November 11, 2016
Volume 60, Issue 45



Power Shifts in DC, Full Republican Control
Trump wins, U.S. Senate and House stay red


In a plot turn that most did not predict, two entire federal branches of government—the Legislative and the Executive—are now all in Republican hands. Going into November 8, many pollsters, the media and political types felt Republicans would largely be on the defensive in trying to hold onto the U.S. Senate and very few expected Trump to win the Presidency. However, those predictions proved false. Not only did Republicans hold onto both the U.S. House and U.S. Senate, Trump won in key, traditionally Democratic states like Wisconsin to convincingly win a majority of the electoral map. See the federal recap below. 

President
In the presidential race, Trump won Wisconsin for Republicans for the first time since 1984. His vote margin was roughly 48 percent to 47 percent and 1.41 million votes cast for him to 1.38 million votes cast for Clinton. See votes by Wisconsin county.

Nationally, while Clinton slightly leads in the popular vote, it is the Electoral College that matters and Trump won key states like Florida, North Carolina, Ohio and Pennsylvania. Michigan is still yet to be decided. As of November 11, Trump wins the Electoral College with at least 290 to 228 (out of 538) votes but not all results are fully in. See the national map

U.S. Senate
In the U.S. Senate, incumbent Republican Senator Ron Johnson won with 50 percent of the vote to Russ Feingold’s 47 percent, roughly 100,000 votes separated the two. Nationally, Republicans will hold onto control of the U.S Senate by a margin of at least 51 seats with several races yet to be called. See the U.S. Senate results.

U.S. House
In the U.S. House, the only real race in play in Wisconsin was the open 8th Congressional District where Republican Reid Ribble chose not to run for re-election. This race was decisive with Republican Mike Gallagher defeating Democrat Tom Nelson with 63 percent to 37 percent of the vote. In the U.S. House, Republicans hold onto the majority with at least 239 seats and several races yet to be called. See the U.S. House map.

 

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Trump, Johnson Wins Trickle Down to GOP Successes in State Legislative Races 
Assembly Republicans gain one seat, Senate Republicans gain at least one seat – possibly two


In Wisconsin, all 99 members of the state Assembly are up for re-election every two-years during the fall general election. In Presidential election cycles, 16 of the 33 state Senate seats are up for re-election. The enthusiasm in Wisconsin for Republicans on top of the ballot trickled down to state legislative races, making what were thought to be toss-up seats less competitive and moving seats that were previously considered leaning Democratic into proactive battleground districts for Republicans.

State Senate
In an open seat to replace retiring Senator Rick Gudex (R-Fond du Lac), Dan Feyen defeated Mark Harris by a substantial margin of 12 percent in what many political observers believed would be the most competitive Senate race this election cycle. This successful race for the GOP allowed Senate Republicans to keep all of their incumbent Senate seats—also successfully defending Sen. Luther Olsen as he went on to defeat Democratic challenger Brian Smith by a 14 percent margin. 

In what some political observers would say were unexpected gains for Senate Republicans, political newcomer Patrick Testin defeated long-time Democratic incumbent Julie Lassa (D-Stevens Point) in Wisconsin’s 24th Senate District (Stevens Point, WI Rapids, Tomah area) by a 4 percent margin—52 percent to 48 percent.

Senate Democratic Minority Leader Jennifer Shilling (D-La Crosse) also faced a difficult challenger in former Republican Senator Dan Kapanke. As of distribution of this newsletter, the race is still too close to call with Shilling holding a 58-vote lead—even though Shilling has declared victory in that race. Election officials will conduct a general canvass and a likely recount of the ballots through next week to determine a winner in that seat.

Regardless, Senate Republicans will pick up at least one seat in the Senate—building on their current majority. The State Senate will have 20 Republicans and 13 Democrats, unless Kapanke moves ahead of Shilling—then the Senate will have 21 Republicans and 12 Democrats.

State Assembly
With Republican’s current 63-seat majority in the Assembly, there were several areas in the state where the GOP was intending to be on defense against Democratic challengers. Republicans successfully defended every single Republican incumbent in the Assembly district and ended up gaining a seat by Republican challenger Treig Pronschinske defeating incumbent Democratic Rep. Chris Danou (D-Onalaska) —an unexpected gain by many political observers. Republicans will now hold 64 seats and Democrats 35 seats in the state Assembly. 

Among the most competitive Assembly races, here are the results:

92nd Assembly District
- Rep. Chris Danou (D-Onalaska) – 48%
- Rep-elect Treig Pronschniske (R-Mondovi) – 52%

51st Assembly District
- Rep. Todd Novak (R-Dodgeville) – 51%
- Jeff Wright – 49%

85th Assembly District (Open Seat)
- Rep-elect Pat Snyder (R-Schofield) – 53%
- Mandy Wright – 47%

68th Assembly District
- Rep. Kathy Bernier (R-Chippewa Falls) - 58%
- Howard White – 42%

50th Assembly District
- Rep. Ed Brooks (R-Reedsburg) – 58%
- Art Shrader – 42%

All members elected or re-elected to the state Legislature November 8 will be sworn into office January 3, 2017, marking the start of the 2017-18 legislative session.

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President’s Column: Caution Ahead

The dust continues to settle from the election and most are still grasping the outcome and have yet to dig into the near and long-term policy and political implications. Indeed, in all the times one party has controlled both Congress and the Presidency, this instance might be one of the most complicated. 

Having said that, and with much to play out over the coming weeks and months, here are some initial thoughts. 

There is no doubt changes are coming to Obamacare, and changes were coming no matter who became President or which party controlled Congress. There was growing, bipartisan consensus that certain elements, particularly the exchanges, were in need of repair prior to the election. Post-election, the question now becomes a complicated (and potentially risky) one of scale, pace and how to effectively translate election year pledges into post-election policy creation, passage and, especially, implementation. For better or for worse, there’s too much here to instantly unwind, and not all of it will be unwound, frankly. 

Love it or hate it, in the six-plus years since it was enacted, there are dozens of elements to Obamacare that have become woven into the health care delivery and insurance systems. There are numerous examples of this, but perhaps the most significant is the gain in health insurance coverage. 

One important gauge by which to evaluate current and future policies is the Wisconsin uninsured rate, which was already low before Obamacare took effect and has dropped another 38 percent since. This is the result of Governor Walker’s hybrid approach of combining a Wisconsin version of Medicaid expansion with Obamacare’s insurance exchanges. Indeed, expanding health insurance coverage is a bipartisan aim, the difference comes in the means of achieving and sustaining this shared goal. 

Expanding coverage is, theoretically, not that difficult, but sustaining coverage expansion is. If Obamacare is repealed, its replacement must prioritize preserving the progress made in reducing the number of uninsured. 

This will be a critical part of the debate that must have as a desired outcome sustaining coverage gains in Wisconsin. It must be, and I believe will be under Speaker Ryan, a substantive and forward-looking debate, because this time repeal and replace won’t be vetoed. The fact that nearly 240,000 people in Wisconsin now obtain insurance coverage on the Wisconsin Obamacare exchange (200,000 of those receiving a subsidy to pay the premiums) means there is a lot at stake when repealing and replacing the law that delivered that coverage. What follows Obamacare must in design and implementation be better and more sustainable than Obamacare. This will not be simple.

While the breadth and scope of the coming changes are of obvious significance, as important is the pace of any coming change. Our health care delivery and insurance systems have seen massive upheaval and fundamental, systemic realignment over the past few years, much of that driven directly and indirectly by Obamacare. Our Wisconsin health care system is of nation-leading quality and value, its leaders remarkably talented, forward-looking and nimble. But despite these attributes, an abrupt U-turn could result in greater confusion, dissatisfaction and frustration across the board. Certain aspects of Obamacare have been a political gift to its opponents. Its replacements could be just the opposite if not handled cautiously.

Because of these factors, repealing and replacing Obamacare may not happen in a single piece of legislation. Rather, Obamacare may undergo a sort of “dissection,” with certain elements receiving greater immediate scrutiny than others. President-Elect Trump is gradually sharing more ideas and last summer Speaker Ryan unveiled a detailed alternative to Obamacare that serves as the most comprehensive menu of options so far. 

With nearly a quarter million Wisconsinites being covered under the exchange, it will take time to implement and transition, or “bridge,” any major changes. The King v. Burwell case in 2015 gave us an early glimpse of this dynamic. Had King prevailed, some of the staunchest Obamacare opponents recognized that the abrupt crippling (akin to a repeal) of the coverage elements of Obamacare would have to be addressed and began contemplating “bridge” contingency plans. 

Flavoring all of this is the state of the GOP majority in Congress, its relationship with President-Elect Trump and what this means in terms of who is driving the pace and content of the health care agenda. Today unity abounds, particularly around the concept of repealing and replacing Obamacare. But much dust to still settle there, and no public policy issue touches as many interest groups, stakeholders and constituencies as health care … there will be plenty of voices and opinions weighing in.

Bottom line is it’s still very early to predict what exactly will happen and how, but we should all be prepared for more changes coming to health care, along with the imperative that we engage. 

Your WHA advocacy team will be on top of the coming changes and, as always, looks forward to working collaboratively and constructively with Speaker Ryan and our elected officials in both Madison and Washington to bring a Wisconsin perspective in shaping the course forward. 

Stay tuned ….

Eric Borgerding, President/CEO

PS: I am writing this from a McDonalds in Oshkosh, where I pulled over from work travel to grab a McMuffin and wifi. There’s a civil and well-reasoned debate going on between some retired gentlemen in the booth next to me. The topic? A ground level discussion on the pros and cons of Obamacare…

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12th Annual WHA Physician Leadership Development Conference, Mar. 10-11, 2017
Early bird discount available; register today

Registration is now open for one of WHA’s premiere education events—the Physician Leadership Development Conference March 10-11, 2017 at The American Club in Kohler. 

Many WHA members register a team and report they find the greatest benefit from the conference is the opportunity to network among themselves and with other teams. 

“WHA has sponsored the Physician Leadership Development Conference for 12 years. It is one of the only conferences of its kind in Wisconsin,” according to WHA Chief Medical Officer Chuck Shabino, MD. “Past attendees often tell us that the greatest benefit they receive is the opportunity to spend time ‘out of the shop’ with their physicians and leaders.”

The full conference brochure is included in this week’s packet. Online registration is available at www.wha.org or directly at www.cvent.com/d/nvq2w6, and discounted registration is available to those registering by January 15.

This year’s conference will include a full day with Kevin O’Connor focusing on the skills needed to elicit connection, communication and cooperation from fellow medical professionals, in a session titled “Emotional Intelligence: The Final Frontier.” In addition, a half-day discussion, led by Jennifer Grebenschikoff will focus on the physician leader’s role in strategic physician recruitment and retention. Continuing medical education credits are available again this year.

Both O’Connor and Grebenschikoff are nationally-recognized faculty from the American Association for Physician Leadership (AAPL), formerly the American College of Physician Executives, and both will discuss important and practical leadership skills that help physician leaders move beyond their clinical training and take a new approach to managerial decision making and problem solving.

For questions about the annual Physician Leadership Development Conference, contact Jennifer Frank at jfrank@wha.org or 608-274-1820.

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Wisconsin is 7th Best State in CMS Quality Incentive Program
85% of WI hospitals will receive bonus in VBP program in 2017

Wisconsin ranked seventh best in the country in the Centers for Medicare and Medicaid Services (CMS) Value-Based Purchasing (VBP) Program. The VBP program rates hospitals on 20 measures including mortality, hospital-acquired infections, complications and patient satisfaction. Hospital ratings are based on comparisons to national benchmarks and year-to-year improvement. 

The VBP payment adjustments in Wisconsin, for federal fiscal year 2017, range from a 4 percent bonus to a 0.65 percent penalty. The average bonus is 0.7 percent. 

CMS also announced the Readmission Penalties for 2017. These penalties are applied to hospitals that have an excess readmission ratio based on patients who receive hospital care for heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease, hip and knee replacements and cardiac bypass surgery. Hospitals with excess readmissions can be penalized up to 3 percent of their Medicare payments. Wisconsin’s average penalty was 0.33 percent, which ranks Wisconsin at #17 when compared to other states; 26 percent of Wisconsin hospitals received no penalty and no hospital will be penalized by more than 1.51 percent. The majority of the penalties are very small.

The adjustments for both CMS programs are applied to hospitals’ DRG payment beginning October 1, 2016. 

“The data continues to prove that patients in Wisconsin are receiving better care than they would expect to receive in other states,” said Kelly Court, WHA chief quality officer. “The hard work of our health care employees and the proactive quality improvement efforts by our hospitals are showing positive results. WHA is proud to be a partner with Wisconsin hospitals on their quality initiatives. Their continuous attention to improvement is delivering high-quality, high-value care and it is paying off for our patients, employers and our communities.” 

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Quality Residency Program Graduates 21 Residents

On November 9, 21 quality professionals completed the highly popular Quality Residency Program. The group, which entered the program last March, completed 10 days of education and networking designed to help them be successful in a quality leadership role. 

Quality roles are complex due to the wide range of roles and responsibilities and lack of formal training programs. The multiple roles often include being responsible for regulatory or accreditation requirements, basic risk management skills, quality data reporting methods, data analysis and ensuring quality improvement efforts are successful. These challenges are compounded in rural areas because of both geographical and professional isolation.

The residency program, a partnership between the Wisconsin Hospital Association and the Rural Wisconsin Hospital Cooperative created in 2013, brings participants together for face-to-face learning and networking. The faculty for the program includes staff from WHA, several outside consultants and experienced peers from other Wisconsin hospitals. The program is structured as ten independent modules that allow new participants to join at any time during the year. 

As part of graduation, each resident shares a “golden nugget,” which is a practical application of something they learned during the program. This provides one last time to share something worth stealing with their peers. 

“The golden nuggets the residents share are proof they are taking complex material and turning it into simple, yet elegant, solutions,” according to Kelly Court, WHA chief quality officer. “Our hospitals are committing the time and energy to build knowledge about how to be really good at quality improvement and the supporting processes. The desire to learn and collaborate we see in this program is just one more example of what makes health care in Wisconsin better than most other states.”
The next quality residency class will start in March 2017. Hospitals that have new people in their quality department or are looking for a way to develop a future quality leader should contact Court at kcourt@wha.org.

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MACRA – Final Rule Update and Pathway Toward Alternative Payment Models (APMs)
December 7, 2016
10:00-11:00 am CST, via webinar

Register for this complimentary webinar today at: https://events.SignUp4.net/MACRA-APM-1207.

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Richards Joins WHA Quality Team

DeAnn Richards is working with the WHA quality department as a consultant to help WHA members reduce hospital-acquired infections. Richards is well known to the WHA quality team and our members across the state. She has been a leader in statewide and regional Association for Professionals in Infection Control and Epidemiology (APIC) chapters and has been instrumental in creating and introducing tools and best practices for infection prevention for hospitals of all sizes.

“DeAnn will bring expertise and knowledge to her work with our members to make measurable strides in reducing infections,” said WHA Chief Quality Officer Kelly Court.

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Prepare Your Chargemaster for 2017 at WHA Seminar, December 9

On December 9, WHA is offering the popular, one-day annual workshop “Preparing the Chargemaster for 2017,” in Wisconsin Dells. Back by popular demand, presenter Glenda Schuler will lead attendees in an overview of all 2017 reporting requirement updates and CPT and HCPCS coding revisions. Schuler will focus on updating the chargemaster as well as on strategies for department staff education. This program has prior approval of the American Academy of Professional Coders (AAPC) for 5.5 continuing education units.

The full day’s agenda and online registration are available at https://events.SignUp4.net/Chargemaster-1209.

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Dec. 6 Webinar Highlights Clinical Integration Strategies

On December 6, WHA’s Legal & Regulatory Webinar Series will feature the webinar “Clinical Integration Strategies in a Changing Payer Environment,” presented by Sarah Coyne and Jon Kammerzelt of Quarles & Brady LLP, a WHA silver-level corporate member. 

This presentation will address the legal framework incenting clinical integration, the legal hurdles that face networks attempting to demonstrate clinical integration, and practical strategies for surmounting those hurdles. In addition, the Medicare Shared Savings Program (MSSP) requirements applicable to accountable care organizations and the benefits of acceptance into the MSSP program, including deeming and waivers, will be discussed.

Online registration for this session, as well as all other sessions scheduled as part of the Legal & Regulatory webinar series, can be found at https://events.SignUp4.net/16LegalSeries.

There is no registration fee for webinars in this series, but pre-registration is required. The series is intended for WHA hospital and corporate members as a member benefit, and includes a range of topics, each presented by a representative of a WHA corporate member law firm. 

In addition, all previous webinars from this series are available on-demand in the WHA members only portal at http://members.wha.org.

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Gov. Walker Proclaims November 17 Wisconsin Rural Health Day

In a proclamation signed November 2, 2016, Gov. Scott Walker declared November 17 Wisconsin Rural Health Day in honor of National Rural Health Day, to recognize the unique contributions of our rural communities and the health care providers that serve these communities. This is the sixth annual National Rural Health Day, and WHA is once again a cosponsor, along with the Wisconsin Office of Rural Health. 

The Proclamation acknowledges that rural hospitals are sources of innovation and resourcefulness and are typically the economic foundation of their communities. 

View the proclamation at www.wha.org/pdf/2016RuralHealthDayProclamation.pdf.

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Member News: Gundersen Tri-County CEO Theiler Announces Retirement

Brian Theiler, chief executive officer of Gundersen Tri-County Hospital and Clinics, will retire December 30 with his wife, Martha, a patient representative in Gundersen Service Excellence.

“During his time at Gundersen Tri-County, Theiler has become an integral member of the community,” said Bryan Erdmann, vice president, regional services. “With his involvement in a variety of community activities, Brian has shared the great work and improvement that is occurring at Gundersen Tri-County.”

Before becoming CEO at Gundersen Tri-County, the Kiel, WI native worked as an inpatient psychiatric social worker, director of teen health services, therapist and director in Gundersen Behavioral Health. He then became director for Gundersen Social Services, followed by a position in regional services administration.

“My time at Gundersen has been rewarding because of the people,” Theiler said, “In my 32 years, hiring people with a passion for patient care and a professional respect has been the key.”

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Fast Facts from the WHA Information Center: November is National Pancreatic Cancer Awareness Month

The American Cancer Society’s most recent estimates for pancreatic cancer in the United States for 2016 are:

• About 53,070 people will be diagnosed with pancreatic cancer.
• About 41,780 people will die of pancreatic cancer.
• Pancreatic cancer accounts for about 3 percent of all cancers in the United States and about 7 percent of cancer deaths.
• The average lifetime risk of developing pancreatic cancer is about 1 in 65 (1.5 percent).

According to the WHA Information Center, there were 1,809 inpatient admissions and 18,217 outpatient visits to Wisconsin hospitals from July 2015 through June 2016, for the primary treatment or evaluation of pancreatic cancer. Some risk factors for pancreatic cancer include tobacco use, being overweight, obesity and workplace exposure to certain chemicals.

For more information on pancreatic cancer, visit: www.cancer.org/cancer/pancreaticcancer/index

Data provided by the WHA Information Center (WHAIC). WHAIC (www.whainfocenter.com) is dedicated to collecting, analyzing and disseminating complete, accurate and timely data and reports about charges, utilization, quality and efficiency provided by Wisconsin hospitals, ambulatory surgery centers and other health care providers.

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