This week the Wisconsin Hospitals Issue Advocacy Council, Inc. (WHIAC), a 501(C)(4) organized to promote, develop, and encourage the distribution of information about Wisconsin’s health care climate and the importance of enabling high quality health care, launched a radio campaign aimed at educating the public about national health care reform and its impact on Wisconsin. The radio message focuses on the many strengths of Wisconsin’s health care system.

"With costs rising and millions uninsured, Congress is looking to make sweeping changes to health care that will impact the entire country …But here in Wisconsin, we’re not waiting for Washington-style health care reform. We’ve already developed one of the best health care systems in America," the narrator says.

The ad goes on to tout Wisconsin’s low number of uninsured and that fact that Wisconsin’s health care system has been ranked as the best in the country by a recent federal report card.

"To improve our nation’s health care, we need a system more like Wisconsin’s, where we have high quality care and physicians and their patients decide what’s best."

The ad concludes by urging listeners to contact their congressperson and urge them to "use Wisconsin as a model for national health care reform."

"Wisconsin certainly has its challenges when it comes to health care, but we are also a national leader in so many ways," said WHA Executive Vice President Eric Borgerding. "We have the second highest percentage of people covered by health insurance, the highest quality of care in the country, and according to the respected Dartmouth Atlas, health care is a tremendous value in Wisconsin. We’ve done all of this in a bipartisan fashion and still have a ways to go, but we are definitely heading down the right path."

Three months into its 2009 campaign, the Wisconsin Hospitals State PAC and Conduit Fundraising Campaign has raised $117,277, or 55 percent of its $213,000 goal. At this time last year, an election year when the Campaign generally starts stronger, the State PAC and Conduit had received $160,000 in contributions, or 76 percent of the Campaign’s goal. In 2007, the last non-election year, the State PAC and Conduit had received $125,000 in contributions, or 63 percent of the Campaign’s goal.

The 2009 Campaign also aims to increase the number of individual contributors by 10 percent, increasing the total number of contributors to 660 people. To date, 253 individuals have contributed on average $460 to either the Wisconsin Hospitals State PAC or Conduit.

Individual contributors are listed below by name and affiliated organization. Contributors are listed alphabetically by contribution category. The next list will be published in the August 21 edition of The Valued Voice. For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.

Contributions Ranging from $1 - $249

Adams, Daniel         Memorial Medical Center - Ashland

Albers, Kirstin         Meriter Hospital

Annala, Shannon         Aspirus Wausau Hospital

Arendt, Kathleen         Aspirus Wausau Hospital

Banaszynski, Gregory         Aurora Health Care

Beckler, Rick         Sacred Heart Hospital

Bernklau, Robert         Memorial Health Center

Bliven, David         Aspirus Wausau Hospital

Bosio, David         Aspirus Wausau Hospital

Boson, Ann         Saint Joseph’s Hospital

Bowe, Cynthia         Sacred Heart Hospital

Bradley, Connie         Columbia St. Mary’s Columbia Hospital

Braun, James         Flambeau Hospital

Brisch, Joe         Holy Family Memorial Medical Center

Brueggeman, Mary         St. Joseph’s Community Health Services

Burgener, Jean         Aspirus Wausau Hospital

Burtch, Sue         Aspirus Wausau Hospital

Campbell-Kelz, Nancy         Aspirus Wausau Hospital

Casey, Karen         Columbia Center

Censky, Bill         Holy Family Memorial Medical Center

Chartier, Jacklyn         Aspirus Wausau Hospital

Coblentz, Kathy Jo         St. Joseph’s Community Health Services

Cohen, Joan         Aspirus Wausau Hospital

Colby, Daniel         Mercy Health System

Collins, Sherry         Wisconsin Hospital Association

Cox, Tamarah         Aspirus Wausau Hospital

Culotta, Jennifer         St. Clare Hospital and Health Services

Davis, Kathleen         Children’s Hospital of Wisconsin

Decker, Dawn         Aspirus Wausau Hospital

Dettman, Amy         Bellin Memorial Hospital

DeWitt, Pamela         St. Joseph’s Community Health Services

Diemer, Peggy         Aspirus Wausau Hospital

Dietsch, Teresa         St. Clare Hospital and Health Services

Dittrich, Peggy         Memorial Health Center

Dorpat, Denice         Aspirus Wausau Hospital

Draxler, Deborah         Aspirus Wausau Hospital

Duda, Carrie         Wheaton Franciscan Healthcare - All Saints

Erickson, Susan         Meriter Hospital

Facey, Alice         St. Clare Hospital and Health Services

Gantner, Sue         Aspirus Wausau Hospital

Garavet, Scott         Aspirus Wausau Hospital

Gengler, Tim         Aspirus Wausau Hospital

Grohskopf, Kevin         St. Clare Hospital and Health Services

Gulan, Maria         Aspirus Wausau Hospital

Haggerty, Peggy         Columbus Community Hospital

Harter, Ellen         Aspirus Wausau Hospital

Hieb, Laura         Bellin Memorial Hospital

Hinton, George         Aurora Sinai Medical Center

Hinz, Russ         Aurora Health Care

Hoege, Beverly         Reedsburg Area Medical Center

Holmes, Sheri         Aspirus Wausau Hospital

Hueller, Julie         Wheaton Franciscan - Milwaukee

Jelle, Laura         St. Clare Hospital and Health Services

Jones, Mary         Meriter Hospital

Jones, Tom         St. Joseph’s Community Health Services

Karow, Deborah         Aspirus Wausau Hospital

Kempen, Jacob         Aspirus Wausau Hospital

Krueger, Pamela         Aspirus Wausau Hospital

Lang, Susan         Aspirus Wausau Hospital

Lerch, Shawn         Columbus Community Hospital

Logemann, Tim         Aspirus Wausau Hospital

Lopas, Mary         Door County Memorial Hospital

Lorenz, Bruce         Aspirus Wausau Hospital

Lucas, Roger         Aspirus Wausau Hospital

Lunde, Pam         Columbus Community Hospital

Marcouiller, Don         Memorial Medical Center - Ashland

Marquardt, Amy         Columbia St. Mary’s Columbia Hospital

Marsch, Jean         St. Vincent Hospital

Mason, Paul         Wheaton Franciscan Healthcare - All Saints

Merwald, Alfred         Aspirus Wausau Hospital

Mickelson, Ronald         St. Clare Hospital and Health Services

Miloszewicz, Angela         Wisconsin Hospital Association

Morauske, Michelle         WHA Financial Solutions, Inc.

Mourey, Gerald         Aspirus Wausau Hospital

Mulder, Doris         Beloit Memorial Hospital

Ohrmundt, Joel         Aspirus Wausau Hospital

Olson, Keri         St. Clare Hospital and Health Services

Osen, John         Aspirus Wausau Hospital

Peck, Lori         Memorial Health Center

Peickert, Barbara         Hayward Area Memorial Hospital and Nursing Home

Peters, Kenneth         Bellin Memorial Hospital

Plaisance, Christopher         Aspirus Wausau Hospital

Powell, Stacey         Sacred Heart Hospital

Prunty, Brian         Aspirus Wausau Hospital

Quade, Steve         Door County Memorial Hospital

Rasmussen, Sheri         WHA Financial Solutions, Inc.

Reding, Rick         Aspirus Wausau Hospital

Rocole, Theresa         Wheaton Franciscan Healthcare - All Saints

Rosenberger, Herb         ProHealth Care

Roundy, Ann         Columbus Community Hospital

Schade, Randy         Aspirus Wausau Hospital

Schraufnagel, Patricia         Memorial Medical Center - Ashland

Schweitzer, Susan         Columbus Community Hospital

Scinto, Jeanne         Aspirus Wausau Hospital

Selberg, Heidi         St. Mary’s Hospital Medical Center

Sergey, Mark         Sacred Heart Hospital

Sheehan, Heather         Hayward Area Memorial Hospital and Nursing Home

Stranberg, Kevin         Memorial Medical Center – Ashland

Sullivan, Anne         Memorial Medical Center - Ashland

Swanson, Kerry         SSM Health Care-Wisconsin

Todd, Jeffrey         Aspirus Wausau Hospital

Tryba, Jennifer         Aspirus Wausau Hospital

Verploegh, Alan         Aspirus Wausau Hospital

Voelker, Thomas         Aspirus Wausau Hospital

Voigt, Yolanda         Aspirus Wausau Hospital

Walker, Troy         St. Clare Hospital and Health Services

Wanserski, James         Aspirus Wausau Hospital

Welch, Kimberly         Aurora Health Care

Wilson, Deanna         Upland Hills Health

Wojciechowski, Gary     Aspirus Wausau Hospital

Zeller, Brad     Hayward Area Memorial Hospital and Nursing Home

Contributions Ranging from $250 - $499

Abitz, John         WHA Financial Solutions, Inc.

Allison Stonebraker, Pat         Children’s Hospital of Wisconsin

Andersen, Travis         St. Elizabeth Hospital

Ayers, Mandy         Wisconsin Hospital Association

Biros, Marilyn         SSM Health Care-Wisconsin

Byrne, Frank         St. Mary’s Hospital

Clapp, Nicole         Grant Regional Health Center

Clough, Sheila         Howard Young Medical Center

Conwell, Lisa         WHA Financial Solutions, Inc.

Curran, Joan         Gundersen Lutheran Medical Center

Danner, Forrest         Aspirus Wausau Hospital

Deich, Faye         Sacred Heart Hospital

Dietrich, Dean         Aspirus Wausau Hospital

Drengler, Kathryn         Aspirus Wausau Hospital

Erickson, Robert         Aspirus Wausau Hospital

Erickson, William         Sacred Heart-St. Mary’s Hospitals

Furlong, Marian         Hudson Hospital

Geiss, Peter         ProHealth Care

Gruber, Richard         Mercy Health System

Grundstrom, David         Flambeau Hospital

Guffey, Kerra         Meriter Hospital

Gutsch, Mike         Southwest Health Center

Hattem, Marita         Aspirus Wausau Hospital

Hessert, Peter         Aspirus Wausau Hospital

Hilt, Monica         Sacred Heart-St. Mary’s Hospitals

Johnson, Charles         St. Mary’s Hospital

Keene, Kaaron         Memorial Health Center

Kostroski, Sharon         Saint Joseph’s Hospital

Mantei, Mary Jo         Bay Area Medical Center

Marciano, Karol         Columbia St. Mary’s Milwaukee Hospital

May, Carol         Sauk Prairie Memorial Hospital

McCoic, Kristie         St. Joseph’s Community Health Services

McKevett, Timothy         Beloit Memorial Hospital

Merline, Karen

Nelson, James         Fort HealthCare

Nevers, Rick         Aspirus Wausau Hospital

Nick, Mary         Meriter Hospital

Olkowski, Leland         Aspirus Wausau Hospital

Olson, Gregory         Memorial Health Center

Pinekenstein, Barbara         ProHealth Care-Oconomowoc Memorial

Pollard, Dennis         Community Memorial Hospital

Roberts, Phillip         Columbus Community Hospital

Ross, Forrest         WHA Financial Solutions, Inc.

Rowe, Jeanne         Aspirus Wausau Hospital

Sanicola, Suzanne         Columbia St. Mary’s Columbia Hospital

Schroeder, Larry         Sauk Prairie Memorial Hospital

Schulz, Janet         ProHealth Care

Sczygelski, Sidney         Aspirus Wausau Hospital

Shapiro, David         Columbia St. Mary’s Columbia Hospital

Spieckerman, Jill         Sacred Heart-St. Mary’s Hospitals

Staffileno, Gerri         Columbia St. Mary’s Ozaukee Hospital

Stout, Johni         WHA Financial Solutions, Inc.

Stuart, Philip         Tomah Memorial Hospital

Swiderski, Julie         Wheaton Franciscan - Milwaukee

Taplin Statz, Linda         SSM Health Care-Wisconsin

Van Meeteren, Bob         Reedsburg Area Medical Center

Voss, Mark         Aspirus Wausau Hospital

Worrick, Gerald         Door County Memorial Hospital

Yunk, Dennis         Agnesian HealthCare

Contributions Ranging from $500 - $999

Anderson, Sandy         St. Clare Hospital and Health Services

Bayer, Tom         St. Vincent Hospital

Borgerding, Dana

Braddock, Michelle         WHA Financial Solutions, Inc.

Buerstatte, Gary         ProHealth Care

Bukowski, Cathy         Our Lady of Victory Hospital

Callies, Julie         WHA Information Center

Canter, Richard         Wheaton Franciscan Healthcare

Desien, Nicholas         Ministry Health Care

Dietsche, James         Bellin Memorial Hospital

Eddy, Lee Anne         Children’s Hospital of Wisconsin

Frank, Jennifer         Wisconsin Hospital Association

Gutzeit, Michael         Children’s Hospital of Wisconsin

Harding, Edward         Columbus Community Hospital

Heifetz, Michael         SSM Health Care-Wisconsin

Huber, Mark         Aurora Health Care

Kersten, Juliet         Children’s Hospital of Wisconsin

Kerwin, George         Bellin Memorial Hospital

Klawiter, Anne         Southwest Health Center

Klimisch, Ronald         Aspirus Wausau Hospital

Korom, Nancy         Children’s Hospital of Wisconsin

Levin, Jeremy         Rural Wisconsin Health Cooperative

Merline, Paul         Wisconsin Hospital Association

Miller, Jim         Children’s Hospital and Health System

Mlynarek, Robert         ProHealth Care-Waukesha Memorial

Neufelder, Daniel         Affinity Health System

Postler-Slattery, Diane         Aspirus Wausau Hospital

Potter, Brian         Wisconsin Hospital Association

Radoszewski, Pat         Children’s Hospital of Wisconsin

Richards, Theresa         Saint Joseph’s Hospital

Sachdeva, Ramesh         Children’s Hospital of Wisconsin

Schafer, Michael         Spooner Health System

Shabino, Charles         Wisconsin Hospital Association

Ship, Mark         Children’s Hospital of Wisconsin

Siebecker, William         Aspirus Wausau Hospital

Stine, Stephen         Aspirus Wausau Hospital

Wallace, Michael         Fort HealthCare

Wolf, Edward         Lakeview Medical Center

Woodward, Jim         Meriter Hospital

Contributions Ranging from $1000 - $1999

Bazan, Bill         Wisconsin Hospital Association

Birkenstock, Timothy         Children’s Hospital of Wisconsin

Bloch, Jodi         Wisconsin Hospital Association

Boese, Jennifer         Wisconsin Hospital Association

Braddock, Jonathan         WHA Financial Solutions, Inc.

Brideau, Leo         Columbia St. Mary’s Columbia Hospital

Britton, Gregory         Beloit Memorial Hospital

Chapin, Rocklon         St. Mary’s/Duluth Clinic Health System

Christensen, Cinthia         Children’s Hospital of Wisconsin

Duncan, Larry         Children’s Hospital of Wisconsin

Dunigan, Thomas         Children’s Hospital of Wisconsin

Eichman, Cynthia         Our Lady of Victory Hospital

Erwin, Duane         Aspirus Wausau Hospital

Gazzana, Thomas         Children’s Hospital of Wisconsin

Grasmick, Mary Kay         Wisconsin Hospital Association

Kachelski, Joe         WHA Information Center

Karuschak, Michael         Amery Regional Medical Center

Kosanovich, John         Watertown Memorial Hospital

Kryda, Michael         Saint Joseph’s Hospital

Leitch, Laura         Wisconsin Hospital Association

Loftus, Philip         Aurora Health Care

Mettner, Michelle         Children’s Hospital of Wisconsin

Morgan, Dwight         Aurora Health Care

Munson, Kenneth         Children’s Hospital of Wisconsin

Niemer, Margaret         Children’s Hospital of Wisconsin

O’Brien, Mary Aurora         St. Luke’s Medical Center

Oldham, Keith         Children’s Hospital of Wisconsin

Olson, David         Bay Area Medical Center

Olson, Edward             ProHealth Care-Waukesha Memorial

Reynolds, Sheila         Children’s Hospital of Wisconsin

Richardson, Dana         Wisconsin Hospital Association

Robertstad, John         ProHealth Care-Oconomowoc Memorial

Roller, Rachel         Aurora Health Care

Sanders, Robert         Children’s Hospital of Wisconsin

Stanford, Matthew         Wisconsin Hospital Association

Titus, Rexford         ProHealth Care

Troy, Peggy         Children’s Hospital and Health System

Turkal, Nick         Aurora Health Care

Warmuth, Judith         Wisconsin Hospital Association

Westrick, Paul         Columbia St. Mary’s Milwaukee Hospital

Contributions Ranging from $2000 - $2999

Brenton, Mary E.

Buser, Kenneth         Wheaton Franciscan Healthcare - All Saints

Katen-Bahensky, Donna

Oliverio, John         Wheaton Franciscan Healthcare

Quinn, George         Wisconsin Hospital Association

Starmann-Harrison, Mary         SSM Health Care-Wisconsin

Tyre, Scott         Capitol Navigators, Inc

Contributions Ranging from $3000 and up

Borgerding, Eric         Wisconsin Hospital Association

Brenton, Stephen         Wisconsin Hospital Association

Size, Tim         Rural Wisconsin Health Cooperative

The recently passed Wisconsin State Budget (2009 Wis. Act 28) included a new requirement for law enforcement (or other authorized person) transporting an individual to a treatment facility for the purpose of emergency detention. The statute now requires the law enforcement officer who took the individual into custody to obtain the approval of the county mental health authority of the county in which the individual was taken into custody. Act 28 added the following underlined language to s. 51.15(2) of the Wisconsin Statutes:

The law enforcement officer…shall transport the individual, or cause him or her to be transported, for detention, if the county department of community programs in the county in which the individual was taken into custody approves the need for detention, and for evaluation, diagnosis, and treatment if permitted under sub, (8) to [a treatment facility].

While this is an important amendment, in order to make sure some of our most vulnerable residents are cared for appropriately, it is important to read the new language in the context of the other statutory provisions related to emergency detention. The goal of this change, which the Wisconsin County Association requested, was to encourage a more collaborative approach to emergency detentions. With the added consultation, a county will have the opportunity to focus its resources to meet a particular need and perhaps influence a decision whether to detain an individual. DHS supports this goal.

All involved, however, must keep in mind that the authority to detain someone under the emergency detention statutes exists only when a law enforcement officer has cause to believe that an individual is mentally ill, drug dependent, or developmentally disabled and evidences the substantial probability of physical harm to himself or herself or to others. An important purpose of the statute is to protect the individual and the public, and we must read the statute and this change with that in mind.

Below are responses to some of the questions the Department’s Division of Mental Health and Substance Abuse has received concerning the new requirement:

When there is a patient in need of emergency detention, what is the process for law enforcement to obtain the approval of the appropriate county? How are hospitals involved in the process?

There is no process specified in the law. Each county may determine its own procedures for law enforcement to seek detention approval from its mental health authority, taking into account the unique demands and resources of that county. It is important to note that the responsibility of complying with the new law falls upon law enforcement and the county mental health authority. While DHS encourages law enforcement and county mental health authorities to coordinate with hospitals and other local actors involved in the emergency detention process, the new requirement is with law enforcement and the county.

What if there is a disagreement between the county and law enforcement concerning whether an individual should be transported for emergency detention?

The new law does not specify a process or criteria for resolving disagreements between law enforcement and mental health authorities regarding the need for emergency detention. DHS hopes the effect of the new requirement will be to improve communication and collaboration between law enforcement and the county mental health authority.

Did the change affect hospital duties?

In its role as operator of the state mental health institutes, DHS does not interpret the new law to create a responsibility on the part of a receiving hospital to guarantee that the connection between law enforcement and the mental health authority has occurred, or that the mental health authority has approved the detention. For that reason, if law enforcement brings a patient for emergency detention to Mendota or Winnebago, the State will not ask if the officers talked to the relevant mental health authority prior to transport. Assuming the admission is otherwise appropriate, we will admit the patient.

As with many of the changes made to Ch. 51 from time to time, people will need to become comfortable with the new process. I strongly believe that if people keep in mind the goal of the change is increased collaboration between law enforcement and the county mental health authority, and recognize that the ultimate purpose of the emergency detention authority is to protect individuals and the public, we can all make this change work for the benefit of our patients and our communities.

In committee action this week, the Joint Committee on Finance approved an allocation and expenditure request from Governor Doyle for moneys the state is poised to receive under the federal American Recovery and Reinvestment Act of 2009 (ARRA) to support activities to reduce health care associated infections (HAIs).

On a 15-0 vote, with Rep. Pedro Colon (D-Milwaukee) excused, the committee approved the Governor’s request to allow the Department of Health Services (DHS) to allocate and expend just over $1.4 million in the 2009-11 biennium.

Under the DHS proposal, a majority of the funding would be used to support program salaries and benefits at the Department, existing improvement projects with MetaStar for their MRSA project, and for the WHA Stop BSI project.

WHA is a key partner in these efforts. Vice President for Quality Initiatives Dana Richardson is a member of the project’s steering committee that includes public and private health care partners. The committee will work with the Department to develop and promote Wisconsin’s statewide HAI prevention strategies.

September 23-25, 2009, Grand Geneva Resort, Lake Geneva

Final cut-off for hotel reservations: September 2
Conference registrations due: September 9

At the request of the Wisconsin Hospital Association, the Wisconsin Medical Examining Board (MEB) created new policy and practice that will greatly improve the time required to receive a Wisconsin license if a physician has an unrestricted license in Minnesota. WHA expects this new process to enhance recruitment of physicians from Minnesota as well as to improve access to both primary and specialist physicians for Wisconsin residents. Thank you to both the MEB and DRL for responding to the WHA request. WHA continues working with the Department of Regulation and Licensing to reduce the time required for all occupational groups to obtain licensure.

As promised, the Department of Regulation and Licensing (DRL) moved quickly to implement a new, faster process for Minnesota physicians to apply for and receive a Wisconsin license. New forms can be found on the DRL Web site by clicking on Health Professions, then choose Physician and choose Forms on the left hand side. The application packet for Minn. physicians is posted there and ready for use. It can also be accessed using this link: http://drl.wi.gov/prof/doct/form.htm. Instructions for the application can be found at: http://drl.wi.gov/dept/forms/fm2861.pdf and will be very helpful to recruiting and credentialing staff.

NOTE: Even though the forms are currently available, it may be wise to submit the application next month. If a physician applies and becomes licensed before 9/1/2009, he or she will have to renew that license by 10/31. A license granted on or after 9/1 will be good until 10/31/2011.

• A few weeks ago a Wall Street Journal editorial asked "What’s the Rush"? The strongly worded opinion piece argued that health reform should NOT be rushed through Congress and used the federal stimulus legislation as an example of what happens when Congress throws a pile of expensive ideas together, claims that there’s an urgent need to "do something," cobbles together just enough votes to get the bill passed, and then looks befuddled and defensive when the public pushes back after learning of the "uneven" results, including the absence of new jobs.

Thankfully, moderate Democrats said "NO" in July to efforts to speedily pass flawed reform legislation prior to the August recess. The public now has the opportunity to weigh in and the results will be a reality check for some.

• In defending the public plan option at a news conference in D.C. last week, Rep. Donna Edwards (D-MD) demonstrated her need for a remedial health economic class when she defended the physician "Medicare plus 5 percent" payment rates as "the only way…to lower costs for all Americans." Her remarks underscore the staggering disconnect that many have with the notion of what health care costs actually are….and that somehow they will actually be "lowered" by imposing Medicare fee schedules on providers. Here’s a bet that Rep. Edwards will elbow her way to the front of the line to blast hospitals for closing community clinics and laying off her constituents because of expense reductions caused by inadequate payments.

• Q. What does the "Cash for Clunkers" program have in common with the Massachusetts’s health care expansion initiative?

A. They both demonstrate the public appetite for "free" (or heavily subsidized) programs and validate the expression "no such thing as a free lunch"…an important lesson to be learned as Congress grapples with the cost of new premium subsidies and determines who’ll pay the tab for what will likely be a program that’s far more expensive than currently forecast.

• WHA’s radio campaign is focused on telling "the Wisconsin story" and making sure that our Congressional Delegation works to ensure that a final health care initiative isn’t a "one-size fits all" approach that fails to account for the hard work and foresight that has shaped a pretty good story for the Badger State.

• In the "someone needed to say it" category comes some commentary from John David Lewis, a Duke University associate Professor who noted the following in the Raleigh News-Observer….

If Congress really wanted to address health care problems, it could begin with three things: (1) tort reform, to end the ruinous lawsuits that force medical specialists into insurance costing hundreds of thousands of dollars per year; (2) Medicare reform, to face squarely the fact of the program’s insolvency; and (3) regulatory reform, to roll back the onerous rules that force doctors, hospitals and pharmaceutical companies (who are pilloried for producing the care that many people then demand as a "right") into satisfying bureaucratic dictates rather than solving patients’ problems.

Steve Brenton
President

On July 31, 2009, the Centers for Medicare & Medicaid Services (CMS) released a display copy of the Final Rule updating the payment rates and policies for the Medicare inpatient prospective payment system (IPPS) for fiscal year (FY) 2010.

In brief, some of the highlights of the Final Rule include:

• Market Basket Update. CMS rebased and revised the structure of the operating and capital market baskets using data from FY 2006. This results in an operating market basket update of 2.1 percent for FY 2010. However, hospitals that do not successfully participate in the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program will receive a market basket update less 2 percentage points (or 0.1 percent).
• Outlier Threshold. The Final Rule will raise the outlier threshold to $23,140 to keep outlier payments equal to 5.1 percent of total IPPS payments in FY 2010.
• Labor Related Share. In the Proposed Rule, CMS proposed lowering the labor related share to 67.1 percent for FY 2010 (from 69.7 percent in FY 2009). However, based on a revised methodology for allocating costs, CMS has calculated a 68.8 percent labor related share for FY 2010.
• MS-DRG Relative Weights. In the Final Rule, CMS does not make any policy changes to Medicare severity diagnosis related groups (MS-DRG) relative weights. However, CMS discusses options for improving the standardization process and summarizes public comments regarding how to process can be improved to more precisely remove cost differences across hospitals.
• DSH/Labor and Delivery Days. CMS will count in the Medicare disproportionate share hospital (DSH) calculation patient days associated with beds for labor and delivery (L&D) services even when the patient did not occupy a routine bed prior to occupying an ancillary bed (because it is CMS’s view that L&D beds are inpatient beds and the patient days spent in L&D beds are generally payable under IPPS).
• DSH/Observation Beds and Inpatient Days. CMS will exclude all patient days and beds associated with observation services from the DSH calculation (because it is CMS’s view that a patient who is receiving observation services is considered an outpatient and not an inpatient). Under this policy, observation beds would also not be counted for determining a hospital’s indirect medical education payments.
• DSH/Aggregating Inpatient Days. CMS will allow hospitals to accumulate the number of days in the numerator of the Medicaid fraction of the Medicare disproportionate patient percentage by date of discharge, date of admission or dates of service. However, CMS will preclude hospitals from "double counting" days should they change their methodology.
• Graduate Medical Education. In the Final Rule, CMS clarifies the definition of a new medical residency training program. CMS also specifies that a new hospital that begins training residents for the first time after July 1 will be permitted to submit a Medicare graduate medical education (GME) affiliation agreement prior to the earlier of the end of its cost reporting period or the end of the academic year in order to participate in a Medicare GME affiliated group for the remainder of the academic year.
• RHQDAPU Program. The Final Rule adds four new measures and program requirements to the current measures, including:
• Urinary catheter removed post-op day one or day two
• Surgery patients with perioperative temperature management
• Participation in a Systematic Clinical Database Registry: Nursing Sensitive Care
• Participation in a Systematic Clinical Database Registry: Stroke Care
• Hospital Acquired Conditions. The Final Rule does not change the list of hospital acquired conditions for FY 2010.

In FY 2008, CMS adopted MS-DRGs. In response, CMS expected for hospitals to change their coding practices (causing Medicare spending to increase). Therefore, CMS proposed to adjust FY 2010 rates by 1.9 percent so that the perceived increase in spending from documentation and coding would not carry forward. However, without knowing the documentation and coding effects on FY 2009 spending, CMS has decided not to implement an adjustment in FY 2010.

"WHA appreciates the work of the American Hospital Association in persuading CMS to hold off on the so-called behavioral offset," said George Quinn, WHA Senior Vice President. "We estimate that this effort by AHA prevented about $35 million in Medicare cuts to Wisconsin hospitals for 2010."

CMS is scheduled to publish the Final Rule in the Federal Register on August 27, 2009.

This week Rep. Steve Kagen held several listening sessions in Green Bay and Appleton. He is one of several in Wisconsin’s Congressional Delegation hosting listening sessions or town hall meetings during the August recess/district work period. Regardless of what they’re called, the events provide constituents a chance to hear from their Members of Congress and to also express their views on important issues. With national health care reform front and center in Washington, DC, this is an opportunity for you to make your voice heard.

In general, WHA has stressed the following with Wisconsin’s Congressional Delegation on health care reform:

• Wisconsin hospitals provide high quality, low-cost care. This has been backed up by Wisconsin’s recent #1 ranking by AHRQ for our health care quality. WHA supports health care reform that promotes and rewards this approach: value (high quality, lower-cost, efficient care) versus the current volume-based approach.

• Wisconsin has some of the lowest uninsured rates in the country. WHA and our hospitals have supported initiatives, like the BadgerCare Plus program expansions, that target uninsured and at-risk populations.

• Medicare reimbursement/geographic disparity – Support for payment reforms that work to reduce geographic/physician disparity issues. If these inadequate Medicare rates are then "baked into" health care reform, such as proposed with a public plan option, Wisconsin will be doubly disadvantaged.

• A public plan option tied to Medicare would have significant negative impacts on our hospitals, would dictate that prices be set at already inadequate Medicare levels, undermine the private insurance market and move large numbers of commercially insured into the public plan option.

• Health care coverage does not necessarily equal access. Simply expanding those who have coverage will not necessarily assure access to care. We already know there are workforce shortages across the country and in Wisconsin. Any health care reform proposal must appropriately recognize and consider this reality.

• Be thoughtful and polite…while we know people are passionate about issues, yelling and bullying your Member of Congress is just not the most effective way to make your voice heard.
• Provide your perspective on the issue…tell your Member of Congress how the issue will impact you, your community, your hospital. Provide district specific impacts if you can.
• Follow up, follow up, follow up…attending a listening session is great and shows that you are paying attention, but make sure to follow up with your legislators. This helps them see you are committed to the issue and are not going away.

Several Wisconsin Members of Congress have already scheduled events in August to hear from their constituents. We’ve listed these events below.

Rep. Ron Kind
Rep. Ron Kind, representing cities like La Crosse, Prairie du Chien and many others, will host four listening sessions in upcoming weeks. Events will be held in Richland Center, Tomah, Whitehall and Darlington. Details below.

Tuesday, August 18
    3-4 p.m., County Courthouse, Conference Room 2 - First Floor, 181 W Seminary St, Richland Center, WI 53581, (608) 647-2626

Thursday, August 20
    11 a.m.-12:30 p.m., City Hall, Council Chambers, 819 Superior Ave., Tomah, WI 54660, (608) 374-7420

Friday, August 21
    11 a.m.-12:30 p.m., Tri-County Memorial Hospital, Education Room, 18601 Lincoln, Whitehall, WI 54773-8605, (715) 538-4361

Tuesday, August 25
    12:30-2 p.m., Memorial Hospital of Lafayette County, Conference Room, 800 Clay St., Darlington, WI 53530, (608) 776-4466

Rep. Tom Petri
Rep. Tom Petri, representing cities like Fond du Lac, Chilton, Manitowoc and Sheboygan, has seven remaining listening sessions scheduled in August.

Monday, August 10
    9:30 - 10:30 a.m., Green Lake, Caestecker Public Library, 518 Hill St., Conference Room
    2:30 - 3:30 p.m., Horicon, City Hall, 404 East Lake St., Activity Room A

        Thursday, August 13
            9-10 a.m., Oakfield, Community Center, 130 North Main St.
            3:30 - 4:30 p.m., Watertown, Municipal Building, 106 Jones St., City Council Chambers

Friday, August 14
    10-11 a.m., Adams, Municipal Building, 101 North Main Street, Council Chambers
    1-2 p.m., Wild Rose, Community Center, 500 Division
    3-4 p.m., Montello, Marquette County Courthouse, 77 West Park St., Public Safety Training Room

Rep. Paul Ryan
Rep. Paul Ryan, representing cities like Racine, Kenosha and Janesville, has over a dozen opportunities for you to make your voice heard in August. You may also talk with his staff during "mobile office hours." Log onto www.house.gov/ryan/moschedule.htm for a schedule.

Monday, August 24
    11:30 a.m.-12:15 p.m., Eagle, Village Hall, 820 East Main Street
    1:30-2:15 p.m., North Prairie, Village Hall, 130 North Harrison

Tuesday, August 25
    9:15-10:15 a.m., Sharon, Community Center, 125 Plain St.
    10:30-11:30 a.m., Genoa City, Village Hall, 715 Walworth St.
    12-1 p.m., Paddock Lake, Village Hall, 6969 236th Avenue
    2:15-3:45 p.m., Kenosha, Gateway Technical College, Science Building, Room S137, 3520 30th Avenue

Wednesday, August 26
    9:15-10:15 a.m., Williams Bay, Village Hall, 250 Williams Street
    10:30-11:30 a.m., Fontana, Village Hall, 175 Valley View Dr.
    11:45-12:45 p.m., Walworth, Village Hall, 227 North Main St.
    1:45-2:45 p.m., Darien, Village Hall, 24 North Wisconsin Street
    3:30-5 p.m., Janesville, City Hall, Council Chambers, 18 North Jackson Street

        Thursday, August 27
              9:45-10:30 a.m., Rochester, Municipal Hall, 203 West Main
             11:15 a.m.-12:15 p.m., Sturtevant, Village Hall, 2801 89th Street
              1:30-2:30 p.m., Racine, Gateway Technical College, Racine Building, Great Lakes Room #114, 901 Pershing Drive, use parking lot D 

        Monday, August 31
            12:45-1:30 p.m., Big Bend, Village Hall, W230 S9185 Nevins Street
            2-3 p.m., New Berlin, Citizens Bank of Mukwonago – New Berlin Branch, 5450 South Moorland Road
            3:30-4:30 p.m., Greendale, Safety Building, 5911 West Grange Ave.

Senator Russ Feingold
Senator Feingold frequently holds listening sessions across the state. Take a look at his interactive map for details on an event near you: http://feingold.senate.gov/listening/index.html.

Rep. Jim Sensenbrenner
Though Rep. Jim Sensenbrenner does not have any listening sessions in August, you can find a complete listing of his listening sessions through the rest of 2009 online at: http://sensenbrenner.house.gov/Contact.

Wisconsin hospitals, many of which are in the process of putting together their staffing budgets for the upcoming fiscal year, need to keep in mind that Wisconsin’s Family Medical Leave Act ("WFMLA") now includes qualified domestic partners. This change was included as part of the new State Budget (2009 Wis. Act 28). Under the amended WFMLA, Wisconsin employers with 50 or more employees must provide up to two weeks leave to an eligible employee to care for the serious health condition of the employee’s domestic partner or the parent of a domestic partner (but not the child of a domestic partner).

Act 28 defines a domestic partner to include same-sex couples who meet the following criteria and, beginning August 3, 2009, register in their county of residence:

• The individuals are at least 18 years old and capable of consent;
• The individuals are not married to, or in a domestic partnership with, another individual;
• The individuals share a common residence;
• The individuals are not more closely related than second cousins, whether of the whole or half blood, or by adoption; and
• The individuals are the same gender.

Alternatively, "domestic partner" includes same-sex or opposite-sex couples who are not (or cannot be) registered but who meet the first three criteria above; are not related by blood in a way that would prohibit marriage in Wisconsin; consider themselves members of each other’s immediate family; and agree to be responsible for each other’s basic living expenses.

Much has changed in the Medicaid program over the last year and the WHA Finance Council met August 6 to discuss those developments with topics including 2010 Medicaid rates, the assessment and potential cuts that confront Wisconsin hospitals.

Rich Albertoni, deputy director, Bureau of Fiscal Management, Department of Health Services (DHS), attended the meeting and went through a presentation on the hospital rate setting methods for state fiscal year 2010. He outlined the steps the state uses to establish the Medicaid base funding pool and how the rates are developed to fit within the pool. The State Fiscal Year (SFY) 2010 base funding is budgeted at $352 million for inpatient and $84 million for outpatient. That is an increase of $12 million on the inpatient side and $3 million for outpatient. Those funding increases reflect DHS caseload and intensity projections.

Albertoni reviewed the many factors that affect individual hospital Medicaid base payments including acuity, outlier methodology, and adjustments for wage index, GME, capital, DSH and other hospital adjustments.

Albertoni ended his remarks with some information regarding the hospital assessment. He told the Council that his Department will be doing a complete reconciliation of the 2009 hospital assessment program. He mentioned that due to claims lag on the fee-for-service payments, the reconciliation won’t be finalized until later this fall.

The American Heart Association and American Stroke Association recently recognized 13 Wisconsin hospitals for their success in using the Get With The Guidelines to improve their heart disease and stroke care. The awards are given for achievement in coronary artery disease, stroke and/or heart failure treatment. To achieve the Gold Performance Achievement Award, a hospital must achieve at least 85 percent compliance with the measures related to that area of care for 24 consecutive months. The Silver Performance Achievement award requires 85 percent achievement for 12 consecutive months.

Get With The Guidelines is a hospital-based quality-improvement program designed to ensure that hospitals consistently care for cardiac and stroke patients following the most up-to-date guidelines and recommendations. The performance measures in Get With The Guidelines are consistent with national measures available through a variety of vendors and used by Wisconsin hospitals to monitor and publicly report their performance.

"All Wisconsin hospitals have worked diligently to assure that the care they provide to patients with heart disease and those experiencing a stroke are consistent with the latest evidence based guidelines. It is great to see hospitals publicly recognized based on measureable performance, as well as their ability to sustain a high level of performance over time," said Dana Richardson, vice president, quality initiatives. "I anticipate that several additional Wisconsin hospitals will achieve this level of performance over the next few years, particularly for stroke care, as Wisconsin continues down the path of creating a stroke system of care."

Get With The Guidelines Performance Achievement

Top of page

From 1999 to 2004, Monroe County’s Hispanic population grew more than 200 percent and Trempealeau County saw an increase of more than 350 percent. Here are just a few ways Gundersen Lutheran is striving to meet the needs of Hispanic patients:

Childbirth education
Prenatal care, labor and delivery, and postpartum care can offer challenges especially for those with language or cultural differences. Gundersen Lutheran New Life Family Center is providing linguistically and culturally sensitive childbirth education for Hispanic families whether patients of Gundersen Lutheran or not. This includes prenatal risk assessment that looks at concerns such as nutrition, medical history and social support. Midwives, nurses and Spanish-language interpreters also work with families to address labor, pain relief, breast feeding, SIDS prevention and other concerns.

Enhanced interpreter services
Describing health concerns can be challenging for any patient, but for patients who do not speak or understand English it can compromise their health care. Skilled language interpreters are so vital in helping patients and providers overcome language and cultural challenges. In addition to Spanish language interpreters, Gundersen Lutheran offers Hmong and sign language interpreters. Through contracted services, patients speaking virtually any language can be accommodated. In 2008, Gundersen Lutheran Interpreter Services also made several enhancements includes simplifying the interpreter request process and enhancing professional development of interpreters.

Equal Footing training for interpreters
As part of continually improving healthcare for culturally diverse populations, Gundersen Lutheran staff and on-call interpreters completed the training, Equal Footing for Limited English Proficient (LEP) Persons: A 16-hour Medical & Community Interpreting Seminar, held last year at Gundersen Lutheran. This training allowed local and regional interpreters to meet one another and to learn from interpreters of other healthcare facilities. Staff learned standard professional interpreting practices, behaviors and ethics. In addition, there was training for healthcare providers on how to work with interpreters. Sharing with providers how best to work with interpreters and LEP patients helps everyone clearly understand the interpreter’s and provider’s roles.

Like all businesses trying to remain viable in these difficult economic times, hospitals must plan carefully for a successful future. As unemployment continues to rise, we serve a growing number of patients who are uninsured, under-insured, or on Medicaid. To more and more people managing their health—or trying to stay alive—safety-net programs have become increasingly important.

One such program is Charity Care. Under this, people who qualify can have a portion or all of their medical bill waived. Charity care is one of the truest means we provide a community benefit and are therefore committed to continuing the program. In 2008, Memorial Medical Center served 159 people through our charity care program—people like Ron.

Ron was brought to our ER after an auto accident. In many cases, that would be bad enough, but this was day four in a series of bad days. First, he was forced to close his business - the family’s primary source of income. The next day, his best friend passed away, and following that, his dog had to be put down.

"I was at my wit’s end. My wife and I didn’t know anything else we could do. We always worked hard—60 plus hours a week easily and carried insurance. We tried to do things right. Even so, we found ourselves in a situation we didn’t know how to fix," recalls Ron.

The Emergency Department physician ordered a full trauma panel on Ron, including CT scans, x-rays, and labs. In all, charges totaled over $5,000 that day.

When Ron received the bill, he called and spoke with Wendy Proffitt, patient services supervisor. Ron explained that he was looking at filing bankruptcy, and he still had over $20,000 in medical expenses from a previous work-related injury. At this point, Ron’s goal was to not lose his house.

"It’s not a fun thing, asking for help. I’m the guy who typically gives help to others. But here I was asking for it," stated Ron.

Wendy asked several questions about Ron’s insurance, assets, income, etc. By the end of the conversation, Wendy thought Ron would qualify for charity care.

Ron completed all forms, supplied every documentation requested, and even placed a follow-up call to Wendy to see if she would like to see anything else.

"Our process hinges a great deal on patients’ honesty and willingness to cooperate. Ron was very humble and extremely appreciative. Quite honestly, he was a pleasure to work with," stated Proffitt.

Within a short time, Ron received the decision letter. It stated that $1,000 of his bill was paid through his automobile insurance, $4,200 would be covered by the hospital’s charity care program, and he needed to pay only $15.40.

"I can’t tell you how relieved and grateful I was after receiving that letter. I called Wendy right away and told her thank you to Memorial Medical Center, and thank you to her personally for being kind, polite, and non-judgmental," stated Ron.

For the most part, we all try to budget or save for health care expenses. In emergency situations, however, this is not always possible, and we may need help. Charity Care is one way Memorial Medical Center can provide that help—enabling people to receive the quality, compassionate care they have come to expect.

Submit hospital community benefit stories to Mary Kay Grasmick, editor, at mgrasmick@wha.org.

Top of page