WHA President Steve Brenton said Wisconsin is one of the few states to voluntarily publicly report information related to births.

"From the inception of CheckPoint, we knew we wanted to include information related to childbirth for a couple of reasons. One, it is one of the most common hospitalizations, and two, patients have time to research their upcoming hospital stay. Over time, the appropriate, evidence-based measures were identified, and we are now confident that the information hospitals will report to CheckPoint related to labor and delivery will be relevant to the public and help our hospitals in their quality improvement activities," Brenton said.

Dana Richardson, WHA vice president, quality initiatives, told the Board that most hospitals that deliver babies already voluntarily collect and report perinatal data to Peridata.net. Peridata.net staff and the WHA Measures Team reviewed a number of measures as they formed their recommendation. They also surveyed consumers to determine what information they were seeking in an effort to meet those needs.

The perinatal measures are:

1. Breastfeeding rate at discharge
2. Low-risk, without a trial of labor cesarean, birth rate
3. Low-risk, with a trial of labor cesarean, birth rate
4. Use of antenatal steroids in at-risk (preterm) pregnancies
5. Term neonatal composite measure
6. Vaginal deliveries with forceps
7. Vaginal deliveries with vacuum extraction

In addition, hospitals will have an opportunity to complete a profile that will include questions related to their labor and delivery services. The profiles, which are voluntary, will be posted to CheckPoint.

Richardson said the perinatal measures will be available on CheckPoint in 2009.

President’s report: RWJ grant brings quality resources to state; WHIO data available Dec. 1

Wisconsin was one of 14 communities to receive significant funding for quality improvement activities from the Robert Wood Johnson Aligning Forces initiative. Brenton said a considerable portion of the $300 million grant is directed at nurses and nurse leaders in an effort to engage those at the "frontline" of patient care more directly in quality improvement activities. Richardson said WHA member hospitals will be asked to share best practices related to nurse involvement in quality improvement efforts.

Brenton reported that the Wisconsin Health Information Organization (WHIO) will have their first data set available December 1, 2008. WHA is an active participant in WHIO, representing providers in a business-dominated agenda. Other participants in WHIO are the Wisconsin Collaborative for Healthcare Quality, Wisconsin Medical Society, and representatives from provider-sponsored HMOs.

Brenton said WHA responded to a request from House Ways and Means Committee Member Henry Waxman (D-CA) to hospital associations asking what they are doing to help reduce hospital-acquired infections. Richardson authored the letter and outlined WHA’s active involvement in advancing a transparency agenda that includes surgical infection prevention measures. Richardson pointed out that without nationally agreed-upon standard definitions of what constitutes an infection, "we believe that data collected by individual hospitals will vary, making the information misleading, if not useless, to consumers."

A meeting initiated by WHA with the Department of Regulation and Licensing (DRL) over growing delays in licensing physicians will hopefully lead to sorely-needed process improvements, according to Brenton. WHA’s Brenton and Judy Warmuth, along with Susan Turney, MD, Wisconsin Medical Society, met with DRL staff earlier in June to discuss the issue. Hospitals report that licensing delays are making it more difficult to recruit physicians. Brenton said DRL gave assurances it would address the problem. A meeting will be held at the end of the year so DRL can benchmark their progress.

WHA met with Wisconsin Manufacturers and Commerce to seek a mutually-beneficial solution as it relates to worker’s compensation reimbursement for hospitals. George Quinn, WHA’s senior vice president, said WHA has three goals: constrain increases in health care costs; prevent provider cuts; and, bring more certainty to payments for both providers and payers.

Borgerding sees "big storm" ahead as Dems, Republicans clash in upcoming elections

As the sky darkened outside the WHA Board room, ushering in yet another big rainstorm in southern Wisconsin, WHA Executive Vice President Eric Borgerding quipped during his legislative update that a storm perhaps of even greater intensity was brewing in Madison. Election 2008 at both the state and national levels promises to be stormy as Democrats and Republicans line up to meet head on in the polls. Both parties are focused on gaining seats in the Wisconsin Legislature.

Borgerding said WHA will raise its level of activity around campaigns considerably this year over past years. Most notably, WHA government relations staff has initiated personal meetings with candidates in their home districts. Staff has developed a package of messages that will be shared with candidates. A priority issue is Medicaid, which has gone more than a decade without an increase. Cost and quality transparency, hospital community benefits, as well as the need to increase the number of people with health insurance will also be emphasized throughout the campaign season.

"Medicaid payments to Wisconsin hospitals are atrocious, and it will take a significant commitment of new dollars to begin addressing this," Borgerding said. "We plan to be very clear with candidates about the magnitude of this problem, the impact over a decade of inaction is having on the price of health care, and ask them specifically how they plan to address the issue in a meaningful way and on a scale that will make a difference. Simply agreeing that there is a problem is not a solution."

Hospital efforts to promote price and quality transparency, provide hundreds of millions of dollars in free community services, and the great strides being made to reduced operating costs will also be highlighted.

"We can’t afford to sit back and think that legislators and candidates are aware of these efforts. We are going to ‘hit the road’ and make sure we get the message out with our members whenever possible," said Borgerding. He said the Association would begin a more aggressive, statewide public education campaign on similar messages this fall.

Borgerding said the Wisconsin Hospitals PAC and conduit is running stronger than ever, up in both the number of dollars raised to date over last year and in the number of individuals who are contributing to the campaign. "We appreciate the growing ‘buy-in’ our members have in all aspects of advocacy, including the PAC and conduit," he said. "When our members take out their checkbook and make that commitment to the PAC and conduit, they can be assured those dollars will go to candidates that support Wisconsin hospitals and their priorities."

Board approves Access and Coverage Task Force’s new principles

Brenton told the Board that the health reform agenda would be a major discussion topic at the Board Planning Session. He asked the Board to approve the Access and Coverage Task Force’s recommended changes to the Principles that the Association utilizes to evaluate outside and develop possible WHA’s health reform proposals. The Principles are at www.wha.org/financeAndData/pdf/accessprinciples.pdf.

New Web site designed to attract physicians to Wisconsin

The Wisconsin Council on Medical Education and Workforce will soon launch a Web site developed by WHA staff that is designed to attract physicians to practice in Wisconsin. Quinn said Association staff recently completed two focus groups with medical residents to gain a better insight on how, when and where they search for career opportunities. The Web site will connect physicians seeking a position directly to hospitals, clinics and academic medical centers that have positions open. It is the only Web site of its kind in Wisconsin. Quinn said the medical residents were enthusiastic about the Web site and felt it would be a useful tool for them in locating positions in Wisconsin.

This week, led by Congresswoman Tammy Baldwin and Congressman Paul Ryan, nine members of Wisconsin’s Congressional delegation urged U.S. Health and Human Services Secretary Michael Leavitt to grant Wisconsin’s proposed BadgerCare Plus waiver. BadgerCare Plus Childless Adults is the second phase of Governor Doyle’s initiative to provide health care coverage to 98 percent of the state. Federal rules limit the ways states can use Medicaid funds, so a waiver is needed to implement the childless adults expansion.

"WHA thanks our Congressional Delegation for their support and advocacy on this initiative," said WHA President Steve Brenton. "We believe this public-private, evidence-based approach to increasing access to health care in Wisconsin will be an important step forward in providing coverage for one of the most difficult populations to insure—childless adults."

WHA applauds Reps. Baldwin and Ryan for leading the effort to urge Sec. Leavitt to grant the BadgerCare Plus waiver, and, thanks Sens. Kohl and Feingold and Reps. Obey, Petri, Kind, Moore, and Kagen for adding their support.

In their letter, Reps. Baldwin and Ryan, joined by Senators Kohl and Feingold and Reps. Obey, Petri, Kind, Moore, and Kagen, asked Secretary Leavitt to grant the waiver so that access to health care coverage for an estimated 81,000 chronically uninsured adults is available. Last year, Wisconsin received a waiver to institute phase one of the BadgerCare Plus expansion that provides health insurance for all children under the age of 19 years.

"BadgerCare Plus provides an innovative and financially responsible path toward ensuring the health and well-being of our state’s most vulnerable individuals," Reps. Baldwin and Ryan said in a joint statement. "We are proud to work together and grateful for the support of other members of our state delegation in offering this bipartisan letter of endorsement. We hope Secretary Leavitt will do the right thing and grant the waiver."

The Wisconsin Hospital Association supports the BadgerCare Plus expansions and, during their annual trip to Washington, DC this past April, urged Wisconsin’s Delegation to advocate on behalf of this proposal. Baldwin and Ryan expressed hope their letter of Congressional support will prompt a timely decision on Wisconsin’s waiver request by the Department of Health and Human Services.

Every day, more than 40,000 patients receive care in a Wisconsin hospital. Of these, nearly 700 receive their care free of charge. In 2006, Wisconsin hospitals provided more than $200 million in charity care to more than 250,000 individuals.

A new issue paper in the WHA Toolkit emphasizes the depth and breadth of Wisconsin hospitals’ service to their community. These mission-driven organizations strive to improve access to health care that will lead to an overall improvement in the health status of the communities they are privileged to serve.

This week the Joint Legislative Audit Committee held a hearing on a Legislative Audit Bureau (LAB) report issued earlier this year following a review of dental care services provided under the State’s Medical Assistance (MA) program. The analysis focused on four counties in southeast Wisconsin in which HMOs provide dental services to MA recipients.

In FY 2006-07, the overall cost of the MA program was approximately $4.7 billion. In the same fiscal year, the total estimated cost for dental services provided to MA recipients across the state was approximately $46 million. Of the 3,493 licensed dentists in Wisconsin, only 1,342, or 38.4 percent were certified as MA providers statewide.

The analysis looked at:

• Trends in program participation, the number of participating dentists and the number of dental visits by Medical Assistance recipients
• Cost and utilization of dental services provided through HMOs and on a fee-for-service basis
• Current initiatives to improve dental care service delivery
• The provision of dental services through Medical Assistance programs in other states

Among the key findings, the audit found that an adequate number of dental providers and timely access to dental care have not been consistently maintained. It also found that the average cost of dental services was higher under managed care fee-for-service than managed care.

Dentists contend that increasing reimbursement rates for MA dental services would lead to greater dentist participation in the MA program. Managed care organizations maintain that by working closer with patients they are able to improve access and utilization of dental care services.

Hospitals have long-struggled with the high costs associated with providing emergency dental services to MA patients for health issues that could have been addressed earlier by routine dental care. A recent WHA analysis of hospital emergency department records for Q4 2006 through Q3 2007 revealed millions of dollars in hospital charges statewide for MA patients presenting with a dental diagnosis as the principal diagnosis.

In the end, the audit recommended that the DHFS develop alternative dental service delivery models to improve access to care and utilization of services by MA recipients in southeast Wisconsin before current contracts expire in December 2009.

During discussion, Committee Co-Chair Senator Jim Sullivan (D-Wauwatosa) said the dental access issue is a statewide concern. Committee member Representative Kitty Rhoades (R-Hudson) added that given the state’s difficult fiscal situation, simply increasing reimbursement rates will be difficult.

In testimony, the DHFS indicated that an internal analysis found results similar to the audit and that they are working on a comprehensive approach that leverages the state’s limited resources and maximizes the increase in dental access to Wisconsin residents.

This week WHA was invited to present real-life examples of coalition building during a session of the U.S. Chamber’s Institute on Organization Management held at the University of Wisconsin-Madison. The Institute program provides management and leadership training for association, chamber, and nonprofit professionals. The Institute’s curriculum consists of four one-week sessions, which typically are attended over a four-year period. Vice President of External Relations & Member Advocacy Jenny Boese presented on WHA’s behalf.

"Coalition building can be extremely useful to advancing an advocacy agenda," said Boese. "However, the most effective coalitions are well thought out, appropriately managed and evaluated on an ongoing manner."

Boese provided Institute attendees a "checklist" of action steps, such as defining the issue, mission and goals as well as establishing expectations and appropriate benchmarks, when deciding to or engaging in coalition building. She then highlighted the action steps briefly with real-life examples of legislative coalitions.

Hospital representatives in Madison attending WHA’s Advocacy Day event on May 15 saw their efforts highlighted in local newspapers across the state.

Arnie Lee, president of the Beloit Memorial Hospital Volunteers, was quoted in an article that ran in the Beloit Daily News:

"We are from Beloit, but share the same goal as every other hospital in the state: to provide the best care possible. Advocacy Day gives us an opportunity to meet with our legislators and reinforce that Wisconsin hospitals provide high quality, safe patient care. We want to share that fact personally with our legislators so they, in turn, understand and support our community hospitals."

"Representatives from Memorial Medical Center and Hayward Area Memorial Hospital joined more than 500 hospital supporters at Monona Terrace in Madison May 15 to attend the Wisconsin Hospital Association’s Advocacy Day," read the Ashland Daily Press on June 3. The article also discussed how hospital representatives focused on quality and transparency issues when meeting with their legislators while in Madison.

The Madison Capital Times was also on hand to cover the Governor’s luncheon keynote address at Advocacy Day. In their May 15 online article, Doyle was quoted as saying the following with respect to the hospital assessment:

"We’ll be putting forth a new budget next January for the next two years, and when we do we’ll be working to make sure that the federal money is coming into the state of Wisconsin and we are working in a way to be able to deliver the reimbursement rate that you have needed."

Now is the time to honor one of your hospital’s community health projects, by nominating it for a 2008 Global Vision Community Partnership Award, presented by the WHA Foundation.

Nominations must be received no later than 5:00 p.m. on July 1, 2008. The final call for nominations for the 2008 Award is included in this week’s packet.

Any WHA member can nominate a community health project. The project must have been in existence for a minimum of two years and must be a collaborative or partnership project that includes a WHA member hospital and an organization(s) within the community.

The Award will be presented at the WHA Annual Convention September 18, 2008. Nominations are due July 1, 2008. Nomination forms can also be found on the WHA Web site at www.wha.org. For more information about the Award, contact Jennifer Frank at jfrank@wha.org or 608-274-1820.

On August 12, WHA is offering a one-day program "Life Safety Code Regulations for Hospitals: Examining Joint Commission Changes & Common State Regulation Issues" in Madison.

This program will help attendees navigate the changes that The Joint Commission is making to their standard with respect to Life Safety for 2009 under their Standards Improvement Initiative and better understand the Wisconsin state surveyors’ process and perspective relative to Life Safety Code regulations.

Susan McLaughlin, current Codes and Standards consultant to the American Society for Healthcare Engineering and former associate director of standards interpretation for The Joint Commission, will provide current information on the survey process, compliance, and interpretation of the code and its changes. In addition, David Soens, lead engineer with the Wisconsin Department of Health & Family Services, will discuss the common and most pressing compliance issues that face Wisconsin hospitals in the area of Life Safety Code, from the state surveyor’s perspective.

Facilities managers, compliance officers, safety officers, quality managers, Joint Commission survey team members, and others involved in regulatory compliance should attend this important session. It will be held at the Holiday Inn at the American Center in Madison.

WHA Financial Solutions, Inc., the wholly-owned, for-profit subsidiary of the Wisconsin Hospital Association and leader in providing employee benefit, retirement, and corporate insurance solutions to health care facilities statewide, announced they will extend their partnership with FinCor Solutions for three additional years.

FinCor Solutions is a consultative, multi-line insurance agency offering health care providers traditional and alternative risk products and services. FinCor Solutions has access to some of the largest, most respected national and regional carriers that offer the typical coverage necessary to protect health care business risks but also unique risks that may differentiate your health care delivery system. Through its Integrated Disability Management Division, FinCor Solutions manages workers’ compensation programs offering general administration, claims, medical management and loss prevention services.

Jon Braddock, WHA Financial Solutions’ senior vice president, states, "We are very pleased to extend our partnership with FinCor Solutions. They offer a quality selection of insurance programs backed with solid risk management products. Working together allows us to provide superior options to Wisconsin hospitals."

For more information, contact Jon Braddock at WHA Financial Solutions at 800-362-7121 or Matt Wahoske at FinCor Solutions at 800-777-6428.

"Because my wife has diabetes and colitis, she needs nearly constant medical care. We lost our insurance in Michigan as the new insurance provider for my company would not cover us due to Judy’s high risk, so we went for a year without insurance. Finally, we were able to get coverage through Blue Cross-Blue Shield. Three months before my retirement, after working 17 years, I was let go at the age of 61. I was too young for Medicare and we had lost everything so filed bankruptcy. When we moved to this area, we went to Unity Clinic to see how we could get help. There we met Dr. Armstrong, who was wonderful, and she began to help us find medical care.

It’s been absolutely astonishing how the people at St. Croix Regional Medical Center helped us. Dr. Michele Armstrong at the Unity Clinic took Judy under her wing and began to make arrangements for help through the Patient Advocate Program and Chronic Care Clinic. So we came to St. Croix Falls, met with Brenda and Dawn for help with medication access. They walked us through the application steps and helped us file the necessary papers to get medical aid. As a result, I now volunteer in the maintenance department and work as a valet. It’s my little way of giving back—like the barter system.

The leadership at this facility is exceptional. How they feel about people in our community and the need for health care for all is very impressive. It’s embarrassing to need this assistance after working and paying for benefits, but we never were made to feel undeserving or discounted at St. Croix. They are a blessing!"

When confronted with barriers -- whether income, language or cultural differences -- people often feel vulnerable placing their well-being in the care of doctors and other health care professionals. Given the potential for miscommunication, women diagnosed with breast cancer like Dora Maldonado, Elena Araujo and Ada Santiago know what it’s like to be at such a disadvantage. They’ve been scared, frustrated and stressed at times due to being without a point of reference when making major medical decisions for themselves. They’ve faced various challenges in navigating health care systems, and seeking financial and other resources to assist their healing and recovery.

Maria Rosario Gonzalez recalled how, after a surgery that didn’t go well, she became sensitive to touch. When she saw a doctor for follow-up, he implied she was imagining her pain and discomfort. Gonzalez, Maldonado, Araujo and Santiago each said they have had misunderstandings with providers when they expressed worries about the potential risks and side-effects from certain medications to treat breast cancer.

As part of the Breast Cancer/Breast Health support group, Abrazar La Vida, for low-income, Hispanic women, the women get to communicate with others who share their experience, in the primary or only language that most of them speak: Spanish. The participants range in age from 42 to 61. One has been in America since 1972. Another is relatively new to the country.

The group, whose name translates to "embrace life," evolved from a collaboration between Froedtert Hospital and Westside Healthcare Association (WHA), a federally-qualified community health center, in response to gaps in community health resources to meet the needs of underserved populations. The group receives in-kind support from Froedtert for basic resources and staffing by Amy Sanchez, a social worker by training, who is bilingual and became the group’s part-time coordinator in September 2005. The group first obtained a grant in spring 2005 from the Milwaukee Affiliate of the Susan G. Komen Foundation, with subsequent funding now through March 2008. Members of the group have access to the educational and medical expertise of Froedtert and Medical College of Wisconsin physicians and nurses, and the involvement of Froedtert staff in volunteer capacities through mentoring, health education and outreach activities in their community. Although relatively small now with six women, the group is open to expanding if a need exists, according to Sanchez.

Abrazar La Vida meets the third Thursday of each month, and provides relevant emotional, psychosocial and resource support to breast cancer patients and their families. As part of the group, the women said they appreciate being able to share both the hard and hopeful times, how they coped with barriers, managed personal and family obligations, handled moments of despair and overcame fears. They exchange information, and provide support to assist and comfort each other along the way.

A few of the women previously participated in other support groups for women with breast cancer, but have found they feel more at ease and fewer restraints in an environment that embraces their native language. "We recognized that it would be more beneficial to have a group in Spanish versus having an interpreter come in, because it’s a delicate situation for these women, and so much can get lost in translation," Sanchez said. "The group makes a difference in their lives because it’s not all about breast cancer. There are cultural issues that come into play. These women have families, and people respond to their illness in different ways, so they want to discuss many things. They are becoming educated by sharing information. They’re learning to become their own health care advocate."

A young man (let’s call him James) who was a student at the Adult Learning Center (ALC) approached Columbia St. Mary’s central city parish nurse, Julia at one of her regular blood pressure screening times. James had his pressure taken and it was fairly good, but as he was leaving, he said, "Oh, by the way, I have had problems when I go to the bathroom recently." This often happens with blood pressure screenings -- they are valuable as the screenings open the door of communication for people who otherwise would have difficulty in approaching the nurse. James went on to describe symptoms of frequent bowel movements, diarrhea, occasional blood in the stool and weight loss. He wondered if this was something about which to be concerned.

Julia told him the story of her son, who had some of the same symptoms and was diagnosed with colon disease as a man in his early thirties. James did agree that he should see a physician. An ALC volunteer agreed to take James to her internist to get an initial diagnosis. Julia also arranged for James to get funding for an application for the County General Assistance Medical Plan (GAMP) coverage. The coverage assisted him in getting testing and ongoing care. James was diagnosed with Crohn’s Disease and is now on a medication management program. Without Julia’s care management assistance, it is quite possible that James’ disease could have advanced quickly and led to surgery and a long recovery period.