In what marks the first formal step in the 2005-07 budget process, last week the Department of Health and Family Services (DHFS) delivered its budget request to Governor Doyle. An ongoing analysis by WHA staff reveals that DHFS has asked for an increase in Graduate Medical Education (GME) funding over 2003-05 levels. GME is an added payment under the Wisconsin Medicaid program made to hospitals that train graduate medical students and residents in their facilities.

Specifically, the DHFS request would restore GME payments over the 2005-07 biennium to roughly $16 million all funds (state and federal dollars combined) – an increase of roughly $4 million over the 2003-05 biennium.

GME was slated for complete elimination in Governor Doyle’s original 2003-05 budget proposal – a potential cut in hospital Medicaid payments of $57.2 million (all funds). Hospital lobbying efforts and help from the Legislature restored some of this funding, and by the time the budget bill made it back to his desk, the Governor had recommitted to funding this important physician training program.

"I support reviewing the funding level for these payments in the 2005-07 biennium," Governor Jim Doyle said in his July 2003 veto message. "Our teaching hospitals play an important role in preparing and training Wisconsin’s future physicians, and I am committed to maintaining this support now and in the future."

"This is a positive first step towards restoring this important program," said WHA’s Eric Borgerding. "We will work with Governor Doyle and the Legislature to build on this recommendation as the budget process moves forward. With a looming physician shortage in Wisconsin, restoring this program is more important than ever."

Unfortunately, the DHFS budget request appears to contain no provider reimbursement increases under the Medicaid program. Wisconsin hospitals are reimbursed at some of the lowest rates in the country by our state’s Medicaid program.

"While we are pleased there are no cuts recommended in an ongoing difficult budget environment, it must be noted that under the DHFS request, hospitals will not have seen an inpatient payment increase for eight straight years," said WHA’s George Quinn. "Ultimately, this means the hidden tax on the health insurance premiums of Wisconsin employers is sure to grow."

Over the next few months, Governor Doyle will consider all state agency requests as he formulates his version of the 2005-07 state budget. The Governor is expected to formally introduce his version of the budget in late January or early February of next year.

The Wisconsin Hospital Association announced on September 23 that it has added four new measures to the CheckPoint^SM Web site that can help consumers evaluate the quality of care that they can expect to receive while in the hospital. Three of the new measures are related to smoking cessation counseling and a fourth measure indicates how often patients with congestive heart failure are leaving the hospital with clear instructions on how they can manage their care at home.

Smoking cession counseling in the hospital setting has been proven to be one of the most effective points in the care process to positively influence long-term smoking behavior. The new smoking cessation measures in CheckPoint will allow consumers to see how well hospitals are doing in providing smoking cessation counseling services to patients who are being treated for heart attack, congestive heart failure, and pneumonia.

WHA is partnering with the University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI) to offer hospitals additional resources to advance their consumer education and support programs that treat tobacco dependency.

Michael Fiore, MD, UW-CTRI director and a national expert on tobacco research, praised the CheckPoint program for emphasizing this significant public health issue by reporting how well hospitals do in providing smoking cessation counseling and services, and then making the information easily available to consumers.

"We know that tobacco use leads to more than 7,000 deaths in Wisconsin every year," Fiore said. "Monitoring treatments is the first step in ensuring that patients who use tobacco do not leave the hospital without receiving the counseling and medications that will help them quit."

Just six months after it was launched, the CheckPoint program has 122 hospitals, which is 99 percent of the hospitals in the state, participating. Of these hospitals, 85 percent are reporting error prevention measures that indicate progress in meeting national patient safety goals, and 88 percent are reporting measures related to the treatment of heart attack, congestive heart failure and pneumonia—three of the most common reasons for hospitalization in Wisconsin.

"The continued growth in both the participation rate and in the number of data sets hospitals are reporting to CheckPoint is indicative of Wisconsin hospitals’ strong support for increasing access to information that will assist consumers in health care decisions," according to WHA Chair Charles Shabino, MD, chief medical officer of Aspirus in Wausau.

WHA President Steve Brenton said the growth in the number of hospitals reporting safety data, 60 percent in March to 85 percent now, shows that Wisconsin hospitals are committed to rapidly increasing the amount of information available to consumers.

"We have demonstrated that our hospitals are national leaders when it comes to voluntary public reporting," Brenton said. "We know the value of sharing information and growing the information base that is accessible to consumers and employers."

The 41st Assembly District stretches west to east from Coloma to Ripon and north to south from Fremont to Kingston and Markesan.

Berlin Memorial Hospital and Ripon Medical Center

James Tostenson is a member of the Constitution Party. He resides in Fremont.

Joan Ballweg is a member of the Republican Party. She resides in Markesan and is current Board Chair of the Waupun Memorial Hospital Board of Directors.

Candidates’ answers to selected abbreviated questions from WHA’s 2004 candidate survey appear below. Candidate James Tostenson did not return the survey. To view the entire survey for this or any other race, contact Eric Borgerding or Jodi Bloch at 608-274-1820.

Wisconsin’s Medicaid and BadgerCare programs pay only 59 cents for every $1 it costs hospitals to care for these patients. The remaining unpaid costs must be recouped through cost shifting to the private sector also known as the "Medicaid Hidden Tax." Would you support proposals aimed at having the state pay more of actual hospital costs for the Medicaid and BadgerCare programs? Ballweg: YES

Do you think the property tax exemption for non-profit hospitals should continue? Ballweg: YES

Hospitals are experiencing a growing shortage of health care workers from nurses to pharmacy technicians and this shortage is projected to worsen as the demands for health care increase even more as the baby boom generation approaches their senior years. Would you support efforts to target new or existing dollars within the technical college system and UW System to alleviate waiting lists and get more people into health care professions? Ballweg: YES

Legislation may be introduced next session mandating nurse-to-patient staff ratios in hospitals. Would you support legislation mandating patient staffing ratios? Ballweg: NO

Would you support legislation banning the use of mandatory overtime? Ballweg: UNDECIDED

WHA has identified a serious and growing shortage of physicians in Wisconsin including specialists and primary care physicians. The last budget slashed $45 million in funding for graduate medical education. Would you support restoring this funding? Ballweg: UNDECIDED

Should state government approve hospital decisions about the purchase of new equipment and construction of new facilities? Ballweg: NO for equipment, POSSIBLY for new facilities

Health care is a top tier public policy issue as measured by public opinion…and by election season rhetoric. But don’t expect a meaningful discussion of public policy "solutions" any time soon. Over the next six weeks, expect a lot of noise but little substance, and simplistic solutions that lend themselves to sound bite recipes for issues that are hugely complex.

Here’s a suggestion that identifies realistic solutions for the robust roster of health care challenges. Let’s identify what we are doing well in Wisconsin. There’s much we can point to.

• Wisconsin today is a national leader in employer-sponsored health insurance despite significant pressures on insurance premiums.
  
• Because of innovative programs like BadgerCare and the Health Insurance Risk Sharing Program (HIRSP), Wisconsin has one of the lowest levels of uninsured in the nation.
  
• At least as of today, Wisconsin enjoys a relatively favorable environment for malpractice coverage.
  
• Much of Wisconsin health care is delivered through a strong health care infrastructure that is largely organized around physician groups and hospital partners that provide a broad continuum of health care services. This organizational structure bodes well for implementation of chronic disease management programs and the coordinated diffusion of technology like electronic medical records that have such tremendous potential to improve quality and delivery efficiency.
  
• Wisconsin’s interest in and commitment to public health and health improvement, while inadequately funded, is comparatively strong.
  
• Wisconsin consistently ranks in the top 10 of all states when it comes to achieving relatively high quality and safety scores as reported by CMS.
  
• And finally, the recent emergence of several significant statewide private sector initiatives (CheckPoint, the Wisconsin Collaborative for Healthcare Quality and the new WHA Information Center) that report quality, safety, service and pricing, has propelled Wisconsin into national leadership in addressing health care transparency (necessary information for decision making).

These seven areas that focus on what is right in Wisconsin provide us with a terrific opportunity to target our strengths as the primary strategy to address our challenges. As we examine "solutions" that are proposed by others, let’s measure how those ideas take advantage of these seven Wisconsin attributes.

Health care marketing and advertising are reaching new levels of sophistication in the use of qualitative and quantitative data. On November 11 at the Country Inn in Pewaukee, the Wisconsin Forum for Healthcare Strategy is hosting an education program that will explore how marketers can shape the patient experience to improve patient satisfaction and quality data, and how the results can be communicated. Speakers will look at the factors influencing patient perceptions, new measurement tools and communication strategies and ethics.

Speakers include Mary P. Malone on patient experience tools; Chris Bevolo on measuring first impressions; and an executive panel discussion on ethics in advertising and marketing by WHA President Steve Brenton; Ford Titus, President/CEO, ProHealth Care, Inc.; and Mark Kaufman, MD, senior vice president and medical director, Dean Health Plan.

Governor Jim Doyle wants to help the Wisconsin health care industry with the workforce issues it faces now and in the future, according to Department of Workforce Development (DWD) Secretary Roberta Gassman. Speaking at DWD’s Select Committee on Healthcare September 20, Gassman reaffirmed the Governor’s commitment to find ways to help the industry attain its workforce objectives. Gassman has reorganized work in her department to provide additional staff support for the Select Committee, which is charged with implementing short and long term strategies to address workforce development challenges in Wisconsin’s health care industry.

Also at the meeting, DWD staff shared newly released 10-year projections (2002-2012) for occupations in Wisconsin, including health care. Health care related positions are predicted to grow 30 percent, while openings for registered nurses are expected to grow 31.4 percent. The data is constructed on historic trends and may not reflect current issues in workforce, such as the age and the number of possible retirements, which would amplify the projections. The projections for health care related occupations can be found at www.dwd.state.wi.us/oea/long_term_projections/lt_occ_healthcare.xls .

Gassman also reported that the U.S. Department of Labor has a new call for proposals for demonstration grants that address the labor shortages in health care. It is planned that the State of Wisconsin Initiative to Fast Track Nurse Educators (SWIFT) grant proposal would be revised and resubmitted to meet the U.S. Department of Labor guidelines.

Future agenda items for the committee include an update from the Wisconsin Technical College System (WTCS) on the status of waiting lists, standardized curricula and credit transfer. The Select Committee will also review workforce updates by each occupational group to gain a better understanding of the current and future need for specific occupations.

The WHA Foundation selected two programs for the 2004 Global Vision Community Partnership Award. The award was established in 1995 to recognize community partnership programs that meet the documented health needs of a community through creativity, innovation and community collaboration. "I continue to be impressed with the quality of the programs submitted for this award. There is no shortage of creativity demonstrated by our hospitals when it comes to identifying and meeting community health needs," said Steve Brenton, WHA president.

Award winners were recognized at a luncheon during the WHA Convention and received a commemorative plaque and an unrestricted grant of $2,500 to support their program. Selection criteria for the award includes: nomination by a WHA member; the program must have been in existence for a minimum of two years; addresses a documented community health need; addresses the need in a creative or innovative way with a collaborative or partnership model including organizations from the community not related to the hospital; and produces measurable results.

Since 1995, the Angel of Hope Clinic has provided primary health care services free of charge to poor and homeless individuals and families on Milwaukee’s near south side. The Clinic provides basic health care services to Hope House of Milwaukee guests - men, women and children who are homeless - and the surrounding low-income community. Community collaborators providing support to the clinic include Hispanic Medical Association, Wisconsin Well Woman Program, Head Start, Milwaukee Breast Cancer Awareness Program, Madre Angela Dental Clinic, and Health Care for the Homeless. Nurse practitioners at the clinic also work with the Milwaukee area colleges to mentor nurse practitioner students. The Angel of Hope Clinic provides primary health care services and health and wellness education to approximately 2,500 individuals per year.

Award Winner: Brown County Child Passenger Safety Program
Nominator: St. Vincent Hospital

In 1998, the Center for Childhood Safety, a program of the St. Vincent Regional Pediatrics Center, convened local agencies that work with children to assess community needs and develop programs to address childhood safety. Local law enforcement, fire fighters, EMTs, representatives from the Oneida Nation, the American Red Cross, Brown County Health Department, WIC Program, Family Services and 10 other social service agencies became the Greater Green Bay SAFE KIDS Coalition. Through this program, the Coalition has conducted free monthly car seat checks and established a Car Seat Inspection Station which is staffed by trained car seat inspectors and is open four days a week for car seat inspections. Low-income families can also purchase car safety seats at half price and receive education about installation and use of car safety seats. The Coalition also participates in community-wide health fairs and special events, in addition to holding free car safety seat inspections six times a year at locations throughout the community. The Coalition estimates over 20,000 Brown County families have benefited from child passenger safety education and inspection.

The agenda for this year’s Wisconsin Quality & Safety Forum, October 18-19, focuses on each of the Institute of Medicine’s Six Aims, including the aim "Safe" which will be presented by David Marx, president of Outcome Engineering and former Boeing aircraft design analyst, who will discuss strategies for balancing the needs for accountability, justice and improved learning in a non-punitive health care environment.

Gordon Mosser, executive director for the Institute for Clinical Systems Improvement, will highlight the aim "Effective" by sharing how physicians and others in Minnesota have gone about cultivating evidence-based health care throughout the entire state. Also, in a session entitled "The Purchasers’ Perspective: Promoting Transparency to Advance Value-Based Purchasing," Nancy Nankivil Bennett, director of strategic health policy for the Wisconsin Department of Employee Trust Funds (EFT), will highlight the aim "Efficient" by providing an overview of the health care information needs of purchasers, and how ETF as well as other purchasers are incorporating health care information into their purchasing strategies and employee education initiatives.

The Forum, scheduled October 18-19 at The Plaza Hotel in Eau Claire, will combine education with a showcase of 90 projects focused on current quality improvement and/or patient safety initiatives, submitted by a diverse group including health care clinicians, researchers, coalitions, advocacy groups and others from across the state.

Health care quality directors, risk managers, CEOs/administrators, clinician managers, physicians, nurses, pharmacists, patient advocates, health care purchasers, researchers, educators, students, legislators, regulators, and other policy makers are encouraged to attend.

The Wisconsin Medical Society designates this educational activity for a maximum of eight (8) category 1 credits toward the AMA Physician’s Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity. The Wisconsin Medical Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Forum has also been submitted to award eight (8) continuing education hours from the National Association of Boards of Examiners of Long Term Care Administrators (NAB)/National Continuing Education Review Services (NCERS). Also, WHA has been authorized to award eight (8) hours of pre-approved category II (non-ACHE) continuing education credits by the American College of Healthcare Executives.

The full conference brochure with registration information is in this week’s packet and is available on the Web site at www.wha.org. Don’t forget to ask for the WHA room block (group #3390) at The Plaza when making your reservation. Call 800-482-7829 to make your hotel reservation. The special room rate will be available only until October 3.

Wadsworth-Rittman Hospital is seeking a President/CEO for this 113-bed acute-care hospital, located in Northeast Ohio. This position is responsible for the overall successful leadership and direction of the hospital. The successful candidate will possess extensive community hospital management skills and experiences, ideally having served as the top officer in marketing, finance, operations or patient services in a comparably sized community health care organization. A minimum of a bachelor’s degree with a MBA, MHA or comparable degree achieved, underway or planned preferred. Contact: Louis Thomas Masterson & Company, 1422 Euclid Avenue, Suite #706, Cleveland, Ohio 44115-2001; Fax 216-621-7320 or email LTMasterson@ltmco.com. Please reference job 0824-W.

Richard Palagi is the new CEO at Sauk Prairie Memorial Hospital & Clinics, Prairie du Sac, effective November 1. Larry Schroeder, chief operations officer, is serving as interim CEO.

Palagi is currently CEO at St. John’s Lutheran Hospital in Libby, Montana, a 25-bed not-for-profit medical facility. He brings 26 years of health care experience and holds a Bachelor of Arts degree from Idaho State University and a Master’s degree in health administration from the University of Colorado. He is a certified medical practice executive and is board certified through the American College of Healthcare Executives.

Board President Bob Lochner led the selection process. "Rick’s expertise in developing strong working relationships with physicians and neighboring health care providers is sure to leverage our efforts to respond to the health care needs of the area," Lochner said.

Send resume and cover letter referring to Position Vacancy Listing #48410 to Judith Brickbauer, 5721 Odana Road, Suite 208, Madison, WI 53719; Email: jmbrickb@wisc.edu; Phone: 608-271-6302.

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