RWHC Now On World Wide Web
Prompted by the Clearinghouse being developed by the Consortium for Primary Care in Wisconsin and with technical assistance from the Catholic Health Association of Wisconsin's Michael Miller the Cooperative has a site on the Internet's World Wide Web (WWW). Our address is:
Having a site on the WWW allows for your direct electronic access to text and graphic information regarding the structure and operations of the Cooperative, our monthly newsletters, recent policy papers and links to other regional and national WWW sites.
Medicare Benefit Varies Widely
For years, Medicare has published data that would be extraordinarily controversial if anyone ever looked at it. This might happen as an unintended byproduct of the current budget debate in Washington. The monthly adjusted average per capita cost paid by Medicare on behalf of fee-for-service beneficiaries sorted by county of residence is called the AAPCC. The average AAPCC for Wisconsin's counties was $278 with the range of monthly costs varying from a low of $211 to a high of $398! The following map of Wisconsin divides the counties into quartiles. Data Source: American Hospital Association from HCFA AAPCC File 7/19/95.
Medicare Equity Fight Continues
As many of you know, the Wisconsin State Medical Society's (SMS) request to the Health Care Financing Administration (HCFA) for a Medicare, single payment locality has again been denied due to opposition from some of those physicians who are advantaged by maintaining the status quo. (Statewide, 65% support the change, including 34% of the "losing" physicians .) Wisconsin's Rural Health Development Council is committed to continuing to seek a way to remedy this most obvious inequity.
In a letter to the Wisconsin Congressional Delegation: "HCFA has told SMS that it is pursuing a course to reduce the number of payment localities throughout the United States as was recommended by the Congressional Physician Payment Commission. HCFA is presently awaiting the results of a comprehensive study on realignment of the payment areas under the Medicare physician fee schedule. The study is to be completed by Fall of 1995 for scheduled implementation in 1997."
"If HCFA creates the reduced payment localities similar to that recommended by the PPRC, Wisconsin will be designated a single payment locality. However, with competing priorities, HCFA's establishment of more equitable payment localities could be delayed beyond 1997, to the detriment of rural communities. The Council, therefore, asks that the Wisconsin Congressional Delegation work with Congress to formally request that HCFA keep to its schedule to reduce the number of payment localities to be effective January 1, 1997."
To further this purpose, the Council's Medicare work group will continue to develop grass roots support within Wisconsin for this change.
Medicare Reform & Rural Health?
The Rural Policy Research Institute (RUPRI) is a consortium of faculty from three midwest universities (Iowa, Missouri and Nebraska) that has become recognized by Congress as a key resource on rural issues. RUPRI's health care panel has initiated a short-term study on the potential impact on rural health of various Medicare reform proposals being discussed in Washington. I am pleased to be participating in this study as one of two outside consultants .
"Medicare represents a disproportionately large source of insurance and health care financing for elderly and disabled rural residents and for rural health care providers. Yet, it has been very difficult for rural communities and providers to gain the significant attention from policy makers to assure that the critical reimbursement and other Medicare policy problems affecting rural health care delivery are addressed."
"There is very little information available on the impact of this program in rural areas and populations, and analysis of the potential rural impacts of proposed Medicare reforms, such as the expansion of managed care or cuts in payments to providers, is virtually non-existent."
A Medicare Cutting Commission?
Another (from last month) reliable but unnamed Washington source believes that it is almost certain that the Congress will punt to a bipartisan commission to balance the Medicare budget. This projection is based on the wide gulf between President Clinton and the Republicans as well as the deep splits within both parties. Such a Commission would be given six months and its recommendation, like that made for military base closings, would have to be voted up or down, no amendments.
Rural Funds Up To Senate Vote
As requested last month, please contact Senators Feingold and Kohl regarding your support for the Federal Office of Rural Health Policy and related programs.
The Senate Appropriations subcommittee is expected to mark-up its health bill on Sept. 12th with full committee action on the 14th.
If the Senate does not restore funding for the Federal Office of Rural Health Policy, the National Rural Health Advisory Committee and our country's only Rural Health Research Centers, these critical components of our national rural health infrastructure are history. These are core functions, please act today.
Rural Health National Direction?
The federal National Advisory Committee on Rural Health will have what is hopefully NOT its last Fall meeting September 17-20. The agenda is dedicated to developing a better understanding of probable national directions for rural health and strategic planning by the Committee in response to those perceived directions.
If there is an issue that you believe should be brought up or emphasized, please let me know.
Support Rural Medical Center Vote
Please contact your state senator and representative and ask them to to support the Rural Medical Center legislation that will be discussed and hopefully brought to a final vote in both the Wisconsin Senate and Assembly this fall.
The purpose of this legislation is to allow currently regulated rural based providers of multiple services to be licensed, inspected and otherwise regulated by the department of Health and Social Services (DHSS) as the single entities that they have become in many communities. Formal recognition of Rural Medical Centers as a provider type will improve the coordination of health services within rural communities through the implementation of a unified set of administrative rules, statutory regulations and surveys.
We believe that this bill proposes to implement a particularly innovative and basic redefinition of what rural hospitals are and what they can become, in Wisconsin and across the country. Recognition of the Rural Medical Center model by both private and public sectors is a major step towards the needed restructuring of local services away from an over dependence on inpatient services towards a more thorough meeting of multiple of health needs through a more locally integrated system of community oriented primary and secondary care.
A lot of effort has gone into developing the Rural Medical Center model over the last six years, the attached review of a few of the milestones that led to the development of this bill demonstrates its grass roots origins and broad state support.
Some Health Policy Takes A While
While many major state policy initiatives are the result of early, small steps over several years, statutory implementation of rural medical centers has been particularly slow.
Spring, 1988: Several rural hospital administrators suggest that the then Rural Wisconsin Hospital Cooperative work plan include an objective to encourage the State to review the effectiveness of its regulation of rural hospitals.
Summer, 1989: A reform bill passes, supported by a broad rural health coalition, that includes language to establish a Special Committee of the Legislature to review the "Statutes and Rules Which Affect Rural Hospitals"
January, 1990: The Special Committee begins its work, chaired by then Secretary of the Department of Health and Social Services, Patricia Goodrich with representation from providers, consumers and the public sector.
Summer, 1990: During a "field hearing", the Director of Nursing of a diversified rural hospital asks the key question: "Shouldn't I have a single counter part in government that understands the variety of programs now offered by diversified rural hospitals?" Committee shifts thinking from individual regulatory revisions to developing a new way for both private and public sectors to think about rural hospitals.
December, 1991: The Special Committee recommends the establishment of Rural Medical Centers: community based organizations providing a diverse range of medical and health services tailored to local need, regulated by a unified licensure and survey process.
Summer, 1991: A Rural Medical Center Work Group is established by DHSS to begin the practical preparatory steps for implementing the public sector component of the model. The potential role for local public health agencies is clarified and added into the model.
March, 1992: Legislation passes supporting the Rural Medical Center concept and directing its development by DHSS.
August, 1992: A Consortium including DHSS, the Wisconsin Hospital Association, the Cooperative and Eagle River, Reedsburg and Whitehall hospitals receives a federal grant to aid the development of Rural Medical Centers.
1992 to date: Development of draft bill, draft rules and piloting of unified surveys.
Faces From The Front
Even as communication systems become increasingly electronic, there are real people working to keep us connected. Here are photos to put with three voices that you are likely to first hear when calling our Sauk City office.
Since using a now museum quality Apple IIe to record HMO of Wisconsin enrollees in 1983, the Cooperative has made extensive use of Apple and Macintosh computers. Our most recent improvement is represented by these photos taken with a "Quickcam" connected directly to a Power-book 540c.
Relatively Related Note: Microsoft's Windows 95 for the IBM is being unveiled this week with a megabucks advertising campaign. What you won't find Bill Gates saying is found in today's Boston Globe. "Most experts agree that Windows 95 isn't quite as good as the current version of the operating system that brings the Apple Macintosh to life."
System Overhead & Competition?
Bob Taylor, President, Wisconsin Hospital Association (WHA) raised the following key question in his August President's Report:
While WHA has consistently opposed the imposition of "assessments" to support publicly-funded health programs or general revenue obligations of the state, this masks an important issue that ultimately will need to be resolved: whether it might be "appropriate" to use a broadly-based financing support among all providers of health care to support necessary elements of the health care system that can't equitably be supported by individual providers in a competitive environment. This includes costs associated with medical and allied education, development of a state-of the-art EMS system, health care for the poor, and other aspects of health care that have broad system applicability.UW Med School Dean Confirmed
Ultimately, it is my opinion that if these costs can't be equitably distributed, a situation could be created where those facilities most committed to serving populations in need and providing needed educational services become noncompetitive casualties in the type of environment that seems to be developing. This raises a whole series of policy deliberations that the (WHA) Board must ultimately address.
Monday, UW-Madison Chancellor David Ward announced the permanent appointment of his interim Dean, Dr. Philip Farrell, apparently continuing his preference for candidates bringing continuity and familiarity with the current campus culture.
The UW Medical School Dean Search Committee, contrary to wide speculation, was able to attract outstanding external candidates, each combining strong academic and community leadership. However, earlier conventional wisdom about the search's outcome was confirmed.
The Cooperative has been and must be neutral as regards the competing clinical titans of Madison and elsewhere. But rural communities have a clear need and right for relevant teaching and research activities by our state university. I wish Dr. Farrell good speed, our common interests need him to succeed.
Marshfield Antitrust Appeal Heard
The U.S. Court of Appeals for the Seventh Circuit has heard oral arguments from Blue Cross and Marshfield Clinic in a case being followed by lawyers across the country. The American Bar Association's Antitrust Health Care Chronicle (Vol. 9/No. 3) published a point-counterpoint feature authored by counsel for both parties:
These articles provide fascinating and entertaining insights into the case. From the plaintiff's standpoint, as Jim Troupis explains, Marshfield Clinic's prices were excessive, a reflection of its market power, and its conduct artificially excluded competition in the HMO market though a variety of activities, including acquisition of a monopolistic share of the physicians providing HMO and managed care services in the relevant markets: control over privileging, and refusal to cross-cover for or affiliate with independent physicians. There are also claimed per se (illegal by definition) violations (market allocation) and conspiracies to monopolize the physician market.
For the defendant, Kevin McDonald points to many claimed deficiencies in the plaintiffs' case, among which are two 'nuclear flaws': the positing of an 'HMO market,' and the question of standing to attack the supracompetitive pricing and market allocation arrangements. In the defendants view, the plaintiffs have failed adequately or properly to define the markets allegedly impacted by the clinic's conduct, much less to associate particular alleged antitrust violations with particular markets.
Mr. McDonald's article also presents the first invocation in the chronicle - and 'chances are' the first in antitrust literature-of the hallowed named Johnny Mathis.
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An actual ad, 8/20 Wisconsin State Journal.