December 18, 2015
Volume 59, Issue 50


WHA Legislative Priority Expediting Physician Licensure Signed into Law
Walker signs Interstate Medical Licensure Compact in WHA-member hospitals

Gov. Scott Walker traveled the western half of the state December 14 to sign WHA-backed legislation implementing the Interstate Medical Licensure Compact in Wisconsin. Flanked by hospital leaders from the region, Walker signed the legislation into law as 2015 Wisconsin Act 116 at two separate ceremonies, one at the Mayo Clinic Health System-Franciscan Healthcare in Sparta and the other at Burnett Medical Center in Grantsburg. In total, Walker was joined by an estimated 150 hospital advocates between both ceremonies.

In delivering his remarks before signing the Compact into law, Walker stated "the Compact is not just about health care, it’s about economic development." Walker talked extensively about how access to high-quality, high-value health care is one of the most important issues on the minds of business leaders hoping to build, expand or relocate their business in a particular state. Walker said Wisconsin is fortunate to have some of the highest quality health care in the nation and said access to high-quality care for their employees is a very important factor for those job creators.

Walker said it is important that Wisconsin is moving forward, not being "left in the dust" when it comes to ensuring we join the Compact and are able to process physician licenses more quickly. He said the Compact will have an even more significant effect in rural hospitals near the Wisconsin border, who may look to recruit physicians who are currently licensed in their home state of Illinois, Iowa or Minnesota—all member states of the Interstate Medical Licensure Compact.

While introducing Walker in Grantsburg, Burnett Medical Center CEO and WHA Board Member Gordy Lewis thanked the Governor for his continued commitment to Wisconsin health care.

"Governor Walker has shown a continued health care focus with his commitment to funding the Medicaid program and re-authorizing the Disproportionate Share Hospital Program, which provides funding to hospitals that treat indigent patients," said Lewis.

Lewis went on to thank Walker for staying true to Wisconsin’s motto of "Forward" and seeing the importance of investing in graduate medical education, especially primary care in rural Wisconsin. In his remarks, the Governor discussed the commitment his administration has made to funding residency programs in his last two budgets. He said training physicians in Wisconsin is an important step toward ensuring access to care in communities all over the state.

A copy of 2015 Wisconsin Act 116 is at http://docs.legis.wisconsin.gov/2015/related/acts/116.pdf.

Top of page (12/18/15)


Health Care Transformation Creates New Job Opportunities in Hospital Workforce
New care models aim to improve care, reduce cost, increase access

Hospitals and health systems are reshaping traditional work roles and creating new positions that did not exist just a few years ago as they transform care delivery models to improve care, reduce cost and increase access, according to a new report released by the Wisconsin Hospital Association (WHA).

Positions such as patient navigator, care coordinator, health coach and telehealth-trained physicians are now regularly included in hospital recruitment efforts.

"As we redesign health care, we also must redesign the workforce to accommodate new models of care," according to Steve Rush, RN, PhD, WHA vice president of workforce and clinical practice. "Health reform was taking shape in Wisconsin well before the law was passed. While the Affordable Care Act accelerated the rate of change in some areas, such as reimbursement, other factors unrelated to the ACA were having a strong influence on workforce."

Those factors included shortages of clinical professionals, the rate of staff retirements and caring for patients with complex medical conditions. In addition, Wisconsin is aging more quickly than most other states, which has implications on utilization and the types of services that are needed locally.

The pace of retirements is expected to accelerate, especially for nurses. More than 40 percent of the registered nurses (RNs) working in Wisconsin are older than 50, and 33 percent are over 55 years of age. Hospitals reported an RN vacancy rate of 4.5 percent in 2014, which is a 15 percent increase from the 3.9 percent vacancy rate reported in 2013.

"Some national forecasting models say the nursing shortage has been largely eliminated," Rush said.

"However, based on the current age of nurses here, we could see as many as 3,000 nurses retire each year for the next decade. That will have implications on how quickly vacancies can be filled, so we are closely monitoring the number of new grads who enter the market compared to the number of nurses who leave it."

Other key findings from the report:

In spite of all the staffing challenges intrinsic to providing high-quality, accessible care around the clock, Wisconsin health care continues to be ranked among the best in the nation.

"Wisconsin is well-positioned to thrive in the health care environment that is taking shape, thanks to the dedicated health care professionals who are finding new and innovative ways to leverage their skills individually and with other professionals to improve care, reduce cost and increase access," according to WHA President/CEO Eric Borgerding.

Read the full report: www.wha.org/pubarchive/reports/2015workforcereport.pdf.

Top of page (12/18/15)


Guest Column: A Report from WHA’s 2015 Board Chair
Therese Pandl, president/CEO of the Hospital Sisters Health System’s (HSHS) Eastern Wisconsin Division

In 2015, WHA set an aggressive list of goals, 14 in all. We will meet 13 of the 14 with one still pending. That’s an "A" and that’s a pretty good grade in my book, especially when you consider we had a lot of non-goal issues come up this year—things that we could not predict but that required a response.

This year has been one of transition between WHA’s previous President Steve Brenton and current President Eric Borgerding. I want to congratulate the entire transition team—Ed Harding, David Olson, and Dan Neufelder—on a job very well done. It was a graceful transition.

WHA is a respected voice in Madison and Washington D.C. Advocacy is our #1 goal, and the most appreciated member benefit. As a Board, we continue to view that as a strength.

On a personal note, it has been a privilege to serve as your Board chair. The caliber of the people sitting around this table and the talent of the WHA team have made this a memorable and rewarding experience. We may be competitors, but we all come together to advance high-quality, high-value health care in this state. We work to make care safer, more accessible and more affordable. This is what continues to make Wisconsin a terrific state for health care.

I want to thank my fellow Board members for their participation on councils and task forces. I also want to acknowledge the hard work of the WHA staff in how thoroughly prepared and hard they work to prepare for meetings. They do an excellent job engaging members in the subject matter. Our Board evaluation reflects our confidence in the WHA team.

It has been a pleasure serving our Association, and I thank you for giving me this opportunity.

Top of page (12/18/15)


WHA Board Approves Resolution to Support Patient, Prescriber Opioid Education

The misuse and abuse of opioids is a growing problem across the country and in Wisconsin. Drug overdose deaths in Wisconsin have doubled from 2004 to 2013.

Recognizing that Wisconsin hospitals have an important role in addressing this public health issue, the WHA Board of Directors unanimously passed a resolution at their December 17 meeting in Madison supporting the efforts of WHA members to raise awareness of this issue. The resolution recognizes and encourages hospitals to develop specific strategies to address the use and abuse of opioids, and create a culture of change that is responsive to this growing epidemic.

The resolution also asks hospitals to support educational programs for prescribers, including sharing best practices related to prescribing opioids and about the role prescribers have in educating patients about the safe use of opioids.

Therese Pandl, WHA Board chair, addressed the Board by saying, "This is an issue that cuts across all socioeconomic and geographic boundaries. This is an issue that touches every single community in the state of Wisconsin, whether you are from a small rural area or a large urban center. I believe we as a hospital association can make incredible impact in this effort to reduce opioid use and abuse."

In presenting the resolution, Steve Rush, WHA vice president, workforce and clinical practice, said WHA staff has been developing executive education programs that provide high-level multi-level guidance on how to address the opioid abuse issue. In addition, WHA has convened a multi-disciplinary stakeholder group that will assess, collaborate and coordinate provider-focused education efforts and programming to avoid duplication. The first WHA webinar on this topic will be in February. More information will be sent to members about this education opportunity early in 2016.

WHA has created a resource page on opioids: www.wha.org/opioid.aspx. View the resolution here: www.wha.org/pdf/WHABoardOpioidResolution2015.pdf.

President’s Report: WHA on Track to Meet 2015 Goals

Each year, WHA staff, with the input of Board members, develops a list of strategic goals. In 2015, there were 14 goals, ranging from legislative priorities in the state budget to communicating the value of health care to Wisconsin employers.

As 2015 draws to a close, WHA President/CEO Eric Borgerding reviewed the goals for the WHA Board while providing a detailed analysis of the issues the Association tackled over the past year.

"Advocacy is our #1 expected member benefit and in 2015, we delivered," Borgerding said.

A recap of the 2015 WHA goals will be published in the December 30 issue of The Valued Voice.

Borgerding called attention to two new reports shared with the Board, the WHA 2015 Workforce Report (see story above) and the Hospital Economic Impact Report (www.wha.org/pubarchive/reports/2015HealthyHospitals.pdf).

In other actions, the Board approved the WHA Council and Committee rosters for 2016 and approved the nominees to the WHA Foundation Board of Directors.

WHA Recognizes Board Members for Service

Four members who are leaving the Board were recognized for their service to the WHA Board: Nick Desien, Wisconsin Ministry Market Leader for Ascension Health; Gordy Lewis, CEO, Burnett Medical Center; Peggy Ose, vice president, patient services/interim COO, Aspirus Riverview Hospital and Clinics; and, Bill Sexton, CEO, Crossing Rivers Health Medical Center.

Five new members joined the Board, including: Joan Coffman, President/CEO, HSHS St. Joseph’s Hospital, Chippewa Falls; Tim Gullingsrud, CEO Hayward Area Memorial Hospital & Water’s Edge; Paula Hafeman, Division CNO, HSHS St. Mary’s Hospital Medical Center and St. Vincent Hospital, Green Bay; Charisse Oland, CEO, Rusk County Memorial Hospital, Ladysmith; and Chris Woleske, executive vice president, Bellin Health and CEO, Bellin Health Oconto Hospital.

WHA President/CEO Eric Borgerding recognized WHA 2015 Chair Therese Pandl for her service to the Association.

"We appreciate Therese’s leadership this year. 2015 was an important year for many reasons—and our entire team is indebted to Therese for her guidance, leadership and commitment to working on issues that are important to every hospital in our state," Borgerding said. "Therese did a fantastic job this year and we look forward to working with her as she chairs the Advocacy Council and the Bylaws Work Group in 2016."

WHA Information Center Expands into Data Visualization

The WHA Information Center (WHAIC) continues to add value to their data products, moving into data visualization and analysis. WHA Senior Vice President Brian Potter told Board members that 2016 will be an important year for WHAIC as it continues to add new initiatives while also focusing on the importance of its day-to-day operations emphasizing data quality, timeliness and security.

WHA Task Force Brings Insurers, Providers Together to Work on Price Transparency Issues

Steve Little, CEO, Agnesian Healthcare and Chair of WHA’s Transparency Task Force, along with Potter and Joanne Alig, WHA senior vice president, policy and research, updated the Board on the progress made in 2015 on consumer transparency. The Task Force created a new toolkit designed to help hospitals meet federal requirements on transparency. The toolkit was highlighted in The Valued Voice December 4. In addition, the Task Force is working with insurers on ways to partner to provide better information to patients.

"As more insurance options include deductibles and other cost sharing, I can’t emphasize enough how important this is for our patients to have accurate and meaningful information about what they will have to pay for services," said Little. "It’s not a new concept, but it is unbelievably complex."

The Task Force will continue to work with insurers over the next year to make it easier for consumers to find and understand information related to health care pricing.

Top of page (12/18/15)


Study Finds Operating Costs for Southeast WI Area Hospitals Well Below National Indices
Cost Shifting from Government Health Care Programs Accounts for 27% of Commercial Payments

A study released December 15 in Milwaukee shows that area hospitals continue to reduce costs, significantly more so than the national average, and commercial payment increases as a result have been far less than in other markets. These findings are significant, especially in light of the study results showing that the 2014 cost shift burdens are at their highest level over the past 11 years.

The Greater Milwaukee Business Foundation on Health, Inc. (GMBFH), sponsors the study, which is conducted by Milliman. The results were presented by Keith Kieffer. The analysis is important as it is one of the only, if not the only, longitudinal study focusing on the factors influencing southeast Wisconsin commercial payer hospital payment levels. The current study updates previous studies released in 2009, 2011, 2012 and 2014. All five studies examined the same factors and utilized the same methodologies to allow for a comparable analysis.

One of the most remarkable findings, according to Kieffer, is that area operating costs are well below national indices.

"All hospitals around the country are focused on holding down costs, and this market has just done a better job," said Kieffer. Operating costs for southeast Wisconsin hospitals actually decreased 0.8 percent from 2013 to 2014.

Operating cost, or the day-to-day expense of running a hospital, is one factor that goes into hospital commercial payment levels. As operating costs have been held down, southeast Wisconsin hospital commercial payment levels have also been far below the national average. The study found that the average increase for southeast Wisconsin hospitals was approximately 45 percent (3.4 percent annually) from 2003 through 2014, less than half of the 93 percent total increase in the national Hospital Component of the CPI for the same period.

Wisconsin Hospital Association President/CEO Eric Borgerding, who attended Kieffer’s presentation, was thrilled at the findings.

"This is really a remarkable trend," Borgerding said in an interview with the Milwaukee Business Journal. "The turnaround in Milwaukee and southeast Wisconsin overall is tremendous."

Borgerding and Kieffer attributed the lower payment increases to increasing competition among health care systems and the systems’ efforts to minimize expense increases."You see a much more competitive market and it’s driving a lot of positive developments," Borgerding said.

While the study found in 2014 the average southeast Wisconsin hospital commercial payment level increase was higher than the Hospital Component of the CPI, it was the first time that was true since 2005. Further, the study found a significant increase in the governmental cost shift burden from 2013 to 2014 experienced by the area’s health systems. Kieffer attributes this higher 2014 cost shift burden to decreased Medicare reimbursement as a result of policies implemented in the Affordable Care Act. According to Kieffer, 27 cents of every dollar in commercial payments goes to offset shortfalls from government payments, as the total governmental cost shift burdens exceeded $1 billion in 2014.

"It’s the elephant in the room, and a massive component of health care costs that only state and federal government can address," Borgerding said. "Imagine the scrutiny, the calls for immediate action by policymakers if it were anything else that singularly comprised nearly one-third of what employers pay for hospital care. Despite the sustained and truly remarkable progress hospitals are making in controlling operating costs, the real anchor here, the issue that continues to impede even greater progress in reducing employer health care costs, is the significantly below-cost reimbursement from government health care programs."

Kieffer also described in some detail the changes in the market over time, and that markets have become more competitive, particularly since 2008. The period from 2008 to 2012 showed declines in the relative market share of the predominant health system in each zip code in the area, and from 2012 to 2014 commercial market share concentration was at its lowest observed over the study period.

Ron Dix, the Foundation’s executive director, complimented hospitals for their work in holding down costs and encouraged them to continue working to keep costs and payment levels down.

Top of page (12/18/15)


WHA Disappointed By Omission of Site Neutral Fix in Omnibus
Appreciates Wisconsin legislators who stood with hospitals/systems

Early on December 16, Congress released over 2,000 pages of legislation to fund the federal government and extend a variety of tax provisions. The Wisconsin Hospital Association (WHA), along with many others in Wisconsin and across the country, had advocated for inclusion of an amendment into this package that would address the recently enacted Medicare "site neutral" reimbursement policy.

This site neutral policy was put into law November 2 and impacted a variety of hospitals and health systems. WHA supported an amendment developed by the American Hospital Association that would have exempted certain facilities from the policy’s prohibition, including projects that were already "under development." Despite support nationally and in Wisconsin from hospitals and legislators, negotiators did not include the site neutral fix into this package of legislation.

Negotiating the omnibus and tax extenders package were Republican leaders Senate Majority Leader Mitch McConnell and Speaker Paul Ryan, and Democratic leaders Senate Minority Leader Harry Reid and House Minority Leader Nancy Pelosi.

"WHA is greatly disappointed by the fact that the President and Congress can, within the span of a week, enact a site neutral policy that upends health care access, financial planning and contracting decisions already well in process. It is entirely appropriate to weigh and debate site neutral reimbursement policy, but no business, health care or otherwise, should be subjected to such arbitrary and abrupt policy decisions out of Washington and that literally in a span of a few days cause such massive disruption across the country," said WHA President/CEO Eric Borgerding. "We will continue to pursue a fix to this poorly-conceived policy in 2016."

WHA would like to thank the vast majority of Wisconsin’s Congressional Delegation who stood with hospitals on this issue, including:

Later this same week, both the U.S. House and U.S. Senate voted in support of the omnibus and tax extenders legislation. The legislation now moves to the President for his signature, which is expected soon.

Top of page (12/18/15)


WHA Recommends Further Changes to Stage 3 Meaningful Use Requirements

On December 15, WHA submitted a comment letter to the Centers for Medicare & Medicaid Services (CMS), recommending that the federal agency make revisions to the Stage 3 requirements for meaningful use of electronic health records (EHRs). WHA called for CMS to revise Stage 3 to better ensure that reporting requirements are supported by mature certification standards, provide greater flexibility for reporting on meaningful use measures, and better ensure that investments made and costs to meet the Stage 3 requirements will yield a "return on investment" in the form of higher quality and more cost-efficient health care consider overall.

WHA’s comments are in response to a joint rule published by CMS October 16, 2015. As discussed in a previous Valued Voice article, the joint rule finalized proposals made in two separate 2015 proposed rules regarding the meaningful use requirements of the EHR Incentive Program: the March 30 Stage 3 proposed rule, and the April 9 proposed rule that modifies program requirements in 2015, 2016 and 2017. In finalizing the Stage 3 meaningful use requirements, CMS rejected calls from the provider community and members of Congress to refrain from finalizing Stage 3 in light of the low Stage 2 performance levels nationwide. In May comment letters, WHA and AHA had encouraged CMS to delay release of the Stage 3 requirements and instead to continue evaluating the experience of Stage 2 and accelerating the availability of mature standards to support meaningful use requirements in accordance with clinical needs.

In the October joint rule, CMS opened a 60-day period to receive comments on the Stage 3 requirements, and CMS indicated that it may consider comments as it prepares meaningful use rulemaking for the Merit-Based Incentive Payment Systems (MIPS). (Under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which Congress passed to replace the sustainable growth rate (SGR) formula, Medicare penalties for physicians that arise out of the EHR Incentive Program will end in 2018 and be incorporated under MIPS beginning January 1, 2019.

In the December 15 comment letter, WHA told CMS there is insufficient experience of successful provider performance at Stage 2 to be confident the requirements for Stage 3 are feasible and appropriate. In addition, WHA expressed concerns that specific reporting measures are unnecessarily difficult to achieve without significant expense or disruption to patient care workflow. Further, some of the standards needed to support many of the Stage 3 requirements are insufficiently mature to be included in regulation.

For additional information, contact Andrew Brenton, WHA assistant general counsel, at abrenton@wha.org or 608-274-1820.

Top of page (12/18/15)


Gov. Signs Bill Requiring Legislative Approval of Self-Funding for State Employee Health Insurance

On December 14, Gov. Scott Walker signed into law Assembly Bill 394, which gives the state’s Joint Finance Committee the authority to approve or reject a proposed contract by the Group Insurance Board (GIB) to provide a self-funded group health plan to state employees. The bill was signed into law as 2015 Wisconsin Act 119.

The legislation, authored by Rep. John Nygren (R-Marinette) and Sen. Alberta Darling (R-River Hills), would require the GIB to provide a report of their plan to the Joint Finance Committee for review. If the Committee chooses to actively review the proposal, the Committee would call for a public hearing and take testimony from the GIB and members of the public. The Committee would then be required to actively approve the proposal before the GIB could move forward and execute any contract for a self-funded health insurance plan offering to state employees.

"Wisconsin’s hospitals and health systems are a key partner with the state in delivering high-quality, high-value health care to state employees, retirees and their families. The Wisconsin Hospital Association believes that review by the Joint Finance Committee, including authority to approve or reject a contract for self-funding, is critical in ensuring transparency for all stakeholders, including providers," according to WHA President/CEO Eric Borgerding.

State lawmakers have been seeking additional oversight of decisions made by the Group Insurance Board after three studies were commissioned by the State to look at self-funding the state employee health plan. The three studies varied in their analysis of the impact of self-funding on the state budget, ranging from an estimated $100 million in additional costs to an estimated $40-$50 million in potential savings.

"A fundamental change to the State employee health plan, such as moving to a self-funded model, could pose significant risk to the state’s budget and for Wisconsin’s health care market. WHA acknowledges the work of Senator Alberta Darling and Representative John Nygren for their steadfast commitment to this important issue," said Borgerding.

The state group health plan covers over 245,000 lives, including 69,000 active state employees and their dependents, 26,000 retired employees and their dependents, and 15,000 active and retired local employees and their dependents. The GIB reviews and approves changes to the group health plan. The Board’s next scheduled meeting is in February 2016, but members discussed meeting prior to that date in special session to ask additional questions about the most recent report from Segal. Read more about the Segal report at www.wha.org/pubarchive/valued_voice/WHA-Newsletter-11-20-2015.htm#5.

A copy of 2015 Wisconsin Act 119 is here: http://docs.legis.wisconsin.gov/2015/related/acts/119.pdf.

Top of page (12/18/15)


WHIO Reminds Providers to Update Registry

The Wisconsin Health Information Organization (WHIO) launched the provider registry so it can offer a more efficient and less error-prone process for making corrections to the provider information in the WHIO Health Data Mart and public reporting. The provider registry is currently open for the reporting period of 10/1/2013 - 12/30/2015.

The site will auto-populate the physician data from WHIO’s data mart. Clinic managers or their designees then have the opportunity to make edits or simply validate the data. The resulting data will go directly into the WHIO data mart and be used to improve the accuracy in reporting. This eliminates potential errors inherent in the process when corrections are emailed and WHIO staff then must enter the corrections. The online registry will be the only source for provider information, therefore it is critical to the overall accuracy that this information is validated by the appropriate medical system designee.

To access the WHIO Registry, contact Mahlet Nigatu (contact information below). WHIO will provide the appropriate person in each organization with instructions for obtaining a login and how to use the registry. This is entirely voluntary, but it will be the only means of providing corrections if the billing data sent to payers is incorrect or incomplete.

Updates must be made in the registry by the close of business Friday, January 15. For more information contact Nigatu at 608-442-3881 or mahlet.nigatu@wisconsinhealthinfo.org.

Top of page (12/18/15)