Just over a month into the 2008 Campaign, the Wisconsin Hospitals State Political Action Funds fundraising campaign has raised nearly $85,000—which is $23,000 more when compared to this same time last year.

"In 2007, the campaign raised just over $200,000, which was a record total. This year’s goal is even more ambitious as this is an election year and we are looking to raise more than $210,000. Last year’s success was attributable to more individuals participating and individuals increasing their contributions by an average of six percent," according to WHA Advocacy Committee Chair Bob Fale. "To meet our goal, we’ll need even more individuals to participate this year so we can help support the candidate campaigns in the 2008 election season," he added.

In the previous election year, the Wisconsin Hospitals State Political Action Funds—which are the Wisconsin Hospitals PAC and Wisconsin Hospitals Conduit—disbursed more than $223,000 to candidates running for office in 2006. This was up 36 percent from the 2002 election year and up 20 percent from the 2004 election year.

The Campaign mailed fundraising packets last month. For more information, contact Jodi Bloch or Jenny Boese at 608-274-1820.

The Wisconsin Association of Health Plans (WAHP) announced on May 27 that its 17 member health plans had pledged to begin providing estimates of out-of-pocket costs to their insured enrollees who request them before receiving services, starting September 1.

In the announcement, WAHP Board President Steve Youso stated: "The cost information we can provide will give consumers a better position from which to evaluate health care options and make more fully informed decisions." WAHP Chief Executive Officer Nancy Wenzel added: "Today’s initiative is an important step in the progression of health care transparency efforts in Wisconsin."

WHA President Steve Brenton applauded the program. "Wisconsin hospitals have been strong advocates of transparency and have been instrumental in helping consumers better understand health care prices," he said. "Insurance companies are in the best position to provide their policyholders with information related to their out-of-pocket expenses. Those organizations best understand the insured’s benefits, they have negotiated the prices with providers, and they know the status of the insured’s out-of-pocket responsibilities. The Wisconsin Association of Health Plans has taken an important step in advancing health care transparency."

In 2005, WHA launched PricePoint, now one of the nation’s most widely recognized hospital pricing Web sites, which provides charge information and consumer assistance in identifying hospital prices. In 2007, WHA released a set of guidelines to assist hospitals in providing price estimates to consumers.

This week Assembly Republicans fell short in their attempts to override three of Governor Doyle’s partial vetoes relating to K-12 education, SeniorCare and transportation funding in the recently completed budget repair bill.

A budget repair bill became necessary to address a projected $650 million shortfall in state finances, related in large part to a slowing economy.

As previously reported, Doyle objected to two items in particular in the repair 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.

With the override attempts, the Assembly had sought to restore exemptions for the programs from potential further cuts or lapses. The Governor argued that only unexpected savings would be taken from SeniorCare or education.

While Assembly Republicans voting in favor of the overrides were joined by several Democrats, the final vote on each of the attempts fell short of the necessary two-thirds majority approval.

Nominations are now being accepted for WHA’s annual Distinguished Service Award and Trustee Award, as well as for the ACHE Young Healthcare Executive Award. These important awards recognize those who display leadership, dedication and professionalism to their community or the Association.

WHA will recognize the award winners at the 2008 Annual Convention in September. You may know someone in your region, in your hospital or on your Board of Directors who deserves such an honor. You now have an opportunity to nominate them for one of these annual awards:

• Distinguished Service Award is presented to a senior health care executive who has made an exemplary commitment to WHA, his/her hospital, and the communities he/she serves.
• Trustee Award honors a trustee of a WHA member organization who has made an exemplary commitment to his/her community and to the organization on whose board he/she serves.
• ACHE Young Healthcare Executive Award is presented to a member of the American College of Healthcare Executives under the age of 40 who has shown exceptional professional development. Nominations for this award should be sent to Mary Hansen, Berlin Memorial Hospital, ACHE Young Healthcare Executive Award, 225 Memorial Drive, Berlin, WI 54923.

Administrators, trustees, senior managers, nurse leaders, volunteers and others are encouraged to review the criteria for the awards and consider nominating someone to receive one of these honors.

The deadline for submitting nominations is July 18. Details about the nomination process and criteria for nomination can be found in the annual awards brochure included in this week’s packet and on the WHA Web site at www.wha.org/about. For more information, contact Sherry Collins or Steve Brenton at WHA, 608-274-1820.

It seems like just about everyone has a health reform plan. And since the election season has just begun, it is likely that another half dozen or so initiatives will be unveiled in the coming weeks. So how about a quick review of several recent approaches?

Earlier this month, the left-leaning Commonwealth Fund laid out a proposal that purports to provide coverage for most of the current uninsured and claims to actually save money in the process! The approach includes an individual mandate, a 7 percent payroll tax on employers who fail to provide employee coverage, and significantly expands public programs for low income workers. Medicaid payment rates would rise to Medicare levels—but be funded in part by eliminating current disproportionate-share funding to hospitals.

While there are several worthwhile ideas to explore in the Commonwealth Fund reform plan, it strains credibility to believe that this approach will somehow save $1.6 trillion over 10 years—a claim made by the Lewin Group, a consulting firm paid (by the Commonwealth Fund) to crunch the numbers. (The Lewin Group is also cited by Healthy Wisconsin supporters as their source for maintaining that "the numbers work.") But past experience with government health care programs and program expansions consistently demonstrate that early cost projections are always understated. The notion that adding millions of lives to public programs that provide generous benefits will end up saving billions of dollars is not believable. Claims to the contrary deserve our deepest skepticism.

Also this month, The Healthcare Leadership Council, a market-oriented group of CEOs who lead major health systems, health plans and medical device manufacturers outlined a health reform plan designed to reward value as the centerpiece of meaningful reform objectives, including necessary cost containment that addresses coverage sustainability in the long term. The Leadership Council approach is heavily influenced by Mayo Clinic leaders and looks a lot like the initiative unveiled recently in La Crosse, Wisconsin by Mayo’s CEO, Dennis Cortese, M.D.

The Leadership Council’s plan recognizes a dynamic that most, more government expansive reform agendas fail to factor into the equation…..rising costs are largely driven by increasing utilization of services and high performing provider organizations (all providers for that matter) must be incentivized to provide effective care.

The Leadership Council initiative calls for private health plans to cover the nation’s poorest patients with public subsidies (similar to the Doyle Childless Adults approach), widespread and rapid diffusion of information technology and transparency to improve quality and patient choice, and aligning payment to reward prevention and effective care. This latter issue is about paying for value—and while a bit thin on detail, it is the essential building block for sustainable health reform.

Steve Brenton
President

Low literacy and limited English skills are creating crisis situations at hospitals across the country. According to the National Assessment of Adult Literacy, 36 percent of all Americans read at or below a basic level. This makes navigating the health care system, or even finding their way through a hospital, difficult. Their ability to understand basic health information and make decisions is limited, which can affect their safety and in the end increase health care costs.

Thanks to a $10,000 grant from the American Academy of Family Physicians Foundation awarded to Paul Smith, MD, associate professor of family medicine at the UW-Madison School of Medicine and Public Health, these patients will be the focus of a study designed to help them overcome their health care communication challenges. Smith will direct a pilot program at St. Mary’s Hospital in Madison that asks six adult low-literacy learners to evaluate hospital signage, facility navigation and patient consent forms. Once they identify the literacy barriers, the team will meet with the staff of St. Mary’s to develop solutions. It is expected that a training manual will be developed to help train literacy consultants statewide who can then assist hospitals in all parts of the state with this issue.

Dana Richardson, WHA vice president, quality initiatives, said, "This grant provides a foundation that creates real solutions that hospitals can then implement within their organization that will ultimately help all patients."

Working with Smith, WHA has helped increase awareness of the literacy issue in the health care community. WHA will continue to fully support this effort as it moves forward.

The pilot program is a collaboration among the Wisconsin Research and Education Network, St. Mary’s Hospital, Omega School, Wisconsin Literacy, Inc., MetaStar and the Wisconsin Hospital Association.

UnitedHealthcare (UHC) will be softening their controversial inpatient admission notification policy announced in late 2007. UHC planned to require hospitals to report inpatient admissions within 24 hours, regardless of holidays or weekends, or face penalties in the form of payment reductions. This change was postponed through June 30, 2008 in response to hospital objections. WHA and other hospital associations have met with UHC to discuss the workability and value of the shortened notification period.

In a letter sent to CEOs of contracting hospitals, UHC says that the 24-hour notification will still be expected regardless of holidays, but payment reductions will be phased in. In Wisconsin:

• Beginning July 1, 2008, payment reductions apply if notification is more than 72 hours after a weekday admission.
• Beginning January 1, 2009, payment reductions apply if notification is more than 24 hours after a weekday admission.
• Beginning July 1, 2008 through September 30, 2009, weekend and federal holiday admissions will have a notification requirement of 5 p.m. on the next business day.
• Critical Access Hospitals will not have payment reductions for weekend or holiday admissions if notification is made by 5 p.m. on the next business day, extending indefinitely.
• Hospitals committing in writing by May 31, 2008 to work toward EDI 278 notification will face no reimbursement reductions through March 31, 2009.
• No reduction for maternity admissions through January 2, 2009.

UHC is also providing protocols for use in extenuating circumstances, such as when the patient is not recognized as a UHC member because they are non-communicative at time of admission.

WHA requested that Department of Health and Human Services (DHHS) slow down the review and finalization of the new Health Professional Shortage Area (HPSA) rule in its comment letter submitted last week. DHHS’s effort to revise and consolidate the shortage designation method and process is commendable, however there are multiple and significant reasons to slow down the review and finalization of a new HPSA rule in order to reduce the risk of serious, unintended consequences on access to basic health care for large segments of the population (e.g., Medicaid, Medicare, SCHIP, underinsured, uninsured).

HPSA designations and the linked federal resources have become critically important for communities to build and maintain access to primary care for their underserved populations.

A number of significant problems and questions have been identified regarding the proposed new HPSA method, data indicators, and lack of scoring for Facility HPSAs, which support the need to slow down the review, refinement and finalization of the Rule.

Also, there are concerns among many about the "transparency" of the new HPSA method and intended use of the new HPSAs, because of: the complexity of the new method, multiple versions of federal impact testing and not as much clarity as needed on data sources and accuracy, multiple versions of the calculator provided for state impact testing, the inability to access accurate data for some criteria in the new method, and lack of clarity on how the new HPSA types and scores will be used to determine allocation of federal resources (e.g., measure the real impact of the new HPSA Rule).

WHA is requesting that DHHS clarify and coordinate how the new HPSA/MUP types and scores will be used by the DHHS programs that currently use HPSAs to determine allocation of their program resources. This clarification is critical to better determine the real impact of the new HPSA Rule on access to care for underserved communities, to target resources to the highest need communities, and to prevent a "yo-yo" effect on access to care in underserved communities across the U.S.

At 7 a.m. on a recent Thursday, the department stores at Oakwood Mall in Eau Claire were dark and empty. However, one section of the mall was brightly lit and bustling with activity as people gathered to learn their risk of stroke.

Luther Midelfort — a certified Primary Stroke Center — offered the free stroke screening in recognition of Stroke Month. Just one of several stroke activities held during the month, the screening involved checking participants’ cholesterol levels, taking blood pressures, discussing family histories and distributing information regarding stroke risk factors.

Representatives from all facets of the stroke team were present, including a neurologist who specializes in stroke, a nurse practitioner, several RNs and LPNs, and rehabilitation therapists.

Keith Sommerfeld of Eau Claire was one of more than 50 people from the community who took advantage of the free screening. "The screening today was real good," he says. "I appreciated the explanations. The information reinforced what my doctor told me, but it’s helpful to have a refresher."

The screening told Keith he has a relatively low risk of stroke. However, if scores came back high, participants were referred to their primary care providers for more thorough testing.

"I realize that cost and staff time are problems," Keith says, "but I really appreciate having the screening available. Thank you!"

Every day the mental-health professionals of Aurora Psychiatric Hospital respond to the unique needs of individuals dealing with mental health issues. Jason (not his real name), now age 19, is one.

He was diagnosed with mental illness at the age of 12. It had proven too much for his family, who eventually abandoned him. But teachers who wanted to see him finish high school had taken him in. Although their intentions were noble, they apparently did not have the capacity to deal with the challenges of his mental illness. They, too, abandoned Jason, leaving him alone, defenseless and without an advocate at the doorstep of Aurora Psychiatric Hospital.

Often, homeless shelters are a good option for feeding, clothing and housing people who are abandoned. But Jason was vulnerable and would not survive in that kind of setting.

Even though it was not a permanent solution, Jason was admitted to Aurora Psychiatric Hospital, which provided shelter, food and a team of care providers who set out to find an appropriate "home" for Jason and a better way for him to build a life for himself.

The average length of stay for inpatients at the hospital is seven days. Jamie and the case managers set to work on finding a permanent residence for Jason. They pursued guardianship with the county where Jason had been living, but that process dragged on. However, the County agreed to supply transportation for Jason to get from the hospital to the high school he had been attending. But after some issues arose, the school washed their hands of Jason.

In the end, the guardianship matter did not work, either. Jason stayed at Aurora Psychiatric Hospital 46 days before Jamie and her team found a residence on Milwaukee’s south side.

But even then, there was a glitch. The facility where Jason could live and be cared for would not take him without a 30-day supply of his prescription medications.

So the staff at Aurora Psychiatric Hospital reached into the Aurora Essential Medication Fund – a fund supported wholly by Aurora employees who contribute through the annual Aurora Employee Partnership Campaign. The medications were purchased and provided to Jason, and he was admitted to the community-based facility where he now resides.

The United Nations has called methamphetamine "the most abused hard drug on earth." It is one of the most significant health threats to men, women, young and old, rural and urban areas, and the rich and poor alike. In one of Memorial Medical Center’s most aggressive outreach programs, thousands of Wisconsin residents have now seen and heard the truth about the drug its own users call "the devil."

"We didn’t wait until our emergency department was saturated with meth users. Treating this epidemic on a patient-by-patient basis wouldn’t work. We had to think bigger and act faster to reach people on a community-by-community basis. Our solution was to partner with the Clark County Sheriff’s Department," explained Karen King, registered nurse and ER/OR supervisor at Memorial Medical Center – Neillsville.

In December 2005, Memorial began collaborating with the Sheriff’s Department and all Clark County municipal police departments to create a very real, eye opening program. Presentations were offered to the public free of charge. King and Sheriff’s deputies were as open as possible about the current drug activity levels, locations of methamphetamine dump sites, and number of seized labs.

To date, over 75 presentations have been made in five counties, reaching over 6,000 people via service organizations, medical facilities, law enforcement meetings, fire departments, schools, businesses, a regional Meth Summit, the Wisconsin Hospital Association’s West Central Hospital Council, and the Wisconsin State Police Association drug training.

On a local scale, our efforts contributed to healthier communities. In 2005 and early 2006, methamphetamine usage was on a steady increase in Clark County. By June of 2006, the Sheriff’s Department reported a leveling of methamphetamine activity, and soon thereafter, a continual drop. Clark County has now achieved a 90 percent decrease in overall meth-related activities. In addition, both Memorial and the Sheriff’s Department receive calls from both adults and students requesting information or providing tips to possible crime sites. At least one area school district plans to incorporate methamphetamine education into their permanent curriculum, with hopefully more to come.

Whenever possible, King still interviews meth users and dealers while they are in Sheriff’s custody. According to King, their stories are basically always the same. "Meth is the devil. I had no idea that using it one time would ruin my life. Stay away from it." With their stories in mind, Memorial Medical Center continues educating people on the dangers of using meth, the signs of production, and the resources available for help.

Lori Koehler is a self-professed plate filler.

"I always thought that I needed to fill my daughter’s plate so she ate enough," says Koehler. "I now realize that parents should give their kids plenty of healthy options and let them take control over their meals."

Last spring, Koehler and daughter Elizabeth, 11, participated in a grant-funded program to reduce childhood obesity in Dunn County. "Food, Fun, Family, Fitness" was sponsored by Red Cedar Medical Center—Mayo Health System in Menomonie. Other sponsors included the Childhood Obesity Coalition, University of Wisconsin-Stout, Dunn County Public Health and the Menomonie Area School District.

"Food, Fun, Family, Fitness" focused on children ages eight to 10 who were overweight or at risk of becoming overweight. Children were referred to the program by schools and clinics. Twenty-two children and their families participated in the program’s three components—in-home evaluations, education sessions with other families, and physical activity.

During in-home evaluations, information was collected about family interactions, meal preparation, family recipes, and where and how meals were eaten. This information was used to develop a healthier eating action plan for each family.

Education sessions were a group activity, combining learning with socializing. Topics included nutrition, goal setting, resiliency, physical activity and meditation. Speakers included Red Cedar Medical Center staff members Dr. Eitrheim; Kathleen Farah, M.D., a family physician; Steve Siegle, Psy.D., a psychologist; and Jane Foos, a dietitian.

Physical activity experts, including certified fitness trainers, worked with the children to increase their exercise using activity logs and pedometers.

At mealtime, Koehler now allows Elizabeth fill her own plate.

"She likes fruits, vegetables and pasta, so she takes plenty of those," says Koehler. "But she usually takes less meat now. It’s hard for me, but I know she is learning to make healthier choices because of it."

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