September 24, 2010
Volume 54, Issue 37

Health Care Reform Study Committee Focuses on Exchanges
Experts from Utah, Massachusetts share experiences and challenges

This week the Legislative Council Study Committee on Health Care Reform Implementation heard from a variety of invited speakers as they began a closer examination of the challenges and opportunities surrounding the creation of a health insurance exchange in Wisconsin. Two hospital CEOs are among the 21 Committee members. They are William Petasnick, president/CEO, Froedtert Health, and Ed Harding, president/CEO, Columbus Community Hospitals.

Among the provisions in the Patient Protection and Affordable Care Act (PPACA), exchanges are required to be established as new mechanisms for expanding access to health insurance. States have the opportunity to establish an exchange. The U.S. Department of Health and Human Services (HHS) is responsible for establishing and operating an exchange for those states that choose not to establish one or for states that will not have their exchange operable by January 1, 2014.

The idea behind an exchange is to create an organized and competitive market for health insurance, governed by common rules, and designed to help consumers (individuals and businesses) better understand their health insurance options. While federal planning grants are available to assist states in their efforts, opinions differ on whether states should be among the first to establish their exchanges or should wait and more thoroughly evaluate how exchanges evolve in other states.

The list of invited speakers for this week’s meeting included: Bill Oemichen – president & CEO of the Cooperative Network; Dave Stella – secretary, Department of Employee Trust Funds (DETF) and staff; Jon Kingsdale, Kingsdale & Associates, former executive director of the Massachusetts Health Connector; Dave Jackson – director, Utah Health Exchange; and Jason Helgerson – Medicaid director, Department of Health Services (DHS). Helgerson was unable to attend; Rachel Currans-Sheehan, executive assistant, DHS, provided testimony to the committee in his absence.

In his presentation, Kingsdale gave a brief description of health reform, its progress in Massachusetts and some of the design issues and lessons learned from the development and implementation of their exchanges – Commonwealth Care, which connects eligible, uninsured, low-income residents to subsidized health plans; and Commonwealth Choice, which connects residents and businesses to commercial health insurance products. According to Kingsdale, a key difference between their exchanges is that Commonwealth Care aggressively negotiates with insurers, whereas Commonwealth Choice acts more as a marketplace, marketing the health plans.

Kingsdale said among the key questions for states are determining the exchange’s goals and addressing design issues, such as determining the governance structure and addressing adverse selection. He listed outreach and marketing to members, integrated eligibility determination, transparency of cost, access and quality, and simplification of choice and enrollment as some of the administrative challenges. Among the lessons learned, Kingsdale mentioned both the challenges and opportunities related to automation (technology) and opportunities for outsourcing, partnering and collaborating where he said a high amount of private commercial capacity exists.

In moving toward the establishment of their exchange, Jackson said Utah identified the same issues that are evident in other states including: escalating premium costs, consumers increasingly detached from the market, employers dropping insurance, too many uninsured, and misaligned incentives. Based on their identification of the issues, he said Utah made a commitment to a systemic change with six areas of emphasis: health insurance reform, personal responsibility, transparency and value, maximization of tax advantages, optimization of public programs, and a modernization of governance.

Jackson listed several similarities between the Utah and Massachusetts exchanges. Both are state-based and state-specific solutions and both are consumer-centered approaches that achieved broad, bi-partisan consensus supporting their basic reform elements.

But Jackson said there are also several differences between how the two states approached their exchanges: Massachusetts has individual and employer participation mandates, Utah does not; Massachusetts acts more as a contracting agent, the State of Utah’s role is that of a market facilitator; Massachusetts established their exchange with broad regulatory responsibilities, the Utah exchange’s regulatory authority is limited to the establishment of electronic data standards; and Massachusetts acted first on public sector reforms and is now rolling out private insurance market reforms, Utah began by implementing private reforms first, with public sector reforms to follow.

In her discussion, Currans-Sheehan indicated that work continues at the state’s Office of Health Care Reform (OHCR) on a detailed exchange plan that is guided by five key ideas: keep the exchange simple; make the exchange transformative; make sure it builds off of Wisconsin’s strengths; make sure there’s a focus on customer service; and coordinate wherever possible with existing initiatives.

Currans-Sheehan said the OHCR has submitted an application requesting nearly $1 million in federal planning grant funding to complete the research and analysis related to implementing an exchange in Wisconsin. According to Currans-Sheehan, a significant portion of the dollars will go toward a comprehensive survey to better understand the insurance marketplace in Wisconsin and to develop a predictive model for what insurance premiums through an exchange might look like.

She also indicated that the OHCR will be submitting comments on health insurance exchanges in response to a request for public comment from DHHS. WHA is also developing and will be submitting comments prior to an October 4 deadline.

According to Committee Co-Chairs Rep. Richards and Sen. Erpenbach, among the decisions the Committee will begin making at their next meeting is whether the Committee should recommend that Wisconsin establish an exchange or allow the responsibility for our state’s exchange to fall to HHS. And if Wisconsin does develop an exchange, should it be our own or done as part of a regional or multi-state exchange.

Also presented at the meeting was a proposal from David Reimer, director – Community Advocates Public Policy Institute; Joe Leean, former secretary of DHS; and Robert Kraig, executive director – Citizen Action of Wisconsin describing what Wisconsin exchange’s governing body and functions might look like.

During discussion after the presentations, Petasnick made the point and Committee Co-Chairs Richards and Erpenbach agreed that before the Committee makes any significant determinations on exchange details, Committee members need to focus on a set of guiding principles for their deliberations. To that end, the co-chairs instructed the Committee members to submit their ideas on guiding principles to Legislative Council staff along with comments and alternatives related to an exchange governing body for development of an options paper for discussion.

All materials related to this study committee, can be found at: The next meeting is scheduled for October 21.

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WHA asks Supreme Court to Review Property Tax Exemption Case
"Common sense often makes good law"

The Wisconsin Hospital Association this week asked the Wisconsin Supreme Court to accept Covenant Healthcare’s Petition for Review of the Court of Appeal’s decision that denied the hospital property tax exemption for St. Joseph Hospital’s Outpatient Center. In its brief, WHA acknowledged that Supreme Court review is the exception rather than the rule, but emphasized, "This is an exceptional case."

David Edquist of von Briesen & Roper, writing on behalf of WHA, argued that the Supreme Court is presented with an opportunity to step back and consider the nonprofit hospital exemption "in light of the history of property tax exemptions generally, and the purposes and functions of modern hospitals in particular." Quoting Justice William O. Douglas ("Common sense often makes good law"), Edquist noted, "[W]hen a lower court adopts an interpretation of the law that is totally contrary to common sense, a second look is in order."

WHA’s brief points to the realities of health care today: "The increased provision of hospital services on an outpatient basis has brought improved access to advanced life-saving and life-enhancing services to Wisconsin communities. […] These innovations have reduced the cost of surgical and treatment procedures while providing the best in patient safety and care." According to the brief, hospitals should not be required to risk their property tax exemption when transitioning services from an inpatient to an outpatient setting.

In WHA’s brief, Edquist also emphasized that the Court’s review is important to restore consistency and predictability for future interpretations of the nonprofit hospital exemption. Finally, when describing the significant statewide impact of the Court of Appeals decision, WHA’s brief explained that the vast majority of Wisconsin hospitals, throughout the state, are nonprofit. Most services provided by these nonprofit hospitals are outpatient services; this is particularly true for small rural hospitals that are relatively more dependent on outpatient services to provide care in their communities.

After filing WHA’s brief in support of Wheaton’s Petition for Review, Edquist said, "We understand that the Court generally accepts less than one out of 10 civil cases for review. But given the impact the Court of Appeals decision could have on the access to and cost of health care in Wisconsin, particularly those areas of the state already struggling to maintain services, we are hopeful that the Court will accept this case. We are asking the Court to review this entire body of law in order to restore consistency, clarity, and common sense."

A copy of the WHA brief in support of the Petition for Review is available on the WHA Web site at

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Political Action Spotlight: 2010 Fundraising Campaign Surpasses $200K Mark

Heading into the last two months before the November election, the 2010 Wisconsin Hospitals State PAC and Conduit fundraising campaign has raised more than $200,000. The $200,571 total raised to date accounts for 93 percent of the $215,000 goal.

To date the Campaign has raised this total from 423 individuals affiliated with 85 hospitals/hospital systems. This is an increase of 35 individuals in the last two weeks.

Contributions to candidate campaigns have also exceeded $200,000 the past two weeks totaling more than $226,000 in disbursements. This is an increase of more than $65,000 ahead of 2008 at this same time, the last election year and no surprise given that there are a record number of open seat state legislative races, an open seat gubernatorial race and competitive Congressional races around the state. Remember to contact WHA’s Jodi Bloch or Jenny Boudreau to check your Wisconsin Hospital Conduit account balance when a candidate campaign requests your financial support.

Individual contributors’ names are published below by amount categories in alphabetical order. They will be published again in two weeks. For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.

Contributions Ranging from $1 - $499

Adams, Daniel         Memorial Medical Center - Ashland

Anderson, Mark         Sacred Heart Hospital

Appleton, Karl         HSHS-Eastern Wisconsin Division

Arendt, Kathleen         Aspirus Wausau Hospital

Arriola, Josephine         St. Joseph’s Hospital

Ashenhurst, Karla         Ministry Health Care

Axelsen, Kathern         Sacred Heart Hospital

Ayers, Mandy         Wisconsin Hospital Association

Bair, Barbara         St. Clare Hospital and Health Services

Baker, Christine         St. Mary’s Hospital

Ballentine, Anne         Wheaton Franciscan Healthcare

Bares, Diane         Aurora Health Care

Barkovich, Catherine         Sacred Heart Hospital

Beckler, Rick         Sacred Heart Hospital

Beglinger, Joan         St. Mary’s Hospital

Bell, Kristine         Aspirus Wausau Hospital

Benz, Staci         Children’s Hospital and Health System

Bergmann, Ann         Spooner Health System

Bernklau, Robert         Aspirus Wausau Hospital

Biros, Marilyn         SSM Health Care-Wisconsin

Bliven, David         Aspirus Wausau Hospital

Block, Jennifer         Sacred Heart Hospital

Bloom, Deborah         St. Joseph’s Hospital

Bosio, David         Aspirus Wausau Hospital

Bosman-Clark, Jane         Children’s Hospital and Health System

Boson, Ann         Ministry Saint Joseph’s Children’s Hospital

Boudreau, Jenny         Wisconsin Hospital Association

Bowman, Andrew         Sacred Heart Hospital

Braddock, Jonathan         WHA Financial Solutions

Braunschweig, Jennifer         Gundersen Lutheran Medical Center

Brenholt, Craig         St. Mary’s Hospital

Brenny, Terrence         Stoughton Hospital Association

Brown, John         St. Mary’s Hospital

Bryans, Richard         Sacred Heart Hospital

Buettner, Susan         Aurora Health Care

Buhl, Mike

Burgener, Jean         Aspirus Wausau Hospital

Burtch, Sue         Aspirus Wausau Hospital

Busch, Rebecca         Spooner Health System

Buss, Diane         St. Mary’s Hospital

Calhoun, William         Mercy Medical Center

Campau, Patricia         Columbia St. Mary’s, Inc.

Campbell, Mark         Aspirus Wausau Hospital

Campbell-Kelz, Nancy         Aspirus Wausau Hospital

Carlson, Carol         Sacred Heart Hospital

Casey, Candy         Columbia Center

Caven, Michael         Memorial Medical Center - Ashland

Cieslak Duchek, Mary         Aurora Health Care

Clark, Mary Ann         Cumberland Memorial Hospital

Connor, Michael         Aurora Health Care

Conwell, Lisa         WHA Financial Solutions

Coon, Lawrence         Hall, Render, Killian, Heath & Lyman

Cox, Tamarah         Aspirus Wausau Hospital

Craft, Carolyn         St. Joseph’s Hospital

Cryns, Janice         Children’s Hospital and Health System

Dalebroux, Steve         St. Mary’s Hospital

Danner, Dean         Aspirus Wausau Hospital

Danzinger, Marcia         Sacred Heart Hospital

Davis, Kathleen         Children’s Hospital and Health System

DeMars, Nancy         Sacred Heart Hospital

Derks, Darla         Sacred Heart Hospital

Dettman, Amy         Bellin Hospital

Dietrich, Dean         Aspirus Wausau Hospital

Dietsche, James         Bellin Hospital

Dillon, Michael         Sacred Heart Hospital

Dixon, Janet         Children’s Hospital and Health System

Dodd, Petra         Aspirus Wausau Hospital

Donlon, Marcia         Holy Family Memorial, Inc.

Dorpat, Denice             Aspirus Wausau Hospital

Drengler, Kathryn         Aspirus Wausau Hospital

Dryden, Shawn         Sacred Heart Hospital

Dwyer, Amy         Sacred Heart Hospital

Eady, Diane         Sacred Heart Hospital

Eddy, Lee Anne         Children’s Hospital and Health System

Elliott, Roger         St. Joseph’s Hospital

Entenmann, Kim         St. Joseph’s Hospital

Erickson, William         Ministry Saint Mary’s Hospital

Ertl, Denise         Aspirus Wausau Hospital

Evans, Kim         Bellin Hospital

Facey, Alice         St. Clare Hospital and Health Services

Feeney, John         Aurora Medical Center in Oshkosh

Feldhausen, Mary         St. Vincent Hospital

Fielding, Laura         Holy Family Memorial, Inc.

Fields, Mary         Aurora Health Care

Fochs, Mary         Aspirus Wausau Hospital

Francaviglia, Stephen         Aurora Health Care

Fuchs, Thomas         St. Joseph’s Hospital

Furlong, Marian         Hudson Hospital

Gantner, Sue         Aspirus Wausau Hospital

Garavet, Scott         Aspirus Wausau Hospital

Gengler, Tim         Aspirus Wausau Hospital

Giedd, Janice         St. Joseph’s Hospital

Gerike, Nancy         St. Clare Hospital and Health Services

Gigot, Kelly         St. Vincent Hospital

Gjolberg, Skip         St. Joseph’s Hospital

Goelzer, Mark         Mercy Health System Corporation

Goffinet, Jo         St. Mary’s Hospital

Gormican, John J.         Agnesian HealthCare/St. Agnes Hospital

Govier, Mary         Holy Family Memorial, Inc.

Grohskopf, Kevin         St. Clare Hospital and Health Services

Gruber, Richard         Mercy Health System Corporation

Gullicksrud, Lynn         Sacred Heart Hospital

Gutekunst, Penny         Children’s Hospital and Health System

Habel, Heidi         Hayward Area Memorial Hospital

Hafeman, Paula         St. Vincent Hospital

Haggerty, Peggy         Columbus Community Hospital

Halida, Cheryl         St. Joseph’s Hospital

Hamilton, Mark

Hammel, Jennifer         Children’s Hospital and Health System

Hansen, Carrie         Ministry Health Care

Hassemer, Robert         Sacred Heart Hospital

Hattem, Marita         Aspirus Wausau Hospital

Hedrington, Brian         Sacred Heart Hospital

Hennessy, Candace         Aurora Health Care

Hessert, Peter         Aspirus Wausau Hospital

Hink, Dawn         Sacred Heart Hospital

Hiremath, Satchi         Aurora Health Care

Hoege, Beverly         Reedsburg Area Medical Center

Hofer, John         Bay Area Medical Center

Holmes, Sheri         Aspirus Wausau Hospital

Huettl, Patricia         Holy Family Memorial, Inc.

Hundt, Pamela         Sacred Heart Hospital

Jelle, Laura         St. Clare Hospital and Health Services

Jensema, Christine         HSHS-Eastern Wisconsin Division

Jensen, Christopher         Children’s Hospital and Health System

Jensen, Russell         St. Mary’s Hospital

Jentsch, Lisa         Children’s Hospital and Health System

Johnson, Charles         SSM Health Care-Wisconsin

Johnson, Kimberly         Sacred Heart Hospital

Johnson, Patricia         Hayward Area Memorial Hospital

Johnson, Roy         Children’s Hospital and Health System

Jones, Linda         Children’s Hospital and Health System

Karow, Deborah         Aspirus Wausau Hospital

Kelsey Foley, Kathy         Aspirus Wausau Hospital

Kempen, Jacob         Aspirus Wausau Hospital

Kepchar, Dennis         Ministry Health Care

Kerecman, Laura         Children’s Hospital and Health System

Kerfoot, Karlene         Aurora Health Care

King, Steve         St. Mary’s Hospital

Klay, Lois         St. Joseph’s Hospital

Kleaveland Kupczak, Sarah         Wheaton Franciscan Healthcare

Kluesner, Kevin         Aurora Health Care-South Region

Klunk, Timothy         Children’s Hospital and Health System

Kowske, Steve         Aurora Health Care

Krueger, Pamela         Aspirus Wausau Hospital

Lange, George         Westgate Medical Group, CSMCP

Larson, William         St. Joseph’s Hospital

Lathrop, Randall         Sacred Heart Hospital

Leonard, Joanne

Leonard, Mary Kay         St. Mary’s Hospital

Lerch, Shawn         Columbus Community Hospital

Lien, Kristine         Sacred Heart Hospital

Logemann, Tim         Aspirus Wausau Hospital

Lorenz, Bruce         Aspirus Wausau Hospital

Lortscher, Loren         Sacred Heart Hospital

Lucas, Roger         Aspirus Wausau Hospital

LuCore, Patricia         Sacred Heart Hospital

Mackey, Theresa         Sacred Heart Hospital

Marcouiller, Don         Memorial Medical Center - Ashland

Margan, Rob         Wisconsin Hospital Association

Marsch, Jean         St. Vincent Hospital

Mathews, Larry         St. Vincent Hospital

Maurer, Mary         Holy Family Memorial, Inc.

McKevett, Timothy         Beloit Memorial Hospital

McNally, Maureen         Froedtert Memorial Lutheran Hospital

Meicher, John         St. Mary’s Hospital

Mello, Sadie         Sacred Heart Hospital

Miller, Clint         Spooner Health System

Mohr, Carol         Sacred Heart Hospital

Moon-Mogush, Cindy         Aurora Health Care

Moraski, Kevin         Ministry Health Care

Mourey, Gerald         Aspirus Wausau Hospital

Mulder, Doris         Beloit Memorial Hospital

Nelson, James         Fort HealthCare

Nelson, Mark         Sacred Heart Hospital

Nevers, Rick         Aspirus Wausau Hospital

Nockerts, Steve         The Richland Hospital, Inc.

Norton, Marcella         Aspirus Wausau Hospital

O’Keefe, Robert         Aurora Health Care

Olive, Willie         Children’s Hospital and Health System

Olkowski, Leland         Aspirus Wausau Hospital

Ordinans, Karen         Children’s Hospital and Health System

Ose, Peggy         Riverview Hospital Association

Osen, John         Aspirus Wausau Hospital

Padilla, Gilbert         Sacred Heart Hospital

Page, Alison         Baldwin Area Medical Center

Palecek, Steve         St. Joseph’s Hospital

Pascente, Maria         Aurora Health Care

Paul, Mary         Columbia St. Mary’s, Inc. - Milwaukee

Peck, Lori         Memorial Health Center

Pedretti, Julie         Children’s Hospital and Health System

Peickert, Barbara         Hayward Area Memorial Hospital

Peiffer, Susan         Sacred Heart Hospital

Pempek, Kalynn         Aspirus Wausau Hospital

Pennebecker,         Allen Ministry Health Care

Perlock, Sandra         Aspirus Wausau Hospital

Peterson, Doulas         Chippewa Valley Hospital

Pichotta, Naomi         Aurora Health Care

Piehl, Steven         Children’s Hospital and Health System

Pielhop, Judy         Sacred Heart Hospital

Piper, Barbara         Sacred Heart Hospital

Pirsig-Anderson, Jane         Aurora Health Care

Podhora, Ida         Children’s Hospital and Health System

Polenz, Scott         Memorial Medical Center - Neillsville

Potts, Dennis         Aurora Health Care

Powell, Stacey         Sacred Heart Hospital

Preston, Mark         Sacred Heart Hospital

Priest, Geoffrey         Meriter Hospital

Proehl, Sheila         Hudson Hospital

Prunty, Brian         Aspirus Wausau Hospital

Reinke, Mary         Aurora Health Care

Richbourg, Mary         Sacred Heart Hospital

Roberts, Paula         Children’s Hospital and Health System

Roberts, Phillip         Columbus Community Hospital

Rocheleau, John         Bellin Hospital

Roethle, Linda         Bellin Psychiatric Center

Ross, Forrest         WHA Financial Solutions

Rouzer, Cindy         Spooner Health System

Rowe, Jeanne         Aspirus Wausau Hospital

Rozenfeld, Jonathan         St. Mary’s Hospital

Rubenzer, Deanne         St. Joseph’s Hospital

Rubenzer-Pike, Janet         St. Joseph’s Hospital

Rudolph, Wade         Sacred Heart Hospital

Rueber, Joel         Aspirus Wausau Hospital

Sachse, Kelly         Children’s Hospital and Health System

Schade, Randy         Aspirus Wausau Hospital

Schaetzl, Ron         St. Clare Hospital and Health Services

Schoof, Susie         Essie Kammer Consulting Group

Schraufnagel, Patricia         Memorial Medical Center - Ashland

Schroeder, Larry         Sauk Prairie Memorial Hospital

Schweitzer, Susan         Columbus Community Hospital

Scinto, Jeanne         Aspirus Wausau Hospital

Sczygelski, Sidney         Aspirus Wausau Hospital

Sheehan, Heather         Hayward Area Memorial Hospital

Skulan-Balmer, Anna         Sacred Heart Hospital

Spieckerman, Jill         Ministry Saint Mary’s Hospital

Stanford, Cynthia         Wisconsin Hospital Association

Stelzer, Jason         St. Clare Hospital and Health Services

Stenson, Jill         Agnesian HealthCare/St. Agnes Hospital

Stine, Stephen         Aspirus Wausau Hospital

Stone, Stacy         Sacred Heart Hospital

Storing, Sandy         Sacred Heart Hospital

Stout, Johni         WHA Financial Solutions

Strobel, Donald         Aspirus Wausau Hospital

Swanson, Becky         Sacred Heart Hospital

Swessel, Catherine         Children’s Hospital and Health System

Tandberg, Christine         Sacred Heart Hospital

Tapper, Joy         Milwaukee Health Care Partnership

Tarantino, Jennifer         Aurora Health Care

Thiel, Mike         Children’s Hospital and Health System

Todd, Jeffrey         Aspirus Wausau Hospital

Turner, Sally         Aurora Health Care

Tuttle, Kathryn         Memorial Medical Center - Ashland

Twinem, Thomas         Children’s Hospital and Health System

Vakoc, Patricia         Aspirus Wausau Hospital

Verploegh, Alan         Aspirus Wausau Hospital

Voelker, Thomas         Aspirus Wausau Hospital

Vogler, Linda         Sacred Heart Hospital

Vogt, Paula         Aspirus Wausau Hospital

Walker, Troy         St. Clare Hospital and Health Services

Warren, Scott         Memorial Medical Center - Ashland

Washburn, Juliane         Bay Area Medical Center

Watts, Susan         St. Vincent Hospital

Weden, Mary         Children’s Hospital and Health System

Werlein, George         Sacred Heart Hospital

Whiteaker, Les         Memorial Medical Center - Ashland

Winter, Jean         Aspirus Wausau Hospital

Wise, Richard         Sacred Heart Hospital

Witt, Heather         Aspirus Wausau Hospital

Wymelenberg, Tracy         Aurora Health Care

Wynimko, Susan         St. Joseph’s Hospital

Zeller, Brad         Hayward Area Memorial Hospital

Contributions Ranging from $500 - $999

Andersen, Travis         St. Elizabeth Hospital

Anderson, Rhonda         Columbia St. Mary’s, Inc.

Anderson, Sandy         St. Clare Hospital and Health Services

Bayer, Tom         St. Vincent Hospital

Bonin, Christopher         Aurora Health Care

Borgerding, Dana

Brenton, Mary E.

Bukowski, Cathy         Ministry Health Care’s Howard Young Medical Center

Butler, John         St. Mary’s Hospital

Callies, Julie         WHA Information Center

Carlson, Dan         Bay Area Medical Center

Chess, Eva         Aurora Health Care

Clapp, Nicole         Grant Regional Health Center

Clough, Sheila         Ministry Health Care’s Howard Young Medical Center

Coffman, Joan         St. Joseph’s Hospital

Deich, Faye         Sacred Heart Hospital

Farkas, David         Aurora Health Care

Frank, Jennifer         Wisconsin Hospital Association

Geboy, Scott         Hall, Render, Killian, Heath & Lyman

Grundstrom, David         Flambeau Hospital

Harding, Edward         Columbus Community Hospital

Heifetz, Michael         SSM Health Care-Wisconsin

Hinton, George         Aurora Sinai Medical Center

Hyland, Carol         Agnesian HealthCare/St. Agnes Hospital

Hymans, Daniel         Memorial Medical Center - Ashland

Jenks, David         Aurora Health Care

Just, Lisa         Aurora Medical Center in Hartford

Kammer, Peter         Essie Kammer Consulting Group

Kellar, Richard         Aurora West Allis Medical Center

Kerwin, George         Bellin Hospital

Klein, Rick         Aurora Health Care

Klimisch, Ronald         Aspirus Wausau Hospital

Korom, Nancy         Children’s Hospital and Health System

Krueger, Mary         Ministry St. Clare’s Hospital

Lambrecht, Randy         Aurora Health Care

Mahoney, Lorelle         Aurora Health Care

Mantei, Mary Jo         Bay Area Medical Center

Marquardt, Amy         Columbia St. Mary’s, Inc. - Columbia

McDonald, Brian         Aurora Health Care

McDonald, Mary Beth         Aurora Health Care

McKennie, Randall         Aurora St. Luke’s Medical Center

Merline, Karen

Miller, Jim         Children’s Hospital and Health System

Mlynarek, Robert         ProHealth Care - Waukesha Memorial Hospital

Moulthrop, David         Rogers Memorial Hospital

Mugan, James         Agnesian HealthCare/St. Agnes Hospital

Murphy, Mike         Bay Area Medical Center

Normington, Jeremy         Moundview Memorial Hospital and Clinics

Oberholtzer, Curt         Bay Area Medical Center

Postler-Slattery, Diane         Aspirus Wausau Hospital

Potter, Brian         Wisconsin Hospital Association

Richards, Theresa         Ministry Saint Joseph’s Children’s Hospital

Russell, John         Boscobel Area Health Care

Selberg, Heidi         HSHS-Eastern Wisconsin Division

Shabino, Charles         Wisconsin Hospital Association

Ship, Mark         Children’s Hospital and Health System

Size, Pat         Rural Wisconsin Health Cooperative

Smith, Linda         Aurora Health Care

Staffileno, Gerri         Columbia St. Mary’s, Inc. - Ozaukee

Strasser, Kathy         Aspirus Wausau Hospital

Stuart, Phil         Tomah Memorial Hospital

Swanson, Kerry         St. Mary’s Janesville Hospital

Taplin Statz, Linda         SSM Health Care-Wisconsin

Topinka, Ralph         Mercy Health System Corporation

Van Meeteren, Bob         Reedsburg Area Medical Center

VanCourt, Bernie         Bay Area Medical Center

Wallace, Michael         Fort HealthCare

Contributions Ranging from $1,000 - $1,499

Bazan, Bill         Wisconsin Hospital Association

Birkenstock, Timothy         Children’s Hospital and Health System

Britton, Gregory         Beloit Memorial Hospital

Brophy, Michael         Aurora Health Care

Buser, Kenneth         Wheaton Franciscan Healthcare - All Saints

Byrne, Frank         St. Mary’s Hospital

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

Christensen, Cinthia         Children’s Hospital and Health System

Devermann, Robert         Aurora Medical Center in Oshkosh

Duncan, Robert         Children’s Hospital and Health System

Dunigan, Thomas         Children’s Hospital and Health System

Eichman, Cynthia         Ministry Our Lady of Victory Hospital

Fale, Robert         Agnesian HealthCare/St. Agnes Hospital

Falvey, Patrick         Aurora Health Care

Friberg, Deb         Columbia St. Mary’s, Inc. - Milwaukee

Garcia, Dawn         Sacred Heart Hospital

Greenberg, Beverly         Aurora Health Care

Hahn, Brad         Aurora Health Care

Hilt, Monica         Ministry Saint Mary’s Hospital

Kief, Brian         Ministry Saint Joseph’s Children’sHospital

Kryda, Michael         Ministry Saint Joseph’s Children’s Hospital

Lappin, Michael         Aurora Health Care

Loftus, Philip         Aurora Health Care

Maciver, Carolyn         Aurora Health Care

Marciano, Karol         Columbia St. Mary’s, Inc. - Milwaukee

Martin, Jeff         Ministry Saint Michael’s Hospital

Nauman, Michael         Children’s Hospital and Health System

Nelson, Dave         SSM Health Care-Wisconsin

Niemer, Margaret         Children’s Hospital and Health System

Park, Dr. Joon         Aurora Health Care

Petasnick, William         Froedtert Memorial Lutheran Hospital

Radoszewski, Pat         Children’s Hospital and Health System

Reynolds, Sheila         Children’s Hospital and Health System

Robertstad, John         ProHealth Care - Oconomowoc Memorial Hospital

Roller, Rachel         Aurora Health Care

Ronstrom, Stephen         HSHS-Western Wisconsin Division

Sanders, Robert         Children’s Hospital and Health System

Schafer, Michael         Spooner Health System

Sexton, Bill         Prairie du Chien Memorial Hospital

Stanford, Matthew         Wisconsin Hospital Association

Titus, Rexford         ProHealth Care

Troy, Peggy         Children’s Hospital and Health System

Warmuth, Judith         Wisconsin Hospital Association

Westrick, Paul         Columbia St. Mary’s, Inc. - Milwaukee

Wolf, Edward         Lakeview Medical Center

Woodward, James         Meriter Hospital

Worrick, Gerald         Ministry Door County Medical Center

Contributions Ranging from $1,500 - $1,999

Bailet, Jeffrey         Aurora Health Care

Banaszynski, Gregory         Aurora Health Care

Bloch, Jodi         Wisconsin Hospital Association

Boese, Jennifer         Wisconsin Hospital Association

Brooks, Alenia         Aurora Health Care

Capelli, A.J.         Aurora Health Care

Fish, David         St. Joseph’s Hospital

Grasmick, Mary Kay         Wisconsin Hospital Association

Herzog, Mark         Holy Family Memorial, Inc.

Johnson, Peter         Aurora West Allis Medical Center

Kachelski, Joe         WHA Information Center

Kosanovich, John         UW Health Partners Watertown Regional Medical Center

Leitch, Laura         Wisconsin Hospital Association

Levin, Jeremy         Rural Wisconsin Health Cooperative

Mettner, Michelle         Children’s Hospital and Health System

Morgan, Dwight         Aurora Health Care

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

Olson, David         Columbia St. Mary’s, Inc.-Ozaukee Campus

Contributions Ranging from $2,000 - $2,499

Bablitch, Steve         Aurora Health Care

Ela, Susan         Aurora Health Care

Katen-Bahensky, Donna

Merline, Paul         Wisconsin Hospital Association

Neufelder, Daniel         Affinity Health System

Oliverio, John         Wheaton Franciscan Healthcare

Pandl, Therese         HSHS-Eastern Wisconsin Division

Quinn, George         Wisconsin Hospital Association

Sanders, Michael         Monroe Clinic

Starmann-Harrison, Mary         SSM Health Care-Wisconsin

Contributions Ranging from $2,500 - $2,999

Brideau, Leo Columbia         St. Mary’s, Inc.-Columbia Campus

Erwin, Duane         Aspirus Wausau Hospital

Contributions Ranging from $3,000 - $3,999

Borgerding, Eric         Wisconsin Hospital Association

Desien, Nicholas         Ministry Health Care

Turkal, Nick         Aurora Health Care

Tyre, Scott         Capitol Navigators, Inc

Contributions Ranging from $4,000 - $5,000

Contributions $5,000 +

Brenton, Stephen         Wisconsin Hospital Association

Size, Tim Rural         Wisconsin Health Cooperative

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Breaking News...

As we go to press, the WIRED for Health Board voted unanimously today (September 24) to recommend that the Wisconsin State Health Information Network (WISHIN) should serve as the state-designated entity (SDE) to implement a system of statewide health information exchange. WISHIN is an organization being formed by a consortium of WHA, the Wisconsin Medical Society, the Wisconsin Collaborative for Healthcare Quality, and the Wisconsin Health Information Organization.

The recommendation next goes to DHS Secretary Karen Timberlake for her approval, which is expected by the end of September. Watch for more information in next week’s Valued Voice.

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WMC Files Lawsuit Challenging New Prohibition on Certain Employer Meetings
Violates First Amendment and is preempted by NLRA

Wisconsin Manufacturers and Commerce (WMC) and the Metropolitan Milwaukee Association of Commerce (MMAC) have filed a lawsuit challenging, among other things, the constitutionality of last session’s amendments to the Wisconsin Fair Employment Act (WFEA). With the passage of 2009 Wis. Act 290, Wisconsin became the second state in the country to pass legislation that, with limited exceptions, prohibits employers from requiring employees to attend meetings to discuss whether employees should join or support a union. WHA joined WMC and other groups opposing what was Senate Bill 585. Senate Bill 585 passed the Senate on a voice vote prior to passing the Assembly 52-45 largely along party lines (all Democrats except Rep. Robert Ziegelbauer supported and all Republicans except Rep. Richard Spanbauer opposed the bill).

WMC and MMAC filed their lawsuit against the State of Wisconsin on September 8, 2010, arguing that the legislation not only is unconstitutional but also is preempted by the National Labor Relations Act (NLRA). As described in the WMC and MMAC complaint, the NLRA expressly protects the right of employees to hold mandatory meetings and other mandatory communications with employees for purposes of communicating their views about whether employees should join or support a labor organization. The National Labor Relations Board (NLRB) has upheld this fundamental right for more than half a century and the NLRB and federal courts have recognized the important contribution such meetings make to informed decision-making. The complaint argues that the new Wisconsin law interferes with these rights and, thus, is preempted by the NLRA.

The WFEA amendment is broader than prohibiting employer-mandated meetings about labor organization; 2009 Wis. Act 290 prohibits discrimination against an employee who declines to attend an employer-sponsored meeting or participate in any communication with an employer, the primary purpose of which is to communicate opinions about religious or political matters. The Department of Workforce Development (DWD) requires employers to post in their workplaces a notice advising employees of their rights under the new law. In addition, employers who violate the WFEA by discriminating or retaliating against employees who refuse to attend such meetings may be held liable for compensatory and punitive damages.

The WMC/MMAC lawsuit is in the U.S. District Court, Eastern District of Wisconsin. The WHA Board of Directors will be briefed on this issue and is considering WHA’s options to support the lawsuit. Watch The Valued Voice for updates as this case proceeds.

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President’s Column: By the Numbers...It’s Been an Eventful Week

6 — That’s the six months that have passed since the Health Reform legislation was passed by Congress and signed by President Obama.

61 — That’s the percent of Americans who favor repeal of the legislation as revealed in a Rasmussen Reports survey just this week. The number is at an all time high.

0 — That’s the likelihood that the law will be repealed prior to 2013 when the President will either leave office or be sworn in for a second term.

100 — That’s the 100 percent guarantee that the law will continue to be a "lightening rod" in 2011 and beyond.

3.1 — As in $3.1 billion dollars—the latest estimate on the structural budget deficit facing the next Wisconsin Governor and Legislature for the 2012-13 Biennium.

1.2 — That also in dollars—$1.2 billion, maybe more, for the likely Medicaid budget shortfall for the next biennium, assuming that Congress will not enact another stimulus bill that will continue higher FMAP.

0 — As in ZERO, which is just about the chance that Congress will enact another stimulus bill next year that will include new Medicaid relief for the states.

The numbers describe what amounts to two interesting story lines for 2011.

Steve Brenton

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2011 Hospital Reimbursement to Increase in HIRSP Program
Hospital outpatient services may be subject to fee schedule beginning in April

The Health Insurance Risk-Sharing Plan (HIRSP) Board has finalized its budget and the associated provider reimbursement rates for 2011.

For inpatient services, the required discount from base DRG rates will increase from 23.2 percent to 24.4 percent. But base rates will increase 3.6 percent, producing a net 2.0 percent reimbursement increase from 2010 levels.

For outpatient hospital services, the discount off billed charges will increase from 51.2 percent to 54.4 percent. Combined with assumed increases in billed charges, the new payment rate is expected to produce a 4.9 percent increase in reimbursement for outpatient services.

The outpatient rates will apply for the first quarter of 2011. The HIRSP Board is considering possible changes to the outpatient hospital reimbursement methodology that will create a fee schedule for some outpatient services effective April 1, 2011.

Joe Kachelski is WHA’s representative on the HIRSP Authority Board of Directors. Questions about HIRSP can be directed to him at or 608-274-1820.

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WHA Toolkit Resources Available on Medicare/Medicaid EHR Incentive Programs

Information on the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, including the EHR meaningful use final rule, is available in WHA’s online Toolkit. The Toolkit includes two separate presentations designed to help hospitals strategically plan for the Medicare and Medicaid EHR Incentive Programs by providing high-level insights into the EHR meaningful use and certification final rules. The EHR Incentive Program/Meaningful Use portion of the Toolkit can be found at

The information contained in the Medicare EHR Incentive Program portion of the Toolkit includes key concerns facing hospitals as they begin short and long-term planning for meeting meaningful use, payment methodologies under the Medicare EHR Incentive Program, and the differences among the proposed meaningful use rules and the final meaningful use rules. The portion of the Toolkit highlighting the Medicaid EHR Incentive Program focuses on eligibility for the program, calculating the 10 percent Title XIX Medicaid volume threshold, Wisconsin’s plans for implementing its Medicaid EHR Incentive Program and the payment differences between the Medicaid and Medicare EHR Incentive Programs.

Additional information on the Medicare and Medicaid EHR Incentive Programs can be found on CMS’s Web site at and on HHS’s Web site at For more information, contact WHA’s Matthew Stanford at or 608-274-1820.

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Hospital CEOs, WHA Meet With Ron Kind
Discuss negative impact of IPPS coding "offset"

Recently all of the hospitals paid under Medicare’s prospective payment system (PPS) in the 3rd Congressional District met with Rep. Ron Kind in La Crosse to highlight their concerns and displeasure with the decision of the Centers for Medicare & Medicaid Services (CMS) to move forward with a 2.9 percent coding offset under the FY 2011 Inpatient Prospective Payment (IPPS) System rule. The Wisconsin Hospital Association is strongly opposed to the coding offset and has been spearheading various grassroots efforts, like the Kind meeting, to push back against the cuts.

For FY 2011, the estimated loss to Wisconsin’s prospective payment system hospitals is $49 million. CMS indicates it will recoup a similar amount through the FY 2012 IPPS rule, costing Wisconsin hospitals another $49 million in FY 2012 and a cumulative $1 billion over the next decade. (See below for estimated impacts by Congressional district)

Congressional District (CD)         2011 Reduction from 2.9% offset

CD 1 - Cong. Paul Ryan                  -$4.399 million

CD 2 - Cong. Tammy Baldwin          -$9.342 million

CD 3 - Cong. Ron Kind                    -$3.894 million

CD 4 - Cong. Gwen Moore               -$9.481 million

CD 5 - Cong. Jim Sensenbrenner     -$9.065 million

CD 6 - Cong. Tom Petri                   -$3.419 million

CD 7 - Cong. David Obey                -$4.668 million

CD 8 - Cong. Steve Kagen               -$4.794 million

Statewide Impact                         -$49 million

Despite an outcry from hospitals, associations and a full majority of the U.S. House and Senate, CMS chose to move forward, saying the 2.9 percent cut is necessary to eliminate the effect of coding or classification changes it believes do not reflect real changes in case-mix when moving to Medicare Severity diagnosis-related groups (MS-DRGs). The agency believes hospitals are "upcoding" under MS-DRGs, which has led an increase in aggregate hospital payments without corresponding increases in actual patient severity of illness.

According to analysis done by the American Hospital Association (AHA), Wisconsin Hospital Association (WHA) and others, the coding and classification reduction is not justified and fails to take into account the historic effect of actual case-mix changes in hospitals, including changes in treatment patterns and patient populations.

WHA and hospitals are particularly concerned with the IPPS cuts in light of the estimated $2.6 billion in Medicare market basket/productivity cuts Wisconsin hospitals will see over the next 10 years due to the health reform law.

WHA will continue to work with hospitals on similar grassroots meetings as well as with the AHA on legislation to fight these cuts.

Find out more by reading WHA’s "Frequently Asked Questions" piece on the IPPS coding offset at

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Quality and Finance Collaboration Workshop Planned for October 19

On October 19, WHA is hosting national health care payment reform expert Harold Miller to kick off a day-long workshop to help attendees explore the potential impact of non-payment for adverse events, quality and value-driven reimbursement models, increasing attention on measurable improvement, and the impact on the bottom line.

Registration is now open for "At the Crossroads: The Collaboration of Quality and Finance," scheduled Tuesday, October 19 at the Ramada Hotel in Stevens Point. This event will provide education and practical takeaways on topics specifically related to payment reform—and how finance and quality improvement leaders can work together to meet the challenges of payment reform.

Presenters from the South Carolina Hospital Association and Bellin Health in Green Bay will share practical experience and tools to determine cost savings as a result of improved quality or patient safety and to find common ground between finance and clinical improvement functions. Also, facilitated discussion work groups will allow attendees to interact as a team and identify ways to improve collaboration and information sharing going forward.

Teams made up of hospital/health system CFO, quality lead, nurse executive and others involved in finance or quality improvement are encouraged to attend together, and a team discount is available.

A full agenda and online registration are now available at

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WHA Leads Statewide Initiative to Eliminate CLABSI - Join Today!

Nearly two million patients develop health care-associated infections, which contribute to 99,000 deaths each year and $28 to $33 billion in health care costs. Each year, 250,000 cases of CLABSI occur in U.S. hospitals with 18 percent of those cases resulting in death. In addition to the hardship this causes the patient, physicians and hospital staff, CLABSIs account for $3 billion in excess health care costs per year. The good news is that CLABSI are often preventable, and the science and methods are available to prevent them.

The Wisconsin Hospital Association (WHA) is leading a statewide initiative to eliminate central line-associated blood stream infections (CLABSI). This National quality improvement collaborative involves numerous state hospital associations, their patient safety partners and member hospitals focusing on the elimination of CLABSI’s in hospitals. "On the CUSP: Stop Bloodstream Infections" is the collective term to describe two similar efforts to successfully reduce infections and save lives in America’s hospitals. The project is based on a system developed by Peter J. Pronovost, M.D., Ph.D, of the Johns Hopkins University Quality and Safety Research Group, and later implemented statewide in Michigan by the Johns Hopkins Quality and Safety Research Group and the Michigan Health & Hospital Association (MHA) Keystone Center for Patient Safety and Quality.

The collaboration leverages the experience of the Johns Hopkins Quality and Safety Research Group (JHU QSRG), Michigan Health and Hospital Association Keystone Center, Health Research and Educational Trust (HRET) and hospitals nationwide over three years. The specific program components include implementation of the comprehensive unit-based safety program (CUSP), and activities to measure and eliminate central line-associated blood stream infections (CLABSI).

Currently 38 Wisconsin hospitals are participating in On the CUSP: Stop BSI. Thanks to additional funding made available by the Wisconsin Division of Public Heath, WHA is proud to announce the expansion of the On the CUSP: Stop BSI initiative, and invites you to join. The next wave of hospitals joining the project begins September 30, 2010 and the final wave will begin January 2011.

Information on this program is included in this week’s packet, or to request an enrollment packet, contact Jill Hanson at 608-268-1842 or

Aligning Forces for Quality is supported by the Robert Wood Johnson Foundation, through a grant to the Wisconsin Collaborative for Healthcare Quality. In Wisconsin, Aligning forces for Quality is a joint project by the Wisconsin Collaborative for Healthcare Quality, Wisconsin Hospital Association, and other organizations.

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EPA Seeking Comments on Draft Guidance on Unused Pharmaceuticals

The Federal Environmental Protection Agency (EPA) has been studying unused pharmaceutical disposal practices at health care facilities and has drafted a guidance document for health care facilities which describes:

The EPA is currently seeking comments on the draft through November 8, 2010. The EPA expects a final version of the document will be published in late 2010.

The draft guidance document as well as instructions for submitting comments on the document to the EPA can be found at

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Introducing the Wisconsin-1 Disaster Medical Assistance Team

The National Disaster Medical System and the State of Wisconsin are pleased to announce the creation of the Wisconsin-1 Disaster Medical Assistance Team (WI-1 DMAT).

The WI-1 DMAT is a team that can be rapidly deployed at disasters and large-scale events where local medical resources are overwhelmed or destroyed. DMAT’s consist of medical personnel, logistical and administrative personnel, and all of the equipment required to provide medical care in austere environments.

WI-1 DMAT is part of the National Disaster Medical System (NDMS). NDMS is a federally-coordinated system that provides medical capabilities in the event of a large-scale emergency that overtaxes local capabilities. NDMS is administered through the Office of the Assistant Secretary for Preparedness and Response (ASPR) in the United States Department of Health and Human Services.

DMAT elements are organized by state, though they are considered federal assets. While under official orders, all DMAT personnel are considered federal employees, allowing their licensure and credentials to be recognized throughout the country. In addition, DMAT personnel receive federal wages and professional liability protection while activated. DMAT personnel are also protected by the Uniformed Services Employment and Reemployment Rights Act, which prevents discrimination in civilian careers due to government service.

The WI-1 DMAT is endorsed by NDMS, the state of Wisconsin, and an academic medical partnership of the Medical College of Wisconsin, the University of Wisconsin School of Medicine and Public Health, Children’s Hospital of Wisconsin, Froedtert Hospital, and the UW Health System.

The creation of a DMAT in Wisconsin adds another capability for disaster medical response in the state. WI-1 is proud to join with the Wisconsin Emergency Assistance Volunteer Registry (WEAVR) and Wisconsin units of the Medical Reserve Corps (MRC) to form a comprehensive, flexible system contributing to local, state, and national readiness.

WI-1 DMAT is also interested in partnering with local agencies, community organizations, and health care institutions within Wisconsin to build a coordinated effort in emergency preparedness.

WI-1 DMAT is currently recruiting professionals interested in assisting in medical care during disasters or mass casualty incidents. The team is seeking people with the following skills:

Candidates for application need to be able to tolerate the stresses of field work in austere environments with limited privacy, and be flexible enough to work in roles that may be different from their regular jobs. Team members are also expected to dedicate their own time for education and training.

For more information on the WI-1 DMAT, visit the team Web site at

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