After passing the State Assembly on Tuesday, October 26, on Thursday, October 28 the Senate Agriculture and Insurance Committee heard testimony on AB 766 and its Senate companion bill, SB 393 authored by Rep. Curt Gielow (R-Mequon) and Sen. Scott Fitzgerald (R-Juneau), which would reestablish caps on jury awards for pain and suffering at $550,000 for minors and $450,000 for adults. The Committee also discussed collateral source reforms (AB 764), and legislation to include all first year residents in the Injured Families and Patients Compensation Fund (AB 765).

Sr. Jomary Trstensky, president of the Hospital Sisters Health System relayed a tale of two states, Illinois and Wisconsin, which while close in proximity have experienced two very different medical malpractice realities. Because the Hospital Sisters Health System operates eight hospitals in Illinois and five in Wisconsin, Sr. Trstensky is in a unique situation to compare the experience of Wisconsin, where for the past ten years there has been a cap on non-economic damages, to Illinois where there has not been a cap until very recently.

In terms of real costs, Sr. Trstensky relayed to the Committee that the difference in the malpractice insurance climate between the HSHS hospitals in the two states meant that, "Illinois liability costs exceed Wisconsin costs by a factor of 3.5 to 1. If we adjust this to add WHCLIP (insurance carrier of the HSHS Wisconsin hospitals) rebates, the picture is even more dramatic. It costs Illinois $35.63 per occupied bed per day to obtain medical liability coverage, while the cost in Wisconsin is $8.41."

Sr. Trstensky explained that Wisconsin patients have benefited from this favorable environment. Wisconsin hospitals were able to use funds to develop new programs, offer new services and invest in new technology, whereas Illinois counterparts instead had to use these funds to cover increased malpractice insurance premiums that did nothing to advance patient care. Instead, patient access to care became problematic, with one hospital in Southern Illinois losing 30 physicians, 1,700 inpatient admissions, 12,000 outpatient admissions, 4,000 surgical procedures and $18 million in revenue. And many patients either went without care or traveled long distances for necessary care.

Unable to refute Sr. Trstensky’s testimony, Committee member Sen. Mark Miller (D-Madison) turned his attention to WHA’s General Counsel Laura Leitch and asked her why if only nine jury awards in the last ten years exceeded the cap on non-economic damages there is a need for a cap. Leitch acknowledged that this is because the vast majority of cases never go to trial and are settled out of court. She noted that since the Supreme Court struck down the Wisconsin caps, hospitals have seen the amount plaintiff’s attorneys demand in out-of-court settlements increase significantly.

Physicians testifying in support of AB 766 traveled from around the state including, Scott Hansfield, MD, an OB/GYN physician practicing at the Waupun Hospital, Rob Nesse, MD, President/CEO of Franciscan Skemp Healthcare in La Crosse, Jeff Thompson, MD, President/CEO of Gundersen Lutheran in La Crosse and Christopher Magiera, MD, with Aspirus Wausau Hospital.

Drs. Hansfield and Magiera told new tales of two states from the physician perspective. Dr. Hansfield left his home state of Illinois two years earlier and Dr. Magiera left Ohio where he and his physician wife chose to uproot their families and move to Wisconsin because of the favorable malpractice climate.

Dr. Hansfield noted that regardless of the underlying statistics of individual states with or without caps, perception is reality for physicians and especially new residents who look at the AMA map – they won’t go to a state that is cited as a medical liability crisis state.

"What I can tell you with 100 percent confidence is that, in today’s medical malpractice climate, the loss of a cap on non-economic damages sends a strong, clear message to doctors: ‘If you don’t want the cap, you must not want us,’" said Dr. Hansfield.

Dr. Magiera further emphasized the health care access problems patients face in states without caps. "It’s not about the physicians, it’s about the patients. If we can’t practice, they can’t get help."

Dr. Nesse echoed these sentiments, and noted that access to care in rural areas is in particular danger unless the cap is reinstated. "Rural hospitals have a higher percentage of Medicare and Medicaid patients and are looking at Medicare physician payment cuts of 4.5 - 5 percent. You could see rural hospitals in Wisconsin facing a double whammy if [caps are] not passed," explained Dr. Nesse. "Specifically, physicians would be getting paid less than the Medicare services they deliver. Medicare pays only 52 percent of our costs right now and they are not projected to increase. If we see increases in Medicare patients along with increases in malpractice premiums, the viability of rural hospitals will come into question."

Dr. Thompson noted how Wisconsin is at the forefront of improving transparency and quality, and that the stability of caps can only improve and enhance these efforts. "I can tell you that an environment that is more stable will affect what I believe we need to do. I would argue that we are making good progress toward ... improving the quality and lowering the cost, becoming more transparent, focusing on higher quality care. In this state… both the hospital association [through CheckPoint] and the Wisconsin Collaborative for Healthcare Quality have put Wisconsin in the absolute forefront of the nation in being more transparent about our health care."

In summarizing the strong hospital and physician testimony supporting AB 766 and SB 393, WHA General Counsel Laura Leitch noted that WHA has consistently maintained that the issue is about patient access to care and the need to recruit and retain physicians and other health care professionals. "Protecting patient access is exactly what the Legislature and Governor need to remember is at the heart of this debate."

The Committee will vote on the bill early next week. The legislation will likely see a vote before the full Senate on November 8 or 9. Senator Miller (D-Monona) indicated that he will offer amendments to the bill when the Committee votes on the bill next week, including an amendment that would cap non-economic damages at $1.5 million for children and $1 million for adults.

For more information about this or any other legislative matter, contact WHA’s Eric Borgerding or Jodi Bloch at 608-274-1820.

With the Assembly voting this week to restore a cap, and the Senate poised to act on the legislation shortly, hospital staff across the state continued turning up the HEAT by contacting their legislators in support of Assembly Bill 766. Heard loud and clear over the past week were the voices of our rural Wisconsin hospitals. Six Democrats, Reps. Sheldon Wasserman (Milwaukee), Chuck Benedict (Beloit), Spencer Black (Madison), Mary Hubler (Rice Lake), Jason Fields (Milwaukee) and Amy Sue Vruwink (Milladore) joined all of the Republicans in voting for AB 766.

Among the hundreds of hospital employees contacting their legislators were Janet Herrell, CEO, and Marge Edwards of Moundview Memorial Hospital, a Critical Access Hospital in Friendship. In their letter to Rep. Marlin Schneider (D-Wisconsin Rapids), they told of past difficulties recruiting physicians and how Wisconsin’s attractive liability climate (before the Supreme Court’s ruling) was working to assist them.

"We have struggled in the past to recruit new physicians to the area and are finally making some headway…Our most recent contracted physician came to us from the state of Washington and one of the primary reasons for relocating to Wisconsin instead of Illinois was our liability environment," the letter read.

"However, without the cap on pain and suffering, this recruitment process could be in serious jeopardy. And, as in so many matters affecting small rural hospitals, the increases in malpractice insurance premiums… will result in fewer funds available to maintain the quality of care that we pride ourselves on."

Unfortunately, Rep. Schneider voted against AB 766.

Candy Casey, president & CEO of Columbia Health System in Milwaukee, wrote to Rep. Sheldon Wasserman (D-Milwaukee) regarding AB 766. Her concerns centered on obstetrical care.

"As president & CEO of a specialty birthing hospital, I am very concerned that Wisconsin would likely see a reduction in physicians offering obstetrical care. Please reinstate the malpractice cap."

Rep. Wasserman, a physician himself, voted in support of AB 766.

Another correspondence came from Sandy Schaffer, RN and cardiac services director at Ripon Medical Center. She asked Rep. Joan Ballweg (R-Markesan) to support her small hospital by voting in favor of AB 766.

"I am a registered nurse working in a small rural hospital in Ripon, Wisconsin…As a small hospital, it is difficult enough for us to keep our heads above water and yet still provide the quality of care we have come to be known for without having to worry about losing physicians, nursing staff, and possibly the very hospital our community depends on for medical service. Don’t allow what has happened to states like Oregon, Washington and Illinois to happen to us. Our community needs our hospital and as our Representative, I am asking you to support us."

Rep. Joan Ballweg listened, voting in support of AB 766.

Yet another rural hospital voice was heard when Joyce Schaefer, administrator of patient care services at Amery Regional Medical Center, told Rep. Mark Pettis (R-Hertel) that physician recruitment was of great concern to her.

"We are a small rural medical center and are currently trying to recruit some new physicians to our facility…Physicians are not going to want to come to Wisconsin if there is not a cap put on medical liability. This bill really is critical to the survival of medical centers like [ours], many of our current physicians are getting older and the need to recruit new physicians is critical."

Rep. Pettis did vote to support Amery Hospital when he voted in favor of AB 766.

Thank you again for making your voices heard by contacting your legislators. If you haven’t done so yet, contact your State Senator by logging onto www.wha.org/speakUp/statesenate.aspx. The Senate Committee on Agriculture & Insurance will vote on this legislation next week with the full Senate taking it up shortly thereafter.

Contact Jenny Boese at jboese@wha.org with your grassroots stories so we can highlight the grassroots efforts of our hospitals on behalf of their communities and communities statewide.

In Congress, the respective Senate and House committees are meeting to mark-up budget legislation. The Senate Finance Committee voted earlier this week to pass its budget reconciliation bill with a required $10 billion in savings from Medicare and Medicaid but without harm to patient care or imposing hospital cuts. Some highlights include:

• Permanent ban on physician self-referral to new limited-service hospitals
• Two-year extension of the 50 percent threshold for inpatient rehabilitation hospitals to qualify as such for Medicare payments
• One-year extension of the outpatient "hold harmless" provision for Sole Community Hospitals and rural hospitals with fewer than 100 beds
• 1 percent update for Medicare payments to physicians in calendar year 2006

AHA has raised concerns about specific details of Medicare "pay for performance" initiatives contained within the Senate Finance Committee version.

On the House side, the House Ways & Means and Energy & Commerce Committees are both working on budget issues under their respective jurisdictions. Should the committees finish this week, a final bill is likely to be sent to the House floor next week. The Ways & Means Committee, of which Cong. Paul Ryan (R-WI) is a member, approved a budget bill that included no Medicare reductions to date. The Energy & Commerce Committee, on the other hand, is seeking roughly $11 billion in Medicaid cuts. Part of that $11 billion will be found by allowing states to impose co-pays for services, including an emergency department co-pay for non-emergent care. Obviously, this poses a problem for emergency departments, as care is provided regardless of ability to pay.

On October 27, Governor Doyle appointed Sandy Anderson, CEO of St. Clare Hospital in Baraboo, to the Pharmacy Reimbursement Commission. The Governor charged the commission with finding alternatives to decreasing the reimbursement rates for pharmacies while achieving comparable biennial savings. Governor Doyle suspended the implementation of rate reductions to pharmacies until the Commission provides him with its recommendations. The Commission will submit recommendations to Governor Doyle by January 31, 2006.

Others appointed to the commission include:

• Shiva Bidar-Sielaff, Madison, Manager of Cross Cultural Care and Interpretive Services at UW Hospitals and Clinics
• Deborah Captain, Abrams, Executive Director of Good Shepherd Services in Seymour
• Gary Donaldson, Mountain, President and Owner of Nicolet Pharmacy in Lakewood
• Patricia Finder-Stone, DePere, Consumer advocate and community activist
• Kimberly Hodgkinson, New Berlin, Director of Finance at Aurora Health Care Ventures
• Tyson Lang, Altoona, Pharmacy Manager of Colby Pharmacy in Whitehall
• Douglas Lee, Marshfield, Medical Director of Pharmacy Services at Marshfield Clinic
• Mark Moody (Chair), Madison, State Medicaid Director at Department of Health and Family Services
• James Riordan, Madison, President and CEO of WPS Health Insurance
• Nicholas Sharrow, Columbus, President of Sharrow Drugs, Inc in Columbus and Owner, Zimbric Pharmacy in Waterloo
• Bruce Weiss, Fox Point, President and CEO of Managed Health Services, Inc.

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As you consider your vote on the medical liability initiatives before you today, please consider the following points:

The "Writing is on the Wall" – Restore Cap to Preserve Access: Despite assurances to contrary by cap opponents, the impact is already being felt throughout Wisconsin’s health care and legal systems. This is not speculation or exaggeration, as our opponents would have you believe — it is a fact.

• Hospital recruiters across the state report physicians canceling interviews and turning down opportunities to practice in Wisconsin.
  
• Personal injury lawyers are already increasing, and in some cases doubling, their out of court settlement demands.
  
• In August, just over a month after the cap was overturned, the Wisconsin Court of Appeals reinstated a $930,000 award for non-economic/pain and suffering damages in the Kaul v. St. Mary’s Hospital, Ozaukee case – more than double what could have been awarded under the cap.
  
• The Wisconsin State Bar Association is already holding seminars – "Who Pays … and How Much," marketing the court decisions to their statewide members.
  
• Wisconsin is gaining national attention for its new "litigation friendly" status:
  
• "Alabama North" Wall Street Journal, 8/9/05  

Texas, Georgia and even Mississippi have all passed tort reform to improve their economies and stop the exodus of doctors. But now bidding to take their place as a favorite trial lawyer destination is the previously sensible state of Wisconsin, led by its Supreme Court.

• "Wisconsin Opens Door to Liability Crisis" American Medical News, 10/17/05
  
  Some physicians in states recently ravaged by soaring medical liability insurance rates have been picking up and moving their practices to Wisconsin, a safe haven for two decades as a state with caps on non-economic damage… Until (three) months ago, when the Wisconsin Supreme Court stripped the state’s doctors of that protection.

A Health Care Access Crisis in States Without Caps: Uncapped pain and suffering awards, and out-of-control litigation are dismantling health care systems in states without effective caps. A few examples include:

• In Oregon, liability premiums for family practice physicians that deliver babies have increased 332 percent since caps on non-economic damages were struck down in 1999.
  
• In Washington, where their short-lived caps were struck down in 1988, fewer doctors are delivering babies and more women are arriving in Washington hospitals never having received prenatal care.
  
• In Illinois, where in 2002 uncapped non-economic damages accounted for 91 percent of the average jury award, OB-GYNs have fled the state, many coming to Wisconsin. Southern Illinois is devoid of neurosurgeons and without head trauma coverage.
  
• In Ohio, where caps were struck down in 1991 and again in 1995, a 2004 survey of physicians conducted by the Ohio Department of Insurance indicated that nearly 40 percent of those who responded said they had retired, or planned on retiring in the next three years due to rising insurance costs.

Steve Brenton,                                     Eric Borgerding,
President                                             Senior Vice President

"In the field of health care, so often the focus is on health – preserving it, restoring it – that we forget how often it is that we simply care," marveled Steve Brenton, WHA president, on reviewing the generosity of Wisconsin hospitals and employees following the disasters of 2005. "The extraordinary support in supplies, personnel, financial contributions and compassion that health organizations offered in the wake of this summer’s natural disasters reminds how much we all care – for our larger community and colleagues near and far."

While the balmy Gulf Coast is hours away from our state, hundreds of our Wisconsin health care providers were ready to travel to the disaster sites and render aid, and those who were called upon were supported with grants for travel and wage reimbursement from their employers and colleagues.

Many professionals were called upon to serve closer to home by providing preventive and routine care to the 678 households registered and served in West Allis at the Tommy Thompson Center at State Fair Park. Another 1,524 households registered in Wisconsin to receive services, and several hospitals have joined their communities in welcoming new permanent residents with assistance in setting up households and accessing health care.

Although Hurricane Katrina garnered most of the headlines, local hospitals made extraordinary efforts to assist in their own communities of Stoughton and Viroqua, when a devastating tornado flattened homes and businesses, changing peoples’ lives forever. Both Stoughton Hospital and Vernon Memorial Health Center thoroughly understand what natural disaster means and the critical role a hospital and its employees play as centers of community and health service. Their efforts helped residents recover and rebuild, making a new future for themselves.

Contributions to WHA’s Caring for Those Who Care For Others fund are listed below. Contributions totaled in excess of $40,000. All funds will be forwarded to the American Hospital Association’s The Care Fund. In addition, included in this week’s Packet is a summary of the many other contributions by Wisconsin hospitals.

Shelley Pederson

Darlene Lauridsen

Elizabeth Ashley Herd

Barbara Belisle

Tonya Vander Wyst

Amy Erickson

Maria Riles

Lori Garrick

Patricia Olson

Chris Steffen

Lorri Lutz

David Skiff

Mary Miller

Christine Ziegler

Deborah Emanuele

Eldray Mcdonald

Dinna Halle

Mary Gorbet

Mary Hadzima

Dorothy Commers

Marilee Kubaskie

Beverly Poeschel

Carol Kinnunen

Jenny Browning

Christine Barr

Linda Vantaggi

Laura Jelle

Karin Sefkar

Joyce Frischman

Tom Opelt

Mary Kipp

Lora Wagner

Sandra Bohach

Jean Sromek

Gloria Hulett

Betsy Shoup

Lorraine Lamarr

Janis Smith

Rose Tibbett

Madalynne Hermandez

Susan Sederholm

Mary Defoe

Janet Kohl

Martha Scott

Barb Krueger

Sandra Kluekmann

Rhonda Rendmeister

Joan Scheffer

Peter Manz

Carolyn Manz

Yvonne Petkovsek

Carol Reither

Linda Ollech

Charlene Hayward

Lisa Cerven

Jean Albrecht

Iva Bizjak

Rita Feirn

Barb Bandarek

Jane Mika

Mrs. Gerald Frisco

Debra Ollanketo

Nancy Dufek

Kathy Lang

Diane Lulich

Julie Ortmann

Lori Gregorich

F. Leatherberry

Luann Klueckmann

Rebecca Johnson

MMC Neillsville Greenwood & Loyal

Ray Shogren

Anna Skiles

Becky Ruesch

Sally Sadowska

Nancy Sparks

Carol Tews

Kathleen Watson

Lori Stress

Geri Schoengarth

Sarah Trunkel

Jody Homann

Madonna Pralle

Marlys Wells

Jill Garrington

Daniel Hymans

Charles Gray

Tricia Skoraczewski

Tom Stipetich

Daniel Gardner

Bernadette David

Sally Wellenstein

Marilyn Forbush

Debra Talg

Leslie Taguba

Cheryl Eddy

Gerry Scharf

Pharmland Midamerica

Sharon Seefeldt

Maria Apolinario

Kathleen Carlson

Betty Harnisch

Vickie Schelvan

Patty Porter

Wendy Kreinbring

Terrance Brenny

Jodi Bloch

Pam Aud

Warren Von Ehren

St. Marys Hospital Medical Center, Madison

Froedtert Hospital, Milwaukee

Osceola Medical Center

Daniel Adams

WSHHRA

William Petasnick

Memorial Pop Fund

Jennifer Frank

Mary Kay Grasmick

Steve and Mary Brenton

Watertown Area Health Services Auxiliary

Thomas Silbernagel

Moundview Hospital, Friendship

Glen Grady

Memorial Medical Center, Ashland

Wisconsin Hospital Association

St Clare’s Hospital, Weston

Sacred Heart-St. Mary’s, Rhinelander/Tomahawk

Bay Area Medical Center, Marinette

Memorial Medical Center, Neillsville

Memorial Health Center, Medford

St Clare Hospital, Baraboo

Waukesha Memorial Hospital

Bellin Health, Green Bay

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Employers across the state now have access to tools to help them educate employees about making informed health care decisions. Responding to feedback from a recent survey of employers conducted by WHA, an Employer Toolkit was added to the CheckPoint web site (www.wicheckpoint.org/about/toolkit.php).

The Toolkit includes a brochure, newsletter insert, payroll stuffer and a list of Frequently Asked Questions - all that can be reprinted for employee communication. The Toolkit also includes information to add a link to CheckPoint on your hospital’s web site, which all hospitals are encouraged to do. There is also an email address where interested people/organizations can join a list serve to receive notice of future updates or changes to the CheckPoint web site. Additional tools will be added over time.

Beloit Memorial Hospital CEO Greg Britton this week was inducted into the Everett C. Haskell Hall of Honor, joining an impressive list of notable Beloit area community leaders who have received the honor that recognizes those who have helped improve the quality of life in the Beloit community.

Britton joined Beloit Memorial Hospital in 1984 and soon became president and CEO. Under his direction, the hospital has experienced a significant turnaround that includes significant service growth and service area expansion, including into northern Illinois.

In accepting the award, Britton acknowledged his family, his professional partners and personal friends and noted that a team effort led to the hospital’s successes.

Robert Tracey, administrator for Franciscan Skemp Healthcare, has been nominated to the Rural Health Development Council. The Rural Health Development Council advises the Department of Commerce regarding administration of several programs that affect rural health, including facility improvement, delivery of health care and coordination of state and federal programs available to assist rural health facilities.

Tracey fills the vacancy left by the retiring Dan Manders of Mauston.

Mercy Health System in Janesville is the only Wisconsin employer recognized on AARP’s 2005 national list of Best Employers for Workers Over 50. Only 50 companies nationwide receive the annual award.

Mercy reports that fully 26 percent of its workforce is 50 years or older. "Mercy clearly recognizes the value that mature workers bring to health care. The commitment, knowledge and life perspective this group brings gives hospitals an advantage in patient satisfaction, skill transference for younger workers and stability in staff numbers. Mercy’s recognition reflects hospitals understand that the growing need for health care workers means that workforce development includes retention as well as recruitment," says Judy Warmuth, WHA Vice president of workforce development.

To continue to keep and attract workers in this group, Mercy has created the Work to Retire program, which allows individuals 55 and over to work 1,000 hours in a year at their discretion while maintaining full-time benefits for the full year.

AARP conducts annual review of American business and industry to discover innovative programs and practices that create an environment support of older workers.

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