• Anne Woodbury, chief health advocate for Gingrich’s Center for Health Transformation will share her insights on the future of American health and health care.
  
• The issue of hospitals billing the uninsured continues to "morph" from a focus on billing practices to attacks on hospitals’ not-for-profit status. Rick Wade, AHA’s senior vice president of strategic communications; Leo Brideau, president/CEO of Columbia St. Mary’s Inc; and George Quinn, WHA’s senior vice president, will present the issue from both a national and state perspective.
  
• California’s nurse staffing ratios have made national news and raised havoc in California’s hospitals. Learn more as Dan Gross, CEO of San Diego’s Sharp Metropolitan Medical Campus shares his experiences.

And that’s just Thursday!

In addition, a legal education track was added this year, which provides an overview of such topics as the Stark II, Phase II regulations, credentialing issues, payment discounts, and more.

The full conference brochure with registration information is included in this week’s packet and is available on the Web site at www.wha.org. The legal education track is a separate brochure and is available at www.wha.org.

The Centers for Medicare & Medicaid Services (CMS) has just issued revised wage index tables originally published in the August 11 Federal Register, as part of the FY 2005 Inpatient Prospective Payment System final rule. The new tables are at: www.cms.hhs.gov/providers/hipps/ippswage.asp.

An initial analysis identifies that CMS’ actions will impact close to 36 hospitals in Wisconsin. The rural rate has been restated from .9493 to .9507. Therefore, if you are in a rural area or are in an MSA that gets the rural floor, your wage index has been bumped up slightly (0.15%). Sauk and Sheboygan counties also have been added to the out-migration adjustment counties which increases those wage indices by .0118 (see table 4J). Review your hospital specific rate at the Web site above to see if your index has changed. It can be found in table 2, and the Wisconsin hospitals begin on page 141 of that table.

For more information, contact Brian Potter at bpotter@wha.org or 608-274-1820.

Governor Jim Doyle has created a statewide task force charged with improving access to oral health care for children. Referred to as the KidsFirst Initiative, the Task Force will focus on and offer solutions to addressing the shortage of dental care professionals with a special emphasis on children’s oral health. Gov. Doyle created this Task Force to develop policy recommendations on the following issues which very well could be part of his next biennial budget proposal to the legislature:

• Recommend strategies for educating an adequate number of dental health professionals if the state is not currently doing so.
• Recommend strategies for how communities and the state might better recruit and retain dental professionals throughout Wisconsin.
• Recommend strategies for how the state can improve access to dental care for children in Medicaid and BadgerCare.
• Recommend ways to improve access and provide better preventive dental care to children.
• Recommend the most effective ways to spend Medicaid dollars on preventive care.

Bill Bazan, WHA VP for Metro Milwaukee, was appointed by the Governor to serve on the Task Force. The initial meeting will take place towards the end of September and most likely will make its recommendations back to the Governor’s office in Spring 2005. Regular updates on the progress of the task force will appear in The Valued Voice.

The best of two annual events, the Wisconsin Hospital Association’s Quality & Safety Showcase and the Wisconsin Patient Safety Institute’s Forum, have come together to offer one program. The new, co-sponsored, Wisconsin Quality & Safety Forum will be held October 18-19 at The Plaza Hotel in Eau Claire, Wisconsin.

This year’s Forum, with sessions on each of the Institute of Medicine’s Six Aims, will combine education with a showcase of projects focused on current quality improvement and/or patient safety initiatives, submitted by a diverse group including health care providers, researchers, coalitions, advocacy groups and others from across the state.

Elizabeth Jeffries, author of "The Heart of Leadership: How to Inspire, Encourage and Motivate People to Follow You," will deliver the keynote address. Jeffries’ session will motivate and inspire attendees on how to influence others through a sense of purpose, a shared vision, positive energy and clear communication.

Health care quality directors, risk managers, CEOs/administrators, clinician managers, physicians, nurses, pharmacists, patient advocates, health care purchasers, researchers, educators, students, legislators, regulators, and other policy makers are encouraged to attend.

The full conference brochure with registration information is included in this week’s packet and is available on the Web site at www.wha.org. Don’t forget to ask for the WHA room block (group #3390) at The Plaza when making your reservation. Call 800-482-7829 to make your hotel reservation. The special room rate will be available only until October 3.

Last week’s General Accounting Office (GAO) report on southeastern Wisconsin health care costs grabbed much media attention and editorial comment. WHA offered up that the report mirrors past association commentary that there are multiple cost "drivers" and that the provision of health care and its financing are hugely complex issues. WHA also embraced calls by U.S. Representative Paul Ryan (R-Janesville) and Milwaukee Mayor Tom Barrett for stakeholders to engage in much needed dialogue aimed at tackling the issue. Here are a few other thoughts regarding the GAO report:

• The Wisconsin Manufacturers and Commerce (WMC) rightly focused on the need to reform the marketplace as key to tackling high costs. WMC noted that "informed consumers, given adequate cost, safety and quality information, and a financial stake in their purchasing decisions, will prove to be an effective driver of quality improvement and cost containment." It’s impossible to quibble with that logic. As long as employers…especially large employers…in southeastern Wisconsin treat health care like an "open bar at a wedding," they will fail to achieve cost discipline. It’s a fact that Fortune 500 corporations refuse to leverage their purchase of health care in a manner consistent with their other purchasing decisions.
  
• The GAO report’s contention that Medicare isn’t part of the cost problem was predicated on highly flawed methodology. The GAO study concluded that just one Medicare inpatient DRG (for heart failure and shock) was sufficient to claim that Milwaukee hospital Medicare payments are higher than the national average. That’s preposterous, and stakeholders deserve more than what GAO delivered. Using just one DRG (from more than 500) is flawed logic and should raise questions about other aspects of the larger research effort. Unfortunately, this flawed methodology has led some to conclude that government shortfalls aren’t a factor in the high cost finding.

The role of inadequate Medicaid payments in fueling higher private sector costs wasn’t factored into the GAO report. And the significance of Medicaid’s absence can’t be understated. WHA has demonstrated that Wisconsin Medicaid payments are in the basement compared to the rest of the nation. And hospitals in Milwaukee, Racine and Kenosha disproportionately treat higher volumes of Medicaid patients. By omitting the important element of government payment shortfalls, the GAO study missed an important ingredient that must be part of the conclusion.

• WHA’s embrace of "transparency" (reliable health care information for decision-making) is the most meaningful, long-term strategy to provide necessary tools for reforming the health care marketplace. And the Wisconsin private sector’s early leadership for the public reporting of quality, safety and service measures, along with our public commitment to deal with the "pricing" aspect of the larger transparency issue, provides us the opportunity to engage stakeholders as partners as we implement market oriented solutions to the cost conundrum. However, the best, most "transparent" data tools that we can develop will be meaningless if employers and consumers do not use them or have no incentive to use them. No legislation can make this happen. Reform starts in the human resources departments and boardrooms of Wisconsin businesses.

Steve Brenton
President

The Centers for Medicare & Medicaid Services has put on display at the Federal Register an application for providers who wish to take part in a program that offers reimbursement for care provided to undocumented immigrants. The voluntary program, established as part of the Medicare Modernization Act, begins in Fiscal Year 2005 and would require providers to ask patients their immigrant status to qualify for the funds. Specific guidelines on patient documentation and payment methodology have yet to be released by CMS. The application can be found at www.cms.hhs.gov/regulations/pra/ under the heading "Federal Funding of Emergency Health Services (Sec. 1011): Enrollment Application."

Everyone is concerned about recruiting and maintaining a great health care workforce, but what are the best programs and strategies to achieve that workforce? There is no need to look further; great ideas are all around Wisconsin. Come and hear about strategies and programs your peers have created and implemented. The Wisconsin Society of Healthcare Human Resource Administration (WSHHRA) and the Wisconsin Hospital Association are cosponsoring a one-day ‘best practices’ workforce seminar. Learn what your colleagues have developed and are using to avoid future shortages in their health care organizations. Hear about The Monroe Clinic’s Back Safety/Lo-lift Program, La Crosse’s Cooperative Health Careers Summer Camp and Menomonee Falls "Shadow a Professional" process.

It is not too late to register for the "Health Care Recruitment and Retention Best Practices" seminar on September 29 from 9 am to 4 pm at the Embassy Suites Hotel, Brookfield. Presenters from around the state will present their successful programs designed to recruit and retain a strong health care workforce. A brochure and a registration form are included in this week’s packet and on the Web site at www.wha.org. Easy, on-line registration is also available on WHA’s Web site.

MetaStar will hold their second of a three-part workshop series on Improving Quality through Public Reporting starting the evening of October 19 through October 20, immediately following the Wisconsin Quality and Safety Forum. The workshops are designed to assist hospitals in their efforts to publicly report data and understand the various public reporting initiatives. Attendance at the first workshop is not required to register for the remaining two. The October workshop will encourage sharing progress reports and discuss lessons learned, barriers and successes. The workshop will also provide teams with sessions on root cause analysis using their own records to do practice analysis, physician profiling, and preparation for the CMS launch of data targeted at consumers.

The Richland Hospital in Richland Center received notification from the Centers for Medicare and Medicaid Services (CMS) that they are Wisconsin’s newest addition to the growing list of hospitals approved for Critical Access Hospital (CAH) status.