August 10, 2007
Volume 51, Issue 30
Recent survey on Healthy Wisconsin disputes earlier poll
WisPolitics Poll says only one-third of residents favor overhaul
A recent WisPolitics.com/CheckPoint survey found that only one-third of the state residents were in favor of a plan proposed by Senate Democrats, and included in the state budget, to overhaul Wisconsin’s health care delivery system.
In a telephone survey of 400 randomly-selected state residents conducted July 24-29, respondents were asked the following question:
"Democrats in the state Senate are promoting a state universal health care plan for individuals and businesses they say would give Wisconsin citizens the same coverage enjoyed by legislators in addition to spurring new jobs. They also say current employer and employee health care costs would fall by more than $2 billion in the first year alone under the plan, called Healthy Wisconsin. But opponents say the government-run plan, to be funded by $15.2 billion in new taxes, would kill jobs and small businesses while limiting consumer choice and slowing delivery of certain medical procedures.
Given what you know about the Healthy Wisconsin plan, would you say that you favor or oppose the plan?"
The survey, which had a margin of error of plus or minus five percentage points, yielded the following results:
— Strongly favor 18.9%
— Somewhat favor 16.9%
— Somewhat oppose 14.6%
— Strongly oppose 28.5%
— Don’t know/No opinion 21.1%
WisPolitics is a highly regarded, non-partisan Wisconsin political report. Additional information on WisPolitics or this survey can be obtained by contacting them at info@wispolitics.com.
The results contrast survey findings from supporters of Healthy Wisconsin. Their survey, conducted
June 12-14 by Lake Research Partners on behalf of the Wisconsin Health Care Reform Campaign, polled 500 likely Wisconsin voters in the 2008 general election and found 69%, or nearly two-thirds, in favor of Healthy Wisconsin. The survey had a margin of error of plus or minus 4.4 percentage points. The actual questions asked in the Lake Research poll have not been released to the public.
The budget conference committee continues to debate state budget priorities, including the best way to address health care reform, in discussions that are expected to last well into fall.
WHA Annual Convention
September 19-21, 2007
Marriott Hotel, Madison
Final cut-off date for hotel reservations: August 29
Conference registrations due: September 7
Fundraising Campaign Update: $60,000 More in Individual Contributions Needed to Reach Goal
357 individuals including CEOs, employees, volunteers, and trustees affiliated with 70 hospitals from around the state have raised nearly $135,000 to date. This accounts for 69 percent of the $195,000 fundraising campaign’s monetary goal. The campaign has raised nearly $13,000 more to date than this time last year.
Contributors by name and affiliated organization are published on a monthly basis in the Valued Voice and are listed below. Contributors are listed by contribution amount categories and in the order the contribution was received.
Contributors will also receive a bi-monthly campaign newsletter, which provides additional information about the campaign, upcoming events, and insider information on the upcoming elections next year.
The next list of contributors will be published in the September 14 edition of The Valued Voice. For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.
Political Action Spotlight: 2007 Fundraising Campaign Contributors
Contributions ranging from $1 - $249
Federal Issues
CMS Cuts Hospital Payments Under Final IPPS Rule
Wisconsin Hospitals to Lose $358 Million
Wisconsin hospitals will face a loss of over $358 million in the next five years under the final Inpatient Prospective Payment System (IPPS) rule released by the Centers for Medicaid & Medicare Services (CMS) on August 1. In spite of the fact that 332 Members of Congress, including six of Wisconsin’s 10 members*, expressed opposition to the cuts, CMS ignored their intent and included the cuts nonetheless. These cuts will now go into effect unless Congress legislatively stops them by October 1. WHA has already contacted each member of Wisconsin’s Congressional Delegation to ask them to stand with their hospitals and to stop the cuts from going into effect.
Wisconsin hospitals will see losses largely due to one provision referred to as the "behavioral offset." Under the final rule, the "offset" will result in a 1.2% reduction in FY 2008 and 1.8% reduction in 2009 and 2010, totaling a 4.8% reduction over three years. CMS claims the offset is needed because hospitals will make "coding and documentation" changes under the new DRG system. That DRG system begins in FY 2008 with a 50/50 payment blend. In essence, the offset is a way for CMS to take back a portion of the marketbasket inflationary update for what it anticipates will happen in the future. The Wisconsin Hospital Association believes that if adjustments are warranted, those should be done retroactively based on the facts, rather than prospectively based on speculation.
The IPPS rule would also have an especially hard impact on metro areas like Milwaukee through an additional provision—the elimination of the 3 percent large urban add-on to capital payments. Additionally the House voted overwhelmingly earlier this year to restrict CMS from spending funds on prospective implementation of this payment cut. However, to date, no companion amendment has been offered in the Senate.
Contact your Members of Congress and urge them to stop these cuts. If you have questions or need assistance, contact WHA’s Jenny Boese at jboese@wha.org or 608/268-1816.
* The six Wisconsin legislators who expressed opposition early on to the hospital cuts are: Sens. Kohl and Feingold; Reps. Baldwin, Kagen, Moore and Petri.
President’s Column
Healthy Wisconsin
The most credible opponent who has emerged to challenge Healthy Wisconsin, the Senate Democrat’s health plan, is John Torinus, President/CEO of SERIGRAPH, a West Bend based company employing several hundred workers. Torinus is also a columnist for the Milwaukee Journal Sentinel and a frequent commentator on health care issues, especially issues associated with insurance affordability and the need to revolutionize the flawed health care marketplace. John Torinus is not an Ivory Tower contemplator or career health care theorist touting the latest silver bullet. He is respected by all sides in the health care debate and pulls no punches, taking employers, providers (including hospitals), politicians and so-called "policy wonks" equally to task.
Torinus isn’t buying the sound bites offered up by Healthy Wisconsin supporters, especially claims that all Wisconsin citizens can somehow be provided LEXUS coverage at the price of a GEO Prism. In a recent column, Torinus observes that the numbers just don’t add up and that the "one-size fits all" approach will penalize "best practice" employers who are successfully managing their health care costs by empowering employees to make cost-effective choices and implementing wellness and chronic disease management programs at their worksites. And Torinus should know, his "hands on" approach at SERIGRAPH has resulted in a sustainable reduction in the growth of health care costs that should be emulated….not dismantled as would be the case should Healthy Wisconsin some day become a reality.
In another recent column, Torinus suggested that Wisconsin consider following the lead of Massachusetts and mandate that individuals be covered by at least a basic benefit package, either through their employer or through individual purchase. Such a mandate would get rid of the "free riders" who in many cases are young and employed but reject employer-offered coverage. Of course to work (as is the case in Massachusetts), an appropriate role for government would be needed to link the uninsured to affordable coverage which in some cases may require a direct subsidy.
Torinus’ sensible call for incremental reform, based on marketplace principles with a role for government, is a worthy alternative to the massive, single-payer, government directed approach currently espoused by some in Madison. Governor Doyle’s health care offerings (expanded Medicaid coverage and tax deductibility for individual insurance purchase) combined with GOP proposals (HSA deductibility, transparency and workplace wellness incentives) make for a good start. While it’s a safe bet that the individual mandate concept may have some early detractors, it is probably the missing piece that’s needed to advance the largely shared goal of expanded coverage.
It is pretty much an accepted fact that service utilization is the number one cost driver and influencer of rising health insurance premiums. The fact that much of that increased utilization is driven by either the early onset of lifestyle induced chronic disease and/or the absence of direct consumer involvement in purchasing decisions is something that must be addressed in any credible health reform initiative. Healthy Wisconsin, as currently designed, misses the mark. A merger of Doyle administration proposals with GOP initiatives and a phased in individual mandate can represent health reform that builds upon the private sector….features an appropriate role for government….and tackles the utilization cost driver in a meaningful way.
Steve Brenton, President
WHA Finance Council Considers Billing & Collection Best Practices
Staff presents papers, resources that help patients understand
billing process
With the release of WHA’s Billing and Collection Guidelines in May, WHA members committed to reviewing their billing and collection policies. As part of that process, hospitals also wanted to improve how they communicate their billing, charity care and discount policies to the public. WHA staff were asked to develop resources that could be shared among hospitals as best practices in responding to requests for pricing, billing and charity care information from consumers.
WHA staff presented their findings to the WHA Finance Council at its August 7 meeting in Madison. WHA Vice President Brian Potter said his workgroup found several hospitals have developed processes and materials that work well for responding to requests for a price quote from a patient prior to a procedure, which he shared with the group. Potter handed out staff scripts that are used by some hospitals when they are responding to pricing inquiries, along with flow charts, data sources, and letters that are used to help patients understand their bill and the process for paying it.
Mary Kay Grasmick, WHA vice president, communications, said her subcommittee focused on how to clearly communicate the billing and collection process to help increase the understanding of what is expected, alleviate patients concerns about the unknown and assist billing office personnel in working out suitable payment arrangements. One of the barriers to understanding their bill is that many patients have never reviewed their health insurance plan. Some learn for the first time upon admission that their deductible has increased, which can lead to frustration. Grasmick said her group recommended that hospitals consider posting their billing and collection process, along with the guidelines that they use to determine discounts or charity care, on their Web sites so they can refer patients to that resource. Since personal communications are preferable, an invitation to meet with a financial counselor should be considered when patients are admitted, or shortly thereafter if before is not practical.
The Council agreed that staff should continue to develop resources that can be shared with WHA member hospitals. Several hospitals have agreed to share materials and policies that they follow, which will be incorporated into the WHA resource file that will be sent to members within the next few weeks.
Significant changes are being proposed to the IRS Form 990 that will have a major impact on hospitals. WHA Legal Counsel Laura Leitch and Potter reviewed the form with the Council and asked for their input on specific sections of the form that will be included in a comment letter WHA will send soon to the IRS.
Negotiations continue on hospital reimbursement rates associated with worker’s compensation cases. WHA Senior Vice President George Quinn and Leitch, who are representing hospitals on this issue, provided an update on the negotiations.
Must Enroll for Payment Update by August 15Hospitals must submit by Aug. 15 a revised Notice of Participation for the inpatient hospital quality reporting program to receive a full market basket payment update for fiscal year 2008. The form must be signed by the hospital CEO and sent to the state Quality Improvement Organization. Hospitals will not need to re-enroll in future years to be considered an active participant. Hospitals that want to withdraw from the program must submit a Withdrawal of Participation form but will receive a 2.0 percentage point reduction to their payment update.
AHRQ Seeks Submissions For New Health Care Innovations Exchange Web Site www.innovations.ahrq.gov
AHRQ is seeking submissions for its new Health Care Innovations Exchange, a dual-component initiative that is designed to support health care professionals in sharing and adopting innovations that improve health care quality.
The two components are a searchable, Web-based national repository of health service innovations and dynamic communities of learning.
Through the AHRQ Health Care Innovations Exchange Web site, physicians, nurses, and other health professionals and providers will be able to obtain detailed profiles of innovative activities and tools, and have opportunities to exchange successes, failures, stories and lessons learned with innovators and fellow adopters. Users of this site will also have access to educational materials on how to innovate.
Innovations described in the AHRQ Health Care Innovations Exchange will represent varying degrees of novelty and scientific rigor and cover many clinical disciplines and care settings in both the public and private sector. The dynamic communities of learning will allow for collaboration and cross-disciplinary interactions that will heighten understanding of the relevance of an innovation to a potential adopter’s organizational contexts and expand on the effort needed to replicate uptake of the innovation. The goal is to accelerate change and transformation in real-world health care.
To learn more about how to submit innovations, visit the AHRQ Health Care Innovations Exchange Web site at www.innovations.ahrq.gov .
For more information about the AHRQ Health Care Innovations Exchange, please contact Cheryl Thompson at 301-427-1271 or via email at cheryl.thompson@ahrq.hhs.gov .
Member News
Wisconsin Hospitals Among 100 Top Hospitals Performance Improvement Leaders
U.S. hospitals that are improving the fastest and most consistently in clinical quality and efficiency also are employing strategies that grow their outpatient services, according to a study released recently by Thomson Healthcare. The study – Thomson 100 Top Hospitals®: Performance Improvement Leaders, 4th Edition – examined the performance of more than 2,800 U.S. hospitals in a variety of clinical, financial, and operational areas and identified 100 hospitals that improved the most from 2001 to 2005.
Three Wsconsin hospitals were on the list:
Teaching hospitals (200 or more acute care beds) - Meriter Hospital, Madison
Medium community hospital (100 - 249 acute care beds) St. Michael’s Hospital, Stevens Point
Small community hospitals (25 - 99 acute care beds) - Aurora Medical Center, Two Rivers
"These performance improvement leaders are bellwethers for the progress the entire hospital industry has pursued since the Institute of Medicine published its landmark study, Crossing the Quality Chasm, in 2001," said Jean Chenoweth, senior vice president for performance improvement and 100 Top Hospitals programs at Thomson Healthcare. "They are an important group to watch because they demonstrate a variety of ways that real improvement can be achieved in many key areas across the hospital organization simultaneously over an extended timeframe."
In August, WHA is offering a three-part audioconference, entitled "Medicare Conditions of Participation Revised Interpretive Guidelines: What Every Hospital Needs to Know," focusing on the recent major changes, including new restraint and seclusion standards, death reporting, informed consent, and Medicare discharge appeal rights. The three-part series will be offered August 16, 23, and 30, from 10 am to 12 pm
You can educate your entire staff on this important topic quickly and economically by registering for this three-part audioconference series. The registration fee for all three sessions is $400 per phone line; or $169 for one or more individual sessions. While not mandatory, participants are encouraged to register for the full series, which is offered at a discounted price. Each session stands on its own, and will have individual presentation materials; however, please be aware that the sessions build upon one another and content may be related/referenced among sessions.
For more information, each session’s planned discussion topics, and to register, go on-line to www.wha.org , or link directly to: http://www.wha.org/education/compliance.aspx . For registration questions, contact Lisa Geishirt, WHA’s education coordinator, at 608-274-1820 or lgeishirt@wha.org .
WHA is offering a three-part audioconference in November, focused on the Medicare Conditions of Participation guideline revisions specific to Critical Access Hospitals (CAHs). This series will focus on helping CAHs comply with recent major changes and several specific COP problem areas. The three-part series will be offered on November 1, 15, and 29, from 10 am to 12 pm.
The registration fee for all three sessions is $400 for one phone line; or $169 per line for one or more individual sessions. While not mandatory, participants are encouraged to register for the full series, which is offered at a discounted price. Each session stands on its own, and will have individual presentation materials; however, please be aware that the sessions build upon one another and content may be related/referenced among sessions.
For more information, each session’s learning objectives, and to register, go on-line to www.wha.org , or link directly to: http://www.wha.org/education/compliance.aspx. For registration questions, contact Lisa Geishirt, WHA’s education coordinator, at 608-274-1820 or
lgeishirt@wha.org.Stories From Our Hospitals
Memorial Health Center, Medford,
Health Screenings Save Lives
For a few years, Lorraine Thomsen of Medford attended the Taylor County Senior Health Fair as her opportunity to gather new health care related information from local organizations and to take part in the health screenings. One screening Lorraine had always participated in was the free diabetes or blood glucose screening offered by Memorial Health Center. The year of 2006 was no different; Lorraine again had her blood glucose tested during this annual event, but this time the results were a bit concerning.
"I used to work at the hospital and knew a little about diabetes," said Lorraine. "I changed my diet right away."
Lorraine followed up in February with her health care provider, Kathy Hemer, nurse practitioner with Memorial Health Center. She retested her at that point and found that her levels were a little better, but still needed medical attention. To help her with nutrition management, Lorraine was scheduled with Memorial Health Center’s registered dietitian and diabetes educator, Rosalyn Haase.
"I learned a lot from Rosalyn about food planning to keep my diabetes under control through diet," said Lorraine.
Each year Memorial Health Center reaches out to hundreds of local seniors during the Taylor County Senior Health Fair, sponsored by the Commission on Aging. Memorial Health Center has a very large presence at the health fair, including offering free health screenings. Over 245 people were screened during Memorial Health Center’s free diabetes screening in 2006.
"The screening was absolutely helpful," said Lorraine. "The symptoms aren’t always obvious and if you don’t go to the doctor or participate in a screening somewhere, you’d never know you have diabetes."
According to WebMD, an estimated 18.2 million people in the United States—6.3 percent of the population—have diabetes, a serious, lifelong condition. Of those, 13 million have been diagnosed, and about 5.2 million people have not yet been diagnosed. Each year, about 1.3 million people aged 20 or older are diagnosed with diabetes. If diabetes is not kept under control, devastating complications can result.
"If diabetes isn’t controlled, it can lead to very serious health conditions," said Haase. "Poorly controlled diabetes is the number one cause of adult blindness and kidney failure, and non-traumatic amputations of the foot or leg. Stroke and heart attacks are the most frequent causes of death in people with type 2 diabetes. New research points to a link between poor diabetes control and Alzheimer’s disease." Lorraine continued, "I feel much better now that I lost some weight and can control my diabetes without medication."
Submit hospital community benefit stories to Mary Kay Grasmick, editor, at
mgrasmick@wha.org.American Family Children’s Hospital Holds Open House
The American Family Children’s Hospital in Madison held an open house on July 29 to unveil the new facility to the community. The new hospital will open with 61 beds with capacity to expand up to 85.
"We cannot wait to unveil this incredible resource to the community," says Donna Sollenberger, president and CEO of UW Hospital and Clinics. "Most families, thankfully, will never see their child hospitalized. Should the need arise, however, any child, parent, grandparent or friend who enters our hospital will be awed by this facility that is designed around a child’s and family’s every need."
The six-story American Family Children’s Hospital will replace the existing UW Children’s Hospital, currently located within the UW Hospital and Clinics building that opened in 1979.
Task Force: Concordia University Should Proceed with Pharmacy School Planning
A Task Force of pharmacy, health care and community leaders has voted unanimously to support Concordia University Wisconsin officials’ plan for a School of Pharmacy. The group has been meeting for several months and has discussed the need for pharmacists in Wisconsin, the community interest in supporting a program with clinical experiences, the costs and timelines for such a program, and the difficulties that might be encountered (e.g. finding qualified faculty). Acting upon all of this information, the Task Force has recommended that Concordia continue the planning process. Under ideal conditions, the program, which would need approval from the faculty and Concordia’s sponsor, could begin admitting students at the pre-pharmacy level in fall 2008. Former State Representative Curt Gielow has guided the Task Force in its deliberations. WHA’s Judy Warmuth, along with many hospital representatives, have served on the Task Force.
WHA Financial Solutions
Reduce Health Claims With Generic Drugs
(From Solutions Spotlight, included in this week’s packet)
Spending on prescription drugs has become the fastest growing component of health care expenditures today, rising more quickly than the cost of hospital or physician services. Since 1990, spending for prescription drugs has more than quadrupled.
According to the Generic Pharmaceutical Association, generic drugs can cost as much as 80 percent less than their name-brand counterparts. In 2005, the average retail price of a generic prescription drug was about $30, compared with $100 for the name-brand drug.
Here are three ways to cut drug costs and encourage the use of generics:
Make sure your pharmacy benefits program includes a well-managed formulary. For example, moving name-brand drugs to the most expensive formulary tier when new generics are introduced will encourage employees to try the generic.
Educate employees about the value of generics. Employee education is an important tool for increasing the use of generics. Any perceived differences in quality or effectiveness must be removed.
Analyze current drug usage and isolate opportunities for improvement. To increase the use of generics, it is important to know which drugs are most prescribed and which cost the most.
For more cost-saving ideas, contact Jon Braddock at jbraddock@wha.org or Fred Bounds at fred.bounds@kunkel-bounds.com .