December 9, 2016
Volume 60, Issue 49

Congress Passes Package that Includes WHA-Supported HOPD Mid-Build Fix
WHA in DC to urge final action on mid-build fix

On December 7, the U.S. Senate completed Congressional action on a 1,000 page bill dubbed the “21st Century Cures” package. The Senate supported the bill by an overwhelming vote of 94-5. While the package includes the 21st Century Cures provisions on medical research and innovation, it also includes significant mental health care reform and other stand-alone pieces of legislation. 

One of those stand-alone bills is a targeted fix for certain hospital outpatient department (HOPD) projects caught mid-build when the Section 603 prohibition was enacted last year under the Bipartisan Budget Act of 2015 (BBA 2015). The U.S. House passed the “21st Century Cures” package November 30 by a 392-26 vote. The legislation now awaits President Obama’s signature. 

WHA has been actively working with Congress to see the HOPD mid-build correction enacted into law, including traveling to Washington, DC December 5. WHA and several Wisconsin health care advocates were in DC to urge Congress to pass the provision this year. WHA is pleased that Congress has completed action on this issue before their final adjournment.

“The abrupt enactment of Section 603 last November put many long-planned projects in limbo and brought unnecessary disruption to important service changes and realignments,” said WHA President/CEO Eric Borgerding. “Over a year later, and after much lobbying by WHA and our members, this provision brings a welcome measure of relief and more certainty for some of those mid-build projects. We thank Wisconsin’s House and Senate Members for hearing our concerns and supporting this partial fix.”

Other provisions contained in this package include: 

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WHA Physician Leaders Council Discusses Wide Range of Topics

PDMP, elections, WHA goals input, MACRA and MD retention discussed 

Established in 2014 to help WHA engage in issues that impact not just the hospital, but also the overall continuum of care, the WHA Physician Leaders Council comprised of physician leaders and chief medical officers from across the state, meets quarterly to provide input and direction on member needs regarding physician workforce, engagement and clinical practice opportunities and challenges. The Council met December 7 and focused on several items:

Secretary Dave Ross, Department of Safety and Professional Services (DSPS), Andrea Magermans, deputy director for the Prescription Drug Monitoring Database (PDMP), and Wendy Krause, ePDMP manager with Wisconsin Interactive Network, joined the Council to share DSPS’s plans to enable the interoperable exchange of information between the PDMP and physicians’ meaningful use certified electronic health records. Pursuant to a bill amendment pursued by WHA as a result of discussions between the Council and Rep. John Nygren in 2015, the DSPS Secretary must first certify the PDMP as capable of exchanging information between the PDMP and electronic health records before DSPS may mandate physician use of the PDMP. 

Hospitals and health systems have made significant investments to meet federal EHR certification requirements that enable the exchange of information in standardized formats. Questions and concerns were raised during the presentation regarding DSPS’s PDMP vendor’s plans to charge implementation and usage fees to health care providers that wish to access the mandated PDMP information through an EHR portal rather than the antiquated web-based log-in system. Questions and concerns were also raised regarding DSPS’s PDMP vendor’s plans to not integrate PDMP data into a provider’s EHR and to not make its EHR portal available to all EHR vendors of certified EHR technology at the same time. Instead, current plans are to make the portal available over time to more EHR vendors. 

WHA Physician Engagement and Retention Toolkit

Chuck Shabino, MD, WHA chief medical officer and Matthew Stanford, WHA general counsel, asked for final input from the Council on the WHA Physician Engagement and Retention Toolkit and asked for direction on plans to distribute the Toolkit to WHA member CEOs and CMOs. Shabino and Stanford reviewed the development and input process that occurred in 2016, beginning with the establishment of a 2016 WHA goal to consider the development of such a toolkit as a means to build on WHA advocacy efforts to address physician supply needs at the state level. Shabino and Stanford said this member value-related goal stemmed from four staff observations: 

Wisconsin’s high level of integration – 70-80 percent of Wisconsin’s physician workforce is employed by or contract closely with WHA member health systems. This is much higher than the national average.
Physician retention is a strategic priority for WHA members – Integrated care models are particularly dependent on organizational-level physician retention.
Physician satisfaction and burnout concerns – WHA members are aware of physician satisfaction and burnout concerns being raised by professional organizations. 
Availability of relevant organizational-level strategies to maintain/improve satisfaction – Does Wisconsin’s advanced integrated environment create unique needs for organization-level physician satisfaction strategies and guidance? 

Shabino said the Toolkit is not a one-size-fits-all set of recommendations or best practices, but instead is a set of questions, considerations and resources for member CMOs and CEOs to consider as they review and update their organizations’ unique strategic plans for physician retention. 

The Council approved a recommendation to present the Toolkit to the WHA Board of Directors and to distribute it to WHA member CEOs and CMOs through WHA’s member-only web portal. 

Impact of the Elections on Health Care Policy

Joanne Alig, WHA senior vice president, policy and research, shared WHA’s analysis of the impact the outcome of the November elections will have on navigating the health care issues and how that will shape WHA’s 2017 legislative agenda. 

Alig discussed various elements of the plan put forward by Congressman Paul Ryan and the GOP this past summer including private exchanges, changes to the current subsidy system, insurance underwriting rules and minimum benefits, as well as changes to Medicaid such as replacing the current federal-state system with block grants. 

“WHA has a number of priorities on our plate now that are related to the evolving nature of health care, the continuum of care and the integrated nature of our work,” Alig said. “Coverage is front and center when discussing Medicaid and the implications of changes in the insurance exchange.”

First and foremost in coverage discussions is ensuring Wisconsin does not move backward on the reduction in the uninsured. Wisconsin has one of the lowest uninsured rates in the country and lower than many states that took the Medicaid expansion. 

“We know expanding coverage is a bipartisan aim, but the question is how or if it can be sustained,” she said. “We think about the subsidies that people are receiving that make coverage affordable, and we have to think about how that will be replaced.”

Input on 2017 WHA Goals

WHA is beginning to develop its 2017 goals that will be presented to the WHA Board of Directors in February. Building upon WHA’s evolving and growing role to engage in issues impacting WHA’s members across the continuum of care, Shabino and Stanford sought Council members’ ideas on potential areas of focus and goals that WHA could pursue in 2017 that could help address physician leaders’ needs in our member hospitals and systems. 

Shabino and Stanford also briefly reviewed WHA’s current and previous engagement to help address members’ needs regarding physician issues, challenges and opportunities, and said Council members can continue to provide potential goal ideas and directions to WHA staff in the coming weeks.

Update on Physician Leadership Development Conference and WHA Physician Quality Academy

Shabino reminded the Council about the upcoming WHA Physician Leadership Development Conference on March 10-11 at the American Club in Kohler, which is designed for Wisconsin physicians who have recently taken on a leadership or management role and those who have the potential of taking on that role in the future. He said this year’s speakers will present on communication skills and emotional intelligence as well as physician recruitment and retention strategies for physician leaders. 

Building on the enthusiastic reaction from the Council at its September meeting, Kelly Court, WHA chief quality officer, provided an update on the WHA Physician Quality Academy. Court said that the WHA Physician Quality Academy is intended for physicians and advance practice providers who have an assigned role related to quality measurement and improvement within a WHA member organization, and will provide a basic education on quality improvement tools and principles. She said the Academy will include two non-consecutive days of in-person training and that participants will have access to supporting resources provided by WHA. Two sessions will be offered in 2017: The first set of sessions will be May 10 and July 21, and the second set of sessions will be September 29 and November 3. 

WHA’s MACRA agenda


Physician payment reform under Medicare and CHIP Reauthorization Act of 2015 (MACRA) was the focus of a discussion led by Alig and Court.

Since the last meeting of the Council, CMS promulgated its MACRA final rule, and Alig and Court shared some important changes that CMS made to the MACRA program. Key changes include:
• A delay in cost measures having an impact on payment in the Merit-Based Incentive Payment System (MIPS).
• New “transition year” options for participating in the MIPS path in 2017 that address concerns of an aggressive 
and unrealistic timeline for implementing MIPS in 2017.
• Creation of additional options for participating in the Alternative Payment Models (APM) path. 

Helping to educate members and their physicians has been an important focus of WHA. Alig and Court discussed the two widely attended WHA MACRA webinars that separately focused on the MIPS path and the APM path. 

Stanford and Shabino also previewed a new video developed by WHA to help physician leaders educate their physicians in advance of and during their organizations’ implementation of MACRA. The video resulted from input shared by the Council on the expected challenges organizations will face in preparing physicians for changes under MACRA. Shabino and Stanford said that the video would be shared with members the week of December 12.

WHA Team-Based Care State Regulatory Reform Package

WHA’s members continue to develop new integrated and team-based models of care that utilize non-physician health care professionals in ways that leverage those professionals’ expertise in a team-based care setting. Although models of care are evolving, licensure and scope of practice laws don’t always keep pace.

At the September meeting of the Council, WHA sought input and ideas from the Council on specific changes to Wisconsin laws that could reduce barriers to team-based care that their organizations are currently facing. WHA also sought input on three principles developed to help guide the development of WHA’s reform package and help WHA evaluate other proposals to change practitioner licensure laws, practice policies separate from licensure laws, and payment policies.

The Council reaffirmed the development principles and the current set of proposed reforms that have been developed from input from the Council, the WHA Public Policy Council and individual member input. WHA staff also discussed next steps for a strategy to introduce and pass legislation in 2017. 

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WHA Joins Panel of Experts to Discuss Scope of Practice and Team-Based Care

Wisconsin Health News (WHN) hosted its monthly Panel Series December 6 and focused on scope of practice, team-based care and Wisconsin’s health care workforce. Steven Rush, WHA vice president, workforce and clinical practice, presented along with representatives from the Wisconsin Dental Association (WDA), Wisconsin Nurses Association (WNA), Wisconsin Academy of Physician Assistants, Wisconsin Dental Hygienists Association (WDHA), Wisconsin Council on Medical Education and Workforce, and the Wisconsin Academy of Family Physicians (WAFP). 

Questions presented by WHN Editor Tim Stumm quickly focused the group on discussions of scopes of practice and the collaboration among health care team members. All panelists agreed that collaboration is an essential element of a high-functioning team, but significant differences in how these collaborations can be assured were shared. 

Rush outlined WHA’s active involvement with Wisconsin’s Board of Nursing (BON) in their recent revision of N8; the BON rule that defines and oversees the practice of advanced practice nurse prescribers (APNPs) in Wisconsin. Rush explained that WHA maintains that collaboration is the “cornerstone of team-based care” and, therefore, supported the BON’s decision to maintain the previously existing collaboration language in N8. 

Gina Dennik-Champion, WNA executive director, questioned the inclusion of this language and stated that such language places additional burdens for APNPs working in rural areas and who are not part of a hospital system. Dennik-Champion explained that it can be difficult for those nurses to secure a collaborative arrangement with a physician. Rush described the safeguard such collaboration provides for both patients as well as the provider. 

“As a nurse practitioner, I’ve always valued collaboration and having somebody to collaborate with, somebody to consult with, somebody to refer to, and quite frankly somebody to transfer the care to when it exceeded my education, training or experience,” said Rush. 

In reference to how this important element impacts quality and safety and ultimately led to WHA’s position that the collaboration language should remain in N8, Rush continued that it “was something so important that it needs a safeguard.” 

Kenneth Schellhase, MD, president-elect of WAFP, shared that collaboration among providers is an important tenet of the health care team, and he agreed with Rush that safeguarding measures should be in place.

The existing scope of practice and practice settings of dental hygienists was also discussed by the panel. Linda Jorgenson, past president of the WDHA, briefed attendees on her organization’s intent to introduce legislation that would lift the practice setting restrictions currently in place for hygienists. Wisconsin law outlines eight settings in which a dental hygienist may practice; three of which where practice does not require direct supervision of a dentist. Jorgenson explained that this lifting of setting restriction does not change the actual scope of practice for hygienists, but simply allows that hygienist to deliver the same care in the new setting that is already allowed in three. David Clemens, DDS, WDA president-elect, stated that although final language of the bill being discussed by WDHA has not been shared with WDA, he expects this change in settings to be supported by WDA. 

WHA has reviewed the initial proposals of WDHA and supports the concept as well.

This WHN Panel Series presentation was recorded by Wisconsin Eye and can be viewed in its entirety at http://www.wiseye.org/Video-Archive/Event-Detail/evhdid/11150 . For more information, contact Steven Rush at srush@wha.org  or 608-274-1820.

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WHA Physician Leadership Development Conference, March 10-11, 2017
The American Club, Kohler
Register today: http://www.cvent.com/d/nvq2w6

Early Bird Discount for all registrations received by January 15! 

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Olson Receives ACHE Chair-Elect Nomination 

David A. Olson, FACHE, chief strategy officer, Froedtert Health, Milwaukee, has been nominated as the 2017–2018 chairman-elect of the American College of Healthcare Executives, an international professional society of 40,000 health care executives. Olson served on the WHA Board of Directors from 2003-2014 and chaired the WHA Board in 2010. 

“There is no question that David’s personal engagement with WHA has greatly contributed to our growth and helped build the foundation for our long-term success,” said WHA President/CEO Eric Borgerding. “As he has done for WHA, David will bring the kind of leadership, vision and commitment that will enhance relevance, strengthen value for current and future members and keep ACHE moving forward.”

The election will take place at the Council of Regents meeting preceding ACHE’s 60th Congress on Healthcare Leadership in Chicago in March, 2017. If elected, Olson will serve the first part of a three-year term in ACHE’s consecutive chairmanship offices: chairman-elect, chairman and immediate past chairman. 

Board certified in health care management as an ACHE Fellow, Olson has served on the ACHE Board of Governors since 2014. He also served as the ACHE Regent for Wisconsin from 2004 to 2007; as a member of the Wisconsin Chapter of ACHE board of directors from 2004 to 2009 and in 2011; on the editorial board of the Journal of Healthcare Management, the official journal of ACHE, from 2007 to 2010; and on numerous ACHE committees throughout the years. 

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Webinar Available On-Demand to Satisfy MEB Opioid CME Mandate

A new webinar that provides a comprehensive review of the Medical Examining Board’s Opioid prescribing Guidelines in now available on-demand from the Wisconsin Medical Society. The two-hour program has been approved by the MEB to satisfy a mandate requiring physicians with a DEA number to complete two CME credits on the Guidelines during the current CME cycle, and another two credits during the next cycle. 

The MEB approved the guidelines in July and recently posted an updated version available at http://dsps.wi.gov/Documents/Board%20Services/Other%20Resources/MEB/20161116_MEB_Guidelines_v4.pdf. The new CME requirement is included as part of the 30 CME credits required per biennium for physician licensure, not in addition.

Presented by Michael McNett, MD, “Wisconsin Medical Examining Board Opioid Prescribing Guidelines” is available through the Wisconsin Medical Society. For more information or to register, go to 
https://wismed.inreachce.com/Details/Information/6016a61c-162e-41e0-827c-51711983d88d.

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Grassroots Spotlight: Senate Health Committee Chair Meets With Hospital Leaders in Wauwatosa
Discuss Medicaid Payment, ACA Repeal & Replace

Senate Health Committee Chair and Joint Finance Committee member Leah Vukmir met with hospital leaders from Ascension, Aurora, Children’s and Froedtert December 7 at Children’s Hospital of Wisconsin to discuss several issues impacting Wisconsin’s health care delivery system at both the state and federal level.

Members discussed the importance of maintaining Wisconsin’s coverage gains as the federal government considers “repeal and replace” of the Affordable Care Act. The group also talked about the impact that Medicaid block grants may have on Wisconsin and talked about ensuring that Wisconsin’s base funding for any federal Medicaid block grant does not disadvantage Wisconsin compared to other states.

Every hospital member talked about the importance of Wisconsin’s Medicaid Disproportionate Share Hospital (DSH) program, established in the 2013-15 biennial budget and reauthorized in the last biennial budget. Members said that Medicaid reimbursement, with Wisconsin paying at 65 percent of the cost of providing care, results in significant losses for hospitals. DSH funding has helped offset some of those losses and given members more resources to invest in primary care, social work and care coordination for patients on Medicaid.

Hospital leaders discussed the importance of investing in behavioral health care, including workforce investments and regulatory reform that can result in care being delivered more efficiently. Discussions also included the importance of access to preventive oral health care and reforms to Wisconsin law that keep pace with the evolutions of team-based care.

Vukmir, who also serves as assistant majority leader in the State Senate, was WHA’s 2014 Health Care Advocate of the Year.


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Muralli Joins WHA Quality Team

Shruthi Murali joined the WHA staff where she will working as a quality improvement advisor to hospitals enrolled in the Hospital Improvement Innovation Network (HIIN). Murali has a bachelor of science degree in neurobiology from UW-Madison and a master’s in public health in administration and policy from the University of Minnesota.

“WHA continues to add knowledge and experience to our quality team that is dedicated to our members’ success,” says Chief Quality Officer Kelly Court.

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