The Workers Compensation Advisory Council again made no discernible progress toward resolving the issues for this session’s Workers Compensation legislation during its meeting September 6. Management continues to seek cuts in payments to hospitals and other health care providers and to limit any changes to permanent total disability payment increases. After six hours of discussions between representatives of management and labor, AFL CIO President David Newby, while summarizing the day’s discussions, expressed frustration with management advocating for an unclear and undefined proposal concerning cuts in payments to health care providers and the resulting lack of progress on improvements to permanent total disability payments (PTD) for workers. He characterized the current low PTD benefit as "barbaric." Newby said he had asked the management representatives to explain their health care proposal to the labor representatives and to the WHA, Medical Society, and Wisconsin Chiropractic Association liaisons to the Council, but that management had refused.

Apparently dismayed, Newby observed, "Our workers compensation insurance rates are going down; the rates in Wisconsin are lower than most other states; our overall medical costs are lower than most other states; and our indemnity rates are low. The Wisconsin Workers Compensation system should be used by businesses and manufacturers to sell Wisconsin." Newby called reasonable the current proposal to constrain the rate of growth in health care costs and again expressed frustration with management’s refusal to accept a proposal that meets management’s stated goal.

Contrary to a recent letter released by Wisconsin Manufacturers and Commerce (WMC), the management representatives did not present their concerns as being how to control increasing health care costs, but rather how to cut payments to health care providers. A spokesperson for management pointed to a disparity between the reimbursement rates for a single procedure for providers in Minnesota, North Dakota, and South Dakota compared to providers in Wisconsin and said that the current proposal from labor would preserve the disparity. "We have an opportunity to do better," said the management representative. A copy of WMC’s letter is available on the WHA Web site at www.wha.org/financeAndData/workerscomp.aspx.

WHA Senior Vice President George Quinn noted, "We have attempted to work with the Council to address reasonable concerns. But it is not reasonable when some people think that millions of dollars can be pulled from a system without impacting patients and employees. We have an excellent system that we all should be fighting to preserve." The next meeting of the Council is September 24.

It’s the last chance to register for the WHA 2007 Annual Convention September 19-21 at the Marriott Hotel in Madison. This is your chance to hear nationally-renowned speakers, a panel of innovative Wisconsin employers taking steps to control their own health care costs, and a variety of other timely topics. Plus, the annual convention is the premiere event to share conversation with your leadership team, your board of trustees, and your colleagues from throughout Wisconsin.

When I ran last year the first things I wanted to work on were ethics reform and health care in the state of Wisconsin. I think we have gone through a number of years that we were really frustrated with the Legislature "acting out" on both sides of the aisle, Republican and Democrat. We had just gone through long trials involving legislators, and it was time to clean up. I spent a number of years outside of Wisconsin and when I returned in 1988, I was shocked at the level of corruption that was going on in Wisconsin state government.

I have known many people in Wisconsin, along with people I met while I was campaigning, who told me they were either without health insurance or in fear of losing it. I would say if 10 percent of the people in Wisconsin don’t have health insurance, another 15 percent are afraid of losing it. I wanted to come to Madison to work on that problem.

2. In his budget proposal, Governor Doyle proposes a tax on hospitals. Several concerns have been raised about the viability of this tax and its negative impact on hospitals and health care consumers across the state. Do you support a tax on hospitals?

I think that my short answer is yes, I support Doyle’s proposed tax. I think there is some tweaking that can take place, and some of that has already started with the change of 1 percent to a .8 percent tax. We have to do some leveraging to get more federal money and this is one method of doing that. I am, quite frankly, interested in investigating more deeply into the conflicting figures that I see coming out of the budget process as opposed to what I see coming from the WHA and individual hospitals. The dollars and cents don’t seem to agree.

3. Governor Doyle also proposes to remove over $873 million from the current state Medicaid budget to use for other state spending unrelated to health care. This Medicaid budget "hole" is then backfilled in part with revenue generated from a tax on hospitals. What are your views on using funding designated for one state program to pay for other state programs?

I don’t like it at all. I don’t like it when we say we are going to segregate funds for a specific item because it is virtually impossible from session to session to keep those items whole. I think we delude ourselves when we take the money for "this" and spend it on "that."

4. As part of the state budget, Senate Democrats approved one of the most sweeping policy changes in state history when they introduced their plan to overhaul Wisconsin’s health care system. This proposal, Healthy Wisconsin, which relies heavily on state government to plan, administer and finance the delivery of health care, has been criticized for focusing on how health care is paid for rather than addressing the underlying causes of what is driving the rising cost of health care. What do you view as the key issues for health care reform? Do you believe Healthy Wisconsin will actually save Wisconsin employees and employers on their health care costs?

I think if it comes to play as it is described it will save everyone money. And it will also be saving all the rest of us who have insurance money, too. I say this because we pay an incredible amount of money to cover people who receive care in hospitals and clinics that can’t pay for it. It translates into higher premiums. I think Healthy Wisconsin will help with this problem. Even if Healthy Wisconsin doesn’t go through, we’ll still be ahead because we have had more discussion about health care reform in the last few months than we have had in the last 10 years. This time I think we get closer to getting something done on health care reform. If not this plan, then something else, but at least we are closer to making some dramatic changes in how we deliver health care services in Wisconsin than ever before.

I disagree with the notion that Healthy Wisconsin focuses only on how health care is paid rather than addressing underlying causes of what drives the costs. Healthy Wisconsin dramatically lowers the administrative costs of providing health care in Wisconsin. And as I stated above, this dialog with ourselves, continues to reaffirm the discussions which took place in hundreds of hearings throughout Wisconsin in the last year and a half on the primary proposals put forth by public interest groups, labor and the Democratic Party. The dialog is with ourselves because the other side refused to take part in these hearings and continues to chant HSA, HSA whenever the subject of health care comes up. By the way, HSA products do have a place in our health care picture, just not the only solution to a very complicated problem.

5. Caring for smoking-related illness adds hundreds of millions to the cost of health care for Wisconsin employees and employers. Inadequate Medicaid provider reimbursements compound the problem of rising health care costs. Governor Doyle has proposed increasing the cigarette tax by $1.25, but wants to use the revenue to backfill existing dollars being taken out of MA. Do you support this increase and if so, how should the dollars it generates be used?

I support an increase in the cigarette tax. I am in favor of doing whatever we can to discourage people from smoking who are now addicted and to discourage people from ever starting. I used to smoke—I know how hard it is to break that addiction. But it goes back to the issue of segregating funds. Then-Attorney General Doyle got Wisconsin a large tobacco settlement and within four years, the then-Governor and Legislature sold it for pennies on the dollar.

6. A Madison nurse was criminally charged after making an unintentional error. Would you support legislation to protect our health care workforce from criminal charges for unintentional errors?

Yes, I would. I would want to see in the legislation how is it determined if it is unintentional. I find that the real crux of the problem is how we enforce and implement our legislation. I don’t want this issue to be one of those things where we pass a bill and then spend four sessions fixing it.

I am looking forward to the health care discussion. After the Senate proposed their budget, I heard a number of people in the "granite and marble dome" say that the Healthy Wisconsin plan did not get a hearing, and it was a surprise when it came out. I will tell you that since January I personally have been to half a dozen hearings of the hundreds taking place all over the state. I have to admit there have not been a lot of legislators going to these hearings. People are talking about health care and legislators need to hear it.

Some legislators say they are hearing people say, cut taxes. But I have to say that the people I have talked to in my district are asking, "What are you doing about health care?" I am afraid that we will not have a definitive answer for these folks after this session. But we might at a later session. We now have everyone’s attention on health care, and that is a major accomplishment in our state. If we find a solution to our health care crisis in Wisconsin, unlike what WMC is saying, it won’t scare people and businesses away, it will attract them because they will be able to see that someone has it right and they have a plan that can be counted upon. It is not to be feared; we should be first and we should do it best.

The WHA Nominating Committee will present its report and recommendations for at-large board members to be voted on by the membership at the Annual House of Delegates meeting on Thursday, September 20 in Madison. The following individuals have been tapped to serve as at-large members and region representatives on the WHA Board of Directors:

Bill Bestor
(term expiring 12/31/08)
President/CEO, Community Memorial Hospital, Menomonee Falls

· Council on Finance and Payment, 2000-2005
· Medicaid Task Force, 2004-2005
· WHA-FS Board, 1994-1999, 2003-2006
· WHA-IC Board, 2004-2006

Mike Decker
(2nd term)
President/CEO, Divine Savior Healthcare, Portage

· Public Policy Council, 1998-2006
· Medicaid Task Force, 2004-2005
· Taskforce on Community Benefits, 2005
· WHA Board, 2005

· WHA Board, 2006-2007

Duane Erwin
(term expiring 12/31/09))
CEO, Aspirus, Wausau

· Task Force on Access and Coverage, 2006

Ed Harding
(1st term)
President/CEO, Columbus Community Hospital

· Public Policy Council, 2002-2006
· Task Force on Access and Coverage, 2006
· WHA-FS Board, 2007

Brian Kief
(1st term)
President/CEO, Howard Young Health Care, Woodruff

· Council on Finance and Payment, 2004-2006
· Task Force on Access and Coverage, 2006
· Physician Task Force, 2003

John Oliverio
(1st term)
President/CEO, Wheaton Franciscan Healthcare, Milwaukee

· WHA Board, 2007

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Earlier this month, the House of Representatives considered an important piece of legislation that affects hospitals, doctors, and families in Wisconsin and across the country. H.R. 3162, the Children’s Health and Medicare Protection (CHAMP) Act of 2007, was passed by the House on August 1 and is currently pending before the Senate. Given the bill’s impact on Wisconsin hospitals and physicians, I would like to take this opportunity to share some of its key points with you, as well as some of the challenges we face moving forward.

Reforming the outdated Medicare reimbursement systems is a necessary and long overdue priority for Congress. Over the past ten years, structural changes in the Medicare program have largely been focused on the Medicare Advantage program (formerly Medicare + Choice), the private plan option available to seniors. Although this work has produced a viable alternative to traditional fee-for-service coverage, it has meant that modernization and reform of the regular Medicare program—which covers about 80 percent of Wisconsin seniors—has been neglected.

I am proud of the steps that the CHAMP Act takes towards infusing fee-for-service Medicare with modern services and benefits and, for the first time, paying providers for doing the right thing. Provisions of particular importance to Wisconsin hospitals include:

• Assistance for rural hospitals, including the extension of Medicare reasonable cost payments for clinical diagnostic tests, hold-harmless treatment for rural hospitals under the Medicare outpatient perspective payment system (OPPS), and the expansion of disproportionate share hospital (DSH) payments for rural hospitals to ensure that rural facilities have access to the same financial assistance for the treatment of uninsured patients as urban facilities receive.

• The reauthorization of the State Children’s Health Insurance Program (SCHIP), the federal-state partnership that funds Wisconsin’s BadgerCare program, which will maintain coverage for 30,000 children and 37,000 adults in Wisconsin and allow the state to expand coverage to uninsured residents.

• The elimination of co-payments for all preventive health services under fee-for-service Medicare, to encourage seniors to obtain more primary and preventive care services and to reduce unnecessary hospitalizations.

• For the first time, the creation of an efficiency bonus payment, so that providers are discouraged from over-utilization and instead have the incentive to provide appropriate, quality care.

• The restoration of lost graduate medical education (GME) slots that fund the training of physicians in rural areas under the University of Wisconsin School of Medicine and Public Health’s Department of Family Medicine (UW-DFM).

The CHAMP Act was endorsed by the National Rural Health Association, the American Hospital Association, the Federation of American Hospitals, the Association of American Medical Colleges, the American Medical Association, and countless other organizations.

To be certain, this bill is not perfect. To meet pay-as-you-go budgeting rules, we were forced to cut payments to a number of providers—hospitals received a shave of 0.25 percent off of their market basket update for both inpatient and outpatient services. We also were unable to modify the recent hospital inpatient rule issued by CMS that overhauls the diagnostic related groups (DRGs) and implements a new "behavioral offset." Lastly, as it currently stands, the new efficiency payment will apply only to physicians.

I understand these issues, particularly the new behavioral offset under the inpatient hospital rule, will remain troubling for you. I want to assure you that I hear your concerns and will continue to work towards responsible solutions for them. Our legislative work on Medicare will always be a work in progress. My goal is to arrive at the right policy for Wisconsin and for the country, not necessarily to find the easy answer.

In closing, I also would like to extend congratulations to you for the nationally renowned work you are doing in Wisconsin in the areas of quality, health information technology, and outcomes-based care. The recent Agency for Healthcare Research and Quality report which ranked Wisconsin first in the nation—led by hospital performance—is the result of your terrific effort. WHA’s CheckPoint initiative and the Wisconsin Collaborative for Healthcare Quality are often held up in Washington as models for how best to measure and assess the quality of care in our nation’s health care organizations. I am proud to represent such a forward-thinking community of providers.

I encourage you to contact my offices in Wisconsin or in Washington, D.C. if we can ever be of assistance.

"While the goal is in sight and the campaign has added over 130 contributors this month, the campaign is still short over $40,000 heading into the last months of the campaign," according to WHA’s Jodi Bloch.

490 individuals affiliated with more than 70 hospitals have contributed to date over $153,000 accounting for almost 80 percent of the 2007 fundraising campaign’s $195,000 monetary goal. Last year’s campaign raised over $187,000, which was the highest total ever raised.

Persons contributing this year have been and will continue to be published in The Valued Voice on a monthly basis. Contributors are listed by amount categories and in the order the contribution was received. The next list of contributors will be published in next week’s edition of The Valued Voice. For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese 608-274-1820.

There’s an old adage in the news business: "If it bleeds, it leads."

That’s probably why we in Wisconsin heard a lot about the U.S. Census Bureau’s recent report that the national uninsured rate climbed from 15.3 percent in 2005 to 15.8 percent last year, but heard little or nothing about Wisconsin’s numbers.

It turns out that only one state, Rhode Island, has a lower uninsured rate than Wisconsin’s 8.8 percent. Moreover, 2006 was the third consecutive year that Wisconsin’s rate has fallen. It is now at its lowest point since 2001.

Of course, the fact that hundreds of thousands of Wisconsin residents have no health insurance is not exactly good news, but clearly there are some things that are going right here that are going wrong elsewhere. We may have our problems, but Wisconsin isn’t Texas, New Mexico, Louisiana or Florida, each of which has an uninsured rate of a staggering 21 percent or more.

What can we learn from the Census data?

First and most obviously, Wisconsin’s experience is not the experience of the nation as a whole: While Wisconsin’s uninsured rate is always among the nation’s lowest, in the recent years the two trend lines are heading in opposite directions. Perhaps there’s something about Wisconsin that other states would do well to emulate. Twenty-one million more people would have health insurance if the rest of the country could achieve Wisconsin’s uninsured rate.

Problem, yes. Crisis, no: Wisconsin’s experience is especially noteworthy given the current sense of "crisis" that underlies various radical health care reform proposals such as the Senate Democrats’ Healthy Wisconsin program. Of course, Politics 101 teaches that in order to build support for major legislation, it is quite useful to depict the current situation as being in desperate need of change. But Healthy Wisconsin proponents will now need to reconcile their claims of an ever-intensifying crisis with trend numbers that tell a different story.

If you’ve seen one uninsured person, you’ve seen one uninsured person: There is no single profile of a "typical" uninsured person. Consider the following:

• More than 9 million, or nearly 20 percent, of the uninsured reside in households having an annual income in excess of $75,000.
  
• 8.3 million (18 percent) of the uninsured are young (age 18-24) and presumably generally healthy, but also likely to be in lower income categories. The uninsured rate declines in each successive age group.

• More than one of every five uninsured residents is not a U.S. citizen.

• A surprising number of the uninsured, and perhaps three of every four uninsured children, appear to be categorically eligible for an existing government health program.

The bottom line is that the Census Bureau report is a timely reminder that there is likely to be no single "solution" to the problem of the uninsured. Rather, it makes sense to prioritize from among the various subpopulations and address them with different solutions. That’s exactly why WHA supports Governor Doyle’s budget proposal to expand Medicaid and BadgerCare coverage. That proposal efficiently targets some of the most vulnerable segments of Wisconsin’s currently uninsured population.

The new Medicare DRG (MS-DRG) payment system will have a wide range of impacts on different aspects of the hospital operation. It is important that the appropriate hospital staff understand the action steps they will need to take in order to prepare for this major change to the CMS DRG payment system.

On October 5, WHA is offering a seminar focused on the new MS-DRG system at Kalahari Resort in Wisconsin Dells. The seminar is intended to provide hospitals the necessary information to understand and make appropriate adjustments in coding, billing and auditing activities to account for the CMS severity adjustments to DRGs and the associated change that may take place with other third-party payers using DRG type payment systems. Additionally, associated concerns such as the UB-04, ICD-10-CM, ICD-10-PCS, Present on Admission (POA), and the DRG grouper logic changes will be addressed.

This program is designed for hospital coding, billing and financial personnel, claims transaction personnel, nursing staff, and physicians, and team attendance is encouraged due to the wide range of impacts that the new MS-DRG payment system will have on hospitals. Please note that this is an advanced seminar, and participants must have a basic knowledge of the CMS DRG payment system and associated coding and billing processes.

Wisconsin-based Children’s Hospital and Health System has received the prestigious Gold Well Workplace Award from the Wellness Councils of America for its employee wellness initiatives.

The Well Workplace Award recognizes the health system’s commitment to its employees’ health and well-being. It is awarded throughout the year to employers from around the nation. Only a handful of companies each year meet the rigorous standards to achieve a Well Workplace Award. In 2006, there were just 127 national awards and only 58 at the gold level.

Saint Joseph’s Hospital, St. Vincent de Paul Free Clinic and RNs from the hospital are teaming up to fill a needed gap in health care services in Marshfield and the surrounding community.

The project, "Volunteer Home Health Nursing Services for the Underinsured/Uninsured in Our Community," coordinates visits from registered nurses to address health care needs of people unable to manage their own, or who have no community resource support.

"We are providing home health services to people who may not be totally homebound, but who still need assistance in their medical care," said Celeste Hilgart, RN, MSN, APNP-BC, manager of Saint Joseph’s Hospital’s Employee Health/Wellness. "At this time, the only resources available for these individuals is to find their own assistance through family or friends, private pay nursing or nursing assistant. Often, they go without the appropriate care and this can increase their health care risks and enhance the possibility of re-admission to the hospital. This only increases the cost of health care."

Patients who could benefit from the program include:

• Those discharged from the hospital that need dressing changes, eye drops following cataract surgery, assistance with TED socks, minor dressing changes or other types of post hospitalization care.
• Those needing assistance with their medications, such as medication box setup or filling of insulin syringes.
• Those needing foot care, nail care or other personal assistance.

Since this patient population is not entirely homebound, or ill enough to be hospitalized, their care is not covered under Medicare and Medicaid or most private insurances. And, since St. Vincent de Paul Free Clinic is open only two nights a month, their daily care needs cannot be met.

"For example, we may have an 80-year-old sight-impaired patient who takes a cab to church each Sunday, but cannot manage self-care," said Hilgart, who helped put the program together. "These are the types of people that are falling through the cracks."

St. Vincent de Paul Free Clinic is the coordinating base for services, and maintains a list of volunteer RNs and the specific services they will provide. Saint Joseph’s Hospital, through its Ministry Fund program, provides the funding for nursing liability insurance and medical supplies.

Parkview LaGrange Hospital (PLH) in LaGrange, Indiana, is searching for a chief operating officer. This leader will have the unique opportunity to move the organization into a new $25M hospital, scheduled to open in the summer of 2008. The chief operating officer for PLH is an excellent opportunity for a leader with a passion for rural health care. Reporting to the President/CEO of Parkview Health and a local Board of Directors, the chief operating officer will be encouraged to challenge the status quo, and bring creativity and innovation in the spirit of strong community partnerships.

Candidates should have an advanced degree, and a minimum of seven years experience leading a small, community-focused hospital. A track record of positive and collaborative medical staff and Board relationships is important, and experience working within a system is a definite plus.

Please contact Patricia Neds, research associate, at 816-373-9988, or email patricia.neds@mgmtscience.com. For additional online information, visit www.parkview.org, or www.mgmtscience.com. All inquiries will be handled confidentially.

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