On September 20, Professor Mary Naylor, PhD, from the University of Pennsylvania School of Nursing, led a discussion with the Wisconsin Council on Medical Education and Workforce (WCMEW) on the state of collaborative practice between physicians and advanced practice nurses (APNs) in today’s health care environment. WCMEW is investigating the potential for increased utilization of advanced practice providers as one solution to the expected shortage of clinicians in Wisconsin’s future.

Naylor described the results of several studies on clinical models that integrate APNs, which showed that clinical outcomes and patient satisfaction measures were superior to other delivery models. She said the keys to greater integration and utilization of APNs are cultural change in health systems and greater numbers of nurses being trained as APNs. Members of the audience related experiences in their practices and systems regarding advanced practice providers in delivering clinical services.

The next steps for WCMEW are to understand the current status of the use of advanced practice providers in Wisconsin and to identify best practices. If you have any questions about this article, contact George Quinn at WHA.

At a September 14 meeting in Madison, the Wisconsin Quality Steering Committee reviewed a recommendation advanced by the CheckPoint Measures Team. The Measures Team recommendation focused on improving the usability of the Web site by increasing the quantity and diversity of the information presented on it. A key consideration of the Team is to select measures that coordinate with other initiatives in an effort to minimize additional resource requirements for hospitals. The focus of the CheckPoint program will continue to be to meet the needs of purchasers and consumers for reliable information on the quality and safety of the care they receive in hospitals.

The Steering Committee suggested minor changes to the recommendation presented by the Measures Team. The recommendation will now be sent on to the WHA Board of Directors for action at their October meeting. For more information on the Measures Team recommendation, contact Dana Richardson at drichardson@wha.org or 608-274-1820.

Kathleen Caron, WHA director of quality systems, presented the results of the first CheckPoint error prevention audit. Sixteen hospitals participated in the audit with all participating hospitals exceeding the passing score of 80 percent. Scores ranged from 81.4 percent to 99.7 percent. Hospitals that participated in the audit completed a survey of their experience with the audit. Seventy-two percent of respondents indicated that they strongly agreed or agreed that the audit helped them to improve their reporting process for the error prevention measures. The next audit will begin in September 2006.

George Quinn, WHA senior vice president, gave an informational review of the community benefits report recently completed by member hospitals. The report will include both financial information and stories about local programs undertaken by hospitals to improve the health of their communities. The report will be unveiled at the WHA Annual Convention next week.

Jim Sullivan is a Democrat from Wauwatosa. Jim is a current Wauwatosa alderman and a practicing health care law attorney. As alderman, Jim lists one of his achievements as leading the successful passage of the first municipal smoke-free restaurant ordinance in Milwaukee County.

Candidate Survey Results: Candidates’ answers to selected abbreviated questions from WHA’s 2006 candidate survey appear below. To view the entire survey for this or any other race, contact Eric Borgerding or Jodi Bloch 608-274-1820.

Wisconsin’s Medicaid and BadgerCare programs pay hospitals about 49 cents for every dollar it costs hospitals to care for these patients. In 2005, this resulted in $550 million of unpaid costs that were shifted to the private sector. Known as the "Hidden Health Care Tax," this level of cost-shifting due to unfunded government programs contributes to rising health insurance premiums. The situation is much the same for Wisconsin’s nursing homes, many of which are owned/subsidized by hospitals. Would you support the state budgeting additional funds to pay hospitals and nursing homes more adequately and to reduce the "Hidden Health Care Tax" on Wisconsin employers?

Reynolds: "Would like to require a greater co-pay by Medicaid and Badger Care recipients."

Sullivan: YES.

Under current law, employee contributions to employer-provided health insurance are exempt from state and federal income tax. However, Wisconsin is one of a handful of states that does not allow a state income tax deduction for contributions to a Health Savings Account (HSA). A bill to accomplish this was passed three times by the Legislature, and vetoed each time by Governor Doyle. Do you support allowing individuals to deduct contributions to HSAs from their state income taxes (estimated cost $4.5 million in 2006)?

Reynolds: YES. Sullivan: NO.

It is anticipated that legislation could be introduced again this session that mandates nurse-to-patient ratios in hospitals (i.e., 1 nurse for X number of patients). Would you support legislation mandating patient staffing ratios?

Reynolds: NO. Sullivan: YES.

With one or two exceptions, all of Wisconsin’s 130 hospitals are not-for-profit and provided over $687 million in uncompensated care to Wisconsin residents in 2005. These same hospitals also provided additional community benefits, such as health screenings or health outreach programs to underserved populations in their areas. While these hospitals are generally exempt from paying local property taxes, they often make voluntary payments in lieu of taxes to support local services. Do you support continuing the property tax exemption for non-profit hospitals?

Reynolds: YES. Sullivan: YES.

Attendees at the WHA annual meeting next week will receive a copy of the Association’s first annual statewide community benefits report. Wisconsin Hospitals Connecting with their Communities is an impressive accounting of community benefits provided by our mission-driven community-based hospitals. Importantly, all 132 Wisconsin hospitals participated in the voluntary community benefit survey. The survey tool, developed by the Michigan Health & Hospital Association, utilized uniform definitions and reporting standards that align with the Catholic Healthcare Association and VHA.

This first statewide report focuses not only on quantifying the magnitude of uncompensated care provided by Wisconsin hospitals but is primarily devoted to recounting real stories about hospital-specific benefits that have touched the lives of real people. And those stories are most impressive!

The community benefits Web site is now under construction and will be promoted to the public and to the press as the place to find out more about the many programs and services that hospitals provide every day in the communities they serve. The Web site, www.wiservepoint.org, will be populated with the stories that hospitals have submitted, and the front page of the site will feature one or two stories from member hospitals that will change every month. In addition, links will be provided to all Wisconsin hospitals’ Web sites. Members are urged to continue to send stories, which will be added to their section on the Web site.

By now, the CEO and the hospital community benefit contact person at each hospital should have received a personalized community benefit summary report from WHA. The hard copies of the annual report and the book containing all the stories submitted to WHA will be released to members only at the WHA convention on September 28 in Lake Geneva. The exact date in late October for the public release of the report, the data, and the stories has not been set. WHA is working with the Madison area hospitals that have expressed an interest in hosting a local news conference in late October to coincide with the community benefit news release being issued statewide.

Wisconsin hospitals have a long and rich history of service to their communities. Our community benefits report effectively documents this ongoing commitment.

Steve Brenton
President

Julie is a Republican from Oshkosh who was a Winnebago County Board Supervisor. She is married to a physician and has four sons. She is currently pursuing her MBA from UW Oshkosh. She has served on local community boards including the YMCA.

Gordon is a Democrat from Oshkosh who worked for U.S. Senator Herb Kohl and former Congressman Jay Johnson. He later worked as a budget analyst for the City of Long Beach, California before returning back to his hometown of Oshkosh where he is now a municipal consultant and teaches government at UW-Oshkosh. Gordon is a member of local organizations including the Oshkosh Rotary.

Candidate Survey Results:

Candidates’ answers to selected abbreviated questions from WHA’s 2006 candidate survey appear below. Candidate Hintz did not return the survey. To view the entire survey for this or any other race, contact Eric Borgerding or Jodi Bloch 608-274-1820.

Wisconsin’s Medicaid and BadgerCare programs pay hospitals about 49 cents for every dollar it costs hospitals to care for these patients. In 2005, this resulted in $550 million of unpaid costs that were shifted to the private sector. Known as the "Hidden Health Care Tax," this level of cost-shifting due to un-funded government programs contributes to rising health insurance premiums. The situation is much the same for Wisconsin’s nursing homes, many of which are owned/subsidized by hospitals. Would you support the state budgeting additional funds to pay hospitals and nursing homes more adequately and to reduce the "Hidden Health Care Tax" on Wisconsin employers?

Pung Leschke:YES. "Part of the problem with our health care system is that the third party payor system of insurance companies and government does a couple of things: it hides the cost from the consumer; it underpays on the government side which results in the need to make up for that on the private side. I have answered ‘yes’ because, ideally, the system will move forward toward a more fair compensation model that will involve more appropriate government payments for the services that are rendered."

Under current law, employee contributions to employer-provided health insurance are exempt from state and federal income tax. However, Wisconsin is one of a handful of states that does not allow a state income tax deduction for contributions to a Health Savings Account (HSA). A bill to accomplish this was passed three times by the Legislature, and vetoed each time by Governor Doyle. Do you support allowing individuals to deduct contributions to HSAs from their state income taxes (estimated cost $4.5 million in 2006)?

Pung Leschke: YES.

It is anticipated that legislation could be introduced again this session that mandates nurse-to-patient ratios in hospitals (i.e., 1 nurse for X number of patients). Would you support legislation mandating patient staffing ratios?

Pung Leschke: NO.

With one or two exceptions, all of Wisconsin’s 130 hospitals are not-for-profit and provided over $687 million in uncompensated care to Wisconsin residents in 2005. These same hospitals also provided additional community benefits, such as health screenings or health outreach programs to underserved populations in their areas. While these hospitals are generally exempt from paying local property taxes, they often make voluntary payments in lieu of taxes to support local services. Do you support continuing the property tax exemption for non-profit hospitals?

Pung Leschke: YES. "Only because it’s not fair to change the rules in the middle of the game."

A new law in Wisconsin changes slightly a requirement placed on employers of caregivers in Wisconsin. Previously, employers were required to have employees complete a background information disclosure form ("BID"), developed by the state of Wisconsin, upon employment and every four years subsequently. The BID requires the reporting (self-disclosure) of any convictions, findings by a government agency of client abuse, neglect, or misappropriation, or certain license limitations.

With the amendments to the law in 2005 Wisconsin Act 351, employers have an option. They may follow the previously required BID process or they may set in place a policy that requires the caregiver to provide all of the information requested in the BID, in writing, to the employer. The employer must inform the employees annually of the obligation to provide the information.

The purpose of the new law is to give employers flexibility in the way they monitor employees, but it does not in any way change the need to perform a complete caregiver background check every four years.

Plan to attend the 2006 Wisconsin Quality & Safety Forum, scheduled October 16-17, for a chance to learn from nationally recognized experts, as well as from your peers at the showcase of 30 current quality improvement and patient safety projects from Wisconsin. Six of these improvement projects will be highlighted as breakout presentations, giving attendees the chance to learn more about the project, its outcome and how to implement it.

Health care quality managers, risk managers, CEOs/administrators, clinician managers, physicians, nurses, pharmacists, patient care services staff, quality improvement team members, and others are encouraged to attend. This year’s Forum is co-sponsored by MetaStar and the Wisconsin Medical Society, and will be held at the brand new Holiday Inn Hotel & Conference Center in Stevens Point.

The full conference brochure with registration information is available in this week’s packet and online at www.wha.org. The special room rates at the Holiday Inn and Holiday Inn Express will be available only until September 24. Call 715-344-0200 today to make your hotel reservation.

On October 18, WHA and MetaStar are co-sponsoring a special symposium focused on well-tested approaches for sustaining and spreading the six changes of the Institute of Healthcare Improvement’s (IHI) 100K Lives Campaign.

The agenda for the "Symposium on Sustainability and Spread will include an expert on the British National Health Service’s sustainability work, an IHI representative to discuss the recent campaign, and a variety of panel discussions by hospitals on the challenges and successes encountered in implementing and sustaining the six changes. Attendees can expect to come away with practical ideas for making the six changes and other improvement efforts in their own hospitals.

The Symposium will be held at the new Holiday Inn Hotel & Conference Center in Stevens Point, and will be held immediately following the 2006 Wisconsin Quality & Safety Forum. Registration information for the October 18 symposium is included in the brochure for the Wisconsin Quality & Safety Forum, which is available in this week’s packet and online at www.wha.org. Attendance at the Quality Forum is not a pre-requisite for attending the symposium, but you must pre-register.

The Wisconsin Chapter of ACHE is presenting a special ACHE advancement session on October 20, 2006, at the GE Healthcare Institute in Waukesha.

The morning session, scheduled from 10 a.m. to 11:30 a.m., is for those college members preparing for the board of governor’s exam and application process to advance to Diplomate status. The afternoon session, scheduled from 12:30 to 2 p.m., is for those college members preparing to advance to Fellow status. A networking luncheon is included for those who attend either session.

Both sessions will be conducted by John Anderson, FACHE. He has 33 years of experience in executive health care management, has taught more than 40 ACHE advancement sessions, and is a national leader in the college. He has been a Fellow since 1995, was a Regent for Illinois, was governor of the college from 2000 to 2004, and was named the 2006 Senior Healthcare Executive of the Year for Wisconsin’s district.

There is no cost to register for this event, but pre-registration is requested. A brochure with registration form is included in this week’s packet and on the web site at www.wha.org. Easy, online registration is available as well.

In an effort to introduce careLearning to health care professionals in Wisconsin, WHA is hosting an informational session about careLearning, which will include a complete demonstration. The meeting will be held Friday, November 10, at the WHA headquarters in Fitchburg, just south of Madison.

Jim Kranz, vice-chairman of careLearning and vice president for the West Virginia Hospital Association, will introduce the concept of careLearning and provide valuable information about the benefits, features and cost of careLearning. Staff development specialists, directors of education, human resource professionals and any other hospital staff involved in the coordinator of mandatory and/or continuing education for hospital employees is encouraged to attend.

careLearning.com, an e-learning and education management solution specifically for health care professionals, is now available to WHA hospital members as a simple, affordable way to keep employees up-to-date on mandatory JCAHO and OSHA training, as well as regulatory and policy issues.

There is no cost to register for this event, but pre-registration is requested. A brochure with registration form is included in this week’s packet and on the web site at www.wha.org. Easy, on-line registration is available as well.

For more information on the session’s content, contact Jennifer Frank at 608-274-1820 or email jfrank@wha.org. For registration questions, contact Sherry Rabuck at 608-274-1820 or email srabuck@wha.org.

Aurora Health Care announced on September 19 that Nick Turkal, MD has been named president and chief executive officer to succeed G. Edwin Howe, Aurora’s founder, who earlier this year announced his plans to retire.

Dr. Turkal, an Aurora senior vice president and president of the health care system’s Metro Region, was selected after a comprehensive nationwide search, said Bev Greenberg, chair of the Aurora Board of Directors and vice president of Time Warner Cable, Wisconsin. The Board unanimously approved his appointment Tuesday, September 19.

Dr. Turkal will transition to his new role October 1. Howe plans to begin his retirement in January 2007.

"I’m delighted with the Board’s decision," Howe said. "Nick is a leader who has earned the trust and respect of our employees and physicians, and I know that community leaders throughout our state will embrace this choice. Nick embodies the values of Aurora Health Care – accountability, teamwork and respect – and he is a passionate advocate for patient care. Our senior leadership team and I feel strongly that Nick is the right leader for Aurora as we move into the future."

Homelessness is a problem with far-reaching effects. It devastates families and in Wisconsin’s cold climate is often an issue of survival. In the mid-1990s, Mercy Health System President/CEO Javon R. Bea, noticed that many families seeking treatment at Mercy’s emergency department listed the family car as their address. He knew Mercy could do more than tend to their health care needs.

With the aid of community agencies, Mercy conducted a survey of Janesville and surrounding communities, which indicated that homelessness in Rock County had increased 81% in three short years. The strain on existing local resources was taking its toll and community leaders knew something innovative had to be done to support our community members in need.

To brainstorm solutions, Mercy organized a community-based task force consisting of representatives from Mercy Health System, Rock County Human Services, the Salvation Army, the AIDS Support Network, the YWCA, First Call, Community Action, Inc., the local ECHO food pantry, and local church and government groups. The task force was charged with setting goals and developing an action plan for an intervention program. Mercy offered to donate a residential facility that could house up to 25 people for 30 days at a time and operate the center, providing a staff of three paid employees and organizing volunteers and fundraisers. Before long, the House of Mercy Homeless Center was born, and it has been providing shelter for community members in crisis since 1996. It is one of the only health system-run centers of its kind in the nation.

More than a temporary shelter, the House of Mercy is dedicated to helping its residents find lasting housing solutions and building life skills that support independence. Residents receive the services of a social worker/case manager, and support services have grown to include parenting classes, stress management training, free childcare, rent assistance programs, budgeting education and housing counseling.

Last year, the Center served 139 households, representing 317 individuals, for a total of 8,086 shelter nights. Since its inception, the House of Mercy has sheltered 3,014 individuals, including 1,537 children, for 79,389 shelter nights. Mercy provides the coordination for the Center’s operation, which includes extensive fund raising efforts such as the annual House of Mercy Charity Ball, which raises approximately $150,000 each year.

Volunteers are crucial to success. The House of Mercy volunteers are a diverse group composed of all age, income, and educational levels. They provide 7,000 to 9,000 hours of service per year. Of the 80 total volunteers, 36 Mercy employees, including three Mercy senior executives, are regular volunteers. Twenty of the 28 initial volunteers still help at the House of Mercy. Many former residents are also volunteers, and provide unique insight and hope to current residents. From fundraising to manning the phones to overnight shifts, the volunteers do a wide variety of things that make this special program possible. Volunteers are celebrated through local newspaper ads, an annual recognition dinner, and with benefits like free flu shots and discounted meals.

The program has been extremely successful. Recidivism rates are low despite increasing economic pressures. Last year, fewer than 15 percent of all House of Mercy residents served required a second stay. A Self-Sufficiency survey is used pre- and post-stay to assess self-sufficiency in six key areas: housing, employment, income, transportation, use of alcohol or drugs, and physical/mental health. House of Mercy residents increased their self-sufficiency scores by an average of 17.8 percent last year, from time of intake to time of discharge. But the most important measure of success comes straight from the residents themselves.

Here are a few stories from recent residents:

"I went to the hospital due to some mental illness. I lost my job. I lost my home. I had no other choice but to come to the homeless shelter. Coming here I see that a lot of people are in the same boat. I felt like I was the only one and now I know I’m not. Everyone is being so helpful. They’re going to help me find a new home, help me find a job. Everybody’s just so nice." - Misty

"They planted seeds of hope in me just by me being there. They’ve got different programs within the House of Mercy, which gave me something to work on and with that they helped me to work out a plan that was workable after I left. [The programs] help you look for work and to get things organized in your life, and it’s a real positive step toward getting your own thing going." - Elliott

"I came to the House of Mercy because I had nowhere else to turn. My boyfriend at that time had kicked me and my two boys out. I would have never dreamed I’d be homeless but if it wasn’t for the House of Mercy it’s hard telling where I’d be right now, and I don’t think it’d be very good. I went from absolute nothing to having everything I need. I have an apartment. I have a job. My kids have food. They even supplied me with resources of people giving furniture away, so I had beds, couches, chairs, curtains, everything when I moved into my apartment. I mean it was a true blessing. A true blessing." – Susan

"I was a full-time student at the University of Wisconsin – Rock County, and my financial aid was supposed to come through on the 31st of January. We were evicted January 10. I never thought this would happen, especially when I was trying to do everything to better my daughter’s future. [Now] we will be moving back to Evansville. We found a 4-bedroom townhouse about 1-1/2 blocks away from the schools. Hopefully in the fall I’ll be able to get myself back in school as well. We actually get to have a happy ending." – Amanda

"The House of Mercy was really incredible, starting from coming in and making me feel comfortable and welcome to letting me know what help was out there for me and helping me find an apartment. I mean, you name it. It’s like they went over and beyond what the job was supposed to be. You know, I guess it’s like being a best friend or something. That’s the kind of warmth I felt here. Now I am working. Most importantly, I think I’m peaceful and content with where I am. You know, things are going up and up and also I have learned so much from being here about how to prevent myself from getting into another situation." - Anesha

Submit hospital community benefit stories to Mary Kay Grasmick, editor, mgrasmick@wha.org or call 608-274-1820.

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