The PAC totals are climbing, but there’s still almost $20,000 to go in order to achieve the goal of raising $175,000 along with increasing the number of individual contributors.

"While many individuals recognize the importance of making a contribution to these funds, there are still individuals at 40 percent of Wisconsin hospitals that have yet to contribute. We can’t effectively contribute to all the candidates that support our hospitals without the help of those who have not yet participated in this important effort," according to WHA’s Vice President of Government Affairs Jodi Bloch. There are only a few months remaining before the 2006 election season begins and Bloch says, "The time to build the base of support is now."

WHA’s CEO Steve Brenton believes that "it is vitally important that WHA work to elect candidates who understand the mission of hospitals and recognize all of the benefits that hospitals provide in communities across the state. We will need the support of legislators on critical issues like medical malpractice reform and increasing funding to Medicaid."

Special thanks goes out to these health systems whose individuals have achieved their goals obtaining "Gold H Club" status; All Saints, Aurora (individuals at 8 of their facilities have reached their goals), Children’s Hospital, Froedtert & Community Health, SSM Healthcare and UW Hospital.

Individuals at the following hospitals have also achieved "Gold H Club" status: Amery Regional Medical Center; Bay Area Medical Center, Marinette; Beloit Memorial; Community Memorial, Menomonee Falls; Flambeau Hospital, Park Falls; Howard Young Medical Center, Woodruff; Memorial Health Center, Medford; Memorial Medical Center, Ashland; Our Lady of Victory, Stanley; Reedsburg Area Medical Center; Sacred Heart Hospital, Eau Claire; Saint Joseph’s, Marshfield; Saint Michael’s, Stevens Point; Spooner Health System; St. Clare Hospital, Baraboo; St. Marys Hospital, Madison; St. Nicholas Hospital, Sheboygan; and St. Josephs Hospital, Chippewa Falls.

Special thanks also goes out to the employees at the Rural Wisconsin Health Cooperative and WHA for their generous support in achieving their goals as well.

"Individual contributions are the backbone of the fundraising campaign and serve as an example for everyone else what can be achieved when everyone works together to raise these funds," says Bloch. For more information about the Wisconsin Hospitals Conduit, PAC or AHA PAC, contact WHA’s Jodi Bloch or Jenny Boese at 608-274-1820.

At a Capitol press conference held this week, State Assembly leadership announced plans to attempt four Medicaid budget veto overrides. The planned veto override votes are to restore the 1.4 percent increase for nursing homes, $12 million (all funds) increase in outpatient reimbursement rates and two pharmacy fee provisions all vetoed by Governor Doyle. All four provisions were included in the Medicaid portion of the state budget that was adopted in June by the Joint Finance Committee on a unanimous, bipartisan vote.

Assembly Majority Leader Michael Huebsch (R-West Salem) was joined at the press conference by Representative Kitty Rhoades (R-Hudson), a member of the Joint Finance Committee and co-author of the Medicaid motion.

"My colleagues on the Joint Finance Committee fully understood the importance of providing health care for Medicaid and families," said Rhoades. "We were able to put partisan differences aside and put the health care needs of Wisconsin in the forefront."

The press conference also included representatives from nursing homes, pharmacies and Spooner Health System CEO Michael Schafer, who provided the unique hospital-owned nursing home perspective.

"Spooner Health System currently loses approximately $16 per day caring for a nursing home resident that is covered by MA. We expect that this will grow to nearly $20 per day by the end of this budget cycle," said Schafer. "As strange as this may sound, we are fortunate that we can pass on some of these losses to our hospital patients. This simply is not fair, but we have no choice. That is what we must do to keep the doors of our nursing home open and accessible to the community."

According to Wisconsin’s own Department of Health and Family Services, roughly half of Wisconsin nursing homes are at "financial risk." The average per diem loss to care for a Medicaid resident is projected to rise from $19.44/day to $28.25/day in 2005-06, which equals a total loss per facility of close to $622,000.

"The Joint Finance Committee’s motion would not even come close to covering our increased costs; yet it was a recognition that something needs to be done with MA reimbursement," Schafer said. "We were thankful for that step in the right direction. Unfortunately, the recent veto only expedites the crisis nursing homes are in."

"As a society, we have an obligation to take care of our most vulnerable and educate the current generation," said Huebsch. "By overriding the Governor’s vetoes, we can fulfill our obligation and make sure all seniors have access to the health care they deserve."

In related news, two Democratic lawmakers announced their plans to introduce legislation to restore the 1.4 percent increase to the nursing home reimbursement rate. Sen. Bob Jauch (D-Poplar) and Rep. Gary Sherman (D-Port Wing) indicate their proposal will make the increase retroactive to July 1 and provide a total of $33 million to nursing homes. However, the proposed increase is tied to whether or not money is available in the budget stabilization fund.

Bill Petasnick, president and CEO of Froedtert Community Memorial Health System, summed up the thoughts of each health system leader in metro Milwaukee: "We stand ready to be present and help in any way we can. The emotional and physical suffering of a most vulnerable community of people must be met with compassion and a staunch commitment by all providers to be of service." That sentiment was echoed by Leo Brideau, president and CEO of Columbia St. Mary’s. "The evacuees from the Gulf Coast are our brothers and sisters. It is not a question of whether or not we will

help; it is a moral imperative that we do. This is in the finest tradition of our nation’s not-for-profit health care system," Brideau said.

Nearly 400 evacuees are now finding a home in Wisconsin. The Tommy Thompson Youth Center at the State Fairgrounds is providing shelter for nearly 300 men, women and children. In addition, about 40 agencies and organizations representing health care and human services are on site to provide immediate help to those in need. Help that runs the gamut from barbers providing haircuts to behavioral health professionals providing support services, from a health care clinic to a warehouse full of donated clothing and furniture, from case workers enrolling people into Medicaid and facilitating unemployment checks, from the Salvation Army providing three meals a day to the Red Cross coordinating a variety of human services. Milwaukee and Wisconsin are responding from the heart.

I have been privileged to represent the metro Milwaukee health care systems at the daily briefing sessions to coordinate hospital responses as well as work with the intermediate care clinic that has been set up on the grounds. The clinic is providing medical services to those in need ranging from prescription refills and skin rashes to treating more acute care needs, as well as helping patients find specialty physicians and primary care homes in the community. The health care needs are many. Allow me to share with you some of the stories I experienced first hand.

When the clinic was first set up, we needed a pharmacy to fill prescriptions. Aurora pharmacy stepped to the plate on day one and began honoring the prescriptions from the clinic, waiving the co-pay. No one was turned away. "It was the right thing to do," said Ed Howe, president and CEO of Aurora. "We are talking about life saving medications for people at a time of their greatest need." The clinic needed a variety of medical supplies. Covenant Healthcare donated not only a wide array of medical supplies, but also two exam tables for the clinic. "Our mission to the community is strong and unwavering…no matter where the person comes from. Our Catholic tradition is rooted in providing community benefits to all in need," said Paul Del Uomo, president and CEO of Covenant. More medical supplies were needed. A quick phone call to Froedtert Hospital and Columbia Hospital brought even more needed medical supplies. Children’s Hospital sent over pediatricians and pediatric nurses to serve the children. ProHealth, Aurora, Froedtert, Columbia St. Mary’s and Covenant did the same with nurses and doctors from their medical groups and employees. Hospital emergency rooms responded with kindness and empathy to the emergent needs of the evacuees. In addition, whenever I called a hospital to see about admitting a patient needing inpatient acute care services, each and every hospital said "yes." Our hospital leadership helped find specialists who were not on our volunteer list. I took an elderly man with end stage renal failure who needed dialysis over to Froedtert. He was immediately seen in the emergency department and taken to dialysis. This is but one example this week of hospitals responding to need first, no questions asked.

As the representative of WHA in metro Milwaukee, I can honestly say I have never been more proud of our health care providers than I am these days. Anyone who doubts the social accountability and commitment to the community that our hospitals and health systems are demonstrating in these challenging times, will have to answer to me. Meeting the health care needs of the Gulf Coast evacuees is only a current example of health care delivery and response at its finest. As a little girl at the clinic said to me the other day, "You are helping mommy and daddy. They are not crying anymore." Health care providers and their leadership are responding to this little girl and her family. This is but one example of the human face of community accountability that is at the heart of our Wisconsin hospitals’ tradition. There are many, many more stories just like it.

This week the Assembly Health Committee passed a WHA-backed bill, AB 493, out of committee on a unanimous 9-0 vote. The bill would create an individual and corporate tax exemption for interest on bonds or loans issued by the Wisconsin Health and Educational Facilities Authority (WHEFA) if the proceeds are used to purchase information technology equipment.

AB 493 is a component of Healthier Choices, a health reform proposal unveiled last year by WHA, the Wisconsin Manufacturers and Commerce and the Wisconsin Association of Health Plans. Healthier Choices identified cost drivers in health care and workable solutions in six key areas, including promoting quality through advances in technology. AB 493 could make purchasing advanced technologies like CPOE and electronic medical record technologies more affordable, particularly for rural hospitals.

WHA would like to thank the sponsors who are also the chairs of the health committees in their respective houses, Rep. Gregg Underheim (R-Oshkosh) and Sen. Carol Roessler (R-Oshkosh), along with Rep. Brett Davis (R-Oregon) for being an early supporter of the bill. WHA would also like to extend thanks to WHEFA for supporting this initiative. Contact WHA’s Jodi Bloch for more information at jbloch@wha.org or 608-274-1820.

Just one week ago, Wisconsin Insurance Commissioner Jorge Gomez suggested the Wisconsin Legislature take a "wait-and-see" approach instead of embarking on a legislative "fix" to undo the recent Wisconsin Supreme Court ruling that caps on non-economic damage awards are unconstitutional.

"We will not be in crisis," Gomez stated. "Without caps, the fundamentals don’t change," he continued, noting that the Patient’s Compensation Fund is "very solvent."

Say what?

The Insurance Commissioner’s commentary is hardly helpful. It’s also hugely disappointing and inconsistent with other historic public statements Commissioner Gomez has made.

Consider these relatively recent offerings from the Insurance Commissioner:

• In his May 2005 mandatory biennial report to the Legislature regarding the 1995 medical malpractice tort reform legislation, Gomez said, "(malpractice premium) rate stability could be dramatically impacted for both the Fund and primary carriers should the caps be removed and insurers face unlimited non-economic damages." Gomez’ commentary later concluded that tort reform of 1995 (the caps)…"has resulted in the stable medical malpractice environment, and the availability of health care in Wisconsin."
  
• In late 2003, Gomez testified at a public hearing in Ohio and discussed reasons why Wisconsin has such a favorable medical malpractice environment (compared to Ohio). According to an article in the Ohio Osteopathic Association newsletter, Gomez said non-economic caps have contributed to the well being of the medical malpractice environment in Wisconsin. "It is estimated the non-economic damages cap has resulted in a $144 million reduction in ultimate loss reserves," Gomez claimed.

The Insurance Commissioner has apparently flip-flopped. Once a strong advocate of Wisconsin’s much envied medical malpractice environment and the statutory underpinnings of that environment, Gomez now takes a "no big deal" attitude about what many believe is a brewing crisis.

At the recent legislative hearing, Gomez pointed to the fact that Wisconsin is not on the American Medical Association’s (AMA) list of "crisis" states. His reasoning was that the omission somehow makes the case for a "wait-and-see" position. That rationale is just plain nonsense. The current AMA state-by-state roster doesn’t take into account the six-week-old Supreme Court decision. The AMA, along with numerous state hospital associations and medical societies, has expressed puzzlement and a degree of outrage regarding the recent Wisconsin decision. The common refrain we hear is "what the heck happened in Wisconsin?"

Fortunately, it appears that most Wisconsin lawmakers will ignore the Commissioner’s testimony. They agree with us that "fixing" the problem today is urgently needed to prevent tomorrow’s crisis.

Steve Brenton
President

The October 26 seminar "Denials Management: How to Improve Payment and Reduce Write-Offs" will focus on the process of properly submitting claims, collecting payment and meeting coding and documentation compliance. This program will show you how to develop, implement and maintain an integrated compliance and denials management system that will improve your cash flow process.

This seminar is for business office managers, reimbursement managers, patient account managers, chief financial officers and others responsible for managing the receivables process.

The conference will be held on October 26, 2005, from 9 am to 5 pm at the Hotel Mead in Wisconsin Rapids. A brochure and a registration form are included in this week’s packet and on the Web site at www.wha.org. Easy, on-line registration is available as well.

Register today for the 2005 Wisconsin Quality & Safety Forum. You’ll find the full education agenda and registration materials for the Forum included in this week’s packet and on-line at www.wha.org. And bring your teammates – two or more paid attendees from the same facility each save $25 on the registration fee.

Health care quality managers, risk managers, CEOs/administrators, clinician managers, physicians, nurses, pharmacists, patient care services staff, quality improvement team members, and others should plan to attend this year’s Quality & Safety Forum, scheduled for October 17-18 at the Radisson Paper Valley Hotel in Appleton.

This year’s Forum has been approved for 9 contact hours by the Wisconsin Nurses Association Continuing Education Approval Program Committee; approved for 8.5 continuing education hours by the Healthcare Quality Certification Board for the Certified Professional in Healthcare Quality Program; and the program has been submitted (but not yet approved) for 8.0 continuing education clock hours from the National Association of Boards of Examiners of Long Term Care Administrators. Finally, the Wisconsin Medical Society designates this educational activity for a maximum of eight (8) category 1 credits towards the AMA Physician’s Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity. The Wisconsin Medical Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Register today, and don’t forget to ask for the WHA Quality & Safety Forum room block at the Radisson Paper Valley Hotel when making your hotel reservation. Call 800-242-3499 to make your hotel reservation. The special room rate will be available only until September 18.

State Senator Mary Lazich (R-New Berlin) urges restoration of Wisconsin’s caps on non-economic damages in a recent column entitled, "The Cap Must Come Back." She uses Illinois as a prime example of one state, considered in a liability crisis by the American Medical Association, turning its medical liability environment around. Illinois enacted into law a $500,000 cap on non-economic damages this August.

A poignant example of how bad things had become in Illinois comes from Carbondale Mayor Brad Cole. Cole lost his friend due to injuries she sustained in a head trauma accident. The two nearest neurosurgeons left their practices in Illinois due to "exorbitant insurance rates," Lazich wrote. The injured woman had to be airlifted to St. Louis, 100 miles away, where she passed away due to the delay in care.

Mayor Cole provided that powerful example at a Wisconsin Hospital Association/Wisconsin Medical Society press conference held in the Wisconsin State Capitol on August 25. WHA released the results of its independent poll on caps at the press conference. Senator Lazich also cited the poll in her column.

"I will work to undo the actions of judicial activists on the state supreme court. For the well-being of all citizens, Wisconsin must restore the cap," Lazich closed.

This week, the Wisconsin Department of Workforce Development (DWD) issued its first of what are to be annual reports on the health care workforce.

Prefaced by messages from both DWD Secretary Roberta Gassman and Governor Jim Doyle, the report, available at www.dwd.state.wi.us/healthcare/pdf/healthcare_annual_report2005.pdf, opens with a quote from WHA’s 2004 Workforce Report that indicates that finding viable and long lasting solutions to health care workforce issues will require collaboration among all parties.

The report has sections on: 1) Focus Areas of the Governor’s Select Committee on the Health Care Workforce; recruitment and retention, educational capacity and workplace issues. 2) Health care employment projections from the Office of Economic Advisors within DWD. 3) Graduate information for selected health care occupations. 4) An overview of DWD’s Workforce Development efforts. 5) State and Regional Highlights, Innovative Programs & Initiatives. The last section includes a long list of organizations and agencies that are actively working to address the workforce issue. With a problem of this size and scope, it is critical that groups do not repeat efforts or duplicate initiatives. The strong point of this report is its broad listing of efforts and resources.

Early in 2004, WHA, Wisconsin Manufacturers and Commerce and the Wisconsin Association of Health Plans unveiled a comprehensive health care reform plan, "Wisconsin’s Healthier Choices for Affordable Health Care." The plan was aimed at lowering health care costs and providing benefit flexibility to employers and employees. Healthier Choices called upon DWD to issue a report annually focused on the five professions of greatest need, which would include information to help direct or redirect workforce improvement strategies. The DWD report describes current efforts, provides information on occupational preparation, lists the efforts of DWD and highlights projects of the Select Committee on the Healthcare Workforce.

"DWD is to be commended for a report that provides an excellent overview of current workforce initiatives, and provides a good base for going forward," said Judy Warmuth, WHA vice president, workforce. "WHA has a strong commitment to health care workforce issues. With this report, DWD and the Governor have verified their commitment to the same agenda," she added.

AHA and the state hospital associations have been working with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to address certain concerns with the 2006 Accreditation Survey Contract and Business Associate Agreement Addendum (see August 5, 2005 edition of The Valued Voice). As part of this process, JCAHO has agreed to accept Wisconsin specific amendments to Section 5 of the Contract concerning confidential information. The Wisconsin amendments specify that JCAHO is a health care review organization within the meaning of the Wisconsin Statutes and that the actions of JCAHO are considered part of the hospital’s own health care review organization investigations, inquiries, proceedings, and conclusions.

WHA recommends that JCAHO accredited hospitals accept the AHA recommended amendments for the Contract and the Business Associate Agreement Addendum and the Wisconsin specific amendments to Section 5 of the Contract. Hospitals must request the amendments by October 1, 2005. AHA’s regulatory counsel, Lawrence Hughes, explains the process for requesting the amendments as follows:

New Web-based Amendment Process. The JCAHO Web site will include different versions of the Accreditation Contract so that hospitals can use a click to indicate their acceptance of the appropriate version of the contract. The need to have different versions of the contract on the Web site is dictated largely by the differing provisions in Section 5 (Confidential Information) related to the unique needs of hospitals in certain states for protections related to the peer review privilege. As a result there will be a version for California, Kansas, New York, Connecticut, Pennsylvania, Virginia, and Wisconsin (and when we’ve finalized language, a version that covers hospitals in Arkansas, Massachusetts, and South Carolina). The basic redlined version that AHA provided in the Quality Advisory will be available for use by the remainder of states. WHA staff has discussed with JCAHO the potential for confusion here, and they are considering how best to minimize such confusion for hospitals.

Please note that JCAHO is in the process of adding the appropriate versions of the contract to their Web site. JCAHO will notify us when the Web versions are available for use. In the interim, JCAHO has asked that hospitals stop faxing in requests for amendments. When the Web versions are posted, all hospitals - including those that have previously faxed requests - will need to go to the JCAHO Web site to "click" on the appropriate version of the contract to submit their request to obtain the amended accreditation contract.

The AHA recommended changes and the Wisconsin specific amendments can be viewed on the WHA Web site under Legal and Regulatory.

Sarah Elliott, Partner, von Briesen & Roper, SC, who is a frequent and incredibly helpful contributor to WHA projects, provided her expertise and guidance on this issue. WHA appreciates her support.

The Memorial Community Hospital Board of Trustees announced that James O. Pernau has assumed his duties as the chief executive officer for the Edgerton hospital.

Formerly with Roseau Area Hospital and Homes in Roseau, Minnesota, Pernau has extensive experience in hospital management, including management of critical access hospitals. He brings strong health care credentials to his new position. He received his bachelor’s degree from Illinois Wesleyan University, and his graduate degree in health administration from the University of Michigan in Ann Arbor. He is also credentialed by the American College of Health Care Executives. Pernau has served as a board member of the Minnesota Health Care Select Association, and the Colorado Health Initiative, and as president of the North Dakota Medical Group Management Association, and the North Dakota Rural Health Care Recruitment Association. In addition, he received North Dakota’s Outstanding Healthcare Professional award.

The Region 4 Workforce Investment Board (WIB) activities were highlighted at the September 14 WHA Council on Workforce Development. The work of this group was presented by WIB member Norma Tirado of Agnesian HealthCare and Cheryl Welch, WIB executive director. Tirado and Welch reported on that regions’ Health Care Workforce Alliance and the ways in which WIB’s can be organized to address health care workforce issues.

Tirado said Agnesian HealthCare is an active member of the Fox Valley Health Care Alliance (FVHCA). The FVHCA has representatives from both public and private organizations in the Fox Valley, Tirado said, and it provides a coordinated approach to assessing the health care workforce needs for the entire region. The FVHCA developed four surveys to assess organizations’ anticipated need for workers in eight health care job categories. The project is designed to outline future demands for health care employees.

The group also designed a survey to find out from health care employees how soon they plan to retire. The results of that survey are sent directly from the employee to a third party, to ensure that answers remain confidential. This part of the project is designed to predict future supply.

Determining when employees will retire is an important piece of data that has been missing in the discussions about health care workforce needs in the future. Tirado said if the surveys are successful in assessing workforce needs in the Fox Valley, they may be used on a statewide level by the Wisconsin Department of Workforce Development (DWD).

Judy Warmuth, WHA’s vice president of workforce development, emphasized the importance of the needs assessment process, as education programs have stressed to her that it is very difficult for them to gear up to train health care professionals without knowing how many workers will be needed and over what timeline. The Fox Valley project should help with the development of a timeline that will be useful to both health care and educational facilities.

Ken Moore of the Apprenticeship Standards Bureau, DWD, described the Adult Apprentice Programs in Healthcare, which are ready to go. The programs are for Computed Tomography Technologist, Mammography Technologist, MRI Technologist and Medical Coder. These programs are structured learning experiences, with educational content in an on-line format, supplied by the Northeast Wisconsin Technical College, that are work-based.

Apprenticeships are a great way to help full-time incumbent workers move into occupations while working and without leaving their home community. Two agencies in Wisconsin are working with the Bureau to implement these Health Care Apprentice Programs. Council members suggested that hospitals may not fully understand the apprenticeship program, or may not have even heard of these programs. They encouraged Moore to continue his efforts to reach hospitals with his educational campaign.

Select Medical Corporation seeks candidates for LTACH hospital CEO opportunities nationwide. Select Specialty Hospitals provide acute care for medically complex patients in unique "hospital within hospital" environments that combine all the personalized attention of a small setting with the best therapeutic and diagnostic services of a large medical center. Candidates must have a successful record in business development, physician relations, fiscal accountability and hands-on daily hospital operations. Select Specialty Hospital CEOs must provide focused and authentic leadership that leads to quality clinical outcomes and positive fiscal results. Successful candidates will have a minimum of five years acute care hospital leadership experience and a Bachelors degree in related field; Masters degree preferred; LTACH experience is a plus. Select Medical Corporation operates over 99 LTACHs in 26 states. Select Medical Corporation is an equal opportunity employer. Contact Connie Newell, Recruitment Director, cnewell@selectmedicalcorp.com; phone 717-972-1397; fax 717-763-8694.

WHA and the Wisconsin Society of Healthcare Human Resources Administration (WSHHRA) are co-sponsoring their second annual seminar focused on best practices for health care human resources departments.

This year’s program, entitled "Best Practices for HR Departments: Improving the Quality of Your HR Department," is scheduled for November 3, 2005, at the Kalahari Resort in Wisconsin Dells.

The day’s agenda kicks off with an interactive presentation by Becky Frederick, interim executive director of the American Society of Healthcare Human Resources Administration (ASHHRA), discussing ASHHRA’s HR self-assessment tool. Additional sessions will focus on a variety of HR best practices from around the state and will include a look at using online performance appraisal, implementing a talent management program, and using a predictive index tool.

Mark your calendar for this event – registration materials will be available online in late September and included in WHA’s Friday Packet on September 30. Call 877-253-5466 to make your hotel reservation at the Kalahari Resort. The special room rate of $99 (standard room with two queen beds/four water park passes) will be available only until October 10.