• Checkpoint
• Doyle Commends St. Mary’s on CAH Designation
• Know Your Legislators...Congressman Paul Ryan (R-First Congressional District)
• Predictions on Physician Workforce: Demand Will Outstrip Supply
• President’s Column -- Washington DC Trip
• Revenue Cycle Strategies Focus of November 6 WHA Seminar
• Schultz, Ladwig Introduce Patient Compensation Fund Legislation
• WMS Hosting Medicare’s National Teleconference, Open Door Forum
• HHS Publishes Presumed Smallpox Injuries Compensable Under the Smallpox Vaccine Injury Compensation Program
• Cherney Explains Pay for Performance Provider Incentive; Inlander Gives the People’s View on Health Care at WHA 2003 Convention
• CMS Releases Final Rule on EMTALA
• Mental Health Parity Legislation Clears Senate Committee
• Federal Dollars Available for Increasing Hospital Isolation Capacity
• Size Reappointed to National Rural Health Committee
• WHA Sponsors Third Annual Quality & Safety Forum October 27-28 in Wausau
• CMS Issues Prospective Payment Rules for 2004
• Physician Discipline Bills Receive Public Hearing

Wisconsin consumers will soon be able to access information about the quality and safety of care provided in Wisconsin hospitals through the WHA quality initiative now known as "Checkpoint."

WHA President Steve Brenton said the new name appropriately describes the kind of information that will be available to purchasers, consumers and hospitals because the data that will be shared constitutes a "check point in time on patient quality and safety."

"Wisconsin hospitals are committed to accounting for quality and safety in their organizations. We spent a lot of time contemplating a name that would be easy to remember and one that emphasizes the fact that the data can or will change from time to time," Brenton said. "‘Checkpoint’ gets that message across."

Dana Richardson, WHA’s vice president of quality initiatives, said the new name and logos will appear on the public Web site, as well as on printed materials. Hospitals that are voluntarily participating in the "Checkpoint" program will have the opportunity to place the logos on their own Web sites, demonstrating their commitment to public reporting.

St. Mary’s Hospital in Superior was one of the stops during Governor Jim Doyle’s recent "Up North" tour. While at St. Mary’s on August 28, Gov. Doyle remarked that community support and politics can work together to bring better outcomes in health care. The Governor said one of the common needs that he heard from residents as he traveled across Northern Wisconsin was their desire for high quality, accessible health care.

"People want good quality health care available right in their communities, and St. Mary’s designation as a critical access hospital is a step in the right direction," according to Doyle.

Department of Health and Family Services Secretary Helene Nelson presented St. Mary’s CEO Terry Jacobson with a plaque commemorating the CAH designation. Jacobson thanked Nelson and the Department for acting quickly in responding to an opportunity that enabled St. Mary’s to attain CAH status in a timely manner. "Secretary Nelson displayed a keen understanding of St. Mary’s plight, while Sen. Bob Jauch made sure that our cause was heard in Madison," Jacobson added.

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The biggest issue is affordability. Double-digit insurance premium increases and the cost of health insurance are a concern for businesses and individuals.

I am actually excited about all the quality initiatives that are taking off right now. WHA’s initiative and the collaborative effort that Froedtert and others are involved in are good first steps. These efforts have the promise of getting to the detailed level where consumers will have access to quality and price data. We are looking at this in the Ways and Means Committee. I would prefer that any quality initiative begins and ends with the providers.

Yes, of course. Understand, we are now in conference and the only vote left to make is an up or down vote. We have one vote on the entire package, and there are thousands of other Medicare policy issues included in the Prescription Drug bill. I have spent considerable time with House Ways and Means Committee Chair Bill Thomas (R-CA). Medicare is the most complicated law in the federal government and we have to get this reform right or we will do the country a huge disservice. Specifically, I believe that GME is a key program and it can help stop the brain drain in Wisconsin and keep good young people in the medical profession here.

I think it will go well. This is part of the bill that I personally spent a lot of time on. I co-authored an amendment with Jim Nussle (R-Iowa) and Jim Ramstad (R-MN) to include the labor share adjustment. We fought behind the scenes and prevailed. I believe the House bill is the best way to achieve the goal of equalizing Medicare reimbursement rates since Medicare was written. It puts approximately $400 million back into the provider system for Wisconsin over the ten years and it moves our reimbursement rates closer to the national average. The House bill puts $2.4 billion more in than the Senate version. The House bill makes the changes in 2004, and the Senate’s doesn’t begin until 2005 and sunsets before the end of the decade. We need to fix reimbursement rates in 2004. The one thing that both bills do well is they move the ball forward from the Wisconsin perspective.

Ultimately, the goal in Wisconsin is to get to the point where area providers effectively set the reimbursement rates themselves through competitive bidding. This is how Wisconsin providers will see their true costs fully reimbursed so they don’t cross subsidize by moving these costs to other payers.

Broadly speaking, we need to make health care an attractive profession for young people. That means the pay must be attractive, physician reimbursement has to be predictable, and we have to improve the nursing education system and address the shortage of instructors. We literally have a situation in nursing where student demand exceeds the supply of available instructors. We can do more to bring resources back to Wisconsin in the area of health education programs for the technical college system.

Medicare has a thousand moving parts, and I want to make sure the way that Medicare pays providers enables them to offer competitive salaries that attract good quality people. This will be a disaster if we don’t do it right because the ranks of retirees will soon swell from 40 million to 77 million as the baby boomers move into their more senior years.

A lot of HIPAA is purely regulatory through the Department of Health and Human Services. The protection of health information is important and we need to protect it; however, HIPAA is an overly burdensome regulation in practice. It is up to regulators to make improvements in the short term. Congress can give it more direction in the long term. It is a complicated law and the executive branch will always need to write the final implementation. Clearly, it needs to be simplified.

I think if we pull the lens back to the big picture, Medicare reform could go one of two ways. We could add new benefits to Medicare without reforming the structure of it and accelerate the bankruptcy of Medicare or we can add new benefits and reform the structure to one of solvency to prepare us for the baby boom generation. The difference is critical between those two options. We need to fix Medicare now, for our children.

I look at my role in Washington, because of my committee appointments, as one representing all the people of Wisconsin. For example, even though I don’t have a very rural constituency in the First Congressional District, I promoted and supported the Critical Access Hospital legislation because I believe it is in the best interests of rural Wisconsin to have this program in place to ensure accessible, affordable health care in all parts of the state.

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Are there enough physicians in Wisconsin now to meet the demand for health care services? Will there be enough in the future? What are the core issues in a problem that experts predict will reach crisis proportions in less than a decade?

Those questions were debated by the Task Force on Wisconsin’s Future Physician Workforce, sponsored by the Wisconsin Hospital Association and the Wisconsin Medical Society, at their second meeting held September 4 in Madison. Physician recruitment expert Kurt Mosley, vice president at Merritt, Hawkins told the Task Force that his firm conducts more searches for specialists than primary physicians. He attributes the shortage of specialists to a drive in the 1990s to herd medical students into primary care instead of the specialties. Before that move, the number of specialists did not lag far behind the number of primary physicians. Now the gap has widened, and hospitals vie in a tight market to attract radiologists, orthopedic surgeons, anesthesiologists and cardiologists.

What is driving physicians out of practice? In some states, it is the cost of malpractice insurance. Wisconsin is fortunate. It is among 18 states that have caps on malpractice liability awards, which plays in its favor when recruiting physicians. In spite of this, Wisconsin hospitals and clinics can still come up short on doctors as other factors come into play. Physicians now seek set hours, vacation time, and place a high priority on quality of life issues. It can take two physicians to replace a seasoned veteran. Another reason physicians become discouraged is the burden of paperwork. "Physicians report spending up to one hour on paperwork for each hour they spend with patients," according to Mosley.

Three members of the task force made presentations and described the issues that are believed to be at the core of the physician workforce issue. Andrew Norton, MD, senior vice president, medical affairs, Froedtert Memorial Lutheran Hospital presented data about and observations on the shortage of specialists. He gave several reasons for the increase in demand for specialty physician services, which included: an aging population and the increasing complexity of medical problems; more complex diagnostic and therapeutic options; changing workforce dynamics with more women, reduced workload per physician, and increase in non-physician clinicians; and heightened patient expectations.

Byron Crouse, MD, associate dean, UW Medical School, addressed the distribution of primary care physicians. He pointed out that rural areas continue to have problems recruiting and retaining physicians, but a few programs are helping to alleviate the problem. Programs that Crouse said are in existence that help encourage physicians to work in underserved or rural areas include: the National Health Service Corps; the J-1 waiver; state loan assistance program; the Wisconsin Office of Rural Health (WORH) Recruitment and Retention program; medical school admissions policies; and, education on the opportunities in rural health aimed at medical students. Crouse said of these, the WORH program places about 20 physicians in rural areas each year. While placing physicians can be difficult, keeping the physicians in rural areas is often a bigger problem.

Robert Phillips, MD, Marshfield Clinic, described how Marshfield Clinic trains and employs mid-level providers, or Advanced Practice Providers (APP), to assist in the delivery and management of patient care. He said these mid-level providers help improve community access to care when physicians are in short supply, can conduct follow-up visits, and sometimes establish their own practices. APPs are working in teams to help patients manage chronic diseases, and are working within the community to deliver health education.

Following the individual presentations, Task Force members formed three break out groups. Their observations follow:

- There is a clear need to inform and educate the public, legislature, employers and health care industry itself about the impending physician shortages and the impact they will have on the delivery of health care in Wisconsin.

- Successful models from other states should be used, when possible, to help address identified challenges, such as encouraging physicians to practice in rural areas.

- Availability of faculty for any expansion of medical education may be an issue.

- Financial issues must be considered if changes are made in how medicine is practiced. For example, reimbursement for email, phone consultations and telemedicine will need to be made if a significant amount of care is delivered through these emerging technologies.

- Addressing the physician shortage will require a collaborative effort on the part of hospitals, professional organizations, medical schools, and state government.

The Task Force is expected to meet in late October. A final report is anticipated before year end.

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Council on Public Policy members and WHA staff will travel to Washington, DC next week to meet with members of Wisconsin’s Congressional Delegation. House and Senate leaders are currently meeting in Conference Committee to hammer out an agreement on Medicare and Medicaid provisions within Medicare prescription drug legislation. Those meetings are likely to continue well into late fall.

Wisconsin hospital and health system leaders will point out that both the House and Senate bills contain provisions that make a good effort at improving the currently poor Medicare payment picture for Wisconsin hospitals and physicians.

Participants will encourage federal lawmakers to fix long-standing equity problems and increase Medicare payments so that providers are fairly paid, patients have access to care, and commercial payers see relief from cost shifting due to inadequate Medicare and Medicaid payments.

Here’s a list of our priority messages:

* Payment Equity—Senate and House legislation include provisions equalizing the standardized amount for rural and small urban hospitals…a major Wisconsin issue! Both bills also lower the labor-related share of Medicare inpatient payment to 62% of the standardized amount…another priority Wisconsin issue!

* Inadequate Payment Updates—The Senate-passed Medicare legislation provides a full market basket update for FY 2004…a major improvement over House-passed legislation that would result in cuts totaling almost $12 billion (nationally) over the next 10 years. We’ll weigh in accordingly.

* Added Flexibility for Critical Access Hospitals—Provisions included within pending legislation improve this vital rural health safety net program. Both the House and Senate bills create additional "flexibility" for counting the current 25-bed cap. And, provisions within the legislation expand cost-based reimbursement for on-call emergency room physician assistants, nurse practitioners and clinical nurse specialists.

* Indirect Medical Education—Wisconsin’s teaching hospitals have been pummeled in recent years by Medicare and Medicaid reductions. But Senate-passed legislation provides a modest (although inadequate) increase in the IME adjustment. We’ll make the case for full restoration of recent cuts, drawing attention to Wisconsin’s looming physician shortage.

* Physician Payment—Medicare physician payment is tied to a flawed formula that unless fixed will find physician payment decreases next year! Thankfully, provisions within Senate and House-passed legislation provide some measure of relief. Specifically, the Senate bill corrects a historic geographic formula flaw that penalizes Wisconsin physicians, and the House bill "fixes" a formula-driven flaw that would otherwise prompt a payment cut.

* Raising the Medicaid DSH Floor—Senate-passed legislation fixes a long-standing disparity for low Medicaid DSH states. The "fix" could mean millions of dollars in new future funding for "safety net" Wisconsin hospitals.

In addition to the variety of Medicare and Medicaid payment issues currently "in play," Wisconsin hospital and health system leaders next week will also draw attention to voluntary efforts that will lead to statewide reporting of hospital quality and safety measurements. That message will demonstrate the hospital field’s ongoing commitment to community accountability responsive to patient and purchaser needs.

Steve Brenton, President

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The revenue cycle is one operational function that can assist hospitals in identifying processes and procedures that can be streamlined to reduce costs while maintaining quality. The WHA seminar, "The Revenue Cycle: Successful Strategies for Positive Reimbursement Outcomes" is scheduled for November 6 at the Great Wolf Lodge in Wisconsin Dells. This seminar highlights key operational concerns impacting cash and deals with the revenue cycle from pre-registration of the patient to closure of the account.

The seminar is intended for business office managers, controllers, financial analysts, registration directors, coding directors, chief financial officers, and chief operating officers; and it is approved for five (5) continuing education hours by the American Health Information Management Association (AHIMA). A brochure with registration form is included in this week’s packet and on the Web site at www.wha.org. On-line registration is available for this seminar.

Senator Dale Schultz (R-Richland Center) and Representative Bonnie Ladwig (R-Racine) recently teamed up to introduce legislation that states the purpose of the Patients Compensation Fund (PCF) and identifies legal rights of health care providers and complaintants. Chairs of the Insurance Committees in their respective houses, Schultz and Ladwig were critical of Governor Doyle’s failed budget proposal to use the one-time money from the PCF to help fund the deficit in the Medical Assistance program and avoid major provider payment cuts (see June 6 Valued Voice). Assembly Bill 487 and Senate Bill 238 are designed to prohibit similar proposals in the future, regardless of their purpose.

"We intend to make it crystal clear that this fund shall only be used to ensure that injured patients and their families receive compensation they deserve," said Schultz. "There must be no more raids on the fund."

AB 487 and SB 238 describe the fund’s purpose as curbing rising health care costs and ensuring medical malpractice claims are satisfied. The bills also provide that health care providers and claimants have contractual rights in the PCF, and that its funds are held in trust exclusively for their benefit. Current law provides that the PCF is held in trust for the purposes for which it was created, but is silent on those purposes.

"Some doctors cite stable malpractice insurance costs as one of the factors in coming here to practice," said Ladwig. "Our Patients Compensation Fund is benefiting every single health care consumer in the state."

The measure also changes the name of the Patients Compensation Fund to the Injured Patients and Families Compensation Fund.

The Senate and Assembly Insurance Committees will hold a joint hearing on the proposals on September 9, 2003. For more information, contact Eric Borgerding or Jodi Jensen at 608-274-1820 or eborgerding@wha.org  or jjensen@wha.org .

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Get your Medicare questions answered in person from high-level Medicare representatives. You’re invited to the Open Door Forum meeting on Wednesday, September 10, 2003 at the Wisconsin Medical Society. Starting at 10:45 a.m., Rich Lawler, senior advisor to the Office of the Administrator from the CMS Baltimore office, will give the latest Medicare updates. Then the floor will be open for questions. Lunch will be served at 12:15 p.m. Phone lines will be open from 1 to 2 p.m. to participate in the national monthly teleconference for physicians called the Open Door Forum.

Space is limited and reservations are required. If you are unable to attend but would like to listen to the Open Door Forum teleconference, go to the CMS Web site listed below and sign up.
http://cms.hhs.gov/opendoor/

The Department of Health and Human Services (HHS) has published by interim rule a list of injuries that shall be presumed to have resulted from the administration of or exposure to the smallpox vaccine, and time periods in which the onset of such an injury must manifest in order for the presumption to apply. The rule also allows certain presumptions to apply to persons who were not vaccinated, but came into contact with recently vaccinated persons.

The interim rule aids persons seeking compensation under the Smallpox Injury Compensation Program by eliminating the need to demonstrate that the listed injuries were caused by the smallpox vaccine. HHS will later publish a companion rule with a separate comment period setting the administrative implementation of the program.

Presumed smallpox injuries under the rule include significant local skin reactions, Stevens-Johnson syndrome, inadvertent inoculation, generalized vaccinia infection, eczema vaccinatum, progressive vaccinia, postvaccinial encephalopathy, encephalitis and encephalomyelitis, fetal vaccinia, secondary infections, anaphylaxis or anaphylactic shock, and vaccinial myocarditis, pericarditis, or myopericarditis. The time intervals for first manifestation of onset for the presumed injuries following vaccination or exposure range from four hours to 30 days depending on the type of injury.

The HHS comment period for this interim final rule ends October 27, 2003. The rule is available on WHA’s Web site at www.wha.org, click on disaster preparedness, then click on smallpox.

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As the CEO of a large Florida employer coalition, Becky Cherney insists that the information that companies are beginning to demand of health care providers will force the industry to change. Cherney heads the Central Florida Health Care Coalition in Orlando and helps shape the benefits purchased by 128 public and private employers, covering more than one million lives in Central Florida. The coalition’s quality initiative seeks to make health care delivery more efficient in order to improve clinical quality, patient satisfaction, and the community’s overall health status.

When asked what prompted the formation of the coalition in Florida, Cherney responded, "Businesses started the coalition because we were spending a ton of money on health care, but had no idea what we were buying."

Cherney will share her views and explain the Coalition’s nationally-recognized business/provider quality initiative that provides pay for performance to providers at the WHA Convention, Thursday, September 25.

While Cherney believes the country is moving towards a single-payer health insurance system, Charles Inlander, president, People’s Medical Society, who follows Cherney on the convention agenda, said the U.S. is heading to national health insurance. "It’s going to happen when we hit the 50 million uninsured mark," he said in a recent interview with Managed Care Magazine.

Inlander has been president of the People’s Medical Society since the group’s founding in 1983. The mission of the society is "to get information to the public about health care that it generally doesn’t have available, and to reform the health care system to be more responsive to consumers," says Inlander.

While some bemoan pharmaceutical advertising, Inlander embraces it. Why? Advertising is a form of consumer education, "not the ideal form, but it’s a form," he says. Second, it brings about product awareness to consumers, and the third point he makes, which he believes is the most important reason he favors drug company advertising, is it brings awareness of the drug’s side effects, something he feels physicians don’t always reveal.

Hospital administrators, management staff, nurse leaders, volunteer leaders, and trustees are encouraged to attend the 2003 Annual Convention, to be held September 24-26, at the Grand Geneva Resort in Lake Geneva. The full conference brochure with registration information is available on the Web site at www.wha.org. To assist in our planning, please be sure to indicate on your registration form which one of the three breakout sessions you would like to attend.

Don’t forget to ask for the WHA Annual Convention room block at the Grand Geneva when making your reservation. For more information on the program content, contact Jennifer Frank at 608-274-1820 or email jfrank@wha.org . For registration questions, contact Bridget Gifford at 608-274-1820 or email bgifford@wha.org .

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The Centers for Medicare and Medicaid Services (CMS) issued the final rule clarifying certain hospital obligations under EMTALA (the Emergency Medical Treatment and Labor Act) on August 29. Through the rule, the Bush Administration concurred with comments from hospitals across the country and the Secretary’s Advisory Committee on Regulatory Reform, which had recommended that the rule focus less on unnecessary requirements and more on providing quality care to patients.

By promoting the more effective provision of emergency medical care, the rule is good news for patients and hospitals. Highlights of the rule include:

It is important to note that the new rule will not change how hospitals screen or treat patients – everyone who comes to an emergency department must be evaluated regardless of their ability to pay. The new rule will be published in the September 9, 2003, Federal Register and the link to the rule is available now at www.wha.org/legalandregulatory. The effective date for the new rule will be November 10, 2003.

WHA will host an education program in October on the new EMTALA rules with Tom Shorter, an attorney with Quarles and Brady, along with Ralph Topinka, vice president and general counsel at Mercy Health System in Janesville. More information and registration materials will be available soon.

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Legislation recommended by a special committee on mental health parity cleared its first hurdle this week. On September 4, the Senate Committee on Health, Children, Families, Aging and Long Term Care approved Senate Bills 71 and 72, which affect insurance mandates for mental health and AODA treatment. The proposals were recommended by a Legislative Council Study Committee earlier this year.

Approved by a vote of 8 to 1, SB 71 provides that prescription drug and diagnostic testing costs are covered under the general health/drug benefit of an insurance policy, and not under the mandatory mental health and AODA benefit. A more controversial measure, SB 72 was narrowly approved by a vote of 5 to 4. It increases the mandated minimum benefit for mental health and AODA treatment based on the change in the consumer price index for medical services since 1985 (when coverage amounts in current law were enacted). In general, coverage increases from $7,000 to $16,800 for inpatient treatment; from $2,000 to $3,100 for outpatient treatment; and from $3,000 to $4,600 for transitional treatment. Business groups and insurers have argued the new mandate will increase health care costs and jeopardize access to care in Wisconsin (see July 25 Valued Voice).

Leaders have not announced plans for a Senate vote on SB 71. SB 72 must be approved by the Joint Committee on Finance before a Senate vote can be held. WHA has not taken a position on either bill. For more information, contact Jodi Jensen at 608-274-1820 or jjensen@wha.org.

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The "Survey of Wisconsin Hospitals’ Negative Pressure Airborne Isolation Capacity" has been completed. The results of this survey will allow the Hospital Bioterrorism Program to identify the isolation capacity of hospitals in Wisconsin. "This will enable the Regional Hospital Teams to determine the need by region and by population for enhancing the isolation capacity of Wisconsin hospitals," says Dennis Tomczyk, program director. These needs will be the basis by which funds from the FY 2003 HRSA Grant will be awarded to hospitals. There is $3.375M allocated in this grant year for the enhancement of isolation capacity.

Beginning September 8, 2003, hospitals that have completed the survey will receive a "Request For Funding" (RFF). The purpose of the RFF is to confirm the existing isolation capacity at each hospital and to confirm the interest of each hospital in participating in this funding program.

The RFF will be due back to the Wisconsin Division of Public Health, Hospital Bioterrorism Preparedness Program, by Friday, September 30, 2003. It is anticipated that funding awards will be made by mid-October with checks to hospitals available after January 1, 2004.

For further information, contact Bill Bazan at WHA at 414-431-0105 or email bbazan@mailbag.com  or Dennis Tomczyk, Program Director, at 608-266-3128 or email tomczdj@dhfs.state.wi.us .

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Tim Size has been reappointed to a four-year term on the Department of Health and Human Services (DHHS) Secretary’s Advisory Committee on Rural Health. (He previously served on this committee under Secretary Shalala from 1995-98.) The National Advisory Committee on Rural Health and Human Services is a 21-member citizens’ panel of nationally recognized experts that provides recommendations on rural health and human services issues to the Secretary of the DHHS. The committee was chartered in 1987 to advise the Secretary of HHS on ways to address health care problems in rural America. Chaired by former South Carolina Governor David Beasley, the committee’s private and public-sector members reflect wide-ranging, first-hand experience with rural issues in medicine, nursing, administration, finance, law, research, business, and public health.

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One of the Association’s key strategic areas of focus is to encourage continuous quality and patient safety improvements. This year, the 2003 WHA Annual Quality & Safety Forum features an expanded agenda that includes national perspectives on the state of health care quality. The forum will recognize quality and patient safety initiatives that have been successful in Wisconsin during both the traditional project showcase and at select breakout presentations. The forum will be held October 27-28 at the Plaza Hotel and Suites in Wausau.

Kenneth W. Kizer, MD, MPH, president and CEO of the National Quality Forum, keynotes the forum with a look at the history of health care quality assurance in the U.S., as well as recent trends and forces driving the current quality improvement imperative. Kizer will also discuss the genesis and maturation of the National Quality Forum, reviewing its work relating to the further evolution of health care quality improvement in our country.

Other general session presentations will focus on the consumer’s perspective of health care in the U.S., working with a computerized physician order entry system, engaging physicians in quality improvement, and a presentation by representatives of the Baldrige Award-winning SSM Health Care.

A special pre-conference seminar focused on the concept of customer service as a component of quality initiatives will be offered from 9 a.m. to 12 p.m. on October 27. Register now for the pre-conference event as space is limited.

Hospital quality managers, compliance officers, risk managers, nurse leaders, physicians, administrators and management staff are encouraged to attend. The cost of the conference is $250; the pre-conference seminar is $75. The full conference brochure with registration information is included 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 #7119) at The Plaza when making your reservation. The special room rate will be available only until September 27.

For more information on the program content, contact Jennifer Frank at 608-274-1820 or email jfrank@wha.org . For registration questions, contact Bridget Gifford at 608-274-1820 or email bgifford@wha.org .

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CMS has been very busy lately issuing many prospective payment rules for 2004. For the actual rules from the Federal Register and for WHA summaries outlining the highlights of these important policies, see the WHA Web site at http://www.wha.org/financeAndData/reimbursement.aspx.

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On Thursday, September 4, the Senate Committee on Health, Children, Families, Aging and Long Term Care heard public testimony on proposals requiring public access to information about a physician’s background and revamping disciplinary procedures for health care professionals. According to author Senator Carol Roessler (R-Oshkosh), Senate Bills 226 and 227 are identical to legislation recommended five years ago by a Legislative Council Committee on the Discipline of Health Care Professionals.

"Now is the time to move forward and address these necessary changes in disciplinary procedures," said Roessler. "There have been numerous reports that Wisconsin lags in the discipline of health care professionals and I feel these bills are important both to patients and to the integrity of the medical profession."

SB 226 makes information about a physician’s education, practice, medical malpractice, disciplinary history and criminal history publicly available, while also establishing a procedure for health care providers to correct health care information collected by the state. The Wisconsin Medical Society (WMS) raised concerns about the funding of these requirements, but expressed support for the bill once they are resolved.

"The Society fully supports providing the general public with comprehensive, easily-understood information about physicians," said WMS President Dr. Paul Wertsch.

SB 227 expands the duties of the Department of Regulation and Licensing (DRL) as they relate to the discipline of health care professionals in the following manner:

• Requires the submission of reports on medical malpractice payments and on professional review actions to the MEB, and establishes a $10,000 fine for failure to comply. These reports are currently submitted to the National Practitioner Data Bank (NPDB).
• Allows DRL to identify health care professionals who warrant evaluation and possible investigation when no allegation of unprofessional conduct has been made.
• Requires DRL to notify a health care professional’s employer when a complaint is filed.
• Requires a coroner or medical examiner who determines a death was therapeutic-related to forward the information to DRL.
• Requires DRL to establish guidelines for the timely disposition of an investigation and requires DRL to provide notice about the status of the investigation to the complainant and health care professional.
• Requires DRL to develop a system for establishing the relative priority of disciplinary cases.
• Authorizes the MEB to summarily limit any credential issued pending a disciplinary hearing.
• Authorizes the MEB to assess a forfeiture of up to $1,000 for a health care provider found guilty of unprofessional conduct.

WMS expressed support for many of the bill’s provisions including prioritizing disciplinary cases, limiting credential holders to specific practice areas, and establishing broader notification requirements, while raising concerns about other provisions. Dr. Wertsch called the proposal to allow DRL to identify health care professionals warranting evaluation troublesome.

"Any such proactive attempts must be evidence-based, and should focus on attributes that have been shown to impact patient outcomes," he said. "Until that evidence emerges, we question the efficacy of such a proactive effort."

Dr. Wertsch also said the provisions requiring a medical examiner or coroner to "red flag" a therapeutic-related death are "extremely vague" and could be interpreted to affect any death that is not clearly "natural."

A committee vote has not been scheduled on SB 226 and SB 227. WHA has not taken a position on either bill. For more information, contact Jodi Jensen at 608-274-1820 or jjensen@wha.org.