Among the "traditional lobbying powers" of WMC, WEAC, and WHA, WHA spent the most lobbying hours devoted to the 2007-2009 biennial budget during the first half of 2007, according to reports filed with the Wisconsin Ethics Board. WHA logged 2,117 lobbying hours on the budget and an additional 530 lobbying hours on other topics for a total of 2,647 lobbying hours during the first half of 2007.

"Navigating this year’s complex budget process, including opposing the hospital tax proposed by Governor Doyle and aggressively advocating for increased Medicaid reimbursement for hospitals, has been the top priority for WHA and our members in 2007," said WHA President Steve Brenton. "That priority is clearly reflected in WHA’s lobbying numbers."

WHA also topped all lobbying organizations in the amount of dollars devoted to lobbying during the first half of 2007. This is the first time WHA has topped that list during a reporting period.

"Wisconsin hospitals place a high priority on improving both the quality of health care and access to health care in Wisconsin. WHA has and will continue to aggressively and effectively advocate for our members at the Capitol," said WHA Executive Vice President Eric Borgerding.

In addition, WHA lobbied on a host of other evolving issues important to hospitals that included: health care reform; quality improvement activity, including the criminalization of medical errors; medical record copy fees; dental access; and job reference immunity for hospitals providing information to other hospitals about former employees.

"The 2007-2008 legislative session has thus far proved to be very busy for WHA and our member hospitals," said Borgerding. "There is no doubt that the rest of the session will continue to present numerous opportunities and challenges in the State Capitol."

I support economic development efforts for Wisconsin that recognize the importance of our college and technical school systems in helping people get ahead and meeting employer demand in the global economy. I want a better partnership between state and local government. I want to work to reduce the property tax burden and reform our campaign finance system in a way that restores the public’s trust in government.

2. As part of the state budget, Senate Democrats approved one of the most sweeping policy changes in state history when they introduced their plan to overhaul Wisconsin’s health care system. This proposal, Healthy Wisconsin, which relies heavily on state government to plan, administer and finance the delivery of health care, has been criticized for focusing on how health care is paid for rather than addressing the underlying causes of what is driving the rising cost of health care. What do you view as the key issues for health care reform? Do you believe Healthy Wisconsin will actually save Wisconsin employees and employers on their health care costs?

Major decisions on health care policy for the state require careful consideration, and while I do not support including the Healthy Wisconsin proposal in the budget, I look forward to separate hearings where we can evaluate the positives and negatives of such a plan. Any health care reform proposal has to address cost and access issues. Our insurance pool should match the demographic and health profile of the state, rather than being selectively chosen because of low health care needs. Insurance only works when you have healthy and unhealthy people in the same risk pool.

The Healthy Wisconsin proposal has many positives including ensuring all Wisconsin residents and employees under the age of 65 have health coverage, allowing participants to choose their own doctor, lowering administrative costs, encouraging competition, and saving taxpayers money.

The biggest cost savings we can achieve in health care will come in preventive care and chronic disease management, both of which are a priority in the Senate plan. Qualitative and quantitative competition will only be possible when everyone is insured and cost shifting is eliminated.

Who should receive or pay for health care often gets caught up in ideological differences. It is extremely difficult to reform health care when decisions are paralyzed by partisan passion and well-financed and well-organized special interest groups.

3. In his budget proposal, Governor Doyle proposes a tax on hospitals. Several concerns have been raised about the viability of this tax and its negative impact on hospitals and health care consumers across the state. Do you support a tax on hospitals?

I think we need to address the low reimbursement rate that leads to cost shifting or losses, and believe that our doctors and hospitals should be partners with the state in developing those proposals as I understand was done in Illinois. The reality is with rising health care costs, an aging population and declining reimbursement, we need to find an alternative revenue source to the general fund. I have spoken with hospital administrators in Wisconsin that are winners and losers under the proposed assessment. I don’t want to back anything that will automatically pass the costs on to patients, so I am not sold (on the hospital assessment) as the best source, but I do support the goal of increasing Medicaid reimbursement.

4. Governor Doyle also proposes to remove over $873 million dollars from the current state Medicaid budget to use for other state spending unrelated to health care. This Medicaid budget "hole" is then backfilled in part with revenue generated from a tax on hospitals. What are your views on using funding designated for one state program to pay for other state programs?

In cases like the Patient Compensation Fund, I oppose moving money from that fund. When it comes to alternative funding for Medicaid programs, it is important to look at the rising costs of health care and the fact that Medicaid is the fastest growing part of the state budget. If we continue to fund Medicaid programs solely from general fund dollars, it is unlikely we will have the funding necessary to invest in core government services like K-12, police and fire services and property tax relief for local government, or economic development expansion through our technical college or university system.

5. A Madison nurse was criminally charged after making an unintentional error. Would you support legislation to protect our health care workforce from criminal charges for unintentional errors?

I recently met with a group of nurses who were very concerned about this case and the potential impact on their ability to provide health care services. Unintentional errors should not be penalized. We should support efforts to reduce medical error rather than having nurses work in fear.

6. Caring for smoking-related illness adds hundreds of millions to the cost of health care for Wisconsin employees and employers. Inadequate Medicaid provider reimbursements compound the problem of rising health care costs. Governor Doyle has proposed increasing the cigarette tax by $1.25, but wants to use the revenue to backfill existing dollars being taken out of MA. Do you support this increase and if so, how should the dollars it generates be used?

I certainly support the efforts to reduce smoking and smoking related illnesses and understand the argument of capturing the costs to Medicaid from smoking. One of my concerns is that we are committing a declining revenue source to fund government programs that are likely to increase. The revenue won’t stay at the level budgeted and when we consider multi-year budgets, I question using a declining revenue source to fund what are long-term needs. This needs to be part of the Medicaid funding discussion.

7. Any other comments?

My view is that we all need to participate in the health care debate. There are proposals before Congress to empower states to develop their own health care policy. I think Wisconsin has an opportunity to be a leader and believe it should be with a collaborative approach as much as possible. In the current debate, I don’t disagree with some of the wellness or healthy incentive initiatives from my Republican colleagues, but believe reform policies must not discourage preventative care or discriminate against people predisposed to illnesses such as cancer.

"The Healthy Wisconsin Board will be unelected and would have taxing authority that will be over $15 billion a year, in the first year," said Dale Knapp, a WTA analyst, who also indicated that is more than the Legislature levies in taxes in an entire year. The WRN story points out that while unusual, it is not unknown for unelected bodies to have taxing authority.

According to Knapp, accountability is the issue. "Where does the taxpayer turn? How is there any accountability? I think that’s the big problem here," he said.

Among several serious concerns with Healthy Wisconsin, WHA also views the Healthy Wisconsin Authority—a group that specifically excludes health care providers from membership—as being granted ominous subjective power and control to micromanage Wisconsin’s health care system.

Health care reform remains a central topic of budget conference committee discussions expected to last well into fall.

WHA has prepared a detailed summary of the Medicare Outpatient Prospective Payment System (OPPS) for calendar year (CY) 2008. It can be found at www.wha.org/financeAndData/pps_outpatient.aspx.

The most significant provisions in the proposed rule for CY 2008 are the elimination of certain Ambulatory Payment Classifications (APCs) by expanding packaging of ancillary services and combining certain APCs into new encounter-based APCs. These new encountered-based APCs would have a single payment made when a certain combination of HCPCS codes are reported on the same date of service, rather than paying for individual services under service-specific APCs.

In addition, CMS is proposing to establish a separate quality measure reporting program called the Hospital Outpatient Quality Data Reporting Program (HOP QDRP) that will measure a hospital’s outpatient quality of care. Under this proposal, to be eligible to receive the full OPPS payment update for services furnished in CY 2009, providers would be required to submit data on ten outpatient measures effective for hospital outpatient services furnished on or after January 1, 2008. Non-compliant providers in CY 2008 would receive the OPPS update reduced by 2.0 percent in CY 2009. More information will be made available on the quality data reporting as it becomes available.

Hospitals should review the proposed rule and the summary and, given the major changes included in the proposed rule, submit comments to CMS outlining how the changes will affect your facility. Comments on the proposal are due to CMS by September 14.