Twenty Wisconsin hospital leaders convened in the nation’s capitol earlier this week to meet with members of the Wisconsin delegation and weigh in on the importance of key provisions in the Medicare Prescription Drug Bill. The WHA policy paper, "Unfinished Business: Medicare Payment Adequacy for Wisconsin’s Health Care Providers" (see www.wha.org) provided the platform for discussions on how key provisions would impact the health care providers in each of the state’s eight Congressional districts and with both senators.

"It is extremely important we meet with our Congressional delegation at home and in Washington on a regular basis to keep pressing our Federal Advocacy agenda," said Mary Starmann-Harrison, chair, WHA Public Policy Council. "The Washington Advocacy meetings demonstrate the importance of these issues and the commitment of our leaders to work with Congress to move these issues along," she continued.

In addition to meeting with the elected officials, Herb Kuhn, corporate vice president for advocacy, Premier, Inc, shared his "inside Washington" observations detailing the political climate for the Medicare bill and other pressing issues that may shape the legislative agenda for the remainder of the congressional session.

The WHA Communications and Education Quality Team held its first meeting September 11 in Madison, with Terri Potter, president/CEO, Meriter Hospital, serving as chairperson. The mission of the team is to develop a communication plan that will be used to guide the communication and promotion activities of the Wisconsin hospital quality public information program, "CheckPoint."

Team Chair Terri Potter, who is a member of the Wisconsin Quality Steering Committee that oversees the CheckPoint program, asked the group to consider how hospital quality information can best be communicated to the public, providers, and purchasers.

"With the CheckPoint program, we are not only giving hospitals more information about themselves that they can use to improve quality, our goal is to create a better informed consumer and purchaser group within Wisconsin," Potter said.

"Providers realize that we need increased transparency about our performance and what we do so consumers can become more educated and take control of their health care decisions."

George Quinn, WHA senior vice president, provided an overview of WHA’s expectations for public quality reporting overall and specifically, the expectations for the communications team to help design a plan to reach key stakeholders. Quinn said the Measures Team designs the technical aspects of the program and chooses the best measures for reporting and the methodology that will be used to collect the data. He said the vision for the Communications and Education team is to determine the best way to communicate not only the measures data, but to also design other visible components of the program that will interface with consumers.

"The objective is to give consumers access to relevant and meaningful information on quality," according to Quinn. "There might be a lot of quality ‘stuff’ out there, but not all of it is as meaningful as it should be. We want to make sure that people are aware of the information and that it is useful to them in selecting a hospital."

Dana Richardson, WHA vice president of quality, presented an overview of the WHA quality initiative. Richardson pointed out that there is a need for hospitals to have information that tells them how they are doing relative to similar hospitals. In addition, over the past few years there has been a dramatic increase in the use of evidence-based practices in hospitals, while patients may not realize the importance or understand the purpose of utilizing this information, it is important to provide them with educational materials that define what evidence-based practices are and what it means to them as patients and consumers of health care services.

Richardson said to date, 80% of the hospitals in Wisconsin are participating in CheckPoint. She said WHA has partnered with MetaStar, Wisconsin’s quality improvement organization, to collect and aggregate the data, as they have much expertise in this area. Richardson pointed out that the safety goals are goals, and the Measures Team had to develop a means of measuring safety efforts. The Measures Team also is charged with determining what consumers need in the way of information. How to get the information out to the public is the charge for the Communications and Education Team (CET).

Potter pointed out that the communications plan must be broad enough to address the current measures, while accounting for new data sets that will be added in the future. Members of the group commented it is essential to educate the public on why these measures were chosen and what these measures tell them about the quality of care in Wisconsin hospitals. He added communications about the CheckPoint program must convey the message that over time, the program will raise the performance bar for ALL Wisconsin hospitals so the public understands that hospitals are good performers in this state.

Hospitals in the program will be discouraged from using the information to compare themselves to others, but will be encouraged to share their own information with their patients and community. The point was made that all employees in the hospital should be conversant about "CheckPoint" and be able to tell a patient or consumer what the program is and how to access it. Robert Koehler, Meriter Hospital, and Melinda Orebaugh, Gundersen Lutheran, both medical library directors in their respective hospitals, emphasized that librarians should be especially comfortable with CheckPoint as they are often the public point of contact when patients/consumers have questions about their condition or the type of medical care that they will receive while in the hospital.

The Communications and Education Team will meet at least two more times this year to continue their work on the communications plan. For more information or to submit comments to the Team, contact Mary Kay Grasmick, WHA 608-274-1820 or mgrasmick@wha.org.

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What are the major issues in the area of risk management?

The market for medical malpractice insurance has reached crisis proportions in the majority of the country. It doesn’t look like it will get better any time soon. However, I can say that Wisconsin is in a better position than are many other states. Here we have tort reform and the Patient’s Compensation Fund. The PCF responds to claims in excess of $1,000,000 when, in other states, large jury awards are paid out by the insurance companies. While hospitals in Wisconsin cannot control the insurance carrier’s rates, they can mitigate their losses by reviewing their policies and procedures, enhancing the staff orientation process, improving in-service training, and devoting more resources to staff education. It is all about providing the best care for patients– and ensuring a safe working environment for the employees. All hospitals are different, and a risk management program must be customized to address those individual needs and situations.

A successful risk management program can help control insurance costs.

One of the elements insurance companies take into consideration in pricing a medical malpractice program are the losses that have occurred at that facility. Losses encompass not only monies that have been paid both for defense and liability, but also pending claims which have been reported to the carrier and have a potential for liability. When an insurance company opens a claim file, they set a reserve amount for the claim based on their experience in defending similar claims and their assessment of potential liability. This doesn’t mean that they either intend or expect to pay out this amount. It represents dollars that they set aside just in case they need them. When it comes time to pricing out the insurance, the current carrier, and any other carriers considering an account, take all of these amounts into consideration. A good risk management program helps to minimize claim frequency and to reduce the severity of claims that do occur. The best scenario is to avoid the situations that can cause injury to patients. Prior to underwriting a risk, more insurance companies will survey the hospital, interview the risk manager, and review the policies and procedures that are in place, which help manage risk. Credits and debits are applied to the base rates for both risk management and claim experience.

While insurance carriers provide risk management services, we also have a nurse/attorney on staff to work with clients on risk issues.

If you can control workers compensation claims and costs, it will have a direct impact on insurance premiums. At FCJK, we help hospitals by holding in-service training, conducting ergonomics studies, and providing OSHA training. We tailor risk services after analyzing the types and frequency of claims at each facility. Our in-house risk specialist will then design a training and education plan to avoid injuries to employees.

The two largest insurance costs to hospitals are medical malpractice and workers compensation, and introducing an effective risk management program can control these costs.

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According to a recently released report from Solucient, consumers are taking greater control of their health as they are being asked to shoulder more of the costs. This increasingly proactive consumer behavior is changing the way hospitals interact with their patients, communities, and each other. Cost and quality information is essential to these consumers as they become increasing more involved in decisions concerning their health care.

On September 25 at the WHA Convention at the Grand Geneva in Lake Geneva, a panel of experts will discuss the issue of health care cost and quality in the rising tide of consumerism. Wisconsin Public Radio assistant news editor Melba Lara; Business Journal reporter Phill Trewyn; and TMJ4 medical reporter Kimberly Kane will ask the questions. Panelists who will share answers and perspectives include: Leo Brideau, president/CEO, Columbia St. Mary’s; Mark Moody, health care financing administrator, Department of Health and Family Services; Charles Shabino, MD, WHA chair-elect and medical officer, Community Health, Inc.; Tim Size, executive director, Rural Wisconsin Health Cooperative; Mary Starmann-Harrison, regional president/CEO, SSM Healthcare; and John Torinus, president, Serigraph, Inc. The roundtable will be moderated by WHA Senior Vice President Eric Borgerding.

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On September 9, House and Senate Medicare conferees came to tentative agreements on a number of "non controversial" items including the Medicare Prescription Drug Bills. (See conferees agreements at www.wha.org, government relations, federal issues.) Among the agreements are key critical access provisions, including increasing the payment amounts to 101% of costs, and "flexibility" allowing up to 25 beds to be used for care. These agreements are the beginning of the conference process. No predictions are available as to when the committee will complete their work and forward the bill to their respective houses. For information about the conference process and progress, contact Ann Lucas at 608-274-1820 or email alucas@wha.org.

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Legislation designed to encourage organ donation cleared its first hurdle this week when it received unanimous approval by the Assembly Committee on Public Health. Assembly Bill 477, authored by Representative Steve Wieckert (R-Appleton) allows living organ donors to deduct up to $10,000 of their travel, lodging, and lost wage expenses from their income taxes. A Wisconsin resident donating bone marrow, or all or part of a liver, pancreas, kidney, intestine, or lung would qualify for the tax deduction. The bill is now before the Joint Committee on Tax Exemptions, which must act before an Assembly vote can be scheduled. A WHA memo in support of the bill is available at the government relations section of the WHA website under "Health Care Legislation". For more information, contact Jodi Jensen at 608-274-1820 or jjensen@wha.org.

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One dozen representatives from WHA, the Wisconsin Manufacturers and Commerce (WMC) and the Wisconsin Association of Health Plans met last Friday at WMC Madison headquarters. The group came together in anticipation of developing a series of recommendations (including specific legislative proposals) likely to emerge as a proactive agenda intended to develop a vibrant, consumer-driven health care marketplace.

This current effort is similar to activity undertaken in 1991 by a group of health care purchasers, payers and provider associations that developed a "12-point plan" that became a viable policy and political alternative to a number of radical ideas that were "in play" over a decade ago. Several 1991 proposals are now law.

Not unlike then, we have today several influential players (including the state’s AFL-CIO and WEAC) that are pushing for a massive reshaping of the health delivery and payment systems. The AFL-CIO plan (single-payer) and the WEAC plan (single-payer "lite") are "sound bite" solutions that resonate well with some. And the current environment relative to health care costs, especially as those costs relate to rising health insurance premiums, provides a level of vulnerability that must be meaningfully addressed.

While it is too early to predict the group’s specific proposals, look for the following themes to emerge:

1. Goals as articulated in the Institute of Medicine (IOM) "Crossing the Quality Chasm" report will likely serve as a framework for the initiatives.
2. Information about health care costs, clinical quality and safety and service quality must be available to consumers in common and understandable formats.
3. Wellness improvement, including specific State of Wisconsin health improvement goals, must be established and benchmarked.
4. Current legislative/regulatory barriers that limit innovation for health benefit redesign, especially for small groups, must be eliminated.
5. The time for talking about "cost shifting" must end and be replaced by meaningful federal and state commitments that begin to roll back the Medicaid Tax.

In addition to WHA senior staff, former WHA chair and current WMC board member, Terri Potter (Madison), and current WHA board member, David Olson (Marinette), are participating in this process.

Steve Brenton, President

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Transfer of credits between the University of Wisconsin System and the Wisconsin Technical College System (WTCS), course duplication, WTCS governance and economic development were discussed during a September 9 meeting of the Speaker’s Task Force on WTCS. UW System President Katherine Lyall and WTCS President Richard Carpenter briefed task force members on a credit transfer proposal requiring UW campuses to accept up to 25 general education credits acquired at any Wisconsin technical college. According to Lyall, UW campuses have historically accepted transfer credits from only three technical colleges, Milwaukee Area Technical College, Madison Area Technical College, and Nicolet Area Technical College. Several task force members relayed complaints from students whose inability to transfer credits has been a significant barrier to pursuing higher education. According to Lyall and Carpenter, the credit transfer proposal was crafted with input from faculty at both systems, but has not yet been reviewed by the WTCS state board or the UW Board of Regents.

In other discussions, Lyall and Carpenter told the task force minimal course duplication is necessary and appropriate. They said some courses, such as English 101, are offered in both systems as a necessary part of the curriculum, noting that the courses are well utilized.

WTCS state board chair A.J. (Nino) Amato joined Carpenter to discuss the system’s role, while stressing its collaborative nature and governance. Referencing a recent audit of the Milwaukee Area Technical College (see August 8 Valued Voice), some task force members said the governance structure raises questions about whether the local district or the state board is accountable for the practices of that district. Members advocated for a clearer allocation of responsibility between the districts and the state. Several members also maintained that electing rather than appointing members of district boards would increase responsiveness to public needs and establish accountability for technical college district property tax levies.

Revisiting past discussions about the economic impacts of higher education (see August 22 Valued Voice), the task force discussed Wisconsin’s "brain drain" and job forecasting. Members shared stories of family members leaving Wisconsin for better paying jobs and said the state must do a better job of attracting and retaining professionals. Sen. Alberta Darling (R-River Hills) encouraged the group to recommend improved job forecasting in Wisconsin. She said with more accurate information, the legislature and higher education institutions can allocate resources more appropriately.

The task force, created by Assembly Speaker John Gard (R-Peshtigo) and co-chaired by Reps. Suzanne Jeskewitz (R-Menomonee Falls) and Gary Bies (R-Sister Bay), is charged with examining WTCS and making recommendations for improvements. Tomah Memorial Hospital CEO Phillip Stuart is one of 15 task force members. The task force will meet at least two more times and finalize its recommendations in late October. For more information, contact Jodi Jensen or Judy Warmuth at 608-274-1820 or jjensen@wha.org or jwarmuth@wha.org.

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On September 9, DWD Secretary Roberta Gassman convened a group of leaders in health care, education, and state government. The group, which is called the Select Committee on Health Care Workforce Development, is charged to function as a state level action team to implement short and long term strategies to address workforce development challenges in Wisconsin’s health care industry.

Secretary Gassman will chair the group, which has been asked to move rapidly to begin working on this important issue. The group will use information, data and recommendations developed by previous groups and may add information of its own. Four focus areas have already been identified. They are:

• Recruitment, retention and related workplace issues
• Educational capacity
• Health care industry issues
• Leadership and infrastructure

The groups will be co-chaired by individuals from the health care industry and the public/education sector. Hospitals will be well represented on the groups, with WHA’s Judy Warmuth, vice president, workforce development, being asked to co-chair the Recruitment/Retention subgroup and Agnesian Health Care’s Norma Tirado, vice president, employee services, co-chairing a subgroup on Educational Capacity.

Chairs for the four groups are:

• Recruitment/Retention: Laura Dresser (Center on Wisconsin Strategy) and Judy Warmuth, WHA

• Educational Capacity: Deborah Mahaffey (Wisconsin Technical College System) and Norma Tirado (Agnesian Health Care )

• Health Care Industry Issues: Candace Owley (Wisconsin Federation of Nurses and Health Professionals) and Alice O’Connor (Wisconsin Medical Society)

• Leadership and Infrastructure: Bryan Albrecht (DPI) and John Sauer (Wisconsin Association of Homes and Services for the Aging)

In her introductory remarks, Secretary Gassman indicated the Administration is focused on creating a strong economy for Wisconsin. She has heard from many sources of the critical nature of the health care workforce shortage and understands the impact of Wisconsin hospitals on Wisconsin’s economy.

"WHA commends Secretary Gassman and the Administration for reaching out and partnering with the private sector on this critical issue," said WHA President Steve Brenton. "These are complex problems in dire need of solutions, and we are very pleased with the comprehensive approach and willingness to seek direct input from hospitals."

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Legislation that would provide income tax deductions to help pay for long-term care (LTC) insurance premiums and allow the insurance to be offered as part of a cafeteria plan is in development. Brokers, insurance providers and consumer support groups are widely supportive of this bill, which would provide a $3,000 tax credit for long-term care needs and allow LTC to be offered as part of an employee benefit plan.

Read the entire article in Solutions Spotlight, included in this week’s packet or contact WHA Financial Solutions at 800-362-7121 for more information.

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During a September 9 joint hearing of the Senate and Assembly Insurance Committees, the Doyle Administration weighed in on legislation designed to prohibit the use of Patient Compensation Fund (PCF) dollars for other purposes, such as the governor’s failed budget proposal to help fund the Medical Assistance deficit.

Testifying at the hearing, State Budget Director David Reimer said Assembly Bill 487 and Senate Bill 238 would tie the hands of all future legislatures and governors even if the state faced a record deficit and the PCF had a surplus. The legislation, authored by Senator Dale Schultz (R-Richland Center) and Representative Bonnie Ladwig (R-Racine) provides, among other things, that health care providers and claimants have contractual rights in the PCF, and that its funds are held in trust exclusively for their benefit (see September 5 Valued Voice).

"If you think the transfer is a bad idea, then don’t do it, but don’t tie the hands of every future legislature and governor," said Reimer pointing to the trust language. "We didn’t get to a $3.2 billion deficit thinking we were going to get there, and we won’t get to future ones thinking we’re going to get there. Future policy makers should be free to debate whether using the money is wise policy at that particular place and time."

Reimer said the governor’s proposal to preserve health care benefits for the poor, elderly and disabled with PCF money in the face of $500 million Medical Assistance deficit, and potentially massive provider cuts, was the right choice. He described it as a policy decision, making continued access to health care today a priority.

Sen. Schultz, the Wisconsin Medical Society (WMS) and Wisconsin Manufacturers and Commerce (WMC) countered that reducing the cash balance of the PCF will create a medical malpractice crisis, which also jeopardizes access to care.

"Addressing medical liability is the highest priority in the medical community for maintaining access to health care," said WMS General Counsel Mark Adams. The state must avoid a medical malpractice crisis, where physician insurance premiums rise to a point forcing them from the state or from practice altogether.

Reimer said the PCF alone is not responsible for Wisconsin’s success. He pointed to private insurance coverage health care providers are mandated to obtain under Wisconsin law, as well as the state’s caps on noneconomic damages.

Rep. Ladwig disagreed, saying Wisconsin’s PCF has been the key to avoiding a medical malpractice crisis faced by 44 other states. But, Reimer noted that not all of the six states without a medical malpractice crisis have a PCF, adding that, of those that do, Wisconsin is the only one with both mandatory participation and unlimited coverage.

Reimer also argued that a $200 million reduction in the existing $600 million fund would not send the state into crisis. He said earnings have outpaced expenditures over the last decade, pointing to annual investment income of about $26 million, annual assessment income of about

$48 million, and annual expenditures of about $34 million. Reimer said the fund experienced "remarkable growth" despite reductions in health care provider assessments almost every year since 1996, which amounted to nearly a 50% reduction in assessments during that time.

"Why would the PCF board do this if there is a huge gap between the fund balance and the expected liabilities?" asked Reimer. "Why would the board reduce assessments despite a recommendation by the fund’s actuary to increase them?"

Schultz maintained that economic growth in the 1990s allowed the board to "take the heat off the medical community" and rely more on investment income than assessments. "It may not have been the best idea, but it was logical," he said.

NOTE: Budget Director Reimer will appear before the WHA Council on Public Policy at its next regular meeting on September 30 in Madison. Reimer will discuss the state budget as well as the prospects for health care reform this session.

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Mark your calendar for the November 14 seminar "The Health and Safety Challenges for the Infection Control Practitioner and Safety Professional" at the Crowne Plaza in Madison. This seminar is more than just a static review of the challenges faced by these practitioners - it includes practical advice and sample procedures that can be implemented at hospitals throughout Wisconsin.

Attendees will learn what they can do to safeguard their hospital workers against unseen infectious foes; gain detailed, practical information on how to comply with the Needlestick Safety and Prevention Act, while reducing employee sharps injuries; and will assess more than 70 safety medical devices. Additionally, the new CDC hand hygiene directive will be reviewed and discussed, as well as the Infection Control Construction standard. Practical information on implementing and complying with these requirements will be shared.

The registration fee is $200 per person. A brochure with registration form is included in this week’s packet and on the Web site at www.wha.org. On-line registration is available for this seminar. For more information on program content, contact Jennifer Frank at 608-274-1820 or email jfrank@wha.org . For registration questions, contact Bridget Gifford at 608-274-1820 or email bgifford@wha.org .

The WHA seminar "2004 JCAHO Environment of Care: A Practical Approach to the Survey Process," is scheduled for November 13 at the Crowne Plaza in Madison. This seminar provides detailed, practical information on how to comply with JCAHO Environment of Care Standards, as well as an overview of the changes in the 2004 standards and planned future changes.

This seminar will give attendees information on the "Shared Visions – New Pathways" initiative; practical techniques for preparing for a survey; a simple but effective system for organizing required documents; essential information on how to format documents; and important tips on how to manage the actual survey. Additionally, a reference manual containing the changes in the 2004 standard will be distributed to each attendee.

The registration fee is $225 per person. A brochure with registration form is included in this week’s packet and on the Web site at www.wha.org. On-line registration is available for this seminar. For more information on program content, contact Jennifer Frank at 608-274-1820 or email jfrank@wha.org . For registration questions, contact Bridget Gifford at 608-274-1820 or email bgifford@wha.org .

Recently, the WHA Workgroup on Payment Issues, of the Council on Finance and Payment, recommended formal education as one vehicle to assist hospitals in dealing with a variety of payment issues, including silent PPOs, non-standard coding requirements, accountability of third party administrators (TPA), and payment delays from self-insured plans and others utilizing TPAs.

As a result of that recommendation, WHA is offering "Improving Your Reimbursement Contracts," a one-day seminar taught by reimbursement contract expert Maria K. Todd, PhD. This is an important seminar for all business office managers, reimbursement managers, contract specialists, chief financial officers, and others charged with managed care contract evaluation and negotiation to attend.

The seminar is scheduled for Wednesday, November 5, at the Kalahari Resort in Wisconsin Dells, and is co-sponsored by the Wisconsin Chapter of HFMA and the Rural Wisconsin Health Cooperative. The registration fee is $200 per person. A brochure with registration form is included in this week’s packet and on the Web site at www.wha.org. On-line registration is available for this seminar.

Attendees may want to couple attendance at this seminar with the November 6 seminar "The Revenue Cycle: Successful Strategies for Positive Reimbursement Outcomes," to be held at Great Wolf Lodge in Wisconsin Dells. Information about this complementary seminar can also be found on the WHA Web site.

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The Business & Health Administration Association released a "call for papers" for presentation at their conference March 17-19, 2004 in Chicago. This conference is held in conjunction with the Midwest Business Administration Association. The submission deadline for competitive papers is October 6, 2003. The conference features a special track in hospital administration and Mary K. Madsen is the track chair.

For more information on the conference and on the call for papers, contact Madsen, UW-Milwaukee, College of Health Sciences, 414-229-3862 or madsen@uwm.edu . To view the conference materials go to http://www.mbaaconference.org.

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A 54-bed acute care hospital located in Michigan’s Upper Peninsula is seeking a CEO. This non-profit community hospital provides inpatient and outpatient services in their hospital and three clinics. The payer mix is 60% Medicare, 5% Medicaid and 35% commercial. The facility is planning an $18 million renovation and expansion project on the physical plant in 2006 and enjoys a collaboration agreement with a larger regional medical center to provide full time residents to this expanded medical staff. This opportunity provides an excellent executive compensation package for this position located in a low cost-of-living area.