost of providing the service, and now cost is being driven in large part by litigation and being all things to all people all the time at all facilities. If you look forward, consumers will use information to make decisions on where to go and what procedure makes the most sense for them in consultation with their physician, instead of showing up at the door to have a battery of tests run. We cannot afford to do all things for all people all the time.

If hospitals are going to be truly integral to our success in reducing the cost of health care and improving quality, they must share information with consumers in a meaningful way so people can compete in a market-based setting.

2. Hospitals are burdened with a myriad of regulations ranging from construction plan review to HIPAA. What can government do to lessen this paperwork burden and how do you think that would affect cost and innovation in health care?

If we reduce regulation, the cost of health care will go down. As a perfect example, the federal government mandates that in order to preserve confidentiality, a desk should be so high; at the same time to provide access to the disabled, it must be so low. That is the thinking that government brings to regulation in all industries, but it is especially prevalent in the health care industry. We must be cognizant of cost and keep an eye on what is happening to consumers. If they have to decide between health care and keeping their job, we (the legislature) haven’t done our job. The legislature needs to create an environment where we promote job growth. That is what we are working on this summer—a series of packages that will promote economic development so employees won’t have to make a decision between staying in a job that does not offer health insurance or leaving for a job that does. We don’t want people and companies facing this decision. We need to create a health care system to reduce cost and continue to provide high quality care.

I have been a consumer of health care, I have been a purchaser, and I have evaluated health care for the public sector. I bring to that evaluation basically the recognition that there are a myriad of options out there today for consumers in terms of plans. My view has changed over time from using pure group insurance, to a belief that the best way to provide insurance is through cafeteria plans, and using a group plan only for catastrophic care. If we give individuals flexibility to add or subtract things from their plans, we will begin to reduce the cost. I think we have to have more flexible rules to provide customized plans for individuals in these groups so they can get the care they need instead of balancing the risk pool for care they don’t need. This will concentrate the emphasis on the consumer instead of assuming "one size fits all" attitude. We need to be aggressive in getting there.

As you look at it, adopting some of the medical savings account reforms are something we need to do. The move we just made to make information available to individuals through WHA, as well as getting to a place where the data is available in real time is just one of the aggressive moves we need to do. Our state is highly educated, and I think we can be more aggressive than other states and we can give more information to our consumers. Just like we all buy other things, like cars and food, we are interested in buying what suits us, at a price that is affordable. In health care we don’t even ask the cost, and I couldn’t tell you the real cost of our last prescription. That is in my view absurd, so we have to aggressively move to a market-based approach and let people keep some of the funds (tax free, or after tax vehicle) so we can incent people to make quality choices and keep the benefits of their shopping, or roll it over to the next year in a medical account.

My preferred means of contact is email. I also like meeting with people in small groups where we can fit around a table, talk about the issues, and have an exchange where I can learn as well as speak out. That is a good way for me to learn. If hospitals in a geographic region want to meet at a local restaurant and kick around ideas, I would welcome that exchange. The market is changing quickly; none of us will understand your business as well as you do. We need exposure to the issues, and we need facts that support arguments. One of the issues that we will tackle is the cost of health care. We have to move towards a consumer model. Be armed with the facts. Be prepared to share information in the light of day.

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State Sen. Sheila Harsdorf (R-River Falls) and State
Rep. Curt Gielow (R-Mequon) introduced Assembly Bill 447 on July 25 establishing up to five cooperative health care purchasing alliances in Wisconsin. An identical companion bill, Senate Bill 204, was introduced in June. The bills allow businesses, farmers, municipalities, associations, labor unions and self-employed individuals to form and participate in the cooperatives. According to Harsdorf, the legislation encourages the creation of these community-based demonstration projects as a tool for increasing access to quality, affordable health care.

"This is a unique collaboration to provide health care coverage that has potential to lower costs and expand services," said Harsdorf. "It provides another choice for those struggling to find affordable health care."

Gielow said AB 447 and SB 204 accomplish this by increasing buying power and reducing existing health care costs.

"This proposal will enhance market competition, build economies of scale, and encourage informed consumer choice," he explained. "Any time you let small businesses buy insurance as part of a larger group, they save money."

Gielow added cooperatives would have incentives to reduce and control costs by educating participants about costs of health care decisions, including prevention. The bills require cooperatives to be designed in a manner that ensures members become better informed about health care trends and cost increases, and also actively participate in the design of health care benefit options and in health improvement decisions for their community.

According to Harsdorf, the bills also set rules designed to ensure success such as requiring a minimum number of participants for each purchasing group and establishing a three-year minimum enrollment to prevent the possibility of adverse selection. The legislation also requires the pooling of all members’ health insurance risks.

Under the bills, the Commissioner of Insurance must designate five geographic areas in which a cooperative can be formed. Each cooperative would have flexibility in tailoring benefit packages to the needs of the region, and use existing defined networks plans. However, the bills also permit cooperatives to offer a point-of-service option for members at a higher cost.

Committee hearings have not been scheduled on either bill. For more information about this legislation, contact Jodi Jensen at 608-274-1820 or jjensen@wha.org  

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President’s Column

In July 2002, the WHA Board Planning Session focused on the question, "We know what we oppose…what do we stand for?"

In answering that question, the Board agreed on three key health care reform principles. Specifically, WHA should focus on promoting an agenda that:

1. enables consumerism;

2. improves coverage and access; and

3. promotes community accountability.

Among the several initiatives that directly came out of the 2002 Planning Session, WHA’s new quality initiative, focusing on evidence-based measurements with expected hospital-specific reporting in 2004, is probably the most significant.

Meeting just two weeks ago in Lake Geneva, the WHA Board’s 2003 Planning Session focused on the theme of "Aligning Member Priorities with WHA’s Strategic Plan." Board members focused on specific membership survey results that point to new "opportunities" for Association programming.

• WHA must gain significant member participation in the quality initiative project.

• WHA must successfully implement new responsibilities associated with hospital claims privatization.

• WHA staff must gain a significant increase in member participation in DataBank in order to enhance the use of this information for advocacy and for individual hospital benchmarking.

• WHA should create a new Council on Workforce Development.

• WHA should position the 2002 Department of Workforce Development (DWD) Healthcare Workforce Task Force report as a template for the state’s health care workforce agenda.

• WHA’s #1 health care workforce priority should be targeted to enhancing supply through building new and expanding existing infrastructure.

• WHA should be a national leader on Medicare payment issues concentrating on the themes of equity, adequacy and rewarding value.

• WHA should continue to take a coalition focus in advancing its advocacy agenda, especially as it relates to anticipated Wisconsin-based health care reform initiatives.

These specific activities, many of which build upon and/or implement ongoing member priorities, will be the focus of staff and member attention over the next several months. Additionally, the current WHA strategic plan (which has not been universally shared with members since 2000) will be amended, reformatted and distributed to gain member buy-in and assure staff accountability.

University of Wisconsin Hospital and Clinics was nationally recognized for its leadership and innovation in quality, safety and commitment to patient care. The American Hospital Association honored four organizations with their Quest for Quality Prize: Abington Memorial Hospital in Abington, Pennsylvania; University of Wisconsin Hospital and Clinics in Madison, Wisconsin; William Beaumont Hospital in Royal Oak, Michigan; and Olympic Medical Center in Port Angeles, Washington.

The Quest for Quality Prize is supported by grants from the McKesson Foundation and McKesson Corporation. The prize was created to highlight innovative patient safety efforts by leading organizations. Award criteria include organizational patient safety efforts related to patient and family involvement, patient and family communication, leadership, strategic planning, information and analysis, human resources and process management.

"Each hospital recognized today has taken a slightly different path to achieving a culture of safety," said Dick Davidson, AHA’s president. "But each has successfully created a new culture – one based on trust, understanding and openness. That culture goes a long way to improving the care patients receive."

"We’re pleased to be recognized as a national leader in this area," says Donna Sollenberger, CEO of UW Hospital and Clinics. "It’s an affirmation of our institution-wide recognition that patient safety is our top priority. Everything begins and ends with that."

At least four recent major patient-safety initiatives helped to distinguish UW Hospital and Clinics from other centers and impress the judging panel:

• In 2001, UW Hospital and Clinics was one of the first hospitals in the U.S. to implement AcuScan, a barcode scanning system used at the patient’s bedside that has reduced medication administration errors by 87%.
• As part of a hospital-wide effort to reduce and prevent patient injuries from falls, all patient beds are equipped with exit alarms to alert nursing staff. The alarms are part of a falls prevention program that includes staff education and improved risk assessment.
• UW Hospital and Clinics established a voluntary, anonymous and non-punitive system for reporting errors or potential errors in care delivery. In 2002, the system added an Internet-based software tool called Patient Safety Net, resulting in a substantial increase in both the number and quality of reports. The information is used to improve safety and risk-management practices.
• Intensivists, physicians specially trained to care for critically ill patients in intensive care units, are available around the clock, seven days a week, with a half-hour overlap between shifts to facilitate staff communication.

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As a result of advocacy by WHA, the American Hospital Association (AHA), many other state associations, and members of Congress--the Centers for Medicare and Medicaid Services (CMS) agreed to reduce the Medicare Inpatient Prospective Payment System (PPS) outlier threshold from its proposed level of over $50,000 to $31,000 for federal fiscal year (FFY) 2004. This threshold triggers Medicare payment to partially compensate hospitals for treating patients who are costlier than the average patient, helping to protect access to care for the highest cost Medicare beneficiaries.

CMS recently determined that Medicare had been overpaying some hospitals and raised the threshold at which a patient’s care would qualify for partial outlier payments from $21,025 to $33,560 for FFY 2003. CMS proposed another increase to $50,645 in its proposed inpatient PPS rule for FFY 2004, which would result in significant losses for Wisconsin’s hospitals. Since CMS has already made other changes to the outlier system to prevent hospitals from receiving excessive outlier payments, a dramatic increase in the threshold is not warranted.

The FFY 2004 final rule for the Medicare Inpatient PPS was published in the August 1 Federal Register. In addition to the outlier changes, it provides a full 3.4% marketbasket update. There are no 2004 hospital payment cuts scheduled by current law. However, the level of the inpatient marketbasket update for FFY 2004 is currently being debated in Congress and could be reduced by the Medicare reform bill being finalized by a House-Senate conference committee. The House has approved 0.4% reduction in the marketbasket for each of the next three years. WHA is advocating for the Senate provision in conference, which did not include any marketbasket reductions.

The final rule expands the post-acute care transfer policy from the current ten Diagnosis Related Groups (DRGs) to 29 DRGs. WHA and AHA strongly oppose the expansion of the transfer policy, which penalizes hospitals that are ensuring patients receive the right care at the right time in the right setting. This policy violates the basic principle that prospective payment is built on a system of averages—cases with long lengths of stay are "underpaid" while cases with short lengths of stay are "overpaid." This proposal would reduce hospital payments for patients transferred to a post-acute care setting after a short length of stay, penalizing hospitals that seek to efficiently move patients into the most appropriate setting. Short stay transfers would be paid at a per diem or per day rate that is likely less than, and cannot exceed, the full DRG amount.

The Inpatient Rehabilitation Facility PPS final rule was also published in the August 1 Federal Register. It contains a 3.2% marketbasket update for Medicare rehabilitation but does not address the qualifying criteria for rehabilitation facilities, known as the "75% rule." However, in response to the protests of WHA, AHA, the rehabilitation community and members of Congress, CMS has agreed to revisit enforcement of the outdated 75% rule. CMS is expected to propose a separate rule that would modify the requirements for qualifying for rehabilitation facility status in the near future.

The Skilled Nursing Facility (SNF) PPS final rule is scheduled for publication in the August 4 Federal Register. It will provide a 3.0% marketbasket update. In addition, SNFs will receive a payment increase of 3.26% in FFY 2004 to adjust for forecast errors pertaining to CMS’ marketbasket estimations for FFY 2000, 2001, and 2002.

WHA will be sending out more detailed information on the final prospective payment rules in the near future. For a copy of the rules, see the finance and data section of the WHA Web site at http://www.wha.org/financeAndData/.

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Included in this week’s packet and on the HIPAACOW Web site is information regarding the HIPAA mandated 837 Electronic Claims Submission Transaction, which takes effect October 17, 2003. This information includes a HIPAA alert, fact sheet, and questionnaire. Please review the HIPAA information and fill out the HIPAA questionnaire by August 15. The questionnaire may be filled out online at www.hipaacow.org.  Also, refer to the HIPAACOW Web site and answer the ten question, "Are You Ready" assessment.

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This fall, the seven regional hospital bioterrorism teams in Wisconsin, in collaboration with the Wisconsin Emergency Management and Public Health Regional Consortia, will host the First Annual State of Wisconsin Bioterrorism Preparedness Tabletop Exercise. Wisconsin Emergency Management will facilitate these regional, collaborative exercises, which will provide an excellent opportunity for WHA member hospitals to participate, learn and observe how these partnerships are working. The objectives of the exercise are to gauge the overall effectiveness the regional partnerships have in activating the State Plan, as well as in effectively implementing inter-organizational communications.

The dates and times for the tabletop exercises follows:

Region 1: September 30, Turtleback Conference Center, Rice Lake

Region 2: October 23, Westwood Center, Wausau

Region 3: October 22, Comfort Suites, Green Bay

Region 4: September 26, La Crosse Center, North Hall, La Crosse

Region 5: November 7, Alliant Energy Center, Madison

Region 6: October 14, Sunnyview Expo Center, Oshkosh

Region 7: November 6, Washington County Fairgrounds, West Bend

An information sheet is included in this week’s packet, including a registration form. There is no fee. The information is posted at www.wha.org, disaster preparedness.

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Last month the Board of Commissioners of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) approved a new requirement to collect and use data for an additional set of core performance measures, increasing the number of core measure sets collected from two to three beginning in January 2004. Currently, hospitals choose from core measure sets relating to acute myocardial infarction, heart failure, community acquired pneumonia, and pregnancy and related conditions. JCAHO is also developing measure sets for surgical infection prevention, ICU care, pain management and inpatient pediatric asthma. These measure sets are expected to become available over the next 24 months.

"By focusing measurement efforts on the most common inpatient conditions, hospital data-driven improvement efforts will have the broadest possible impacts," said Dennis O’Leary, M.D., president, JCAHO. "These are also clinical conditions that are of great interest to a variety of regulatory, purchaser and consumer groups."

The new requirements also provide alternatives for hospital to whom the current core measure sets do not apply. For these hospitals, the increased requirement options include the following:

• Hospitals currently reporting data on one core measure set and three non-core measures will report data on one core measure set and six non-core measures.
• Hospitals currently reporting data on six non-core measures will report data on nine non-core measures.
• Hospitals currently reporting data on two core measure sets, but unable to identify a third core measure set, will report data on two core measure sets and three non-core measures.

For more information about the JCAHO ORYX and core measure requirements, go to www.jcaho.org or contact Dana Richardson, drichardson@wha.org  or at 608-274-1820.

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Your help is needed to provide affordable medical malpractice!
One of the primary and most pressing objectives of WHA Financial Solutions, Inc., is to provide a stable and affordable medical malpractice market for Wisconsin hospitals. To that end, we and our partners at Fitzgerald Clayton James & Kasten (FCJK), have been working with a number of insurance companies and alternative risk transfer vehicles to develop a program for WHA members.

We have reached the stage wherein we must compile additional information to begin assessing the feasibility of these various options. We are asking that all interested parties forward to FCJK a copy of your most recently valued loss run for hospital professional, general liability and automobile liability. This information will be kept confidential and used solely for the purpose of exploring alternative solutions for Wisconsin hospitals. Providing this information in no way obligates you to participate in any program that is ultimately developed.

Please forward the information directly to Carla Borda at FCJK, 10335 N. Port Washington Road, Mequon, WI 53092 by August 20, 2003. Contact Carla at 262-478-3310 or cborda@fcjk.com  with any questions.

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As the dog days of August settle across Wisconsin, the Healthy Wisconsin/AHAPAC effort grows to achieve the $125,000 annual goal. Week 11 results include kudos to Community Health Care/Wausau Hospital for reaching $5,005 in contributions. Of note, CHC/Wausau Hospital contributed $1,250 to AHAPAC. The AHAPAC supports candidates running for federal office. In the 2002 election cycle, the AHAPAC contributed $28,000 to Wisconsin federal candidates. The AHAPAC goal for 2003 is $25,000, and Wausau’s contribution places Wisconsin at 35% of goal.

We anticipate more campaigns being launched this month and look forward to reaching the goal long before September. If you have questions about participation or need assistance, contact Ann Lucas at alucas@wha.org