Make plans now to attend WHA’s Advocacy Day April 8 in Madison. We can, and we do, make a difference when we speak with a unified voice for hospitals. We proved it in the last legislative session, and this year we will be back at it again.

The timing couldn’t be better. The legislative committees will be considering the budget and other issues important to hospitals. Armed with up-to-the-minute information and briefings from political experts, you’ll be well prepared to meet with your legislator.

Advocacy Day is a key event for Wisconsin hospitals. It is an opportunity to improve our grassroots effectiveness, while learning about the issues that will shape the future of health care delivery in Wisconsin.

A strong turnout for WHA Advocacy Day is needed to get the hospital and health care message across to our legislators. Register today! Registration materials are in the packet and on the Web site. For more information contact Jennifer Frank 608-274-1820 or email at jfrank@wha.org, or to register contact Bridget Gifford at 608-274-1820 or email at bgifford@wha.org.

Nearly 40 physicians and hospital representatives are scheduled to meet with members of the legislature and press on Tuesday, March 11 as WHA continues to draw attention to the Governor’s proposed cuts in the Graduate Medical Education (GME) program. Residents, physicians, and members of the medical academic community will emphasize that Wisconsin is already coping with an acute health workforce shortage. Eliminating funding for residency programs and for hospitals that help train nurses, physical therapists and other heath care professionals only exacerbates the shortage. History has shown that the most effective way for Wisconsin to recruit physicians is to train them here. In fact, over the past several years, 60 percent of the graduates of Wisconsin’s residency programs have stayed in the state.

The Governor’s proposal eliminates $57 million for physician and non-physician training over the biennium. Currently, the state’s Medicaid program provides funding for Graduate Medical Education (GME) at Wisconsin’s teaching hospitals. By eliminating about $23 million of GPR funding for a portion of these hospitals’ direct and indirect costs, the state forfeits another $34 million of federal funding.

"WHA recognizes the predicament legislators are in as they work to pass a balanced budget, but cutting GME is not a solution. Eliminating a proven program as a short-term fix will have long-term devastating implications for access to health care in the state of Wisconsin," according to WHA Senior Vice President Eric Borgerding. To learn how you can participate in this and other efforts to restore proposed state funding cuts, contact Ann Lucas at WHA, alucas@wha.org or 608-274-1820.

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As reported in the last issue of The Valued Voice, more than 50 organizations recently signed a letter to Wisconsin legislators voicing support for Governor Doyle’s proposal to capture roughly $550 million in additional federal Medicaid funds through an intergovernmental transfer (IGT). In response to aggressive lobbying by WHA and other IGT supporters, over 80 legislators cosigned a letter to the Department of Health and Human Services urging approval of the IGT.

Although many legislators were skeptical of the Governor’s proposal at the outset, most have realized that without it, the ramifications for Wisconsin’s current budget crisis are enormous. Medicaid funding cuts already proposed would pale in comparison to those resulting from a half a billion-dollar shortfall. WHA will continue to work with the Doyle Administration to rally support for the IGT proposal and do all it can to see that Wisconsin receives its fair share of federal Medicaid funding.

Legislators signing the February 28 letter:

• Senator Bob Jauch

• Senator Alberta Darling

• Representative Dean Kaufert

• Representative Michael Huebsch

• Senator Mary Lazich

• Representative David Ward

• Senator Ted Kanavas

• Representative Dan Meyer

• Senator Sheila Harsdorf

• Representative Kitty Rhoades

• Senator Russell Decker

• Representative Jeff Stone

• Senator Gwendolynne Moore

• Representative Spencer Coggs

• Representative Dan Schooff

• Senator Carol Roessler

• Senator Jon Erpenbach

• Representative Michael Lehman

• Representative Stephen Freese

• Representative Daniel LeMahieu

• Senator Dale Schultz

• Senator Judy Robson

• Representative Bonnie Ladwig

• Senator Fred Risser

• Representative Luther Olsen

• Representative Sheryl Albers

• Senator Tim Carpenter

• Representative Lorraine Seratti

• Representative Gregg Underheim

• Senator Ronald Brown

• Representative James Kreuser

• Senator Mark Meyer

• Representative Jean Hundertmark

• Senator Roger Breske

• Representative Margaret Krusick

• Representative Shirley Krug

• Representative Alvin Ott

• Representative John Ainsworth

• Representative Mary Hubler

• Representative Phil Montgomery

• Senator Gary George

• Representative Terese Berceau

• Representative Sheldon Wasserman

• Representative Scott Suder

• Representative Robin Kreibich

• Senator Bob Wirch

• Representative Daniel Vrakas

• Representative Marlin Schneider

• Representative Gary Sherman

• Representative Terri McCormick

• Representative Frank Lasee

• Representative Scott Gunderson

• Senator Chuck Chvala

• Representative Judy Krawczyk

• Representative Frank Boyle

• Representative Karl Van Roy

• Representative Bob Ziegelbauer

• Representative Becky Weber

• Representative Garey Bies

• Representative Samatha Kerkman

• Representative Thomas Lothian

• Representative Tony Staskunas

• Representative Ann Nischke

• Representative Suzanne Jeskewitz

• Senator Dave Hansen

• Representative Tom Hebl

• Representative Curt Gielow

• Representative John Steinbrink

• Representative Jeffrey Plale

• Representative J.A. Hines

• Representative Greg Huber

• Representative Robert Turner

• Representative Mark Miller

• Representative Pedro Colon

• Representative Joe Plouff

• Representative Mark Pocan

• Representative Leon Young

• Representative Jennifer Shilling

• Representative Wayne Wood

• Representative Gabe Loeffelholz

• Representative Barbara Gronemus

• Representative Amy Sue Vruwink

• Representative Christine Sinicki

• Representative John Townsend

• Representative Mary Williams

• Representative Terry Van Akkeren

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The new WHA Web site is the web source for members, legislators and members of the public to find the latest information about hospital issues. For those who regularly accessed the previous site, they may find that some information may have been redistributed to new locations. To assist in the transition, and to help new users, WHA developed a brochure that will serve as a guide in finding information quickly on the new Web site. A copy of the brochure is included in the packet, or it can be downloaded from the WHA Web site under the help button at the top right section of the home page.

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WHA has been asked several times in recent days to explain our position on Governor Doyle’s budget proposal that takes $200 million in Patient Compensation Fund (PCF) "reserves" to help finance Medicaid’s vulnerable funding stream. Having met just two days after the Doyle budget was released, the WHA Board last month chose appropriately a "wait and see" position on the PCF initiative. And that decision…three weeks later…has proven to be a wise one.

• In normal times, the notion of taking $200 million from an account that has helped stabilize Wisconsin’s malpractice environment would be viewed as a particularly bad…maybe outrageous…idea. After all, the assessments were paid by hospitals, physicians (both personally and by their employers) and CRNAs for malpractice protection, not to pay for Medicaid services.
• But these are extraordinary times. And the $200 million, if matched with federal funds, becomes $500 million. That’s a half billion dollars that, if subtracted from the biennial budget, translates into provider payment cuts, the elimination of services and eligibility reductions. Hence, unless replaced by other funds (at a time when both the new governor and GOP leaders are pledging to not raise taxes) the consequences of losing the PCF contribution might be described as…catastrophic.
• The current debate over using PCF reserves should be put on hold until necessary legal and actuarial issues can be defined and addressed by experts. Ultimately, the most significant question that needs to be answered may not be whether the "taking" of dollars is legal, but just what is the impact of removing these reserves on the short and long-term fiscal health and viability of the PCF?
• Finally, it should be noted that the Doyle Administration’s budget language transfers the $200 million from the PCF to a "health care provider availability and cost control fund" to be administered by the Commissioner of Insurance. The purpose of the fund is to "ensure the availability of health care providers in the state and controlling the cost of health care services to state taxpayers, workers and employers." The budget bill directs that the funds be used primarily to fund Medicaid benefits but also mentions that expenditures from the fund can be made to "assist in the education and training of health care providers."

WHA’s top budget priority is the restoration of teaching hospital cuts and the special rural hospital adjustment. Should PCF-related legal and actuarial questions be adequately addressed, the possibility of restoring those cuts with this revenue source may be very much in play.

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Medicare makes outlier payments to health care providers for services that cost significantly more than Medicare’s fixed payments. To receive these payments, a provider’s outlier costs must exceed the outlier threshold. While the proposal did not revise the outlier threshold, CMS has suggested a decrease might be provided in the final rule, should first quarter 2003 outlier data support such a change.

WHA also has concerns about provisions in the proposed rule that would require hospitals to provide more data to calculate outlier payments, and would push much farther into the future any final settlements for these payments.

Comments on the proposed rule are due to CMS on April 4. WHA is soliciting member input to help formulate its comments. To push CMS toward making appropriate changes to the rule, WHA urges hospitals to submit their own comments directly to CMS.

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The annual cost of diabetes in medical expenditures and lost productivity climbed from $98 billion in 1997 to $132 billion in 2002, according to a study by the American Diabetes Association (ADA) published in the March issue of Diabetes Care. The direct medical costs of diabetes more than doubled in that time, from $44 billion in 1997 to $91.8 billion in 2002.

The study’s findings were announced jointly by Health and Human Services Secretary Tommy G. Thompson and American Diabetes Association President Francine R. Kaufman, M.D.

"Diabetes continues to be a huge financial burden on patients, their families and society, a burden that continues to grow in parallel with the obesity and diabetes epidemics in this country," Secretary Thompson said. "We must all work to fight this disease that touches so many of our daily lives. Fighting diabetes through research and public education on new treatments and prevention is one of our top priorities at the Department of Health and Human Services."

According to the study, the nation spends $13,243 on each person with diabetes, compared to $2,560 per person for people who don’t have diabetes. After adjusting for differences in age, sex, and race/ethnicity between people with and without diabetes, the study found that people with diabetes incur medical expenses that are about 2.4 times higher. The figures take into account spending by individuals, employers, insurers and government programs such as Medicaid and Medicare. No cost estimates were projected for the nearly six million people believed to have diabetes but who have not yet been diagnosed.

The study also found:

• Direct medical expenditures of $91.8 billion included $23.2 billion for diabetes care, $24.6 billion for chronic diabetes-related complications and $44.1 billion for excess prevalence of general medical conditions.
• Indirect costs resulting from lost work days, restricted activity days, mortality and permanent disabilities due to diabetes totaled $39.8 billion.
• Cardiovascular disease is the most costly complication of diabetes, accounting for more than $17.6 billion of the $91.8 billion annual direct medical costs for diabetes in 2002.

HHS’ Centers for Disease Control and Prevention estimates that 17 million Americans have diabetes, including many who are unaware of their condition. In addition, an estimated 16 million additional Americans have pre-diabetes and can reduce their risks of developing the disease by losing a modest amount of weight and increasing their activity levels.

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The Agency for Healthcare Research and Quality has developed the nations’s first Web-based patient safety resource and journal. It is funded by the Agency for Healthcare Research and Quality, edited by a team led by Drs. Bob Wachter and Kaveh Shojania at the University of California, San Francisco, with the technical support of DoctorQuality, the Philadelphia-based healthcare quality company. An panel of experts in the relevant patient safety and clinical disciplines guide the editorial team.

Every month, five cases of medical errors and patient safety problems--one each in medicine, surgery/anesthesia, obstetrics-gynecology, pediatrics, and other fields such as psychiatry, emergency medicine, and radiology--are posted. These cases are submitted through the Web site (anonymously). Writers of cases for posting receive an honorarium. Cases raise key issues, and involve errors that did not result in permanent harm to patients.

One case each month is expanded into a "Spotlight Case"-an interactive learning module that features readers’ polls, quizzes, and other multimedia elements. Practicing physicians may obtain continuing medical education (CME) credit by successfully completing the spotlight case and its questions, and trainees can receive certification. A Powerpoint version of the spotlight case is available to download for educational use, such as in student teaching conferences or residents’ reports. The site includes a users’ forum, on which readers can post and react to comments that relate to the cases and links to other resources and interesting facts about patient safety, medical errors, and health care quality. The site is available at http://webmm.ahrq.gov.

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William Watson, M.D., board certified psychiatrist and medical director of Rogers Memorial Hospital, has been elected a Fellow of the American Psychiatric Association (APA), the national society of psychiatrists. The distinction recognizes Dr. Watson’s achievements in psychiatric care and his specialty in child and adolescent psychiatry.

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Baldwin Area Medical Center (BAMC) has an opportunity for a full time Director Clinic Operations. This is a growing family practice clinic consisting of five MDs, one Doctor of Osteopathy, and two PAs. The position will report to the CEO of BAMC and will be responsible for day to day operations of the Rural Health Clinic operation. This includes design, development and implementation of Rural Health Clinic policies and procedures; business operations management; staff recruitment and training; strategic, budget and financial planning; compliance with all regulatory agencies; conducting clinic operational meetings; collaboration with supporting departments to insure peak patient flow; compile/prepare operational reports and analysis on reimbursement, practice patterns, referral patterns and industry trends; assist administration with negotiating third party payor relationships.

Bachelor’s degree (B. A.) with a minimum of two year applicable clinic and business operations (health care management) related experience. An understanding of Rural Health Clinic regulations desired.