November 13, 2015
Volume 59, Issue 45


Barca Discusses Worker’s Comp, Med Mal with WHA Public Policy Council
“In rankings on quality of life, health care is one of the key drivers,” Barca says


There is absolutely no doubt that Rep. Peter Barca (D-Kenosha) sees economic development as a top priority in Wisconsin. As a board member of the Wisconsin Economic Development Corporation and a former administrator of the U.S. Small Business Administration, Barca’s business background gives him a real-world perspective when he is evaluating the impact legislative and regulatory proposals will have on Wisconsin’s business climate.

That probably explains Barca’s position on two of WHA’s top priorities: worker’s compensation and Wisconsin’s medical malpractice system. 

Barca said the worker’s compensation process works very well with employer and employee members of the Worker’s Compensation Advisory Council developing an “agreed upon” bill that the Legislature usually passes. However, last year was the exception when the Council presented a bill that contained a medical fee schedule.

“They wanted to move forward with a fee structure. Your team kicked into gear and helped us understand the impact a fee schedule would have,” Barca said. “We made it clear we can’t support the bill because not everyone was at the table, especially the providers. We can’t have a strong system, or be a national leader, unless we have a balanced system that works for everyone.”

“That is a much bigger victory than you realize,” said Barca about WHA’s successful advocacy work opposing a medical fee schedule in the “agreed upon” bill. “When stuff comes through that Council—it usually goes through in record time…we respect the council process—but recognize what a big victory that was.”

Barca acknowledges that worker’s compensation will continue to be a major issue, but he feels strongly that the process should not be rushed and must allow time for people to weigh in and for important issues to be vetted.

The importance of Wisconsin’s balanced medical malpractice system was also addressed by Barca. “Our medical malpractice environment is important in terms of recruiting physicians to Wisconsin,” said Barca. “Wisconsin has a pretty good system overall and balances interests pretty well overall.” Barca said that before making changes to Wisconsin’s medical malpractice system, Wisconsin needs to carefully “analyze the long-term impact overall of making changes to the system. Wisconsin needs to protect patients and physicians but also the [Injured Patients and Families Compensation] Fund.”

Barca said he supported two of WHA’s key legislative priorities, the Interstate Medical Licensure Compact and Assembly Bill 394, legislation that would require the Joint Finance Committee to review actions taken by the Group Insurance Board (GIB) impacting the state employee health insurance program. 

WHA President/CEO Eric Borgerding said WHA continues to promote Wisconsin’s high-quality, high-value health care as an economic development asset, as it is also just completing a report that will quantify the impact the state’s hospitals and health systems have on the economy.

Barca praised WHA for that work, adding that he feels there is not enough discussion in the state about the positive impact the health care sector has on the economy.

“There is not nearly enough discussion about that impact,” Barca said. “How do we help employers recognize the importance of health care? The focus is usually on costs v benefits of what you are receiving. When you see these rankings of quality of life, health care is one of the key drivers.”

The number of people from out-of-state who come to Wisconsin is also a point that is important to make, according to Barca. Borgerding said WHA is currently analyzing that impact, and it will be included in the Association’s next economic impact report, which will be released soon. 

Barca said he continues to support expanding eligibility for the Medicaid program up to 133 percent of the federal poverty line, a decision that he said would bring in another $360 million of federal funds to the state of Wisconsin in each biennium. Barca said it is a discussion he believes needs to still be on the table and he believes Wisconsin will have another opportunity to take a look at this decision in future legislative sessions. 

Barca said that there is “no other place you can go to realize that kind of revenue” for the state budget. When discussing where those dollars should go in the state budget, Barca said federal dollars brought into the state need to go toward increasing Medicaid reimbursement for hospitals and supporting higher education to fill health care workforce vacancies.

State Advocacy Update
Kyle O’Brien, WHA senior vice president, government relations, updated the Council with recent developments on several WHA priorities that received action during the fall legislative floor period. Legislation adding Wisconsin to the list of 11 states included as part of the Interstate Medical Licensure Compact took a significant step forward in the Legislature’s upper chamber, passing the State Senate November 6 with a vote of 31-1. O’Brien briefed the Council on an amendment to the legislation from Sen. Leah Vukmir (R-Wauwatosa) that would require the state to reauthorize its participation in the Compact within four years. WHA member engagement was critical to successfully moving this legislation through the State Senate, according to O’Brien.

On the same day, the Senate also passed a WHA-backed proposal that would require oversight by the Legislature’s budget-writing Joint Finance Committee of any contract between the state’s Group Insurance Board and an entity providing a self-insured health plan for state employees. The bill was amended in the Senate and received a unanimous 32-0 vote. O’Brien reported that both measures will be taken up by the Assembly November 16 for final concurrence before being sent to the Governor for his signature.

O’Brien also discussed several other issues, including recent legislation to implement Medicaid behavioral health care pilot programs; legislation to combat opioid abuse as part of the Heroin, Opiate, Prevention and Education (HOPE) package; recent activity on legislation prohibiting employers from mandating influenza vaccination policies for employees; and a proposal allowing physical therapists to order x-rays.

Interstate Medical Licensure Compact Commission 
Matthew Stanford, WHA general counsel, discussed the convening of the Interstate Medical Licensure Compact Commission, a key step in the implementation of an expedited medical licensure process under the Interstate Medical Licensure Compact. The Commission met October 27 and 28 for the first time, and is made up of two members of each participating states’ medical licensing boards. Stanford attended the meeting as did two members of Wisconsin’s medical examining board; however, they cannot participate as commissioners until Wisconsin enacts the Compact into law and are confirmed by the Senate.

Stanford reported the Commission is developing implementation plans and has set a goal to have an infrastructure in place to enable states to issue expedited licenses under the Compact as early as July 2016. Stanford said WHA will continue to monitor the Commission and work with the Department of Safety and Professional Services to advance Wisconsin’s implementation of the expedited licensure process under the Compact.

“By eliminating duplicative primary source verification efforts, the time to process Wisconsin medical licenses will be reduced from months to a couple of weeks for Compact-eligible physicians,” said Stanford.

Worker’s Compensation
Joanne Alig, WHA senior vice president for policy & research, provided the Council an update on recent activity regarding the Wisconsin Worker’s Compensation program. The two major proposals that are currently being reviewed include the “agreed-to” proposal of the Worker’s Compensation Advisory Committee (WCAC) (see October 23 Valued Voice article), and AB 501, which was introduced November 10 and referred to the Assembly Insurance Committee. 

Council members were reminded of the significant achievement by WHA and its coalition partners in 2014 in stopping legislation that would have imposed a fee schedule on providers in the Worker’s Compensation program. WHA staff and several WHA members have completed a tremendous amount of work since that time in continuing to educate employers and legislators about the very positive aspects that result from the high-quality care provided to injured workers in the state—including that injured workers get back on the job quicker than in most any other state and that overall utilization per episode of care is lower in Wisconsin than in other states. Alig thanked members who have engaged in this issue. 

As a result of these efforts, Alig noted that a fee schedule is not included in either the WCAC proposal or AB 501, and neither are the provisions of a recent WMC proposal that would have called for a new council to set prices on behalf of all worker’s compensation payers, a provision that WHA opposes not only for its similarity to a fee schedule, but due to the new government bureaucracy that would be created to set provider prices.

“We are very glad to see that both the WCAC and the Legislature understand that the way forward for the Worker’s Compensation program is to improve its administration, not engage in price setting,” Alig said. 

The Council discussed the issue of “directed care,” noting that AB 501 includes a version of directed care, and the labor members of the WCAC also put a directed care provision on the table as well. A long-standing tenet of the Worker’s Compensation program in Wisconsin is that employees can seek care from the health care provider of their choice. Directed care would limit this choice. Under AB 501, employees who participate in an employer’s group health plan would be required to seek care from the network of providers established under the group health plan. The proposal by the labor members of the WCAC would be narrower, apply to a limited group of highway workers who are represented by a bargaining unit, and would sunset after five years. The management members of the WCAC have not yet agreed to this proposal and indicated they prefer a broader application of directed care. 

The WCAC is expected to meet again November 19. A hearing is not yet set for AB 501. WHA is continuing to work to analyze the provisions of both proposals and will be fully engaged in changes to the Worker’s Compensation program that are considered by the Legislature in the coming months. 

Federal Advocacy Update
Jenny Boese, WHA vice president, federal affairs & advocacy, discussed with the Council the recently-enacted Bipartisan Budget Act of 2015 (BBA 2015). President Obama signed the BBA 2015 into law November 2, 2015 as Public Law 114-74. The law took effect immediately. The new law extends the debt ceiling through March 2017, increases and sets spending levels for the 2016 and 2017 budget years and addresses the Medicare Part B premium spike expected to hit a small portion of Medicare beneficiaries. Unfortunately, the BBA 2015 also included two Medicare cuts impacting hospitals and health systems: a “site neutral” change impacting use of the Outpatient Prospective Payment System (OPPS) and an extension of the Medicare sequester (now through FY 2025). 

Under the site neutral provision, new off-campus provider-based hospital outpatient departments (HOPDs) will be prohibited from using the OPPS and will, instead, be required to bill under another Medicare Part B payment system (ex: Ambulatory Surgery Center, Physician Fee Schedule, etc). Under the Act, off-campus means a location not on the main campus (or a remote location of the hospital) and more than 250 yards from it. “New” is considered to be an entity that had not been billing Medicare under the OPPS prior to November 2, 2015 unless it is a dedicated Emergency Department. The law allows these new locations to bill under the OPPS through December 31, 2016, but then prohibits them entirely from using the OPPS beginning January 1, 2017. If an entity is a provider-based HOPD and has billed Medicare under the OPPS prior to the date of enactment (Nov. 2, 2015) then it should be grandfathered in. 

Because the law was enacted and the prohibition on provider-based HOPDs took effect within the span of a week, it left no time for hospitals to comment, let alone plan for or adjust construction projects already in the pipeline. 

“We strongly object to having the decisions of our providers upended within the span of a week by a surprise Congressional act,” Boese told the Council. “At a minimum, relocated facilities or facilities under development must be exempted from the law’s prohibition, and that fix must happen by year’s end.” 

WHA is already engaging with Wisconsin’s Members of Congress and the American Hospital Association on this legislative fix. Boese also provided the Council with several regulatory updates, including details on WHA’s comment letter to the Health Resources and Services Administration on its proposed 340B guidance. WHA’s full comment letter is available at: www.wha.org/pdf/2015-340BWHACommentLetterHRSA10-26.pdf.

PAC/Conduit Report
Jodi Bloch, WHA, told Council members that contributions continue to come in with just under two months left in the calendar year of the Wisconsin Hospitals State PAC & Conduit Campaign. The Campaign is now at 90 percent of the goal to raise $270,300 by the end of the year.


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Register Today for Physician Leadership Development Conference, March 11-12

Register today for WHA’s annual “Physician Leadership Development Conference,” scheduled Friday, March 11 and Saturday, March 12, 2016, at The American Club in Kohler. The full conference brochure, with agenda, registration and resort information, as well as online registration, can be found at http://events.SignUp4.net/16PLD.

This year’s conference will include a full-day session with Stacy Nelson, MEd, EdD, presenting the Crucial Conversations and Influencer training, focusing on the tools needed to tackle conflict and challenges and the strategies to change culture, thoughts and actions in your organization. In addition, learn to run an effective meeting, use group dynamics to build support and deal with disruptive personalities effectively in a half-day session with Michael Guthrie, MD, MBA, FACPE. Both Nelson and Guthrie are nationally-recognized faculty from the American Association for Physician Leadership (AAPL), formerly the American College of Physician Executives, and both will discuss important and practical leadership skills that help physician leaders to move beyond their clinical training and take a new approach to managerial decision-making and problem solving.

A discounted “early bird” registration fee is available to those registering by January 15. Additionally, a “host” registration option is available for senior-level hospital representatives (non-physicians) who accompany one or more of their physicians to the conference but do not need CME credit. 

Questions about the 2016 event can be directed to Jennifer Frank at jfrank@wha.org or Chuck Shabino, MD, at cshabino@wha.org.

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Desien Receives WHA Distinguished Service Award 

Nick Desien, senior vice president, Ascension Health/Wisconsin Ministry Market Executive, received the Wisconsin Hospital Association 2015 Distinguished Service Award for his service to the health care industry, community and to the Association. 

WHA annually honors individuals who have served the health care community and who have made an exemplary commitment to WHA and the communities they serve. WHA President/CEO Eric Borgerding presented the award to Desien at a Ministry Board of Director’s meeting November 2 in Milwaukee. 

Desien began his career at Baltimore City Hospital in Maryland. He arrived in Wisconsin in 1986 as the first chief financial officer of Ministry Health Care. Desien was named executive vice president in 1996, president and chief operating officer in 1997, and president/CEO in 1998. In 2013, he led the merger of Ministry Health Care and the Marion Health System, with Ascension the nation’s largest Catholic and nonprofit health system. Desien currently serves as senior vice president of Ascension Health and Ministry Market Executive for Wisconsin. In this capacity he provides strategic direction for Ascension Wisconsin, and has executive oversight of Ministry Health Care and Columbia St. Mary’s, the two Ascension ministries in Wisconsin. 

His career has been distinguished by his leadership of Ministry Health Care and Ascension, and his commitment to the industry through his service to the Wisconsin Hospital Association. Desien’s engagement with and support of WHA spans nearly 30 years. He currently serves on WHA’s Board of Directors and has served on numerous WHA councils and task forces. 

In presenting the award, Borgerding said Desien’s leadership is evident not only in the organizations he serves, but also in the contributions he has made to the broader health care community in Wisconsin.

“We are fortunate to have committed health care leaders, who have not only helped make Wisconsin one of the best states in the country for health care, but who’s engagement and commitment to WHA has made it one of the state’s leading advocacy and lobbying voices. Nick Desien is one of these outstanding leaders,” according to Borgerding. “Nick has made an exemplary commitment to WHA, but through his engagement in public policy, he has also made a significant contribution toward the high-quality, high-value health care that is a hallmark of Wisconsin.”

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New Law Allows Out-of-State EMS to Respond to Requests for Mutual Aid in Wisconsin

A bill that will allow out-of-state emergency medical service providers to respond to requests for mutual aid requests in Wisconsin is now law. Senate Bill 210 was signed into law by Governor Scott Walker November 11 as 2015 Wisconsin Act 83. Act 83 permits an out-of-state person providing emergency medical services (EMS) to act as an ambulance service provider, emergency medical technician, or first responder without holding a license, training permit, or certificate in this state when responding to a request for mutual aid if the person holds a valid license, training permit, or certificate in the state from which that person is responding. 

Previously, a person could not act as or advertise for the provision of services as an ambulance service provider, emergency medical technician, or first responder unless that person held the required Wisconsin license, training permit, or certificate. This Act creates a limited exemption from that requirement for those holding appropriate credentials in another state when they respond from that state to a request for mutual aid from within this state.

See Act 83 at http://docs.legis.wisconsin.gov/2015/related/acts/83.

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Board of Nursing Advances Draft Language for N8 Revision

The Wisconsin Board of Nursing (BON) advanced changes to the advance practice nurse prescriber (APNP) scope of practice rules in chapter N8 of the Wisconsin Administrative Code at its November 12, 2015 meeting. The BON voted to advance the changes drafted by the Board of Nursing’s Rules and Legislative Committee for consideration as a proposed rule. The changes approved by the Board include clarification and modernization of renewal requirements, prescriptive authority and collaboration requirements. The regulations and the draft proposed changes can be found at: www.wha.org/pdf/20151112_NUR_Open_Session.pdf.

The draft will now be submitted for plain language analysis and for evaluation of economic impact before being published as a proposed rule. Sharon Henes, administrative rules coordinator for the Department of Safety and Professional Services, expects the proposed rule to be presented at either the February or March BON meeting for public comment. Multiple procedural steps still need to occur following public comment before any change to the rule is finalized and effective. 

WHA is reviewing the draft and will provide comment at the public hearing. WHA members are encouraged to examine the draft language and provide comments to Steven Rush, WHA vice president for workforce and clinical practice, at srush@wha.org or 608-274-1820.

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Save-the-Date for 2016 Advocacy Day
March 30, 2016 *** Monona Terrace, Madison


Make an impact in Madison for your hospital by attending Advocacy Day March 30, 2016.
Mark your calendar today for this important event.

Online registration will be available by late November.

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Register Today for Payer/Provider ICD-10 Exchange Forum
December 14 in Madison


Register today for the “Payer/Provider ICD-10 Exchange Forum,”; a one-day event bringing together Wisconsin providers and major Wisconsin payers to discuss common issues related to the recent ICD-10 implementation. 

The Wisconsin Hospital Association, the Wisconsin Medical Group Management Association and the Wisconsin Medical Society have partnered to offer this important event for our members. Facilitated discussions will focus on topics such as prior authorizations, translation tools, unspecified code issues, inpatient issues like PCS and DRG shifts, and more. Attendees are encouraged to submit questions prior to the conference, as part of the registration process, to ensure the day’s discussions focus on the attendees’ greatest needs. 

Hospital and health system billing and coding managers, revenue cycle managers, health information managers, and CFOs, as well as clinical managers, will benefit most from attending this event. The one-day event will be held at the Madison Concourse Hotel in Madison. To view the full day’s agenda and to register for this event, visit: www.wmgma.org/events/event_details.asp?id=702456&group=.

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WHA Members Learn About New EHR Meaningful Use Requirements

WHA offered a complimentary Member Forum webinar November 11 to discuss important provisions of a joint rule that finalizes proposals made in two separate 2015 proposed rules regarding the meaningful use requirements of the EHR Incentive Program. The webinar highlighted new compliance provisions for meaningful use “modified Stage 2” (2015 through 2017) and meaningful use “Stage 3” (beginning in 2018).

An interdisciplinary group of 50 WHA members, including COOs, CFOs, physician and nurse leaders, quality improvement leaders, and HIMs registered for the webinar. Particpants learned that certain provisions of the joint rule provide some flexibility for hospitals and physicians in 2015 and 2016. Other provisions could raise the bar for provider performance starting in 2015 and could result in health care providers incurring Medicare penalties for failure to meet reporting objectives that are unnecessarily difficult to achieve without significant expense or disruption to patient care workflow.

For additional information, contact WHA’s Andrew Brenton at 608-274-1820 or abrenton@wha.org.

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Member News: Flambeau Hospital CAO David Grundstrom to Retire

David Grundstrom, chief administrative officer for Flambeau Hospital in Park Falls, will retire December 4. He has led Flambeau Hospital (co-sponsored by Marshfield Clinic and Ministry Health Care) for the past 14 years. Grundstrom has held numerous health care leadership positions throughout Wisconsin and Minnesota. His name is widely recognized throughout numerous health care organizations. 

Before coming to northern Wisconsin, Grundstrom held positions of vice president of administrative services for St. Joseph’s Hospital in Marshfield, executive vice president of Oconomowoc Hospital and president of New Ulm Medical Center and Trinity Hospitals in Minnesota. Grundstrom has served on many civic and health-related boards including the Wisconsin Hospital Association Board of Directors from 2005-2011. He also served on WHA’s Governance Council, 1992-1997; Council on Medical and Professional Affairs, 2003-2005; and Council on Workforce Development, 2009-2014.

“Dave is a remarkable health care leader and has always been a strong supporter of WHA,” said WHA President/CEO Eric Borgerding. “His knowledge and commitment was an asset to the WHA Board of Directors. Dave will be missed, and we wish him and his family all the best.” 

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Fast Facts from the WHA Information Center: November is National Lung Cancer Awareness Month

Lung cancer is the leading cause of cancer death and the second most diagnosed cancer in both men and women in the United States, according to the Center for Disease Control. After increasing for decades, lung cancer rates are decreasing nationally, as fewer people smoke cigarettes.

Data from the WHA Information Center found there were 6,827 inpatient admissions and 57,708 outpatient visits in Wisconsin hospitals with a principal or secondary diagnosis of lung cancer in Wisconsin from July 2013 through June 2014.

Data provided by the WHA Information Center (www.whainfocenter.com). The WHA Information Center is dedicated to collecting, analyzing and disseminating complete, accurate and timely data and reports about charges, utilization, quality and efficiency provided by Wisconsin hospitals, ambulatory surgery centers and other health care providers.

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Gov. Walker Proclaims November 19 Wisconsin Rural Health Day

In a proclamation signed October 16, 2015, Gov. Scott Walker declared Thursday, November 19 Wisconsin Rural Health Day in honor of National Rural Health Day, to recognize the unique contributions of our rural communities and the health care providers that serve these communities. This is the fifth annual National Rural Health Day, and WHA is once again a co-sponsor, along with the Wisconsin Office of Rural Health. 

The Proclamation acknowledges that rural hospitals are sources of innovation and resourcefulness and are typically the economic foundation of their communities. 

View the proclamation at www.wha.org/pdf/2015RuralHealthDayProclamation.pdf.

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