This week the Legislature’s Joint Committee on Finance held the first two of six planned public hearings on the proposed 2003-2005 state budget. Jack Sutliff, vice president and CFO at Sacred Heart-St. Mary’s Hospital, testified at Monday’s hearing in Rhinelander. On Tuesday, Jim Hemes, director of community and government affairs at Mercy Medical Center, Oshkosh, met with committee members prior to the hearing in Menasha. Both discussed the effects of proposed cuts to Medicaid, explaining in detail the ramifications if funding for rural hospitals and Graduate Medical Education (GME) is not at least partially restored.

Both Sutliff and Hemes talked about the impact of funding cuts on their individual hospitals and the communities they serve. It is crucial that committee members continue to hear how their actions will affect constituents back home and residents across the state. These individual stories are extremely powerful and are key to influencing the ongoing debate on the state budget.

The Joint Committee on Finance public hearing schedule:

• Monday, March 31; 10 a.m.-5 p.m. -- Milwaukee-Washington High School

• Thursday, April 3; 10 a.m.-5 p.m. -- River Falls-River Falls High School

• Tuesday, April 8; 10 a.m.-5 p.m. -- Platteville-UW Platteville

• Wednesday, April 9; 10 a.m.-5 p.m. -- Madison State Capitol

WHA President Steve Brenton presented the Association’s quality reporting initiative to a crowd of nearly 175 business leaders and health care providers at an American Society for Quality program on March 25 in Milwaukee. The program, "Health Care Quality in Wisconsin: Measuring and Improving Health Care Value" is designed to facilitate an exchange of information regarding the variety of initiatives that are emerging throughout the state.

Brenton said the first phase of the WHA initiative will include 10 evidence-based measures of care for patients with pneumonia, congestive heart failure and heart attack. Five measures of progress towards nationally recognized safety goals will also be reported. He added,"There is a strong desire for information to help purchasers enable a consumer driven market. The WHA information will not only assist in provider selection, but assure those paying the bill that Wisconsin hospitals are responsive to their requests for information and eager to benchmark meaningful performance data."

Dr. Jeffrey Thompson, chief executive officer of Gundersen Lutheran Medical Center, presented the first glimpse of the Wisconsin Collaborative for Healthcare Quality, a new collaborative formed by seven integrated systems in Wisconsin. The purpose of the collaborative is to bring order to the landscape of quality reporting, to engage business, industry and legislators, and to develop a template that minimizes duplicative efforts. Thompson said, Wisconsin is not in bad shape, but, "We need to work hard to enable further progress. This is one of several groups and organizations that are committed and working hard to facilitate quality improvement."

Dr. Martin Merry, senior advisor for medical affairs for the New Hampshire Hospital Association and Foundation, stressed that health care providers need to redesign care processes that put the needs of the patient at the center. He indicated that the health care system is collapsing under the weight of its sheer size and staggering complexity. He further hypothesized that the future health care system will not emerge incrementally, but will arise from the ground up, based on fundamentally different assumptions about health care and its delivery. "By planning the process around the patient experience, we can achieve not just quality improvement, but quantum leaps," according to Merry.

Geoffrey Schick, co-director of the Kenosha Community Healthcare Initiatives (KCHI), defined the initiatives mission as, "The community initiative process will stimulate community activity, including coalitions and other consensus building forums, to encourage collaboration and cooperation of consumers, purchasers, caregivers and providers to improve the health care system…" The KCHI currently consists of a steering committee that coordinates the communication among the sub-committees, identifies funding resources, and facilitates public communication. The KCHI currently supports five committees focusing on issues in cardiovascular care, mental health resources, racial disparity, health care economics, and lifestyle and wellness.

Milwaukee Mayor John Norquist presented the recommendations of the City of Milwaukee Health Care Task Force. Among these recommendations are the need to encourage employee health care choices, to provide all residents access to medical care, to improve quality measurement, to improve access to affordable insurance for small employers, to assure an adequate supply of health workers and facilities, and to eliminate legislative obstacles. He stated that one of the primary reasons the health care market is broken is that purchasers have not been paying attention until the last few years, when high health care costs have created something of a crisis environment. He believes that employers are "frightened and concerned, but that they are focusing that concern on improvement."

The American Society for Quality is a national group whose mission is to encourage research, innovation, and the formation of learning partnerships to advance knowledge of health care quality. For more information on the WHA quality initiative, contact Dana Richardson, drichardson@wha.org or 608-274-1820.

This week WHA announced the members of the statewide Quality Steering Committee that will help shape the evolution of the Association’s quality initiative, which includes collecting and publicly reporting hospital quality and safety data. The information, which will be published to a Web site and to print, will provide consumers with reliable, valid measures of health care quality. The data collected will also be shared among hospitals as they work on internal quality improvement activities. Charles Shabino, MD, chief medical officer at Community Health Care, Wausau, will chair the steering committee.

WHA President Steve Brenton said the Association recognizes that the success of the project statewide requires the oversight, assistance and expertise of key stakeholders beyond hospital administration. That is why WHA is forming a high level and diverse steering committee that will help shape the evolution of the initiative. The steering committee will include practitioners, hospital administrators, purchasers and public health representatives. The six committee members who are involved in the purchase of health care services include: James Buchen, vice president, Wisconsin Manufacturers and Commerce; James Mueller, president, Frank Haack & Associates, Milwaukee; Nancy Wenzel, executive director, Wisconsin Association of Health Plans, Madison; Eric Stanchfield, secretary, Wisconsin Department of Employee Trust Funds, Madison; Chris Queram, chief executive officer, The Alliance, Madison; and Sheila Jenkins, president, Network Health Plan, Menasha. Public health and policy interests will be represented by Patrick Remington, MD, MPH, co-director, Wisconsin Public Health and Health Policy Institute, Madison.

Committee members include: Shelly Egstad, RN, manager of quality/compliance/risk management, Tomah Memorial Hospital; Robert Fale, president, Agnesian HealthCare, Fond du Lac; Glen Grady, administrator, Memorial Medical Center, Neillsville; Brad Manning, MD, UW Health, Madison; Loren Meyer, MD, vice president, quality & medical education, All Saints Healthcare System, Racine; Terri Potter, president/CEO, Meriter Hospital, Madison; Patricia Schroeder, senior vice president-clinical performance/chief nursing officer, Covenant Healthcare System, Milwaukee; Tim Size, executive director, Rural Wisconsin Health Cooperative; Nick Turkal, MD, senior clinical vice president-academic & medical affairs, Aurora Health Care, Milwaukee; and Frederic Wesbrook, MD, president, Marshfield Clinic.

According to Brenton, "The intent is to have a highly collaborative process that encourages the open exchange of ideas. Diversity of opinion will drive the evolution of the quality initiative."

The WHA will initially collect and report on 10 quality measures related to the quality of care received for congestive heart failure, pneumonia, and heart attack, along with five measures commonly associated with patient safety. The steering committee will review the measures selected for the first round of reporting and identify new quality measurements that could be included in future quality reports.

Remember to mark your calendar and register now for the May 2 "JCAHO Survey Preparation Trends" seminar in Wausau. Learn about the "make-or-break" issues of JCAHO accreditation visits, as well as how to meet the significant survey process changes put into effect in January 2004. Participants will leave the seminar with specifics on what should be done to prepare for these significant survey process changes.

Attendance is open to and encouraged for all hospital survey preparation team members, but is especially important and timely to those hospitals scheduled for JCAHO surveys within the first six months of 2004. This seminar will be held on Friday, May 2, 2003, from 9 a.m. to 4 p.m. at Stoney Creek Inn in Wausau. A brochure and registration form are available on the web site at www.wha.org. Team attendance is encouraged, and a registration fee discount for teams of three or more individuals from the same facility is available.

Last month, the AHA, in collaboration with the UnitedHealth Foundation and our state partners, sent every hospital CEO a courtesy copy of the Strategies for Leadership Evidence-based Medicine for Effective Patient Care - a comprehensive resource hospitals can use in the practice of evidence-based medicine. Produced by the BMJ Publishing Group, Clinical Evidence contains the most up-to-date information on what’s proven to work in medicine.

As recipients of the Strategies for Leadership toolkit, hospitals are eligible for free Web access to the BMJ’s Clinical Evidence online for a six-month period, but they must register soon. Such access can allow a hospital or health system to make Clinical Evidence readily available in patient care areas throughout the organization.

To take advantage of the online subscription, hospitals must register no later than April 4, 2003. Visit www.aha.org for the registration form.

The Bureau of Health Information (once known as the Office of Health Care Information) has existed for over 15 years. The agency was created as something of an alternative to the Wisconsin Hospital Rate Setting Commission, which was abolished by the Wisconsin Legislature in 1987.

The Bureau of Health Information (BHI) has historically enjoyed a legislative mandate to collect hospital, ambulatory surgery center and physician data to produce a variety of reports and make available information to the public. Hospital-related information has been the primary focus of activity.

BHI has an annual budget of $3 million. All of that revenue comes from provider assessments ($2.2 million) and data sales ($700,000).

Importantly, Governor Doyle’s proposed state budget eliminates the current mandate for provider claims submission, hence, collapsing the underlying authority for BHI’s existence. Claims data is largely what BHI uses to conduct its business. Removing that statutory mandate is like shutting off the gas pilot light…the furnace shuts off.

Governor Doyle’s proposal provides an excellent opportunity for WHA to offer up a private sector alternative to BHI that aligns with our commitment to make timely health care provider cost and quality information available to consumers and payers in order to facilitate a consumer-driven marketplace.

Our proposal should agree to continue a hospital claims submission requirement. But that data should now flow to a publicly accountable private data repository operated by WHA under contract with the State of Wisconsin. Our efforts should also be aimed at "fixing" longstanding and very real complaint about current BHI performance. Current BHI shortcomings include: lack of timeliness, limited usefulness of available health information, high cost, and inability to adjust to hospital industry changes.

WHA’s specific proposal is still under development. The notion was well received by the Association’s Council on Public Policy this week and, to date, has also been well received by stakeholders beyond the Association.

Thank you to all who have completed the WHA membership satisfaction survey. We have 59% response to date, but it’s important to hear from as many members as possible in order to get a true picture of member needs. Remember – this is your opportunity to rate WHA’s value and effectiveness.

If you have not yet completed the survey, using the following URL address, you can complete the survey on-line: http://www.memberinput.com/wha/2003survey.htm

Otherwise, to get another copy of the written survey, contact Jennifer Frank at 608-274-1820 or jfrank@wha.org . The response deadline has been extended from March 28 to April 4, in order to accept some additional completed surveys.

The Wisconsin Division of Public Health reminds Wisconsin hospitals that they need to have the dressings of each of their vaccinated employees checked before each work shift. All hospital workers who will be caring for patients or working with immuno-suppressed people need to have their smallpox vaccination site covered by a 2x2 piece of gauze and a semi-permeable dressing. The daily dressing check is to ensure that the gauze is not saturated and the semi-permeable dressing is occlusive.

This week two nurses – one in Maryland and one in Florida – who had recently received smallpox vaccinations died of heart attacks. It is not known at this time if smallpox vaccination caused these problems or if they occurred by chance. The Centers for Disease Control and Prevention (CDC) is investigating. As a precautionary measure, however, the CDC is recommending that people who have been diagnosed by a doctor as having heart disease with or without symptoms should not get the smallpox vaccine at this time while the investigation is continuing. These heart conditions include heart attack, angina, congestive heart failure and cardiomyopathy. According to the CDC, the presence of these conditions in a close contact is not a reason to defer vaccination. The CDC recommends that anyone who has received the smallpox vaccine and develops chest pain, shortness of breath, or other symptoms of cardiac disease in the weeks following vaccination should see their health care provider immediately. Starting with the vaccination clinic held last Wednesday, March 26, all volunteer vaccinees receive information about the new contraindication and are asked medical screening questions about heart disease.

What does it take to be an organization driven by quality? How do you communicate your quality successes to patients and the community? The Wisconsin Healthcare Public Relations and Marketing Society (WHPRMS) will host a professional development day- - the Quality Journey, April10 from 9:30 a.m. to 3 p.m. at the Sheraton Hotel in Madison to target answers for these questions.

SSM Health Care, St. Louis, is the first health care system in the country to be named a Malcolm Baldrige National Quality Award winner. Tim Hallock, quality facilitator for SSM Health Care, will begin the quality in health care discussion by introducing SSM’s decade-long journey to becoming a performance excellence organization. Hallock will talk about the challenges faced and work with participants in recognizing quality opportunities in their own organizations.

Steve Sparks, St. Marys Hospital Medical Center, Madison and Mary Pat Elsen, St. Clare Hospital & Health Services, Baraboo will discuss how their public relations departments focus on quality and how they communicated earning the award to their communities. Barbara Thompson from The Roberts Group, a health care advertising agency, will discuss the best way to communicate quality achievements.

Paul Dell Uomo, president and CEO of Covenant Healthcare System, Inc. will speak at an April 15 roundtable hosted by the University of Wisconsin-Milwaukee.  Dell Uomo, who is known as an innovative leader in finding solutions to complex health care problems, including workforce development, will present "Enhancing Quality and Containing Cost." Dell Uomo will discuss many of the strategies Covenant has developed, both internally and in collaboration with academic and other community partners, to solve one of the most challenging problems facing health care—a shrinking pool of health care professionals. 

The session will be held at the UW-M student union, and it starts with a 7:30 a.m. breakfast buffet and is scheduled to close at 9 a.m. The cost for the round table is $10, which includes the breakfast buffet and parking (pay at the door).  For more information, or to preregister contact Cheri Dziekan Chapman at 414-229-3225 or email cheridc@uwm.edu . 

Gather the health care and hospital supporters in your community and head to Madison for WHA’s Advocacy Day on April 8. Governor Doyle’s attendance is confirmed, and we are excited to have him as our keynote at 10:45 a.m.

A legislative panel starts the day featuring Senate Majority Leader Mary Panzer, Assembly Speaker John Gard, Senate Minority Leader Jon Erpenbach and Assembly Minority Leader Jim Kreuser. A full briefing on the issues facing Wisconsin hospitals will arm you with the facts and position papers, and leave you well prepared to visit your legislator in the Capitol after 2 p.m. All Capitol offices have been notified and are awaiting your call to set an appointment to meet with your elected official. (Go to www.wha.org , Speak Up, Legislative Directory, for phone numbers of legislators.)

Bring your grassroots team, key leaders, volunteers, and trustees to put a face on the issues facing your hospitals. It’s easy to register, and it’s free! Join the organizations already registered and help tell the hospital story on April 8.

You can register one of three ways: print the registration form from the Web site, complete it and fax it to 608-274-8554; email your registration information to Bridget Gifford at bgifford@wha.org ; or call Bridget at 608-274-1820. Register today.

The Centers for Disease Control and Prevention says the leading hypothesis for the cause of Severe Acute Respiratory Syndrome (SARS), a mysterious respiratory illness that has spread from Asia to the U.S. and other countries in recent weeks, is a virus from a family of viruses known to cause the common cold. The Center for Disease Control (CDC) announced late on March 24 that laboratory analysis had identified the so-called coronavirus in clinical specimens from patients with the illness.

The Wisconsin Division of Public Health (WDPH) continues to monitor for the presence of SARS in Wisconsin. Two reports of possible SARS were identified in Wisconsin, although one was eliminated due to travel in areas other than those specified in the case definition. The second report continues to be followed by the WDPH. The patient has made a complete recovery. Local public health agencies and clinicians in the state have been notified to be on the alert for those patients that present with clinical illness consistent with SARS. Criteria for SARS patients are defined as:

This data was reported to the World Health Organization on March 27, 2003. The data is available at: http://www.cdc.gov/od/oc/media/sars.htm.

The American Medical Group Association selected Red Cedar Medical Center’s team of health care professionals as one of three national 2003 Acclaim Award honorees. The Association recognizes organizations that demonstrate outstanding performance in improving the quality of health care in the areas of disease prevention, tobacco cessation, and community fitness. The American Medical Group Association noted that the judges were "extremely impressed with Red Cedar Medical Center’s results, and the organization’s commitment to quality improvement."