March 25, 2016
Volume 60, Issue 12


Kolste Discusses Recently-Enacted Laws with WHA Public Policy Council

As a medical technician for several decades and the wife of a family physician, Rep. Debra Kolste (D-Janesville) understands hospitals are “one of the biggest [economic] drivers in the state.” Kolste’s experiences give her a unique and informed perspective in her role as a second-term legislator and the ranking Democrat on the Assembly Health Committee.

At the WHA Public Policy Council meeting March 24, Kolste discussed a number of laws that made their way through the Legislature this session. Referring to this session’s bill for worker’s compensation that Gov. Scott Walker signed into law February 29, Kolste said “I think it works well...[W]e found a compromise that everyone got on board with.” The new law, Act 180, includes provisions agreed to by management and labor representatives of the Worker’s Compensation Advisory Council; importantly, it does not include a fee schedule for medical services and maintains an injured employee’s ability to choose their care provider. Kolste told the Council that some proponents of directed care, which would limit an injured employee’s ability to choose their health care provider, may try including that provision in future worker’s compensation legislation. Kolste said directed care may leave some providers out of the worker’s compensation system.

Kolste also remarked on the ongoing discussions surrounding whether Wisconsin should pursue a self-funded arrangement within the state employee health insurance program. In December, Gov. Walker signed into law Act 119, 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. Kolste supported this legislation and said “we have to be careful” about moving toward self-funding. 

“This is a huge portion of the market that we’re saying we can control. I’m not sure that’s what free markets are about, especially when one group controls most of the market,” she said.

Kolste said she was “privileged to be a co-author” of legislation, signed February 26 by Gov. Walker, that will provide over $2 million in funding to test alternate payment models in the state Medicaid program that encourage mental health care coordination within an integrated health system and promote psychiatric consultations between providers. The new law, Act 153, incorporates many WHA-driven recommendations, and Kolste thanked WHA for its help. Act 153 also will help to reduce emergency room (ER) wait times for individuals who require an inpatient psychiatric bed by funding the creation and operation of an online database and tool that will enable ER staff to more quickly identify hospitals that have an available and appropriate psychiatric bed at a given time.

“Sometimes when people are in crisis, hospitals are not sure where there are available psychiatric beds,” Kolste said. “I think it makes absolute sense to try pilot programs to handle crises—to take over-utilizers and find a better and cheaper way to drive outcomes.”

Kolste said she was “on board right away” with the Interstate Medical Licensure Compact, WHA-backed legislation signed into law December 14 that will create a voluntary, alternative, expedited process for a physician to receive a Wisconsin license. Kolste predicted the Compact “will be a valuable tool” in removing red tape in the medical licensure process.

Kolste also discussed how important it was that the 2015-17 budget made the Medicaid Disproportionate Share Hospital (DSH) program an ongoing, annual appropriation. She said she realized “how truly important that is, especially that we authorize DSH for hospitals.” She also said the hidden health care tax is an important concern for Wisconsin businesses. If the state cuts Medicaid reimbursement to hospitals and physicians, “this becomes a concern for everyone in the state.”

In the 2013-14 legislative session, Kolste was one of eight Assembly Democrats who voted in favor of legislation that addressed the Supreme Court’s Jandre decision, which clarified Wisconsin’s informed consent law. Kolste said informed consent should not be about “hindsight being 20/20,” since medicine is as much an art as it is a science. Kolste said it is impossible to tell a patient what diagnoses a physician has absolutely ruled out and all the alternate modes of treatment.

WHA President/CEO Eric Borgerding thanked Kolste for speaking to the Council, and said, “The remarks you made illustrate how truly bipartisan good health care policy can be. Good policy makes good politics. You’re a good example of this, and we appreciate our working relationship.”

Borgerding Discusses WHA 2016 Strategic Goals
WHA President/CEO Eric Borgerding reviewed the Association’s 2016 goals, which were approved by the WHA Board at their February meeting. He noted that close attention was paid to ensuring the goals are forward looking and successfully align with the Association’s 2014-2018 Strategic Plan. 

“As WHA’s membership has evolved in recent years, so, too, have WHA’s goals,” said Borgerding. “Increasingly, WHA’s proactive agenda and goals have broadened across multiple components of the continuum of care.”

Examples of this evolution include WHA’s goals focusing on physician workforce and engagement as well as a new post-acute care set of goals.

“Issues associated with post-acute, post-discharge care are an area that we have been working on in our quality initiatives, but this year we will establish an agenda for WHA,” Borgerding said. “We plan to weigh in much more heavily in this policy area than we have in the past, including partnering with related associations when possible.”

Borgerding highlighted several issues that are also addressed in the goals, including Medicaid, behavioral health, workforce, physician engagement, health care transparency and federal advocacy. With the legislative session over for 2016, Borgerding said the remainder of this year will also be spent preparing for the 2017 session, including educating legislators and, in the fall, candidates about WHA’s agenda.

Governor Signs Three WHA Legislative Priorities into Law
Matthew Stanford, WHA general counsel, discussed the enactment of three of WHA’s legislative priorities—$2 million in funding for new behavioral health Medicaid pilots focusing on care coordination and reimbursement for psychiatric consults, funding for the creation of an inpatient mental health bed finder, and the Wisconsin Health Care Data Modernization Act. 

In late February at the Bellin Psychiatric Center in Green Bay, Gov. Walker signed into law legislation creating the behavioral health pilot programs and the mental health bed finder. Stanford said WHA has begun discussions with DHS regarding the process for soliciting pilot applicants and implementing the pilots. Stanford also said the launch date for the mental health bed finder is targeted for June 30. The WHA Information Center will develop and operate the bed finder, and participation in the program will be voluntary. 

Stanford said the Governor will sign the Wisconsin Health Care Data Modernization Act at WHA’s Advocacy Day March 30. This bipartisan legislation will improve data tools used by health care providers to assess population and community health care needs and help further streamline Wisconsin’s hospital and ambulatory surgery center data collection program. Stanford said following enactment, the WHA Information Center will work with its Data Advisory Committee and others as it plans and executes an incremental implementation of the updates to the data collection program. 

WHA is also advocating on several administrative rules regarding telemedicine, Advanced Practice Nurse Prescriber (APNP) scope of practice, state hospital regulations and medical malpractice insurance coverage. Stanford provided an update on WHA’s positions and advocacy on MED 24, N8, DHS 124, and INS 17.35(4) respectively.

Worker’s Comp “Agreed to Bill” Enacted; State Continues to Study Self Funding 
Joanne Alig, WHA senior vice president for policy & research, provided updates on worker’s compensation and on considerations for the state employee health care program. Alig noted the Worker’s Compensation Advisory Committee’s “agreed to” bill was enacted into law in February without a fee schedule and without a “directed care” provision that would have removed the ability of an employee to seek care from his or her provider of choice. WHA anticipates these issues are likely to be raised again even though Wisconsin’s Worker’s Compensation Program produces some of the best outcomes in the country. WHA will remain vigilant to protect the current program. 

On the state employee health care program, Alig described the differences between the two studies commissioned by the State with vastly different conclusions about the impacts of changing from the current managed competition model, which has worked well for the State to a self-funded model, which will bring significant risks to the state budget and to the overall health care market. The current program works well for patients in Wisconsin, where providers and insurers work together to manage care and provide high-quality integrated care solutions. Alig also noted the State saved an estimated $89 million in 2016 from changes to medical and pharmacy benefits and insurer negotiations without drastically disrupting the current system. WHA will remain engaged on this issue, which could affect an estimated 15 percent of the entire health care market in the state.

Federal Issues: WHA Pushes HOPD Fix; Engages in MACRA Implementation
Jenny Boese, WHA vice president, federal affairs & advocacy, updated the Council on federal legislative and regulatory activities. She provided insight into WHA’s continued focus and advocacy surrounding the need for a targeted fix to Section 603 of the Bipartisan Budget Act of 2015 on provider-based hospital outpatient departments (HOPDs). Boese also briefly highlighted where things stand with the federal budget process. She updated the Council on WHA’s continued engagement with the implementation of MACRA—the replacement for the old physician reimbursement model known as the sustainable growth rate. Finally, she reminded the Council about the upcoming start date of Medicare’s mandatory hip and knee bundled payment model. In Wisconsin, this Medicare program will begin April 1 in two metropolitan statistical areas (MSAs)—the Milwaukee MSA and Madison MSA.

Wisconsin State PAC and Conduit Sets Strategic Direction
In turning to advocacy-related items, Boese discussed that WHA will undertake a “recalibration” of its political fundraising program. The recalibration is to review all elements of the program, build on that success, and launch new and innovative approaches to fundraising for the Wisconsin Hospitals (WH) State PAC and Wisconsin Hospitals (WH) Conduit. She encouraged individuals to look for the WH State PAC/Conduit booth at WHA’s Advocacy Day March 30 and participate in a WH State PAC/Conduit.


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Attorney General Schimel Confirmed to Keynote WHA Community Health Summit

Attorney General Brad Schimel is committed to doing what he can in partnership with other stakeholders to prevent heroin use and opioid abuse in the state of Wisconsin. He also knows the power of the community health needs assessment (CHNA) process to identify existing and emerging health issues and then bring the right partners to the table to address them and improve the health of residents. 

As district attorney in Waukesha County prior to his role now as the state’s attorney general, Schimel participated in ProHealth Care’s CHNA. That process gave him the opportunity to talk to physicians to describe what he saw at that time as a growing problem with the use of opioids in the community. 

Fast forward to today, and Attorney General Schimel is at the forefront of a statewide campaign, “Dose of Reality” aimed at improving the health and lives of those who suffer from heroin or opiate addiction and to prevent others from this terrible disease.

WHA is pleased to announce Schimel will keynote the WHA Community Benefit/Population Health Summit May 5 in Madison at the Sheraton Madison Hotel. This conference is aimed at helping staff within Wisconsin’s hospitals and health systems develop and implement plans that will improve the health of all Wisconsinites.

The Wisconsin Hospital Association has made it a priority to help hospitals and health systems meet the requirements of the Affordable Care Act related to Schedule H and the CHNA planning and implementation process. The Summit on May 5 will feature state and national experts who will share their expertise in the areas of compliance, the CHNA process and best practices. 

Topics and speakers in addition to the Attorney General include:

    “Creating and Sustaining Local Partnerships that Improve Community Health”
    Karen Timberlake, Director, UW Population Health Institute
    
    “Wisconsin State Health Plan: Working Together Toward a Healthier State”
    Karen McKeown, RN, MSN, State Health Officer and Administrator of Public Health

    “Building Collaborative Relations Across County Lines”
    Kevin Stanberg, Director of Public Relations, Memorial Medical Center, Ashland

    “Get on the Bus: From CHNA to Action!”
    Paula Morgen, Community Health Manager, ThedaCare
    Kurt Eggebrecht, Director and Public Health Officer, Appleton Health Department


    “Schedule H, CHNAs and Implementation Plans: An Update on Collection and Reporting Requirements”
    Trina Hackensmith, Vice President, Lyon Software

    “WHA Update: Collecting and Reporting Community Benefits”
    Jenna Hanson, WHA Community Benefits Liaison
    Mary Kay Grasmick, WHA Vice President, Communications


WHA members are encouraged to invite public and community health partners and participate in this Summit as a team. The fee for the Summit is $150. A small room block is available at the Sheraton Madison Hotel. Call 608-251-2300 to make a reservation. Registration information is available at: https://events.SignUp4.net/16CBSummit0505

For questions about the Summit, contact Mary Kay Grasmick at mgrasmick@wha.org. Direct registration questions to Kayla Chatterton at kchatterton@wha.org.

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Doeringsfeld Joins WHA Information Center

WHA is pleased to announce Jean Doeringsfeld will join the WHA Information Center (WHAIC) as vice president beginning April 4. She will lead the day-to-day operations of WHAIC and direct the ongoing work of the organization to improve the way health care data is collected and used to be more efficient, meaningful, accurate and timely.

Doeringsfeld has been the chief operating officer with the Wisconsin Statewide Health Information Network (WISHIN) for the last five years overseeing operations including marketing, contracting and policy development. She also served as WISHIN’s privacy and security officer. Prior to that, she worked with the Department of Health Services in leadership positions focusing on Medicaid integrity, project management, contract management and information technology.

“Jean will be a key part of the WHAIC team, and her leadership will be very important as we evolve as an organization. Her background and operational skills will help WHAIC continue to meet the growing data and analytics needs of our members and other data-driven organizations,” said WHA Senior Vice President Brian Potter.

Doeringsfeld has a bachelor’s degree in computer information systems from UW-Stevens Point and an MBA from the University of Wisconsin-Madison.

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The Other March Madness 
Resident Match Day results


The big day for senior medical students came March 18 when they learned where they will be taking the next step in becoming practicing physicians. The National Resident Matching Program (NRMP) announced the results of pairing 40,000 medical student applicants to 27,860 first-year residency positions. 

Applicants included 20,000 continental United States allopathic and osteopathic medical school seniors of whom 94 percent matched, 80 percent of whom secured one of their first three program choices. U.S. citizens graduating from international medical schools had a match rate of 54 percent, while nonresidents had a match rate of 51 percent.

Nationally, programs in dermatology, orthopedics, vascular surgery and radiation oncology filled all their positions in the initial match. Family medicine filled 95 percent of their 3,238 positions. All of Wisconsin’s primary care first-year positions have been filled.

Similar to the experience of the last few years, 40 percent of graduates of Wisconsin’s two medical schools will be starting residency programs in primary care. Thirty percent of all Wisconsin school graduates, regardless of specialty, will be entering a residency program located in Wisconsin. Of the nearly 370 medical students graduating from our two state medical schools, all but a handful secured a residency position and are pursuing alternative plans.

“It is important to remember that the probability of a graduate of one of our two medical schools entering practice in Wisconsin increases from less than 40 percent to over 70 percent if they do their residency training in a program located in our state,” noted Charles Shabino, MD, WHA chief medical officer.

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Save the Date for WCMEW Statewide GME Summit, May 25

The Wisconsin Council on Medical Education and Workforce (WCMEW) will host a summit, “Getting It Done: Status Report on Expanding GME in Wisconsin,” May 25 at Glacier Canyon Lodge at The Wilderness Resort in Wisconsin Dells.

The Summit will showcase those who have been at the forefront of expanding graduate medical education (GME) in Wisconsin and in other parts of the country. The event will help attendees understand the successes, challenges and lessons from Wisconsin’s GME grant recipients as they implement new programs. Attendees will also increase their knowledge of how GME programs have overcome resource and distance challenges by creating rural training tracks, making use of distance learning and finding innovative approaches to faculty development.

The full event agenda and registration information will be available in early April. Mark your calendar today and plan to attend this unique and informative one-day event May 25.

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Health Care Coalition Equips Hospitals with Portable UV Lights
Lights being used as an additional and final step in current ambulance cleaning practices

As reported in the March 18 edition of The Valued Voice, WHA works with hospitals to decrease infection rates through the implementation of best practices. Infection prevention, however, is a priority not just within hospital facilities but also in ambulances. This is evidenced by a recent initiative of the Western Health Care Coalition (WHCC) to equip every hospital and certain ambulance services in the western part of the state with portable UV lights to assist with ambulance disinfection.

The WHCC is a group of health care organizations and emergency preparedness partners (e.g., hospitals, EMS, trauma and public health) in Buffalo, Trempealeau, Jackson, La Crosse, Monroe, Vernon and Crawford Counties that collaborate for the common goal of uniform and unified response to a medical surge emergency. After discussions with hospitals and ambulance services in the region, the WHCC decided to invest in the portable UV lights as a part of the regular cleaning practices of ambulances. 

With hospitals’ access to these lights, the ambulance can use this additional cleaning tool when it is at the hospital after transporting a patient. Alternatively, the ambulance can set up a time to go to the hospital to use or borrow the light. The lights can be used to kill certain bacteria, including MRSA, in less than an hour.

If you have questions regarding emergency preparedness or health care coalitions, contact Andrew Brenton, WHA assistant general counsel at 608-274-1820 or abrenton@wha.org, or visit: www.wha.org/emergencyPreparedness.aspx.

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Member News: Bernie Sherry to Lead Ascension Wisconsin

Bernie Sherry has accepted the role of senior vice president, Ascension Health/Wisconsin Ministry Market executive, effective April 4, 2016. Sherry currently serves as chief operating officer of Saint Thomas Health in the Ascension Nashville Ministry Market. Sherry will replace Vince Caponi, who has served as interim Wisconsin Ministry Market executive since January 1.

“Ascension has been a longstanding contributor to the health and economic activity of Wisconsin through these mission-focused health systems, which combined employ more than 24,000 dedicated associates including more than 1,000 medical group physicians,” Sherry said. “As a strong community partner in regions across the state, Ascension Wisconsin is focused on meeting the health care needs of individuals and communities, providing compassionate, personalized care to all persons, especially those living in poverty and who are most vulnerable. I’m looking forward to leading the health systems of Ascension Wisconsin as we work even more closely together to improve the health and well-being of Wisconsin residents.”

Previously Sherry served as executive vice president, system integration, Saint Thomas Health, and president/CEO of Saint Thomas Midtown and West Hospitals. Earlier, as president/CEO of Saint Thomas Midtown Hospital beginning in 2003, he focused on building a culture of high reliability, resulting in strong operational results. In 2013 he led operational and strategic integration of the West and Midtown hospitals as Saint Thomas Health created a unified identity across the region. Sherry joined Saint Thomas Health in 2000, first serving as vice president of managed care.

Prior to joining Saint Thomas, Sherry held increasingly responsible leadership roles at Greenville Health System, a 1,100-bed, multi-hospital system in South Carolina. He earned his bachelor’s degree from Gannon University, Erie, Pennsylvania, and his master’s degree in health administration from the Medical University of South Carolina.

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Is Your Benefits Program Multi-Generational?

Did you know that millennials have become the nation’s largest living population? Millennials, also known as “Gen Y,” are projected to surpass 75 million this year. In fact, more than 1 in 3 American workers is a millennial. That means millennials—those workers age 18-34—have the largest share of the country’s workforce, and this number will only increase as more finish college and enter the workforce. That’s a big deal for employers, and here’s why.

Every generation has their own unique set of characteristics and expectations. Millennials are no different, which is why it is important for employers to know more about this group and, more importantly, how to recruit them. 

According to recent research by the Society for Human Resource Management, just under half of all millennials consider their overall benefits package to be very important toward their job satisfaction. So, let’s take a look at what matters most to millennials when choosing their benefits:

Millennials challenge employers to provide a benefits program that appeals to the unique needs of their generation. When this challenge is met through a combination of core benefits (such as medical, dental, and retirement) and voluntary benefits (such as accident, critical illness, and supplemental life insurance), employers find that they end up with a benefits program that appeals to the needs of the individual, regardless of the generation. How? By allowing employees to choose from a variety of benefits that can be customized to their specific needs.

Embracing some of these concepts in your organization’s recruitment, retention, and communication efforts will help you become more appealing as an employer to all generations and will help you build a stronger connection with the powerful millennial generation.

About ISG Advisors
As WHA’s Premier Partner, ISG Advisors goes above and beyond to help hospitals balance employee needs with the cost of employee benefits. Through strategic planning, professional services and technology-based solutions, ISG can help reduce benefit costs, increase efficiency and improve employee satisfaction—bringing your employee benefits program to new heights in quality and performance. Learn more at www.isg-advisors.com/wha.html.

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