Last week, Governor Doyle used his veto pen to make major changes to the budget repair bill narrowly approved by lawmakers last week. The repair bill was necessary to address a projected $650 million shortfall in state finances.

Doyle objected to two items in particular in the bill passed by the Legislature: a one-time refinancing of future payments from tobacco and cigarette manufacturers, from which legislators had expected to raise $209 million; and delaying $125 million in aid to public schools that would have pushed payments into the next state budget.

The Governor deleted the school aid delay entirely and scaled back re-securitization of the tobacco funds. Depending on the bond market, state government now hopes to get a one-time payment of $150 million from the refinancing deal.

Also vetoed was a limit included by lawmakers on the amount that could be taken out of the transportation fund. Instead, the Governor opted to take $103 million from transportation to help balance the budget. Governor Doyle did use his veto pen to increase the amount of additional cuts to state government to $270 million. Lawmakers had approved $69 million in their bill.

Additional vetoes from Governor Doyle included:

• A veto removing the property tax exemption for certain low-income housing, which the Governor called "major non-fiscal policy and should not be included in this bill." The provision related to tax exemption changes for property owned by churches or benevolent associations that is used for nursing homes and retirement homes.

• A veto to restore Joint Finance Committee (JFC) authority over funding for implementation of the federal Real ID program, limiting the transfer of funds for the program to the general fund to $2 million, and leaving about $20 million for JFC to supplement the Department of Transportation for the program.

• A veto restoring the $65 million statutory requirement for the General Fund Balance (up from $25 million in the bill).

As previously reported, the re-worked hospital assessment was not included in the budget repair bill approved by the Legislature. When combined with the federal matching revenue, the $419 million assessment would have returned a total of $708 million to hospitals in the form of much needed increases in Medicaid payments — $292 million more than the assessment. Governor Doyle will introduce the hospital assessment again in 2009.

This week, two more legislators were added to the list of those not seeking re-election in 2008. The total currently stands at 13.

Governor Doyle announced that State Senator Roger Breske (D-Eland) would replace Rodney Kreunen as the Railroad Commissioner. Breske’s appointment is effective June 4 and will expire in March of 2011. Breske was first elected to the Senate in 1990.

Representative Terry Musser (R-Black River Falls), whose first term in the Assembly began in 1984, also announced he was retiring from the Legislature.

In the Senate, Breske joins Senator Carol Roessler (R-Oshkosh) who announced her retirement in March.

In the Assembly, Musser joins a long list of both Republicans and Democrats deciding not to run, including: Sheryl Albers (R-Reedsburg), Gene Hahn (R-Cambria), Suzanne Jeskewitz (R-Menomonee Falls), Carol Owens (R-Oshkosh), Steve Wieckert (R-Appleton), Frank Boyle (D-Superior), Barb Gronemus (D-Whitehall), Jim Kreuser (D-Kenosha running for Kenosha County Executive); Dave Travis (D-Waunakee), and Sheldon Wasserman (D-Milwaukee running for state Senate).

This fall’s state elections will again be critical, and the balance of power in both houses of the Legislature remains close. Prior to Breske’s appointment, Democrats held the majority by an 18-15 margin. In the Assembly, Republicans hold a slim 52-47 majority.

This week the U.S. Senate voted 75-22, a veto-proof margin, to approve a domestic spending amendment that includes a moratorium on seven Medicaid regulations. The moratorium has the support of the American Hospital Association and Wisconsin Hospital Association. There has been activity on many fronts related to the issue, so what follows is a brief update:

In Congress, both Houses have now passed legislation delaying implementation of harmful Medicaid regulations until April 1, 2009. The Senate’s version would also ban self-referral to new physician-owned hospitals. The Senate version, which has been added to the pending Iraq war spending bill, must go back to the House for further deliberations. It could be before the President in June, though he has threatened a veto.

Just this week the Bush Administration announced it will voluntarily extend for another 60 days (until August 1) a pending moratorium on three Medicaid regulations related to intergovernmental transfers (IGT), certified public expenditures (CPE), and graduate medical education (GME). The pending moratorium on these three provisions would have expired this coming Sunday, May 25.

In related news, the American Hospital Association and others filed suit against the U.S. Department of Health & Human Services earlier this year on these Medicaid provisions. The court’s ruling in this case is imminent.

Wisconsin hospitals this week received a toolkit aimed at helping them implement the recommendation from the WHA Board to standardize the colors they use for alerts. Dana Richardson, WHA vice president, quality initiatives, told members of the WHA Medical & Professional Affairs (MPA) Council at their May 22 meeting that the goal is to achieve 100 percent voluntary use of colors by March 1, 2009. Richardson said not all hospitals use color to indicate a safety alert, but for those that do, the colors should be standardized.

"We are aware of variation within our hospitals on how they alert their staff to patient safety conditions. Given that physicians, nurses and other care providers practice in more than one organization, and we transfer patients from hospital to hospital, it is imperative from a patient safety perspective to have a standard for color alerts," Richardson said.

The colors hospitals are recommended to use are:

White or clear: Patient Identification
Purple: DNR
Red: Allergy
Yellow: Fall

Richardson also indicated that there are two statewide wristbands—one for do not resuscitate (DNR) and a new gray wristband for multiple casualty tracking by EMS. The State of Wisconsin DNR only applies to community and emergency services. The state requires hospitals to re-evaluate DNR status upon admission. Hospitals may cover, but cannot remove, the state-issued DNR wristband.

Council member Doris Mulder, Beloit, said she had an opportunity to review the contents of the color standardization toolkit before the meeting and felt it would be very helpful to hospitals implementing the new standard.

Wisconsin hospitals have made significant, measurable quality improvements

Richardson told the group that Wisconsin hospitals have continued to do "very well" when Wisconsin’s averages on clinical measures are compared to those of other states.

"In the four years since we introduced CheckPoint (www.wiCheckPoint.org), we have made incredible progress in public reporting and quality improvement," Richardson said. As she distributed the most recent CheckPoint report, Richardson pointed out that not only has CheckPoint provided information to consumers, it has also produced results by helping Wisconsin’s hospitals improve the quality of care they provide their patient. The most recent CheckPoint report is in this week’s packet and at: www.wha.org/pubArchive/special_reports/checkpoint.pdf.

"CheckPoint is living up to its promise of providing useful information and improving hospital quality," Richardson added.

WHA, Medical Society to jointly announce non-billing for serious adverse events

The WHA Board approved a resolution that would establish a step-by-step approach to implementing a unified statewide response to the issue of non-billing for serious adverse events. According to George Quinn, WHA senior vice president, both organizations are firmly committed to working toward improving patient safety and quality that will eliminate these very rare events. WHA and the Wisconsin Medical Society are working together to develop materials that will be distributed to hospitals, medical directors and physicians. A joint public communications plan is also under development.

MPA Chair Brad Manning, MD, said it is important that the list of non-billable serious adverse events be reasonable and include events that are "not debatable." The MPA Council developed the list that was later approved by the WHA Board. The Council is charged with reviewing any suggested additions to the list.

Robert Wood Johnson Foundation funds "Aligning Forces" grant in Wisconsin

Cindy Schlough from the Wisconsin Collaborative for Healthcare Quality (WCHQ) presented an update on Wisconsin’s Aligning Forces for Quality initiative, funded by the Robert Wood Johnson Foundation. Wisconsin has been invited to participate in a national satellite broadcast with the Robert Wood Johnson Foundation on June 5. The events will be held in Madison from 10 - noon at the Monona Terrace. The 30-minute broadcast will feature Risa Lavizzo-Mourey MD, MBA, the Foundation’s president and CEO. Immediately following the broadcast there will be a Wisconsin-based agenda that will include a representative from the Robert Wood Johnson Foundation, WHA President Steve Brenton, WHA Chair Ken Buser, Clyde (Bud) Chumbley, MD, and WCHQ President/CEO Chris Queram, as well as a perspective from a consumer and a purchaser/employer. If you are interested in attending, register by visiting: www.wchq.org/events.

MetaStar will initiate pressure ulcer project

Eric Streicher, MD, medical director at MetaStar, told MPA Council members that MetaStar will begin a new phase of work later this year that will focus on reducing pressure ulcers across several care settings, including hospitals and nursing homes. Streicher said the work is aimed at standardizing the interventions that are used to treat and prevent pressure ulcers. More information on this project will be presented to the Council as it progresses.

Over the past few years WHA has raised concerns at legislative hearings and meetings of the Medical Examining Board about the length of time it takes for the Department of Regulation and Licensing (DRL) to license Wisconsin physicians. Recently, a mountain of evidence has emerged that strongly suggests that delays are lengthening and that the licensure process itself is in need of reform.

A recent survey of WHA members finds dozens of anecdotes regarding: loss in Madison of necessary licensure paperwork (some sent in via registered mail); lengthening delays in posting materials to applicants’ files; delays in updating Web site records; and unanswered and unreturned phone calls.

As if this unfortunate track record isn’t enough, a high level DRL official recently informed members of the Wisconsin Association of Medical Support Staff (WAMSS) that they should anticipate that licensure of new physicians will take six months. Inadequate resources were blamed for a licensure timeline that, if allowed to happen, will arguably be among the worst in the nation.

Physician workforce issues are the top priority concern of hospital and clinic leaders all across Wisconsin. And out-of-state recruitment is a necessary strategy to address adequate physician supply. But licensure delays lead to lost opportunities to locate physicians to Wisconsin to care for Wisconsin patients and families. It doesn’t have to be this way. A recent Wall Street Journal article described the state of Texas as a new Mecca for physicians, largely due to an increasingly favorable tort environment. The goal in Texas is to license new physicians in 51 days.

WHA and WMS leaders will soon meet with DRL leaders to demand a course of meaningful and measurable action as it relates to correcting and improving processes that are contributing to growing licensure delays. We will offer up partnership and collaboration—but we will accept nothing less than timely and measurable improvement.

Steve Brenton
President

Ministry Health Care, through its Home Care division, took a new approach to grassroots by bringing an elected official into a patient’s home to see new telemonitoring technology in action. Recently State Representative Dan Meyer (R-Eagle River) visited Marguerite "Peggy" Kogut who has been utilizing this new technology in her home.

"I am so delighted this patient-centered technology is accessible for my constituents in the communities I represent," stated Meyer during his visit.

Ministry Home Care’s telemonitoring project – remote electronic and nurse monitoring of patients – was piloted in the Fox Valley last fall at their Affinity Visiting Nurses agency. In April the technology was extended to the Northwoods through the Rhinelander and Arbor Vitae agencies. The technology will be extended to additional communities in coming weeks.

Patients participating in the project receive one central monitoring unit, which connects to a home telephone line. All peripheral services – such as weight scales, blood pressure cuffs, pulse-oximeters, and glucometers – are wireless and send data directly to the central monitoring unit, which transmits the data to Ministry Home Care. A nurse reads all of the data received from the central monitoring unit. If a patient shows instability in glucose, blood pressure, weight, or other areas of concern, the nurse can ask follow-up questions, and if necessary, a nurse can be dispatched to the home.

According to Ministry Home Care President Jerry Cleveland, the patients who utilize the telemonitoring units are already seeing reduced visits to hospital emergency departments.

"We are seeing exactly the results we wanted," said Cleveland. "Reduced hospitalizations not only decrease overall health care costs, but they also keep our patients comfortable in their own homes and communities, where they prefer to be. Telemonitoring puts the patient first."

Cleveland said initial concerns over patients feeling uneasy about the high level of technology in their homes have been dispelled. "Our patients love their telemonitoring units. They feel safer knowing their conditions are constantly monitored by a nurse who is committed to ensuring the patient receives excellent and timely care."

If you have a great legislative grassroots story, please contact Jenny Boese at 608-268-1816 or jboese@wha.org.

Wisconsin State Medicaid Director Jason Helgerson visited Howard Young Medical Center in Woodruff on Friday, May 2, as part of a tour of Wisconsin hospitals and health care facilities during "Cover the Uninsured Week." While at Howard Young he met with hospital President Sheila Clough and had an opportunity to tour the facilities.

During his visit, Helgerson discussed how local hospitals and state agencies can work more collaboratively to help ensure community members have access to health care services.

"He was noticeably impressed with our facilities and what we offer for patients in the Lakeland region," said Clough.

Helgerson also expressed appreciation for efforts at Howard Young and other Ministry facilities to train individuals to then assist Wisconsin families in obtaining health care coverage (through programs like BadgerCare Plus) and other state benefits including FoodShare.

"Connecting families with these services started during Cover the Uninsured Week and we will continue to help families register for coverage," noted Clough.

Wisconsin hospitals have a long tradition of providing needed health care to their communities, 24 hours a day, seven days a week. Every day, hospitals provide uncompensated care to thousands of patients costing millions of dollars. In 2006, 871,000 individuals received over $809 million in uncompensated care.

New in the WHA Toolkit is a paper authored by WHA Senior Vice President George Quinn that outlines the WHA principles on billing and collection. First developed in 2004, the principles were revised in 2007 to include specific income eligibility levels for financial assistance, ways to address catastrophic hospital bills, and reasonable collection practices.

"The revised 2007 guidelines, which have been acknowledged and embraced by Attorney General J.B. Van Hollen, embody the Association’s principles while allowing flexibility for hospitals to adopt the guidelines in a way that reflects the needs of their communities," according to Quinn. Most importantly, the principles and guidelines reflect the caring and compassionate mission of Wisconsin’s not-for-profit hospitals, he added.

The new billing and collection paper is included in this week’s packet and at: www.wha.org/financeAndData/pdf/BillingCollectionPaper5-08.pdf.

Overweight children are at increased risk for serious health problems, including: high blood pressure, high cholesterol, type 2 diabetes, and sleep apnea. In response, Memorial Health Center’s nutritionists Kate Bromann, Rosalyn Haase and Odessa Gallett presented a free informational health forum for families entitled SHAPEDOWN.

Families in attendance learned how to make delicious, healthy, low-fat meals; they acquired an activity plan/schedule; took home recipes and learned how a healthy lifestyle can positively affect your physical, emotional and financial health now and into the future.

In addition, a 10-week SHAPEDOWN program was offered at a discounted rate. The program consisted of a weekly consult with a nutritionist, assignments, and group exercise sessions with a physical therapist.

Deb Strobl of Prentice (whose family participated) commented, "This was the best money I spent; SHAPEDOWN benefited my entire family."

"I love it for the fact that it was directed to the children. The children were motivated to take ownership and responsibility, in addition to the parents."

"I was overweight as a child, my whole family was," continued Deb. "But I’ve learned that it’s not how you have to be – it’s how you choose to be. It’s a choice! We’ve incorporated more fresh fruits and vegetables in our diet; we limit the quantity of processed foods; we choose those menu items from fast food restaurants that don’t exceed 500-600 calories per meal, and we choose to make tradeoffs – If we want ice cream, we take a walk first."

"My daughter has lost 40 pounds since last October; I’ve lost weight as well. It was a great program," concluded Deb.

Alyssa, age 5, has met "Mr. Yuk." She knows that Mr. Yuk means poison, and she’s taught her parents how to keep their home safe for her younger brother, Sam. And she’s taught Sam to stay away from bottles with the Mr. Yuk sticker on them.

Each spring, Watertown Area Heath Services and the Volunteers of Watertown Area Health Services reach out to area kindergarten and pre-kindergarten students, teaching the youth about poison prevention.

Initiated in 1988, the poison prevention program initially reached five schools and 350 children. With extremely positive feedback from educators and parents, the program has grown to reach more than 1,200 youth at a total of 30 schools annually.

For those in Sheboygan and its surrounding counties who are without medical insurance, without any form of Medicare or BadgerCare and who do not have the necessary funds to seek care at traditional medical facilities, The Salvation Army Red Shield Free Clinic provided medical treatment to 888 local individuals during 2006 and wrote 1,023 medical orders including prescriptions, glasses and labs.

Since adding two daytime sessions, those numbers are going up in 2007. Aurora Sheboygan Memorial Medical Center/Aurora Health Care partners with the Red Shield Clinic by providing funding to assist with prescription medications. Each clinic client is allowed up to $350 per year in paid prescription medications. Additionally, on their own time, Aurora physicians and nurses donate services to care for patients, including specialized care on a referral basis.

A young man with severe allergic reactions to almost everything in the environment and in serious need of medications and medical attention is one of the patients at the Red Shield Clinic. He has no health insurance and a less-than modest income, but with support of the Clinic is able to manage his allergies enough to enjoy some quality of life.

The Aurora Essential Medication Fund
The Aurora Essential Medication Fund in Sheboygan helps patients in need. Through a voucher arrangement with both Walgreen’s and Aurora Pharmacies, patients without jobs, insurance or resources treated at an Aurora facility and discharged from care obtain the medications they need to recover and heal.

Franciscan Skemp Healthcare is working to eliminate the common barriers that often inhibit women from having annual mammograms. We all know that early detection is key to better results when the diagnosis is breast cancer. The solution seems so simple – just have a mammogram. However, oftentimes many women feel there are a number of barriers to receiving this important test. Franciscan Skemp Healthcare is dedicated to erasing those barriers.

Reinforcing their commitment to their communities, 12 more hospital and clinical laboratories around the state have qualified for the Certificate of Achievement for Laboratory Training in Emergency Preparedness from the Wisconsin Laboratory Response Network (WLRN). Since its inception in 2006, 45 laboratories have qualified for the honor.

The WLRN is a network of more than 130 clinical laboratories in Wisconsin, with the Wisconsin State Laboratory of Hygiene as the coordinating laboratory. The WLRN is a subset of the National Laboratory Response Network (LRN), a collaborative, voluntary system of laboratories that are equipped to respond quickly to acts of chemical or biological terrorism, emerging infectious diseases, and other public health threats and emergencies.

Laboratories in the WLRN have three primary roles in emergency response: 1) recognition of unusual organisms in patient specimens; 2) ruling out unusual organisms according to the laboratory’s testing capabilities and protocols; and 3) referral of unusual organisms to the Wisconsin State Laboratory of Hygiene in those cases where a bioterrorism agent or other unusual organism cannot be ruled out.

The WLRN developed a series of four laboratory examination modules (Biosafety, Emergency Laboratory Response, Packaging and Shipping Samples, and Laboratory Diagnostics for Bioterrorism) to document laboratory training achievements in emergency preparedness. To qualify for the award, at least two members of laboratory staff must successfully complete each module. There is no deadline for participation in the voluntary training program, so more laboratories are expected to qualify for the award in the future.

More than just emergency preparedness

Although the WLRN was created to facilitate the response to acts of terrorism, according to WLRN Coordinator Carol Kirk its impact extends beyond emergency preparedness.

"Wisconsin has one of the best response rates to food-borne illness outbreaks in the country," Kirk explains. "We believe that this is at least partly due to our network of actively engaged hospital and clinic laboratories that swiftly send to the State Lab of Hygiene isolates of E. coli O157:H7, salmonella and other enteric pathogens from ill patients. This enables the WSLH to rapidly identify the matching "DNA fingerprints" from multiple patients and help local, state and sometimes national public health agencies respond effectively."

The Wisconsin State Laboratory of Hygiene commends the staff and leadership of the laboratories that have qualified for the award, both for their commitment to emergency preparedness and their contributions to public health in Wisconsin.

Below is a complete list of all 45 hospital labs (alphabetical by city) that have received the Certificate of Achievement for Laboratory Training in Emergency Preparedness so far.

Langlade Memorial Hospital, Antigo
Memorial Medical Center, Ashland
Luther Midelfort Northland, Barron
Black River Memorial Hospital, Black River Falls
Calumet Medical Center, Chilton
St. Joseph’s Hospital, Chippewa Falls
Columbus Community Hospital, Columbus
Cumberland Memorial Hospital, Cumberland
Upland Hills Health, Dodgeville
Sacred Heart Hospital, Eau Claire
Consultants Laboratory, Fond du Lac
Bellin Hospital, Green Bay
St. Vincent Hospital, Green Bay
Hudson Hospital, Hudson
United Hospital System, Kenosha
Franciscan Skemp Healthcare, La Crosse
St. Mary’s Hospital, Madison
UW Health Medical Foundation-Central Lab, Madison
Holy Family Memorial, Manitowoc
Bay Area Medical Center, Marinette
Community Memorial Hospital, Menomonee Falls
Red Cedar Medical Center, Menomonie
Monroe Clinic, Monroe
Westfields Hospital, New Richmond
Osceola Medical Center, Osceola
Community Memorial Hospital, Oconto Falls
Mercy Medical Center, Oshkosh
Southwest Health Center, Platteville
Divine Savior Healthcare, Portage
Prairie du Chien Memorial Hospital, Prairie du Chien
Reedsburg Area Medical Center, Reedsburg
Richland Hospital, Richland Center
Ripon Medical Center, Ripon
Aurora-Sheboygan Memorial Medical Center, Sheboygan
St. Nicholas Hospital, Sheboygan
Indianhead Medical Center, Shell Lake
St. Croix Regional Medical Center, St Croix Falls
Ministry Health Care—Our Lady Victory Hospital, Stanley
Stoughton Hospital, Stoughton
Ministry Health Care—Door County Memorial Hospital, Sturgeon Bay
Tomah Memorial Hospital, Tomah
Vernon Memorial Hospital, Viroqua
Consultants Laboratory - Waupun, Waupun
ACL Laboratories, West Allis
Riverview Hospital Association, Wisconsin Rapids

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