The Workers Compensation Advisory Council (WCAC) this past Monday, September 24, agreed to a number of changes to the Workers Compensation Program. Significantly, those changes will NOT INCLUDE PROVIDER PAYMENT CUTS.

Monday was the final meeting before submitting a bill to the Legislature. WCAC had been meeting since February to develop consensus ("agreed to") budget language as part of its biennial process.

From the beginning of the process, labor and management each had major changes they wanted implemented in the program. Labor wanted payments to permanently disabled workers to be updated and enhanced; permanent disability payments had been stuck at 1988 levels. Management wanted to constrain medical cost increases; medical costs in the Wisconsin Workers Compensation Program have been increasing at double-digit rates for the past five years.

In a surprising move, management proposed a fee schedule in June that would have resulted in over $100 million in hospital payment cuts and millions of dollars in physician payment reductions. Over the next four meetings, management submitted a number of proposals that involved both cuts to current rates and unreasonable (1 percent to 2 percent) annual inflationary updates. These proposals went far beyond management’s stated goal of constraining medical cost increases.

Providers, represented by WHA, the Wisconsin Medical Society, and the Wisconsin Chiropractors Association, while not members of WCAC, have been very active in the process. The provider group presented information to WCAC that highlighted the great value employers and injured workers receive in medical treatment, outcomes, and access to care, with average medical costs per claim. Numerous studies have repeatedly shown the Wisconsin’s Workers Compensation Program as one of the best in the country.

At the same time, the providers presented a proposal that would address the stated concern of management – rapid increases in medical expenses. The "freeze and grow" proposal would have kept the current payment system, but constrained payment increases to the Medical CPI. Labor incorporated these provisions into its draft of "agreed to" language for WCAC to consider. Management consistently rejected the provider proposal, insisting that payment cuts be part of the provider payment modifications.

After meeting in separate closed caucuses on Monday, labor and management agreed to not include any changes to provider payment. They also agreed to a modest enhancement to the permanent disability payment, updating it from 1988 to 1992. Other minor changes to the Program were also agreed to.

"We are very pleased with this outcome and our joint efforts with the labor side of the table," said George Quinn, WHA senior vice president. "We greatly appreciate labor holding firm and look forward to working with them in the future to maintain the high standard of care that sets Wisconsin’s workers comp system apart from those in most every other state."

"While WHA is pleased that onerous payment cuts will not be part of WCAC’s budget language, we remain concerned about our lack of involvement in the Wisconsin Workers Compensation Program policy development process," said WHA President Steve Brenton. "The WHA Board will be exploring options to increase provider involvement at its October meeting."

If you have questions about these developments in the Workers Compensation Program, please contact Laura Leitch or George Quinn at WHA at 608-274-1820.

Though top budget negotiators met all week behind closed doors at the Governor’s Mansion, no deals on health care have been made and it appears roughly a billion dollars still separates the two sides. The closed-door meetings include Assembly Speaker Michael Huebsch and staff, Senate Majority Leader Judy Robson and staff, and top officials from the Doyle Administration.

Offers and counter offers involving the hospital tax, hospital Medicaid payments and other key provisions in the budget have been swirling over the past few days, but contrary to some reports, as we go to press it appears little has actually been agreed to.

"It has been more than ten years since Medicaid payments to hospitals have increased, and many of Wisconsin’s safety net hospitals are in desperate need," said WHA Executive Vice President Eric Borgerding. "Increasing payments to these hospitals should be a priority for budget negotiators."

Helping propel discussions forward this week were offers by Speaker Huebsch to accept the $1.25 cigarette tax, which WHA strongly supports, and the Senate Democrats removal of their health care reform proposal, "Healthy Wisconsin."

A significant item budget negotiators have reached general agreement on is funding for K-12 education. On September 18, the State Assembly voted on separate legislation outside the budget process to fund K-12 education at the levels proposed by the Governor and Senate Democrats. The vote on this legislation was 70-27, including 50 Republicans and 20 Democrats. Though Senate Democrats indicate they will not act on this separate legislation, the Assembly’s action helped spur budget discussions.

In addition to the hospital tax, also unresolved is the proposed transfer of funds out of the Injured Patients & Families Compensation Fund (IPFCF). The Governor’s original budget proposed taking $175 million from the IPFCF and using it to fund other health care expansion proposals in the budget.

Last week, hospital representatives on the DHFS Medical Record Copy Fees Advisory Committee met with DHFS Deputy Secretary Karen Timberlake and department staff to again discuss hospital concerns with current limits on allowable fees that can be charged for copying medical records.

Participating in the meeting were committee members Cathy Ptak, regional director, clinical information services for Aurora Health Care and Meg McElroy, director, patient health information, Children’s Hospital of Wisconsin. Aurora Health Care and WHA government relations staff also participated in the discussion.

Hospitals maintain that an increase in the allowable fees for copying medical records is necessary because current limits do not cover the actual costs of making copies, which involves not only the copies themselves, but considerable overhead including salaries, equipment, postage and even significant privacy training related to the release of personal medical information, in addition to covering the costs of those not paying the full cost of copies.

As previously reported, DHFS staff is in the process of finalizing an issue paper, based on recommendations from the Advisory Committee, which will be submitted to department Secretary Kevin Hayden for a decision on whether the current fee limits should be modified.

The DHFS issue paper draft will be finalized soon and circulated among Committee members for comment before being submitted to Secretary Hayden.

WHA and the Rural Wisconsin Health Cooperative met with staff from the Division of Quality Assurance, DHFS, on September 26 to continue the regularly scheduled open discussions between the hospital community and the regulators. George Quinn, WHA senior vice president, Laura Leitch, general counsel, and Tim Size, RWHC executive director had a frank discussion with DQA staff about ongoing survey, plan review, and post construction inspection issues. "We appreciate that the DQA staff are taking the concerns of the hospital community seriously and are conducting thorough investigations related to specific problems. We will continue to work with DQA to address the problems," noted Quinn. In addition to the investigations, as a result of the discussions with WHA and RWHC, DQA will be piloting a "post construction inspection questionnaire" requesting feedback from hospitals about their construction inspection experiences. A copy of the questionnaire will be available on DHFS’s Web site.

In addition to the survey issues, the highlights from the meeting follow:

• DHFS pharmacist Doug Englebert provided an update on the new federal requirement that prescriptions for Medicaid recipients be written on tamper resistant pads. (See story in this edition of The Valued Voice for additional details.)
• Englebert also reported that DQA would be releasing a new memo concerning APNPs verbally issuing prescriptive orders.
• WHA and RWHC discussed problems identified with CMS Memo 07-35 as it relates to Critical Access Hospitals continuing to meet certain regulatory requirements when the CAH builds a new facility.
• DQA provided the most recent Hospital Citation Report. The report describes the most common hospital citations issued by DQA surveyors from April 1, 2007 to June 30, 2007. A copy of the report is available at http://dhfs.wisconsin.gov/rl_DSL/Hospital/Stat_data/2006_07/hospCitnQ2_07.pdf.

WHA staff is baffled by a recent decision by the Injured Patients and Families Compensation Fund (IPFC) Board to become a third party plaintiff in a medical malpractice case and pursue a claim against a health care provider (Aurora)—a claim the patient’s attorney in the case (Dan Rottier) is not pursuing. The Fund alleges that injuries caused by an act of medical malpractice were at least in part caused by negligent training and supervision by the health care provider. The Fund is arguing that injuries caused by negligent training and supervision should be paid by a health care provider’s corporate general liability insurance policy rather than the medical malpractice policy and the Fund. WHA staff believes that the decision is unprecedented and could have profound consequences on hospitals, nursing homes and physician clinics. WHA is concerned for the following reasons:

• Essentially every corporate entity providing medical services (Hospitals, Clinics and Nursing Homes) would be a potential target for this litigation.

• By shifting what has been considered medical malpractice to general liability, this and future claims could have a serious negative impact on the general liability insurance market. The impact on that market and the ability for hospitals and physicians to obtain general liability coverage in the future may be in jeopardy.

• A successful claim could create new claims that might circumvent Wisconsin’s medical liability reforms, such as the cap on non-economic damages.

• The relationship between health care providers and the Fund could be damaged, impacting the handling of future medical malpractice cases.

The Fund’s board, which includes representatives of insurers, attorneys, the Wisconsin Medical Society, and WHA, ultimately voted to provide the Fund’s staff with the authority to pursue the action. WHA argued against the Fund becoming a plaintiff against a health care provider and was the lone vote (George Quinn) against.

WHA will file an amicus brief supporting Aurora’s request to dismiss the action. While it is unusual to file an amicus brief at the trial court level, WHA believes that submitting a brief is warranted in this case because of the potential significant negative impact of this claim moving forward.

Steve Brenton,
President

540 individuals have contributed this year to the 2007 Campaign. This includes CEOs, employees, volunteers, and trustees affiliated with 88 hospitals from around the state that together have contributed nearly $172,000 to date. This accounts for 88 percent of the $195,000 fundraising campaign’s monetary goal.

Contributors by name and affiliated organization are published on a monthly basis and are listed below. Contributors are listed by contribution amount categories and in the order the contribution was received. The next list of contributors will be published in the October 19 edition of The Valued Voice. For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.

Wallace, Michael Fort HealthCare

Shabino, Charles, MD Wisconsin Hospital Association

Kryda, Michael, MD Saint Joseph’s Hospital

Byrne, Frank, MD St. Mary’s Hospital

Hospitals can breathe a bit easier this week as Congress acts to reduce cuts under the Inpatient Prospective Payment System (IPPS) final rule and delay a requirement that written prescriptions be on tamper resistant pads. Both were to go into effect October 1.

Under the IPPS final rule approved by the Centers for Medicare & Medicaid Services (CMS) earlier this year, Wisconsin hospitals would have seen large losses due to a provision referred to as the "behavioral offset." That offset would have resulted in a 1.2 percent reduction in FY 2008 and 1.8 percent reduction in 2009 and 2010, totaling a 4.8 percent reduction over three years. In essence, the offset is a way for CMS to take back a portion of the marketbasket inflationary update for what it anticipates will happen in the future under the new system of DRGs that begins in FY 2008 with a 50/50 payment blend.

The Wisconsin Hospital Association aggressively opposed the cuts and worked with Wisconsin’s Congressional Delegation to stop them. This week Congress voted to prevent CMS from fully implementing the cuts. Instead, Congress reduced the cuts by half. In 2008 and 2009, this then amounts to a 0.6 percent cut and 0.9 percent cut, respectively. WHA thanks the following members of our Congressional Delegation for their efforts and support over the past months: Senators Kohl, Feingold; and Representatives Kagen, Baldwin, Petri and Moore.

Tamper-Resistant Prescription Pad Requirement Delayed Six Months

Tucked away in an Iraq War funding bill approved earlier this year is a provision requiring Medicaid prescriptions to be in written form unless executed on a tamper-resistant pad. After intense pressure, Congress voted this week to delay implementation of this provision for six months. The President is expected to sign the legislation, S. 2085.

"Amidst all the issues Congress tackled this week, we commend our Congressional Delegation for working to ensure this small but important delay was approved," said Jenny Boese, vice president of external relations & member advocacy at WHA.

WHA worked in a coalition of groups including the Pharmacy Society of Wisconsin, Wisconsin Dental Association, Wisconsin Medical Society among others to address the issue. It is now scheduled to go into effect April 1, 2008.

Congress Reached SCHIP Agreement, But President Will Veto

This week Congress reached agreement on a plan to fund the State Children’s Health Insurance Program (SCHIP), due to expire on September 30. While both the House and Senate are in agreement on SCHIP funding, the President continues to reject their funding level as too high. In fact, President Bush said he will veto this latest agreement if and when it reaches his desk. In that case, it is expected Congress will pass a stop-gap funding measure for SCHIP by September 30.

The most inspired marketing campaign ever created is of no value if the patient experience does not match up to the image portrayed in the ads. That is just one of the points that a panel of health care chief executive officers shared with the audience at the 2007 Wisconsin Healthcare Public Relations and Marketing Society (WHPRMS) annual conference held recently in Wisconsin Dells.

Mike Wallace, president and CEO of Fort HealthCare in Fort Atkinson, told the group, "There is no doubt that marketing plays a very important role in the health care business, but you can’t over sell and under deliver. You need to match the patient experience to what we are saying we will provide our patients when they are in our care."

Wallace encouraged marketers in rural areas to build community awareness of the important role that a hospital plays in economic development, especially in rural communities. In addition, he said, "Make sure the community knows the breadth and depth of the medical services that are available locally. It is always frustrating to see patients seek care in larger communities when the same service could have been provided closer to home but they just didn’t know it."

When asked what health care executives expect of their marketing/PR staff, Marian Furlong, president and CEO of Hudson Hospital, said she looks to that department to keep her in touch with what new innovations are taking place not just in health care, but in other industries, too. "I need to know what is new not just in Wisconsin, but in hospitals in other states and industries outside of health care. I look to the marketing experts to provide that information and insight," she said.

Furlong and Wallace were joined on the panel by Steve Jaberg, executive director/CEO of Cedar Community and Richard Rolston, MD, FAAP, president/CEO of Prevea Health.

WHPRMS presented their annual recognition awards for excellence in health care marketing and communications. Congratulations to the following hospitals who received awards in 2007:

Aspirus, Wausau
Community Memorial Hospital, Menomonee Falls
Fort HealthCare, Fort Atkinson
Gundersen Lutheran Health System, La Crosse
Memorial Health Center, Medford
Mercy Health System, Janesville
Meriter Health Services, Inc., Madison
Ministry Health Care
Sacred Heart Hospital, Eau Claire
St. Mary’s Hospital Medical Center, Green Bay
Synergy Health St. Joseph’s Hospital, West Bend
UW Health, Madison
Wheaton Franciscan Healthcare

Making the transition from being a staff person one day to a supervisor or manager the next is a pretty significant step. Those who make the leap discover they not only carry responsibility for high productivity combined with financial and regulatory prudence, but also must balance human relations skills to work closely and collaboratively with others. Individuals who are new to hospital mid-level management will find the "Leaping from Staff to Management" series helpful in making that initial leap.

Part one of the series, "You’re a Manager…Now What?" will be offered on October 10, and will explore the basics of management and leadership in theory and applied practice, and will lay the groundwork for continued development of leadership and management skills. Part two of the series, "The Next Steps," is scheduled October 11, and will focus on learning and reviewing realistic and workable techniques for managing and leading people that will help ensure continued effectiveness and success. New or experienced managers can register for either individual session, or discount pricing is offered to those registering for the full two-part series.

A May 2007 Joint Commission report recommends targeted strategies to address language and cultural issues that increasingly post challenges to hospitals seeking to deliver safe, effective care to the diverse American population. Moreover, the Joint Commission says it will educate its surveyors to better assess compliance with accreditation standards related to linguistically and culturally appropriate care.

To assist Wisconsin hospitals with understanding this Joint Commission focus, WHA is offering a one-day seminar, "Diversity and Cultural Competence in Health Care" from 8 a.m. - 4 p.m. on Tuesday, October 30 in Madison. This seminar is an introductory session to cross-cultural medical care and is intended to raise awareness of the issue, the requirements, and the changing health care environment. Practical steps to address racial, cultural, and linguistic disparities that are occurring in health care throughout Wisconsin will be discussed.

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

This is an opportunity to find out what strategies and programs your colleagues are implementing that have had proven success in improving their HR departments. Sessions will focus on a variety of HR best practices from around the state and will include an overview of FMLA process improvement, increased exposure to health careers for children, providing an affordable health plan to all employees, and addressing the needs of an aging workforce.

October 3 launches a new series of grassroots training workshops for hospital leaders. As hospital leaders are lynchpins in their facilities and leaders in their communities, they can also serve as key leaders in the legislative arena as well. WHA’s new Grassroots Leadership Training Workshop is designed to assist leaders in this area.

Each half-day workshop includes two primary components: an in-depth issue analysis by a member of WHA’s government relations team; and hands-on grassroots training. Resource materials will be provided as well as ample time to network and ask questions.

"The Legislature is dealing with significant issues such as the hospital tax, Medicaid budget that will impact the delivery of health care in Wisconsin," said Jenny Boese, vice president of external relations and member advocacy. "This Workshop will bring hospital leaders up to speed on these issues and help them see how to they can effectively impact those issues."

The first workshop is slated October 3 in Eau Claire, from 9-11:45 a.m. Day-of registrations will be accepted. Future Workshops are scheduled October 16 in Green Bay, October 24 in Madison and October 30 in Pewaukee, all from 9-11:45 a.m. The cost is $25 per person. Register online at www.wha.org/education/grassroots.aspx.

The Wisconsin Chapter of ACHE is presenting a special ACHE advancement session on October 23, 2007, at Meriter Health Services in Madison. The session is available at no cost to attendees through the generosity of sponsorship by Meriter Health Services, St. Mary’s Hospital and UW Health, all of Madison.

The session, scheduled from 10:30 a.m. - 12 p.m., is designed to prepare ACHE members to take the Board of Governor’s exam in health care management and assist in advancing to Fellow status. This session includes information on how to meet the advancement requirements, and will be followed by a networking luncheon from 12-1 p.m.

This session will be conducted by John Anderson, FACHE. He has 34 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 Wisconsin Chapter of ACHE Web site at www.ache-wi.org. Easy, online registration is available as well.

Manny B. is a self-employed musician and for the last three years he and his fiancé, Laurie, have made their home in a small town in rural Lafayette County. With being self-employed, Manny and Laurie have had no health insurance coverage and had opted not to have regular medical care because of it.

"Because of the inability to afford health insurance, we’re in a difficult position," relayed Laurie.

In the spring of 2005, after intense testing, Laurie was diagnosed with MS. If that wasn’t devastating enough, on the weekend of Thanksgiving 2005 after a performance in Illinois, Manny woke up that morning feeling very nauseous and dizzy. Laurie was very concerned, called the ambulance and Manny was rushed to the area hospital where he was diagnosed with having had a stroke. Manny returned to their home in Lafayette County after a two-week hospital stay. He decided to follow up with further medical care at Memorial Hospital of Lafayette County in Darlington, WI. After having many consults by specialists and diagnostic testing, Manny and Laurie had accrued medical bills exceeding $10,000.

Over the course of the last two years, Manny and Laurie have always made payments towards their bills on a regular basis, but recently felt it was time to ask for additional financial assistance. After review of their cases by the finance and billing department of MHLC, the hospital was proud to contact Manny and Laurie and relay that they have qualified to have their entire bill cleared.

Deborah A. Thompson was appointed director of the William S. Middleton Memorial Veterans Hospital in Madison. Prior to her current position, she served as director of the Northern Arizona VA Health Care System (NAVAHCS) in Prescott, AZ. She began her career as a medical librarian, working for the VA, the Air Force, Purdue University, University of Missouri Medical School in Kansas City, and the Indiana University School of Medicine. After serving as chief, library service at the VA Medical Center in Denver, she became the special assistant to the director at that facility in 1991. She was selected for the associate director training program in 1994 and trained at the Portland VA Medical Center. She served as associate director for operations at the VA Black Hills Health Care System in South Dakota, the associate director at the VA Medical Center in Madison, Wisconsin, and as the director at VA Medical Center Iron Mountain, Michigan prior to being appointed director of Northern Arizona VA Health Care System, Prescott, Arizona.

Thompson earned a bachelor’s degree in American History and a master’s of library science from the University of Missouri, as well as a master’s in business administration from the University of Phoenix.

James G. Coller this week was named as the chief executive officer of both St. Vincent Hospital and St. Mary’s Hospital Medical Center, a unique management arrangement for the city’s two Roman Catholic hospitals designed to enhance patient care and medical excellence, as well as streamline operations and foster new cooperative opportunities to serve the community.

Coller, 62, is currently the CEO at St. Mary’s. The decision to add management authority over St. Vincent to his responsibilities is part of a larger change in the administrative organization of the two facilities by the Hospital Sisters Health System, the Franciscan health care ministry that sponsors both hospitals. St. Vincent has been without a permanent CEO since Joe Neidenbach retired in March 2007.

"Jim Coller has done an outstanding job at St. Mary’s, and as we contemplated the future direction of St. Vincent, it quickly became apparent that he is also the right person at the right time to lead both ministries," said Stephanie S. McCutcheon, president and chief executive officer of the Hospital Sisters Health System. "Jim is an excellent administrator who lives the values of the Hospital Sisters, knows Green Bay well and fully understands all of the health care challenges and opportunities in the community."

Top of page