November 21, 2012
Volume 56, Issue 47
Zipperer Discusses Health Care Priorities at WHA Public Policy Council
Rich Zipperer, deputy chief of staff to Governor Scott Walker, was the featured speaker at the WHA Council on Public Policy meeting November 20. Zipperer, a former Republican State Senator from the 33rd Senate district, covered a host of key hospital and health system issues in a wide-ranging, interactive discussion.
Opening with a discussion about PPACA’s insurance exchanges, Zipperer noted that Governor Walker had been expressing his concerns about federal involvement in a state-run health insurance exchange for several months prior to his decision last week to defer operation to the federal government.
"Would it even have been possible for us to set up a state exchange and run it the way that we want to?" Zipperer said. "It was really a decision about how best to handle this. The feeling was that we wouldn’t have been able to put our stamp on it either way."
Zipperer noted the Administration seriously considered the strong support for a state-run exchange that was communicated by WHA and other key provider, employer and insurer constituencies. In the end, however, Zipperer said it came down to the Administration believing that with a state-run exchange, the real decision-making authority would rest with the federal government.
Moving forward, Zipperer said the Wisconsin Office of the Commissioner of Insurance (OCI) and the Department of Health Services (DHS) will be in discussions with the U.S. Department of Health and Human Services (HHS) to determine what role the state will have in the federal exchange process.
While the exchange decision was front and center, Zipperer spent as much time covering other hospital and health system issues that are also top priorities for WHA in the upcoming session. Zipperer said the Governor will continue to work on tort reform.
Zipperer indicated there would be forward movement on WHA’s regulatory streamlining proposal. The current regulations have not been substantially updated since the 1980s. The goal of the Administration’s soon-to-be-released proposal is to assure patient safety by making Wisconsin’s hospital regulations consistent with current industry standards.
Discussing tort reform, Zipperer said, "We recognize the risk (the Jandre decision) is to your profession and that it must be addressed by the Legislature." According to Zipperer, "There has been a growing consensus that lawsuits are driving up the costs of health care with no real benefit to patients at the end of the day."
On Medicaid, Zipperer said the Governor demonstrated his commitment to preserving the health care safety net when he added nearly $1.3 billion to the program in his last budget. Zipperer noted that the Governor is putting together his 2013-2015 budget now and remains committed to ensuring proper funding for the Medicaid program. Zipperer said the Administration is interested in continuing to work with WHA on Medicaid-related issues.
"The exchange decision has been made, and WHA’s focus now shifts to affecting its implementation in the appropriate federal and state venues and in a manner that best preserves Wisconsin’s superior health care system," said WHA Executive Vice President Eric Borgerding. "We have another ambitious state policy agenda in 2013, ranging from Medicaid funding to regulatory and tort reform and addressing the primary care physician shortage. We are gearing up for a busy legislative session, and we are pleased to have support from the Administration in many of these areas."
WHA State Policy Agenda Hinges on Health Care Quality, Value
Wisconsin’s high quality, high value health care provides a strong platform for WHA’s state and federal advocacy efforts. "Health care is an economic development asset in Wisconsin, and it gives us a competitive advantage over other states for attracting employers," according to Borgerding. "That theme resonates with many audiences and forms the platform for our 2013 advocacy agenda—enabling our members to achieve superior outcomes."
WHA’s key issues include:
Physician Workforce – WHA praised the news of the Medical College of Wisconsin expanding their medical school campus to Central Wisconsin and Wausau. While recognizing the positive development, Borgerding said attention must be given to ensuring that the medical school graduates have opportunities to complete their medical residencies in Wisconsin (see related story below).
Medicaid – DHS initial budget projections for the 2013-2015 biennium include an estimate of $650 million in state funds needed to continue the current Medicaid program. DHS is forecasting a relatively steady caseload overall with a 2 percent increase in the elderly, blind, and disabled populations and a decrease in the number of adults participating in the BadgerCare Plus program. Ensuring adequate Medicaid funding will continue to be a high priority for WHA.
Tort Reform – Laura Leitch, senior vice president and general counsel, discussed WHA’s efforts to address the effect of the Wisconsin Supreme Court’s Jandre decision, which could encourage defensive medicine and impede efforts to move from volume-based to value-based health care. WHA, Wisconsin Medical Society and a broad coalition of partners will be seeking legislation that clarifies the physician’s duty of informed consent in Wisconsin.
Regulatory Reform – Following up on Zipperer’s comments about the Administration’s regulatory streamlining efforts, Leitch described WHA’s discussions with the Administration seeking to synchronize DHS 124 with the Medicare Conditions of Participation. This change would allow hospitals to focus resources on patient care rather than on dated and inconsistent regulations. Leitch also discussed WHA’s proposal to survey additional health care practitioners to ensure health care providers and policymakers have the data they need to make health care workforce decisions. Finally, Leitch outlined legislation that would address Family and Medical Leave Act (FMLA) complexities and other issues for employers. She said the goal is to address the considerable confusion for human resource departments created by having inconsistent state and federal standards.
HIPAA Harmonization/Mental Health Care Coordination – Matthew Stanford, WHA vice president, policy and regulatory affairs and associate counsel, provided an overview of the WHA-supported HIPAA Harmonization/Mental Health Care Coordination Bill. Passage of the bill in the next legislative session is a goal of WHA’s Behavioral Health Task Force. The bill would remove statutory barriers to care coordination for individuals with mental illness. The Task Force and other stakeholders are actively working to build support for the bill, and Stanford asked Council members to contact him if they would be interested in advocating for the bill.
WHA Medicaid Advisory Groups Study Policy Questions, Meet with DHS
Joanne Alig, senior vice president of policy and research, provided an update on the status of the WHA Medicaid Reengineering Group (MRG) discussions (see related Valued Voice articles at www.wha.org/medicaid.aspx). Alig reviewed the policy questions being discussed by the MRG. Alig noted that aspects of the policy questions are still in flux, but the MRG is moving forward with its discussions of the potential advantages and disadvantages of various options. The MRG has met three times and will have an additional conference call in December.
On the topic of Medicaid, Alig also noted that the Medicaid Advisory Group met with DHS last week. DHS is delaying the implementation of the enhanced ambulatory patient grouper (EAPG) from January 1, 2013 to April 1, 2013 in order to provide additional time for hospital review and comment. Alig also updated the Council on the timeline for rate setting for 2013 and 2014, noting that DHS is working on new inpatient and outpatient rates for fee-for-service and HMO hospital payments effective January 1, 2013. More information about rates will be provided at an upcoming Medicaid Advisory Group meeting at DHS in December.
WHA Advocates to "Protect Hospitals" at Federal Level as "Fiscal Cliff" Looms
Jenny Boese, vice president external relations and member advocacy, provided the Council an overview on the federal lay of the land with respect to the "fiscal cliff" - a confluence of fiscal issues Congress must address within the next several months. These issues include whether to extend dozens of expiring tax policies, including several important Medicare policies, address the impending sequester cuts, as well as stop a 27 percent cut in Medicare physician reimbursements. Unfortunately, in order to pay for these policies, there is concern that hospital/health system payments will be targeted as they have been in the past. Boese highlighted several of those potential vulnerabilities, including reductions to Hospital Outpatient Department Evaluation & Management Services, a coding offset and additional Medicare bad debt reductions.
Boese also summarized WHA’s comprehensive and ongoing "Protect Hospital Care" advocacy campaign. Campaign elements have included the creation of a micro-advocacy webpage on wha.org, multiple WHA led trips with hospital leaders to Washington, DC and five WHA Telephone Town Halls and in-person Hospital Listening Sessions, and other activities. To date, some 300 hospital leaders and advocates have participated in WHA’s town halls, listening sessions and trips to DC, demonstrating the hospital field’s commitment to "protecting hospital care."
Wisconsin Hospitals PAC and Conduit Campaign at 97% of Goal
Jodi Bloch reported that the 2012 Wisconsin Hospitals State PAC and Conduit campaign has raised $231,917 to date putting the campaign at 97 percent of the annual goal. This total is the largest amount that the campaign has raised in a single year and just $8,000 away from the $250,000 year-end goal.
Bloch said since 2001, the campaign has raised more than $2.1 million and disbursed nearly that much to candidate campaigns of both parties.
Top of page (11/21/12)
As The Valued Voice went to press, the Department of Health Services (DHS) Secretary Dennis Smith announced that Logisticare has notified DHS that, effective February 17, it is terminating its contract as the state’s Medicaid and BadgerCare Plus transportation manager. During the next 90 days, DHS "will be working closely with LogistiCare to continue providing" this transportation benefit, according to a statement by Secretary Smith.
Secretary Smith also stated that "the Department intends to rewrite and issue a new Request for Proposal (RFP) for a non-emergency medical transportation manager, with updated data, so we can secure a transportation manager who will be able provide this important benefit to our members as soon as possible."
A link to statements by Secretary Smith and Logisticare can be found here: www.dhs.wisconsin.gov/News/PressReleases/2012/112112.htm and here: http://wisconsinhealthnews.com/wp-content/uploads/2012/11/2012.11.21-logisticare-termination.pdf.
Over the coming weeks, WHA will continue to monitor this developing story and communicate new information about the transition and new RFP to Wisconsin hospitals. Contact WHA’s Matthew Stanford with questions at firstname.lastname@example.org or 608-274-1820.
Top of page (11/21/12)
Over the past several weeks, WHA has joined our member hospitals and completed five editorial board visits as part of our ongoing campaign to position Wisconsin health care as a competitive advantage for businesses to stay, grow or move here.
"Our health care system is an asset, and it’s a good reason to consider locating in Wisconsin," according to WHA Executive Vice President Eric Borgerding. "In the past we have promoted our hospitals and health systems as employers themselves and emphasized our impact on the local job market. Now it is time to move in a new direction that touts our efficiency, high quality and health care value in our community as an economic advantage to employers."
In the past we’ve heard the media report that, "If you are a patient, you want to be in Wisconsin." That’s still true. But let’s add to that, "If you are an employer, you’ll want to be in Wisconsin."
WHA is now starting the next phase of the campaign, and that is with a direct mail to businesses with more than 100 employees, along with administrators of school districts, mayors/county executives, and regional economic development and Chamber executives. The publication that will be mailed is here: www.wha.org/Data/Sites/1/quality/HighQuality11-13-12.pdf. WHA plans to follow the initial mailing up with four postcards, starting after the first of the year.
WHA and our member hospital visits with the media have paid off. The Wausau Daily Herald and the Green Bay Press Gazette both had positive editorials following a board visit, the Eau Claire Leader Telegram just ran a good story, the Appleton Post Crescent live-streamed the editorial board visit and promoted it to area businesses through their local chamber. Wisconsin Manufacturers and Commerce ran a WHA editorial and an article on this topic in their monthly publication. And, perhaps the most exciting news is WHA received national media coverage on this new messaging in Area Development Magazine (www.areadevelopment.com/laborEducation/November2012/healthcare-a-business-location-consideration-16161555.shtml), a publication circulated to more than 40,000 individuals who are integral to their company’s site selection process. In addition, Governor Scott Walker and his team have been on record touting the value of Wisconsin health care as they promote economic development. See all the media coverage at this link: www.wha.org/healthcarevalue-news.aspx.
In all its communications, WHA is encouraging employers to reach out and partner with local hospitals or health systems to learn more about what they can do to improve the overall wellness of their workforce. Big or small, WHA member hospitals are doing what they can to work with communities, and oftentimes directly with employers, to help them improve the health of their workforce and to hold the line on costs.
Please alert your receptionists and staff to the campaign and provide them with a person/number to refer calls related to this campaign. Share the brochure with key employees. Let us know how WHA can help you. If you would like hard copies of the brochure, or if you have questions, contact Eric Borgerding at email@example.com or Mary Kay Grasmick at firstname.lastname@example.org or call 608-274-1820.
Top of page (11/21/12)
The news that the Medical College of Wisconsin (MCW) has selected sites in Green Bay and Central Wisconsin was praised by members of the WHA Graduate Medical Education (GME) Task Force meeting in Madison November 19. Earlier in the day, MCW announced that they had identified facility sites at multiple locations as they embed a community-based medical education program in the region. Read the announcement at www.wha.org/pubarchive/news_releases/News_MCW11-19-12.pdf.
MCW will engage the academic institutions and health systems in both Central Wisconsin and Green Bay in helping to identify faculty members for each region’s medical education program. The medical education programs in those regions are targeted to open as early as July 2015. Enrollment at both campuses in the first year will be approximately 15 students with class sizes increasing to at least 25 students in subsequent years.
MCW’s plan is consistent with the recommendations made by WHA in its physician workforce report, "100 New Physicians a Year: An Imperative for Wisconsin." MCW’s commitment to provide medical education outside of Milwaukee County, along with the outreach efforts of the University of Wisconsin School of Medicine and Public Health’s Wisconsin Academy of Rural Medicine (WARM), will both have a positive impact on the state’s ability to keep up with the demand for primary care physicians.
WHA Senior Medical Advisor Chuck Shabino said the movement toward community-based medical education by both of Wisconsin’s medical schools is a step in the right direction. He said work is still necessary to ensure that Wisconsin has an adequate number of post-graduate positions for students as they finish medical school.
"The increase in medical students must be met with an expansion in the number of primary care residency positions to ensure that we keep these physicians in our state," Shabino said. "We know that where physicians do their residency training influences where they practice medicine. We need to have enough openings here to meet what we hope will be a growing demand for residency positions."
Medical residencies require a lot of coordination and resources, which can be a major barrier to creating a program. Kenneth B. Simons, MD, Associate Dean for Graduate Medical Education and Accreditation, MCW, presented a model to the Task Force that is working well in Milwaukee and has the potential to work in other locations. The Medical College of Wisconsin Affiliated Hospitals (MCWAH) is a collaborative between the MCW and the Milwaukee health systems that provides infrastructure for and acts as the administrative body for the medical residency program. Presently, MCWAH offers 102 residency and fellowship programs. Each program is supervised by a program director who is a full-time faculty member of the Medical College. Most of the residents and fellows rotate through two or three of MCW’s 10 affiliated institutions. MCWAH has nearly 700 residents and 160 fellows in its graduate training program.
A new program at the Rural Wisconsin Health Cooperative (RWHC) is helping rural hospitals address the administrative burden associated with post-graduate physician training. The Wisconsin Collaborative for Rural GME was launched in partnership with the Baraboo Rural Training Track, the UWSMPH and several individual rural hospitals. RWHC Executive Director Tim Size said the Collaborative recruited a manager, Kara Traxler, who will provide support with the infrastructure necessary to meet ACGME requirements.
WHA Senior Policy Advisor George Quinn provided an overview of the WHA Board-approved GME plan and Task Force members provided feedback on upcoming curriculum for webinars aimed at helping WHA members better understand the basic principles on how to create and sustain on-site GME opportunities.
Top of page (11/21/12)
Top of page (11/21/12)
Congressman Ron Kind (D-La Crosse) recently visited Ministry Saint Michaels Hospital in Stevens Point for the first time. Under new district boundaries, the hospital moves into Kind’s 3rd Congressional District.
During his visit, Kind met with hospital and Ministry Medical Group leadership, led by Jeff Martin and Mark Fenlon, MD, respectively. Kind also had an opportunity to spend time with a larger group of hospital leaders. In addition to learning about the hospital and the medical group, Kind toured select portions of the hospital, including the emergency department.
Top of page (11/21/12)
WHA had the privilege recently of hosting three distinguished guests representing Xin Hua Hospital/Jiao Tong University School of Medicine in Shanghai, China. Xiao Bin, Gu Songtao, and Jin Zhongming were particularly interested in learning more about the Association’s role in facilitating collaborative quality improvement projects among WHA member hospitals. With nearly 2,000 beds, Xin Hua Hospital is one of the largest hospitals in China. The three gentlemen also visited the University of Wisconsin Hospitals and Clinics, along with several Milwaukee-area hospitals.
Top of page (11/21/12)