March 27, 2015
Volume 59, Issue 12


Congress on Verge of Fixing SGR Once and For All
House approves with large 392-37 bipartisan vote


Intense negotiations continue in the U.S. House and U.S. Senate on repeal of the much-maligned Sustainable Growth Rate (SGR). This week, members of the U.S. House Republican and Democratic leadership unveiled a negotiated package, H.R. 2, which would permanently address this issue. The House then approved passage of the package on March 26, by an overwhelming bipartisan vote of 392-37. Wisconsin’s House Members voted as follows: WHA expressed support for the SGR repeal package earlier this week based on the following reasons: it finally addresses full and complete repeal of SGR, the package moves Medicare physician payments toward value, the package includes important Medicaid and Medicare program extensions and the package mitigates the negative impact of provider cuts. 

“The Wisconsin Hospital Association appreciates the tireless work by Congress over the past few years to once and for all repeal Medicare’s Sustainable Growth Rate (SGR). The replacement package, 
H.R. 2, crafted by Congress and passed overwhelmingly by the U.S. House of Representatives, includes important policies that move Medicare physician payments toward value,” said WHA President/CEO Eric Borgerding in a statement. “In the context of a truly permanent solution to the SGR, we believe the package as a whole fulfills a hard-fought effort to achieve a very important, long-term goal.”

Read Borgerding’s President’s Column this week, WHA’s letter on the SGR package and WHA’s full statement on House passage for additional insight. 

Background - SGR Package 
Under the House-approved proposal, the SGR formula would be repealed and replaced with a series of stable payment updates for physicians over the next decade. Additionally, the negotiated package would consolidate multiple programs—the physician quality reporting system, electronic health record and value-based modifier programs—into one program called the Merit-Based Incentive Payment System (MIPS). 

Also included in the package are key programs of importance, including a two-year extension of the Children’s Health Insurance Program and important Medicare extender policies, like the Medicare Dependent Hospital program and the low-volume hospital adjustment. Important to note are items that were excluded from the package, including rejection of another delay to ICD-10 implementation.

The hardest work to date by Republican and Democratic leaders in the U.S. House has been on how or whether to fully pay for this package. While the entire packages costs in the realm of $210 billion, roughly $70 billion of that cost will be paid for under the negotiations. Those costs will be split between Medicare structural reforms and Medicare provider payment reductions. With respect to structural reforms, the package includes changes to certain Medigap plans and allows for targeted means-testing for certain high-income Medicare beneficiaries. 

Reductions to hospitals and other providers will make up the rest of the cuts. Hospital inpatient rates under the Prospective Payment System were to have seen a one-time increase in fiscal year (FY) 2018. That increase will be slightly reduced and then spread out over the next six years. Post-acute care providers will also see a reduced market-basket increase for FY 2018 and Medicaid Disproportionate Share Hospital reductions (already in law) will be pushed out another year and then increased in subsequent years. 

Over the years, WHA has supported full repeal of the SGR and encouraged Congress to replace it with more valued-based payments. The package as it currently stands moves forward with this policy approach. In terms of paying for the plan, WHA has repeatedly opposed cuts like “site neutral” or bad debt reductions, which have all been excluded from the negotiated package. 

The U.S. Senate must now approve this package, which is anticipated in April. President Barack Obama has indicated he will sign it into law. 


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Team-Based Health Care Scores Big with Patients
Hospitals, health systems find new care delivery models alter workforce needs


The magic of University of Wisconsin men’s basketball coach Bo Ryan is in his ability to strategically place the right players on the floor at the right time throughout the game to optimize the team’s opportunity to win. Wisconsin hospitals and health systems are following a similar principle, and that is to provide the right care, at the right time, at the right place. Increasingly, they are finding team-based care can lead to winning results, both in terms of patient satisfaction and better health outcomes. 

A new report released March 24 by the Wisconsin Hospital Association (WHA) sees multi-disciplinary teams as one way to ensure that patient care will continue to be accessible, affordable and effective, especially for those with chronic or complex diseases. The report suggests that Wisconsin’s ability to meet an increased demand for care will require finding new ways to deliver care more efficiently, along with being able to recruit, educate and retain an adequate workforce. See the 2014 WHA Workforce Report at: www.wha.org/pubarchive/reports/2014WorkforceReport.pdf.

The WHA report is based in part on its annual survey of 150 hospitals, health systems and specialty hospitals. The survey found health care employees are older than the general Wisconsin workforce. Almost 20 percent of the people who are employed in hospitals in professional occupations are age 55 or older. Nearly a quarter of the nurses employed in hospitals are over 55 years of age and more than 30 percent of the nurses in ambulatory care settings are over 55 years old. The anticipated shortage of registered nurses has eased in part because nurses have extended their working careers by delaying retirement. 

“Health care workers are older, and the competition to attract young people to a health-related career is intense,” according to Judy Warmuth, RN, PhD, WHA vice president, workforce development. “As those employees retire, it is going to create a new round of personnel shortages. Developing effective workforce strategies will require hospitals, policymakers and the academic community to work together to create an educational and regulatory structure that will support tomorrow’s workforce.” 

The highest vacancy rate was for advanced practice nurses (APNs) at 9.7 percent. Hospitals are creating new positions for advanced practice professionals, which includes APNs, certified registered nurse anesthetists and physician assistants. Many hospitals reported that positions for APNs are their most difficult vacancies to fill. APNs may practice in the emergency room, urgent care, specialty nursing units or as hospitalists, and they are frequently included in team-based patient care models. 

Shifts in where patient care is taking place are also influencing the job requirements for many positions. Technological advances have allowed more surgeries and procedures to be performed in outpatient settings; however, the WHA report suggests that education and training models for health care workers may not be keeping pace with the changes. In the past, acute care hospitals have provided the vast majority of training sites for health care professions, such as nurses, physical therapists, surgical technicians, etc., who must complete a rotation in a clinical setting, according to Warmuth. 

“The decrease in the number of patients receiving inpatient care has not reduced the number of students, but it has increased the competition for clinical learning experiences in hospitals,” Warmuth said. “New, innovative and outpatient-focused learning must be designed, implemented and utilized to ensure future health care workers are prepared to practice in the environments where care is increasingly being provided.” 

According to WHA, 108,900 people were directly employed by a hospital in November, 2014. That makes hospitals one of Wisconsin’s biggest employers. However, since 2011, the number of employees in outpatient settings has exceeded the number employed in acute care hospitals, with 119,900 workers in ambulatory health care facilities in 2014. According to the WHA Information Center, more than 70 percent of all surgeries and medical procedures are performed in outpatient and ambulatory care environments. 

“The future of health care is based on creating value for patients, employers and payers,” according to WHA President/CEO Eric Borgerding. “Wisconsin hospitals and health systems are well-positioned to thrive in this new world, but the availability of a workforce that is highly trained and of adequate size is critical, whether the care is provided in a hospital, clinic, or through telemedicine.” 

In developing what is considered to be one of the most complete reports in the state on Wisconsin’s health care workforce, WHA obtained data from the WHA Information Center and several state and federal sources. However, in the report, WHA recommended that the state improve and expand their data collection capabilities to provide the type of analysis and supply/demand forecasts that are required by those tasked with the complex duty of staffing hospitals that provide care 24 hours a day, 7 days a week. 

“A workforce plan requires accurate workforce data and, to some degree, an ability to predict the future,” according to Borgerding. “In an industry that is changing as rapidly as health care, one thing is certain—organizations that are committed to providing high-quality, high-value care, as we are in Wisconsin, are developing strategies now to ensure they will be able to meet the health care demands of people living in their communities today and in the future.” 

A direct link to the news release and report is here: www.wha.org/nr3-24-15WorkforceReport.aspx.

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Guest Column: Seize Your Opportunity to Rate WHA’s Effectiveness and Value
By Therese Pandl, WHA 2015 Chair


In this time of rapid cycle change in our industry, the effectiveness of WHA’s voice is critical. WHA conducts a survey of the full membership about every two years, with the intention of staying aware of the members’ changing needs and priorities and getting a clear picture of what WHA should be doing to address those member priorities. 

WHA will again conduct this survey in April. I encourage you to carve out some time to provide WHA with your ratings and comments on a variety of essential topics. On April 1, one executive at each member hospital and health system will receive an invitation to complete the survey online. The survey will only take 10 minutes to complete, but the feedback is essential to tee up the future priorities of the Association. 

Member participation in the confidential survey is critical to the success of this effort. Significant participation, followed by incorporation of survey findings into WHA’s current and future programming, can only enhance member value. The collective opinions and ratings will be reviewed by the WHA senior management team, shared with you, and be used by the WHA Board for strategic planning later this year.

This is your opportunity to rate WHA’s effectiveness and value. Please take full advantage of it and provide your feedback.

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Rush Named WHA Vice President, Workforce and Clinical Practice

Steven Rush, RN, PhD, joined WHA’s staff as vice president, workforce and clinical practice as of March 23. Rush brings more than 30 years of combined nursing, education and clinical experience to this key position in the WHA government relations department.

Rush comes to WHA from Herzing University where he was dean of health care, and he had oversight of the associate of science nursing program (ADN), the RN-to-BSN bridge program, the traditional BSN program and the LPN, medical assisting service, and nurse aid training (CNA) programs. While at Herzing, he improved the school’s NCLEX-RN exam pass rate from 42 to 92 percent, while doubling enrollment in the RN program. 

Rush served on the Wisconsin State Board of Nursing and chaired the education and licensure committee. In addition, he has authored or co-authored several white papers, including a white paper on “Increasing the BSN Workforce in Wisconsin.” 

“We are very pleased to have Steve join WHA. He brings not only clinical knowledge to our team, but immense experience in health care education that will enhance our ability to develop statewide strategies that will ensure we have an adequate, well-trained health care workforce in an ever-changing environment,” said WHA President/CEO Eric Borgerding. “Steve’s experience and skill sets will be an asset not only on our public policy work, but also to WHA’s quality improvement initiatives.”

Rush received both his PhD in nursing and a dual pediatric nurse practitioner and clinical nurse specialist master’s degree from the University of California, San Francisco. He holds a B.S. in speech communications from Southern Illinois University and a diploma in nursing from Augustana Hospital School of Nursing in Chicago.

Contact Rush at srush@wha.org, or call 608-274-1820. 

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President’s Column: SGR: “Better a Diamond with a Flaw than a Pebble (With Another 'Patch')”

Typically this time of year we are reporting another 9 to 12-month delay, or “patch,” of the SGR’s 21 percent physician payment cut, financed by years-long cuts to hospital reimbursement. But on March 26 that changed with the U.S. House of Representatives overwhelmingly passing H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015. The SGR was created 18 years ago, and has been delayed/patched17 times! Though certainly not perfect, H.R. 2 is an historic opportunity to bring this absurd Sword of Damocles to an end, and it has WHA’s full support (see WHA’s letter to Congress at www.wha.org/pdf/SGR-Ryan3-25-15.pdf). 

Over 18 years the SGR has amassed much baggage, and bringing this behemoth to an end involves many moving parts. The package adopted yesterday would, in fact, permanently repeal the SGR, but also keeps provider-focused “pay-fors” to a relative minimum, strategically allocates those pay-fors over time, extends important hospital reimbursement programs and children’s health coverage, delays/allows us to keep fighting other damaging policies—and DOES NOT delay ICD-10 (for more details see article above).

That’s the how of this SGR package, here’s our why—given that as many as 80 percent of physicians in Wisconsin are employed by, or closely affiliated with, WHA’s member hospitals and health systems, “they is us” to a large extent. Hits to one are felt by the other, and perhaps nowhere more so than in Wisconsin given our levels of local and regional partnership and integration. Here, Peter and Paul are brothers (or close step brothers), and bringing a relatively balanced end to the cuts that finance this annual crisis is of significant long-term, positive consequence to our member hospitals, health systems and physicians. 

There is clear momentum to get this done, but hurdles remain. The Senate will not take up the bill until after a two-week recess—plenty of time for mischief. Passage in the Senate will require a bipartisan coalition, and some want to spend more, others want to pay for more, and providers could still be caught in the middle, again holding more of the “pay-for” bag.

Bottom line....hospitals and health systems have paid enough for SGR patches, and the time is now to end this nearly two-decade game of Kick the Can. 

The perfect is often the enemy of the good, and perfect politics is an oxymoron. When it comes to the SGR, it’s time to stop paying for the annual promise of an impossible perfect. Let’s get on, and move on, with the good and put H.R. 2 on the President’s desk. 

Eric Borgerding
President/CEO

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New WHA “Cut Hidden Health Care Tax” Page Goes Live

In WHA’s continuing efforts to educate and advocate on the negative impacts of Wisconsin’s “hidden health care tax,” WHA unveiled a new web page on the issue. At the page, readers can access relevant issue papers, WHA’s ongoing “Medicaid in the Spotlight” series, advocacy information and recent articles. Go to www.wha.org/HiddenHealthCareTax.aspx.

The Hidden Health Care Tax amounts to $960 million annually in Wisconsin and is a result of underpayment by the State’s Medicaid program to hospitals. On average, hospitals are paid 65 percent of the actual cost of providing care. Unfortunately, Wisconsin’s Medicaid program reimbursement is second to last in the country, something WHA is working to change. 

Additional information on Medicaid overall is also available at WHA’s Medicaid page at www.wha.org/medicaid.aspx

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ETF Consultant Recommends Self-Funding State Employee Health Plan Beginning 2017
Conflicting state studies paint an uncertain picture


Segal Consulting, a benefits consulting group hired by the State, released a report estimating the state could save $50 million to $70 million annually by self-insuring state employees. The report, presented to the State Employee Trust Funds’ Group Insurance Board on March 25, is the first of at least two reports expected by the consulting firm. 

The Segal report comes just over 18 months after the state procured two separate analyses from Deloitte Consulting, both of which indicated significant risks of self-funding, including that the current managed competition model is providing savings to the state that could be lost by moving to a self-funding model. Deloitte estimated that the state could save up to $20 million, but also could incur costs of up to $100 million by self-insuring state employees. 

Unfortunately, the Segal study provides little analysis to understanding the savings estimate and simply lists reasons why employers in general may want to self-fund. Segal expects to provide a more detailed report to the Group Insurance Board in May. As a preview to the second report, they indicate that self-insuring all of the 18 existing health plans would be difficult, but they could consider administering the program through a combination of health plans or through a single network provider and third party administrator.

Segal recommends that the Employee Trust Fund (ETF) prepare for self-funding in 2016 by capturing additional data from health plan submissions. Segal indicates they believe such changes are “imperative” to preparing for self-insurance. 

In the meantime, the Governor’s proposed biennial budget documents would require ETF to find 
$25 million in state savings but isn’t prescriptive in how they accomplish those savings. Segal has several recommendations, short of a self-funding option, that could achieve more than $60 million in savings over the biennium. These include:

Other recommendations Segal made for the 2016 benefit year include enhancing quality and efficiency metrics; adopting a premium credit for participation in wellness programs with increases in rates for those who don’t participate; obtaining pricing guarantees from the pharmacy benefit manager; and improving use of the Wisconsin Health Information Organization’s ability to meet ETF data needs. 

Segal is expected to return to the Group Insurance Board in May with a more detailed report, particularly on the self-funding recommendation.

The Segal report and presentation can be found at: 
www.wha.org/pdf/SegalReport1.pdf
www.wha.org/pdf/SegalReport2.pdf

The Deloitte reports can be found at:
www.wha.org/pdf/DeloitteReport1.pdf
www.wha.org/pdf/DeloitteReport2.pdf

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Grassroots Spotlight: Sen. Lazich Meets with Hospital Leaders at Wheaton Franciscan-Franklin

Sen. Mary Lazich met with hospital leaders at Wheaton Franciscan Healthcare-Franklin. The discussion focused on state budget issues, including the Medicaid program and Disproportionate Share Hospital funding. The group further discussed funding approaches that could be used in Medicaid to target key primary care physician services and behavioral health services. 

In addition, the group spent time on the U.S. Supreme Court case, King v. Burwell, which could have profound impacts on Wisconsin’s plan for coverage expansion. At issue in this case is whether or not premium subsidies can be granted to individuals in states that elected not to create a state-based insurance exchange but rather have their citizens get coverage through the federal exchange, as Wisconsin elected to do. In this situation, individuals purchase coverage on the federal exchange and then receive premium assistance in order to afford the costs of the coverage. In Wisconsin, 207,000 individuals purchased coverage on the federal exchange and 89 percent of those—185,000 people—are between 100 percent and 400 percent of the federal poverty line and qualify for premium subsidies. This means that approximately 185,000 individuals would lose subsidies (and likely ability to afford coverage) under an adverse Supreme Court ruling. 

Lazich expressed concerns with the extent of those potential impacts and asked the Wisconsin Hospital Association and hospital leaders to keep her informed.

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Grassroots Spotlight: Ministry’s Mercy Medical Center (Oshkosh) Hosts Cong. Grothman

U.S. Rep. Glenn Grothman visited the Cancer Center at Mercy Medical Center in Oshkosh March 13. During his visit, Grothman was able to learn more about the Center, treatment options and the mission to serve cancer patients. 

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Advocacy Day 2015 – April 28: Join the 700 Already Registered to Attend

More than 700 hospital supporters have already registered and made plans to attend WHA’s Advocacy Day 2015 on April 28 in Madison. Advocacy Day is one of the best ways hospital employees, trustees and volunteers can make an important, visible impact in the State Capitol. You won’t want to miss this opportunity, so join your colleagues and register today at http://events.signup4.net/15AdvocacyDay0428.

Tucker Carlson, a nationally-known veteran journalist and political commentator, will kick off the day with an insider’s view on Washington, D.C. and a look ahead to the 2016 elections. A bipartisan legislator panel discussion will wrap up the morning session, and Gov. Scott Walker has been confirmed as the luncheon keynote speaker.

The highlight of Advocacy Day is always the hundreds of attendees who take what they’ve learned during the day and then meet with their legislators in the State Capitol in the afternoon. During Advocacy Day, the State Legislature will be in the thick of determining the state’s biennial budget bill. This means Advocacy Day attendees have the opportunity to meet personally with their legislators or legislative staff to advocate for policies that keep Wisconsin hospitals and health systems strong so they can continue to provide high-quality, high-value care. The day will include an issues briefing for attendees before heading to the Capitol for scheduled legislative meetings. Optional pre-event webinars are also available for those going on legislative visits. 

Although the event is only four weeks away, there is still plenty of time to register for 2015 Advocacy Day, taking place at the Monona Terrace Convention Center in Madison. Event and registration information at: http://events.signup4.net/15AdvocacyDay0428

For Advocacy Day questions, contact Jenny Boese at 608-268-1816 or jboese@wha.org. For registration questions, contact Jenna Hanson at jenna.hanson@wha.org or 608-274-1820. 

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American Hospital Association Annual Meeting 
May 3-6 in Washington, DC 


The American Hospital Association (AHA) Annual Meeting will be held May 3-6 in Washington, D.C. The AHA Annual Meeting provides programming and networking opportunities. In addition, WHA will host several Wisconsin member events during this meeting. Those WHA events include a luncheon issues briefing, a members-only dinner and scheduled Hill visits with Wisconsin’s Members of Congress.

Every year Wisconsin hospital leaders provide essential insight to their Members of Congress during their Capitol Hill visits. WHA briefs attendees on issues and facilitates all Hill meetings on your behalf. WHA encourages you to participate in this important portion of the trip. 

For more details or to register for the AHA Annual Meeting, log onto www.aha.org/advocacy-issues/annual-meeting/15-index.shtml.

If you are planning to be in Washington for this event, contact Jenny Boese, WHA vice president, federal affairs & advocacy, at jboese@wha.org or 608-268-1816 for details about WHA’s member events.

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HHS Releases EHR Meaningful Use Stage 3 Proposed Rules

The federal Department of Health and Human Services (HHS) published its proposed Stage 3 electronic health records (EHR) meaningful use rules as well as its proposed 2015 Certified EHR Technology (CEHRT) rules on March 20. Final rules are expected later this year.

The rules propose that by 2018 all hospitals’ and eligible providers’ EHRs must meet the 2015 CEHRT standards and the Stage 3 meaningful use standards. Under existing rules, hospitals and eligible physicians are subject to Medicare payment penalties in 2015 and future years for failure to meet the applicable CEHRT and meaningful use rules. Those penalties increase each year after 2015.

The draft rules provide in part:

As expected, the proposed rules do not include rulemaking promised by HHS in January that would shorten provider reporting periods in 2015 from the entire year to 90 days to address concerns about software implementation, information exchange readiness, and other related concerns in 2015. That rulemaking is still expected this spring. 

Comments on the two proposed rules are due May 29. WHA will be soliciting input from WHA members regarding the proposed rules in the coming weeks to help guide WHA’s comment letter to HHS on the proposed rules. If you have questions or comments on the proposed rules or other meaningful use or EHR issues, contact WHA Assistant General Counsel Andrew Brenton (abrenton@wha.org), or General Counsel Matthew Stanford (mstanford@wha.org), at 608-274-1820.

The proposed meaningful use rule can be found here:
https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-06685.pdf.

The proposed CEHRT rule can be found here: 
https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-06612.pdf.

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2015 Residency Match Results Illustrates Need for More Slots

March madness is not just about basketball. For medical student graduating seniors, it means they will move on to the next stage of their journey to become practicing physicians—namely, being matched with residency training.

At the University of Wisconsin School of Medicine and Public Health (UWSMPH), 36 percent of the 155 graduates entered primary care programs including family medicine, pediatrics and general internal medicine, while 39 percent of the Medical College of Wisconsin (MCW) graduates were matched in similar programs. These results are similar to the national interest in primary care.

The percentage of graduates from both the MCW and UWSMPH staying in Wisconsin for their residency training were similar, both at 37 percent.

“WHA’s physician workforce report in 2011 indicated that the probability of a physician choosing to practice in Wisconsin is 70 percent if they attend one of our state’s medical schools and train in a residency program in Wisconsin,” according to WHA Chief Medical Officer Chuck Shabino, MD. “While we would like to see an even greater percentage of our medical school grads staying in Wisconsin for their residency, we must acknowledge that all the primary care residency programs in our state filled.”

Nationally, the match process with residency programs this year offered 27,293 resident positions to 41,334 applicants including 24,298 graduates of U.S.-based medical schools, 6,917 U.S. citizens graduating from international medical schools and the remainder non-U.S. citizens graduating from international schools.

The number of U.S. medical schools graduates participating in this year’s match increased by 1,200, reflecting the recent growth in size of current U.S. medical schools as well as creation of new schools. This increasing output from the medical schools is positive, but it mandates the need to create more residency positions.

Wisconsin examples of this trend are the two new MCW campuses in Green Bay and Central Wisconsin, which when fully enrolled, will add 50 more seniors a year to the applicant pool. The Green Bay campus received more than 2,200 applicants for its inaugural 2015 class that will enroll 25 students. The Central Wisconsin campus is scheduled to enroll its first class in 2016.

While the number of qualified medical school graduates applying for residency positions has increased, the number of available residency positions has not kept pace.

“The increase in the number of U.S. medical student graduates by 1,200 is the good news,” Shabino said. “The bad news is that the number of available residency positions in all specialties increased by only 400, leaving some qualified graduates unable to continue their training—a problem that will only increase in the future if more residency positions are not created.”

The Wisconsin Department of Health Services has provided grant funding to both expand existing residency programs and create new programs in primary care as well as general surgery and psychiatry. When fully implemented, these programs will add 60 new residency positions in Wisconsin.

The physician workforce issue is a high priority for the Wisconsin Hospital Association, whose members employ the majority of Wisconsin’s practicing physicians. 

“The Governor and our state legislators have taken important steps to create new residency positions in Wisconsin,” said WHA President/CEO Eric Borgerding. “The grant programs will go a long way in helping hospitals establish new on-site residency programs that will educate and train primary care physicians who will care for Wisconsin patients and families for years to come. At the same time, we must continue to look for opportunities to expand residencies into more rural and under-served areas to ensure we can meet the demand for health care in all parts of the state.” 

WHA has issued two comprehensive reports that have catalyzed high-level engagement and action among stakeholders interested in expanding Wisconsin’s medical education and training system. See WHA’s most recent report, “100 New Physicians a Year: An Imperative for Wisconsin.”  

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WCMEW Establishes Team-based Care, Post-grad Workgroups
DHS, WCMEW continue to explore GME expansion in NW Wisconsin
 

Wisconsin Council on Medical Education and Workforce (WCMEW) established two new workgroups and reviewed their progress to date on a number of ongoing initiatives at its March 19 meeting in Madison. 

The Wisconsin Department of Health Services (DHS), WCMEW and other partners will continue to explore the expansion of graduate medical education (GME) in northwest Wisconsin. During SFY 2014 and 2015, six organizations were awarded funding totaling over $3.5 million to create programs that will have 60 new GME slots in family medicine, psychiatry, and general surgery. In addition, four organizations were awarded funding of more than $3 million to expand their existing programs by a total of 10 slots, in family medicine, general surgery and psychiatry. Linda McCart, director, Policy and Research Section, DHS, reported that DHS received approval from the Centers for Medicare and Medicaid Services to draw down the Medicaid match for existing programs, thus significantly expanding available funding for this component.

“This initiative is very exciting,” said McCart. “We look forward to working with WCMEW as we continue to bolster GME in critical areas throughout rural Wisconsin.”

One of the two new workgroups established by WCMEW will be a team-based care workgroup, chaired by Sarah Sorum, PharmD, vice president of professional and educational affairs, Pharmacy Society of Wisconsin. The workgroup will conduct research on team-based care in Wisconsin and nationally; plan and convene conferences, including one in 2015; meet with experts and practitioners; and prepare periodic reports for WCMEW and the public.

“As the Wisconsin health care field expands team-based care delivery, WCMEW will continue to monitor, communicate and facilitate innovative approaches across our state,” said Sorum.

The second workgroup, chaired by Sandy Anderson, president, St. Clare Hospital, Baraboo, will address post-graduate training. One of WCMEW’s 2015 goals is to strengthen and expand post-graduate training. The post-graduate workgroup was asked to develop ways to preserve/expand funding in the state budget; address infrastructure needs (faculty development, scarcity of clinical sites, regulatory issues, etc.); and evaluate how inter-professional curricula will affect training. 

“Our GME state funding needs to be preserved, but we also need to look at how we can strengthen the training infrastructure for physicians and other practitioners,” said Anderson.

WCMEW will publish a health care workforce report in 2015. The Council discussed how this project relates to the National Governor’s Association (NGA) project and the Data Collaborative. WCMEW Executive Director George Quinn said the 2015 report would serve as both an update to the 2011 report, “100 New Physicians a Year: An Imperative for Wisconsin,” and as a strategic plan for the health care workforce. Jon Hoelter, Office of the Governor, indicated that the NGA project would result in an infrastructure for developing and maintaining a workforce plan for Wisconsin. Tim Size, executive director, Rural Wisconsin Health Cooperative, said the Data Collaborative, as a WCMEW workgroup, would also play a major role as it creates a process for gathering and analyzing workforce data.

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UW Population Health Institute Releases 2015 County Health Rankings 

Ozaukee County ranks healthiest in Wisconsin, and Menominee County is the least healthy county in the state, according to the sixth annual County Health Rankings, released March 24 by the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute (UWPHI). The Rankings are available at www.countyhealthrankings.org.

The Rankings are an easy-to-use snapshot comparing the health of nearly every county in the nation. The local-level data allows each state to see how its counties compare on 30 factors that influence health, including education, housing, violent crime, jobs, diet, and exercise. Hospitals and health systems find the resources that the County Health Rankings & Roadmaps programs offers to be valuable as they conduct community health needs assessments and develop implementation plans. 

According to the 2015 Rankings, the five healthiest counties in Wisconsin, starting with the healthiest, are Ozaukee, Pepin, Calumet, Florence, and Kewaunee. The five counties in the poorest health, starting with the least healthy, are Menominee, Milwaukee, Forest, Washburn, and Rusk.

“Since the County Health Rankings began in Wisconsin more than a decade ago, we’ve seen them serve as a rallying point for change,” said Karen Timberlake, director of UWPHI in the University of Wisconsin School of Medicine and Public Health. “Communities are using the Rankings to form their priorities as they work to improve health for all their residents.”

Nationally, this year’s Rankings show that the healthiest counties in each state have higher college attendance, fewer preventable hospital stays, and better access to parks and gyms than the least healthy counties. The least healthy counties in each state have more smokers, more teen births, and more alcohol-related car crash deaths. This year’s Rankings also look at the links among income levels, income distribution, and health. 

Across Wisconsin, hospitals are playing a vital role in improving population health. WHA continues to work closely with the UW Population Health Institute to develop and share resources and tools with member hospitals and health systems that will enable hospitals to not only meet the requirements for developing and implementing a health assessment, but to improve the efficiency, effectiveness and overall value of the process and the outcome in Wisconsin communities.

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UWPHI Website Facilitates Health Improvement Collaboration Statewide 

Across Wisconsin, hospitals and health systems are working with local health departments and health-minded community organizations to assess local health needs and select priorities for action. The University of Wisconsin Population Health Institute (UWPHI) has collected and posted the hospital and county health department community health needs assessments to: www.improvingwihealth.org. This website is organized to allow people interested in a particular health priority area to identify other communities across the state that are also working on that priority. 

The UWPHI identified eight key health improvement priorities that were featured in more than 30 percent of the health needs assessments, which were:

WHA also has a number of resources related to community health activities on its www.WiServePoint website posted here: www.wiservepoint.org/Resources.aspx, or contact Mary Kay Grasmick, mgrasmick@wha.org, or Mandy Ayers, mayers@wha.org, or call 608-274-1820.

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