November 20, 2015
Volume 59, Issue 46


WHA 2016 Advocacy Day Scheduled for March 30, 2016 
Registration now open


Each year, the WHA Advocacy Day event grows both in the number of attendees and in the impact it makes on our legislators in Madison. Advocacy Day is one of the best ways hospital employees, trustees and volunteers can have an important, visible impact in the State Capitol. Help make the 2016 event a great success by assembling your hospital contingent for 2016 Advocacy Day, set for March 30 at the Monona Terrace in Madison. Registration is open at http://events.SignUp4.net/16AdvocacyDay0330.

As always, Advocacy Day 2016 will have a great lineup of speakers, including morning keynote Rick Pollack. Pollack is the president and CEO of the American Hospital Association (AHA). He’s been a member of AHA’s advocacy team for the past 33 years and will share his Washington DC insider’s view of federal political activities during this presidential election year. Our legislative panel discussion will round out the morning session, followed by a luncheon keynote address from Governor Scott Walker (invited).

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. In fact, over 650 visits were made last year that directly impacted the outcomes of priority legislation, including: 
2016 Advocacy Day will be no different in terms of the value these legislative meetings have on priority hospital and health system issues. WHA schedules all meetings, provides transportation to the State Capitol two blocks away, and prepares attendees for their visits. In addition to an issue briefing at Advocacy Day, WHA offers an optional webinar on legislative visits prior to Advocacy Day. Speaking up on behalf of your hospital by meeting with your legislators during Advocacy Day is essential in helping educate legislators about your hospital and on health care issues. 

“WHA’s Advocacy Day continues to be a powerhouse event in Wisconsin’s State Capitol each year,” said WHA President/CEO Eric Borgerding. “Last year, we had 1,100 hospital advocates travel to Madison because they care deeply about their hospitals and local communities. There is no substitute for this level of engagement.”

Join over 1,000 of your peers from across the state at Advocacy Day 2016 on March 30. The day’s agenda and online registration are available at http://events.SignUp4.net/16AdvocacyDay0330.

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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WHA Continues Push to Amend Site-Neutral Prohibition
Sends letter to Congressional Delegation, will travel to DC in December


As previously reported in The Valued Voice, the Bipartisan Budget Act of 2015 was signed into law by President Barack Obama November 2, 2015 and included several Medicare cuts to hospitals. One of those cuts prohibits new off-campus provider-based hospital outpatient departments (HOPDs) from using the Outpatient Prospective Payment System (OPPS). WHA is aware of multiple situations in Wisconsin where this unexpected site-neutral prohibition will impact projects already in motion.

“WHA is very disappointed with the last-minute inclusion of the site-neutral policy and strongly objects to having the long-term strategy and operational decisions of our providers upended within the span of a week by this surprise Congressional action,” said WHA President/CEO Eric Borgerding in a letter to Wisconsin’s Congressional Delegation. 

Under the site-neutral provision, 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. If an entity is a provider-based HOPD and has billed Medicare under the OPPS prior to the date of enactment (November 2, 2015) then it should be grandfathered in. 

WHA is advocating Wisconsin’s Congressional Delegation support and work to quickly pass an amendment that will also grandfather relocated facilities or facilities under development at the time the law was enacted. 

“Due to the incredibly short timeframe before the BBA 2015 was enacted, our hospitals and systems were unable to comment, let alone plan for or adjust construction projects and care strategies already in the pipeline,” Borgerding continued. “At a minimum, WHA believes Congress must immediately fix Section 603 for providers that have already based their planning and construction decisions on current law,” he said. 

WHA will continue advocacy and grassroots efforts on this amendment, including traveling to Washington, DC in early December to meet with Congressional offices. With Congress in recess during the Thanksgiving holiday, it is a perfect opportunity to discuss the need for this amendment personally with Members of Congress when they are back home in their Wisconsin districts. WHA strongly encourages you to do so. 

If you believe your hospital/system may be impacted or if you have other questions, contact Jenny Boese at 608-268-1816 or jboese@wha.org.

Read the full letter at: www.wha.org/pdf/SpeakerRyanSiteNeutralAmdt11-20-15.pdf.

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Wisconsin Hospitals Conduit & Wisconsin Hospitals PAC Campaign Update: $20,000 Left to Reach Year-End Goal

In the last two weeks, $20,000 in contributions has come in from across the state raising the total contributions to over $250,000. There are just six weeks left in the calendar year of the Wisconsin Hospitals Conduit & Wisconsin Hospitals PAC Campaign and there is now under $20,000 to go to reach the goal. The Campaign is at 92 percent of the annual goal to raise $270,300 by the end of the year.

The average contribution is $838. So far, 298 individuals have joined together to support this year’s annual campaign. Thank you to those listed below by name and affiliated organization in amount category. The next publication of the contributor list will be in the December 4 edition of The Valued Voice. For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.

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Contributors Ranging from $1 - $499  
Aittama, Craig Ministry - St. Michael's Hospital
Alstad, Nancy Fort HealthCare
Anderson, Phil Sacred Heart Hospital
Appleby, Jane Aurora Health Care
Arnett, Eugene Aurora Health Care
Ballentine, Anne Wheaton Franciscan Healthcare
Bayer, Tom St. Vincent Hospital
Bard, Jeffrey Aurora Medical Center - Oshkosh
Bisterfeldt, Joan Wheaton Franciscan Healthcare
Bollig, Dale SSM - St. Mary's Hospital
Braun, James Flambeau Hospital
Brenny, Terrence Stoughton Hospital
Brisch, Donald Holy Family Memorial
Bunten, Sherry Aspirus Langlade Hospital
Cardinal, Lori Agnesian HealthCare
Carlson, Dan Aurora - Bay Area Medical Center
Carter, Shane Aurora Medical Center - Oshkosh
Clark, Julie HSHS - St. Joseph's Hospital
Clark, Renee Fort HealthCare
Cliffe Kucharski, Elizabeth Wheaton Franciscan Healthcare
Collins, Sherry Wisconsin Hospital Association
Colman, Gerard Aurora Health Care
Coniff, Barbara HSHS - St. Mary's Hospital Medical Center
Coopman, Dianne St. Mary's Janesville Hospital
Cormier, Laura Bellin Hospital
Culotta, Jennifer St. Clare Hospital & Health Svcs
Curran-Meuli, Jane Holy Family Memorial
Danner, Forrest Aspirus Wausau Hospital
Davidson, Lisa Wisconsin Primary Health Care Association
Dettman, Amy Bellin Hospital
Donlon, Marcia Holy Family Memorial
Dube, Troy Chippewa Valley Hospital
Dux, Larry Froedtert & MCW Community Mem. Hosp
Dwyer, Maxine SSM - St. Mary's Hospital
Evans, Kim Bellin Hospital
Ewald, Sandra Aurora Health Care
Feeney, John Community Health Network, Inc.
Fielding, Laura Holy Family Memorial
Freitag, Vanessa                       Our Lady of Victory Hospital
Gagnon, Annette HSHS - Eastern Wisconsin Division
Grundstrom, David Flambeau Hospital
Gullicksrud, Lynn Sacred Heart Hospital
Gutsch, Mike Cumberland Healthcare
Hafeman, Paula St. Vincent Hospital
Halida, Cheryl HSHS - St. Joseph's Hospital
Harasim, Edward Wheaton Franciscan Healthcare
Harrington, Kathleen Mayo Health System - Eau Claire
Helgeson, Jason HSHS - Eastern Wisconsin Division
Hernandez, Terri HSHS - St. Joseph's Hospital
Herzog, Sarah Wheaton Franciscan Healthcare
Hofer, John Bay Area Medical Center
Hupf, Angela Aspirus Medford Hospital & Clinics, Inc.
Jelle, Laura St. Clare Hospital & Health Services
Kaufmann, Marilyn Holy Family Memorial
Kelsey Foley, Kathy Aspirus Wausau Hospital
Kempen, Jacob Aspirus Wausau Hospital
King, Vivian Aurora Health Care
Klay, Chris HSHS - St. Joseph's Hospital
Klay, Lois HSHS - St. Joseph's Hospital
Knutzen, Barbara Agnesian HealthCare
Koebke, Troy Bellin Hospital
Krueger, Kari St. Mary's Janesville Hospital
Kruse, Joe Mayo Health System - Franciscan Healthcare La Crosse
LaBarge, Margie Ministry Health Care
Lampman, Sandra St. Mary's Hospital
Leschke, John Mercy Medical Center
Lineberry, Timothy Aurora BayCare Medical Center - Green Bay
Lynch, Sue Mayo Health System - Franciscan HC
Maurer, Mary Holy Family Memorial
Mays, Laura Stoughton Hospital Association
McArdle, PeggyAnn Agnesian HealthCare
McMeans, Scott Holy Family Memorial
Mercer, Carla Reedsburg Area Medical Center
Merrick, Marianne SSM - St. Mary's Hospital
Miller, Thomas Children's Hospital of Wisconsin
Monahan, Jane Monroe Clinic
Nevers, Rick Aspirus, Inc.
Nicklaus, Todd Aspirus, Inc.
Norell, Brett Children's Hospital of Wisconsin
O'Hara, Tiffanie Sundial Software
Olson, Bonnie Sacred Heart Hospital
Ordinans, Karen Children's Hospital of Wisconsin
Ostrander, Gail HSHS - Eastern Wisconsin Division
Palecek, Steve HSHS - St. Joseph's Hospital
Peck, Lori Aspirus, Inc.
Peiffer, Susan Sacred Heart Hospital
Pempek, Kalynn Aspirus Wausau Hospital
Penovich, Carrie Aurora Medical Center - Two Rivers
Pritchard, Paul Prevea Health/HSHS
Radke, Chad Aspirus Wausau Hospital
Range, Bonnie Holy Family Memorial
Revnew, Dorothy ProHealth Care - Oconomowoc Memorial Hospital
Richman, Tim Affinity Health - Calumet Medical Center
Riddle, Roberta Rusk County Memorial Hospital
Risley-Gray, Ruth Aspirus, Inc.
Rocheleau, John Bellin Health
Roethle, Linda Bellin Memorial Hospital
Roundy, Ann Columbus Community Hospital
Rudquist, Debra Amery Hospital & Clinic
Schaetzl, Ron SSM - St. Clare Hospital & Health Services
Schneider, David Aspirus Langlade Hospital
Schubring, Randy Mayo Health System - Eau Claire
Sciuti, Jennifer Aurora Health Care
Selle, Ginger St. Clare Hospital & Health Services
Sheehan, Heather Hayward Area Memorial Hospital
Sio, Tim Wheaton Franciscan - All Saints
Statz, Darrell Rural Wisconsin Health Cooperative
Stelzer, Jason St. Clare Hospital & Health Services
Strobel, Victoria Marshfield Clinic
Swanson, Kaitlin HSHS - Eastern WI Division
Tandberg, Ann HSHS - St. Joseph's Hospital
Tapper, Joy Milwaukee Health Care Partnership
Theiler, Brian Gundersen Tri-County Hospitals & Clinics 
Thornton, Eric SSM - St. Mary's Janesville Hospital
Van Abel, Lois Bellin Hospital
Vergos, Katherine Agnesian - Ripon Medical Center
Voelker, Thomas Aspirus Wausau Hospital
Waldoch, Timothy Columbia St. Mary's Inc.
Walker, Troy St. Clare Hospital & Health Services
Werkheiser, Cindy Monroe Clinic
Wheeler, Susan St. Nicholas Hospital
Whitinger, Margaret Agnesian HealthCare
Wipperfurth, Kay Fort HealthCare
Wold, Gwen Amery Regional Medical Center
Contributors Ranging from $500 - $999
Bagnall, Andrew St. Nicholas Hospital
Bailet, Jeffrey Aurora Health Care
Deich, Faye HSHS - Sacred Heart Hospital
Dexter, Donn Mayo Health System - Eau Claire
Dicus-Johnson, Coreen Wheaton Franciscan Healthcare
Dietsche, James Bellin Hospital
Dolohanty, Naomi Aurora Health Care
Elmer, Paula Monroe Clinic
Ericson, Allen Froedtert & MCW HSHS - St. Joseph's Hospital Campus
Frangesch, Wayne Wheaton Franciscan Healthcare
Freimund, Rooney Bay Area Medical Center
Furlong, Marian Hudson Hospital & Clinics
Gille, Larry HSHS - St. Vincent Hospital
Golanowski, Marie Aurora St. Luke’s Medical Center
Goldberg, David Froedtert & MCW Community Memorial Hospital Campus
Graebner, David Aurora Sheboygan Memorial Medical Center
Graul, Mark Children’s Hospital of Wisconsin
Gullingsrud, Tim Hayward Area Memorial Hospital & Nursing Home
Gustafson, Andy SSM Health Care-Wisconsin
Hamilton, Mark UW Hospitals and Clinics
Heaney, Dwight Fort HealthCare 
Jablonski, James Children's Hospital of Wisconsin
Jacobson, Terry St. Mary’s Hospital of Superior
Jensema, Christine HSHS-Eastern Wisconsin Division
Kersten, Juliet Children's Hospital of Wisconsin
Kingston, Mary Beth Aurora Health Care
Kirsch, Jennifer Gundersen Health System
Kneiser, Patti Froedtert & The Medical College of Wisconsin
Korom, Nancy Children's Hospital of Wisconsin
Kostroski, Sharon Ministry - St. Joseph's Hospital
Lange, George Westgate Medical Group, CSMCP
Larson, Margaret Mercy Medical Center
Latta, Richard Godfrey & Kahn, SC 
May, Carol Sauk Prairie Memorial Hospital
McNally, Maureen Froedtert & MCW
Mugan, James Agnesian HealthCare
Mulder, Doris Beloit Health System 
Nelson, James Fort HealthCare
O’Day, Thomas Godfrey & Kahn, SC
Oland, Charisse Rusk County Memorial Hospital
Ose, Peggy Riverview Hospital Association 
Peterson, Douglas Chippewa Valley Hospital
Pollard, Dennis Froedtert & The Medical College of Wisconsin
Quinn, George Wisconsin Hospital Association
Reardon, Brian Hospital Sisters Health System
Richards, Theresa Ministry - St. Joseph's Hospital
Richardson, Todd Aspirus, Inc.
Rocole, Theresa Wheaton Franciscan Healthcare
Roesler, Bruce The Richland Hospital
Rohrbach, Dan Southwest Health Center
Rude, Nels The Kammer Group
Rutkowski, Jennifer Grant Regional Health Center
Sczygelski, Sidney Aspirus Wausau Hospital
Seitz, Verna ProHealth Care, Inc.
Selberg, Heidi HSHS-Eastern Wisconsin Division
Shabino, Charles Wisconsin Hospital Association
Shorter, Tom Godfrey & Kahn, SC
Sisney, Mary Children's Hospital of Wisconsin
Smith, Gregory Wheaton Franciscan Healthcare
Spencer, Paul Froedtert & The Medical College of Wisconsin
Stern, Robert Wheaton Franciscan Healthcare
Strasser, Kathy Aspirus, Inc.
Stuart, Philip Tomah Memorial Hospital
Teigen, Seth St. Mary’s Hospital 
Thurmer, DeAnn Waupun Memorial Hospital
Van Court, Bernie Bay Area Medical Center
Van Meeteren, Bob Reedsburg Area Medical Center
Yaron, Rachel Ministry St. Clare’s Hospital
Zenk, Ann Ministry St. Mary’s Hospital
Contributors Ranging from $1,000 - $1,499
Ashenhurst, Karla Ministry Health Care
Bagemihl, Katherine Froedtert & The Medical College of Wisconsin
Bakkum, Kyle Vernon Memorial Healthcare
Bedwell, Elizabeth Children's Hospital of Wisconsin
Bowers, Brenda Wheaton Franciscan Healthcare
Brenton, Andrew Wisconsin Hospital Association 
Colpaert, Gary Froedtert & The Medical College of Wisconsin
Connors, Larry St. Mary's & St. Vincent Hospital
Cullen-Schultz, Jeannie JP Cullen & Sons
Garcia Thomas, Cristy
Geraghty, Tricia Children's Hospital of Wisconsin
Gorelick, Marc Children's Hospital of Wisconsin
Gunn, Veronica Children's Hospital of Wisconsin
Gutzeit, Michael Children's Hospital of Wisconsin
Hanus, Andrew Aurora Health Care
Just, Lisa Aurora Health Care-South Region
Killoran, Carrie Aurora Health Care
Lentz, Darrell Aspirus Wausau Hospital
Lepore, Michael Wheaton Franciscan Healthcare
Lewis, Jonathan St. Mary's Hospital 
Lindberg, Steve Mayo Clinic Health System - Red Cedar
McCawley, Thomas Beloit Health System
McGowan, Kathryne Aspirus, Inc.
Nelson, David HSHS Sacred Heart Hospital
Punzenberger, Lindsay Children’s Hospital of Wisconsin 
Radoszewksi, Pat Children's Hospital of Wisconsin
Rakowski, Mark Children's Hospital of Wisconsin
Reynolds, Sheila Children’s Hospital of Wisconsin 
Rickelman, Debbie WHA Information Center
Robertstad, John ProHealth Care - Oconomowoc Memorial Hospital
Roller, Rachel Aurora Health Care
Rush, Steven Wisconsin Hospital Association
Sanders, Robert Children's Hospital of Wisconsin
Sato, Thomas Children’s Hospital of Wisconsin
Schafer, Michael Spooner Health System
Schmidt, Cheryl Affinity Health - St. Elizabeth Hospital
Shanahan, Thomas Children's Hospital of Wisconsin
Simaras, Jim Wheaton Franciscan Healthcare
Swanson, Kerry St. Mary’s Janesville Hospital
White-Jacobs, Mary Beth          Black River Memorial Hospital
Woleske, Chris Bellin Hospital
Wolf, Edward Lakeview Medical Center
Zenk, Ann Ministry - Sacred Heart-St. Mary's Hospital
Contributors Ranging from $1,500 - $1,999
Anderson, Layton Ministry - St. Joseph's Hospital
Bloch, Jodi Wisconsin Hospital Association
Clapp, Nicole Grant Regional Health Center 
Coffman, Joan HSHS - St. Joseph's Hospital
Court, Kelly Wisconsin Hospital Association 
Decker, Michael Divine Savior Healthcare 
Dotson, Jason Beloit Health System
Frank, Jennifer Wisconsin Hospital Association 
Grasmick, Mary Kay Wisconsin Hospital Association 
Heywood, Matthew Aspirus, Inc.
Harding, Edward Bay Area Medical Center
Martin, Jeff Ministry - Saint Michael's Hospital
McKevett, Timothy Beloit Health System
Mohorek, Ronald Ministry Health Care
Natzke, Ryan Marshfield Clinic 
Nauman, Michael Children's Hospital of Wisconsin
Olson, David Froedtert & The Medical College of Wisconsin
Rozenfeld, Jon St. Mary’s Hospital - Madison
Russell, John Columbus Community Hospital 
Schulze, Connie Ministry Health Care 
Sexton, William Crossing Rivers Health Medical Center
Sheehan, John UW Hospitals and Clinics
Wallace, Michael Fort HealthCare
Contributors Ranging from $2,000 - $2,999
Alig, Joanne Wisconsin Hospital Association
Andersen, Travis Columbia St. Mary's 
Anderson, Sandy St. Clare Hospital & Health Svcs
Boese, Jennifer Wisconsin Hospital Association 
Duncan, Robert Children's Hospital & Health System
Geboy, Scott Hall, Render, Killian, Heath & Lyman
Hanson, Gail Aurora Health Care
Herzog, Mark Holy Family Memorial
Hilt, Monica St. Elizabeth Hospital
Kachelski, Joe WI Statewide Health Info Network 
Kief, Brian Ministry - St. Joseph's Hospital
Leitch, Laura Hall Render
Levin, Jeremy Rural Wisconsin Health Cooperative 
Lewis, Gordon Burnett Medical Center 
Meyer, Daniel Aurora BayCare Medical Ctr Green Bay
Oliverio, John Wheaton Franciscan Healthcare
Pandl, Therese HSHS-Eastern Wisconsin Division
Potter, Brian Wisconsin Hospital Association
Potts, Dennis Aurora St. Luke’s Medical Center
Sanders, Michael Monroe Clinic 
Sliwinski, Ron UW Hospitals and Clinics
Stanford, Matthew Wisconsin Hospital Association
Troy, Peggy Children’s Hospital of Wisconsin
Contributors Ranging from $3,000 - $4,999
Boatwright, Damond SSM Health Care-Wisconsin
Jacobson, Catherine Froedtert & The MCW 
Kammer, Peter The Kammer Group
Kerwin, George Bellin Hospital
Little, Steve Agnesian Health Care
Mettner, Michelle Children’s Hospital of Wisconsin 
Neufelder, Dan Ministry Health Care
Normington, Jeremy Mercy Medical Center
O’Brien, Kyle Wisconsin Hospital Association
Standridge, Deb Wheaton Franciscan Healthcare
Starmann-Harrison, Mary  Hospital Sisters Health System
Turkal, Nick Aurora Health Care
Contributors Ranging from $5,000 - $9,999
Borgerding, Eric & Dana   Wisconsin Hospital Association
Brenton, Stephen Wisconsin Hospital Association
Size, Tim Rural Wisconsin Health Cooperative
Contributors Ranging $10,000+  
Tyre, Scott Capitol Navigators, Inc.

 

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WHA Submits Comments on MACRA Request for Information
WHA member-employed and affiliated physicians impacted


On November 17, WHA submitted comments to the federal Department of Health and Human Services in response to their Request for Information (CMS-3321-NC) on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The law, which was enacted in April 2015, repealed the sustainable growth rate (SGR) payment system for physicians and in its place created regular physician fee schedule updates along with value-based payment programs for physicians and other professionals.

Wisconsin is known for its regional and local integrated delivery systems, and increasingly physicians are employed by or closely affiliated with WHA’s member hospitals and health systems. WHA has also played a strong role in the past several years on quality improvement strategies and ways to deliver better care for patients. While WHA’s role has largely been in the area of hospital quality measurement, the new physician payment program is an aspect of quality and value that will also have implications for hospitals and health systems as work with member-employed and affiliated physicians continues to evolve and becomes even more integrated. 

The SGR was an outdated system that was in an annual crisis situation and forced the federal government and Legislature each year to find cuts elsewhere—often from hospitals—to pay for physician payment increases. WHA was pleased to see it repealed, and is closely watching the implementation of the alternative payment system that was created under MACRA. 

MACRA creates a new Merit-Based Incentive Payment System (MIPS) and incentive payments for participating in Alternative Payment Models (APMs). MIPS payment adjustments and APM incentive payments will begin in 2019, based on MIPS performance or APM participation in a prior performance period. 

WHA commented on several aspects of the MIPS and APM programs, including quality measures and performance standards. WHA now has several years of experience with the hospital value-based purchasing program and other measurement reporting to drive improvement, and comments focused on ways to implement these programs while recognizing the administrative complexities and capabilities of larger and smaller practices. WHA also suggested that CMS use the same method of setting standards and measuring improvement as is used in the hospital value-based purchasing program, allowing providers to receive credit for improvement and achievement. 

WHA’s comment letter can be found here: www.wha.org/pdf/WHAresponseMACRARFI11-17-15.pdf.

For more detailed information on the MIPS and APM programs, visit the CMS website at:
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html.

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ETF Consultant Recommends Phasing in Self-Funding the State Employee Health Plan 
A regional model that narrows plan choice recommended for first phase
 

On November 17, Segal Consulting, a benefits consulting group hired by the State, released a report estimating the state could save $40 to $50 million annually by self-insuring state employees. This estimate is down from their previous report which estimated savings at $50 to $70 million annually. The report, presented to the State Employee Trust Funds’ (ETF) Group Insurance Board November 18, recommended a phased-in approach to the self-funded model with the state gathering additional data in 2017, and beginning to transition to the self-funded model after that “on a timeframe that is most advantageous to the program and allows ETF staff to manage the transition in a thoughtful manner.” 

When asked by a Board member why the state shouldn’t self-fund immediately if there are savings, the consultants responded that there is a need for the Department to ensure it has the expertise and staff to administer the model, that there is uncertainty and going slow would allow time for additional data and information to be obtained, and that it would be a lot for the state to handle to implement any sooner. 

A previous report by Deloitte Consulting estimated that a move to self-funding was risky and could cost the state up to $100 million in part due to the loss in existing provider discounts and care management that occurs with the provider-owned health plans. Segal noted they believe provider discounts can be maintained even in a self-funded model. However, Segal also notes that their information on provider discounts came from a request for information, and that “the information submitted with the RFI is not ETF specific and the results could vary if the analysis were conducted using ETF claims and utilization patterns.”

The Segal report provides several other recommendations that could be done separately from, or as a precursor to, self-funding. These recommendations include narrowing plan choice by establishing three regions in the state and contracting with up to two health plans per region, alongside a single statewide health plan. Segal recommends marketing these regional plans for 2018. Segal claims there is an opportunity for ETF to save between $45 and $70 million in medical costs from this approach without sacrificing provider access. 

Other recommendations in the report include improving benefit design by contracting with health plans that implement tiered provider networks, reference-based pricing, and centers of excellence. ETF has recently engaged a separate consultant to analyze these concepts and their use in the state employee health plan. These options, Segal recommends, can be implemented in 2018 along with the regional approach. 

The report also includes suggestions for improving incentives for employees to participate in wellness and disease management activities, pharmacy changes, and implementing a data warehouse. Each of these would involve procurements, and it is unclear how these procurements and vendors would be funded. Finally, the report makes recommended changes to the state program for retirees. 

In 2016, the ETF and the Group Insurance Board made several changes to the group health program that Segal estimates have saved the state $89 million for 2016. These changes include: higher deductibles; modifications to copayments for medical and prescription drugs; increasing the incentive for employees to participate in the high deductible health plan; increasing the out-of-pocket maximum; and improvements in the negotiation process with participating health plans. 

The state group health plan covers over 245,000 lives, including 69,000 active state employees and their dependents, 26,000 retired employees and their dependents, and 15,000 active and retired local employees and their dependents. The Group Insurance Board reviews and approves changes to the group health plan. The Board’s next scheduled meeting is in February 2016, but members discussed meeting prior to that date in a special session specifically so members could learn more and ask additional questions about the report. 

In the meantime, a bill that would give the Joint Finance Committee review of a self-funded model has now been approved by the Legislature and will be sent to Governor Walker (see related article below.)

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Worker’s Comp Council Moves Closer to Labor-Management Bill Draft Completion

On November 19, the Worker’s Compensation Advisory Council (WCAC) met to review draft bill language that reflects the proposals agreed to by labor and management at their last meeting in October. The agreed-to proposals are still expected to move forward without a fee schedule, but also without the pilot for “directed care” (see previous Valued Voice article at www.wha.org/pubarchive/valued_voice/WHA-Newsletter-10-23-2015.htm#1). The Council agreed to some minor technical changes in the draft bill language and is expected to review and approve those changes in the next few weeks. 

At the beginning of the meeting, Council members heard from guest speaker State Rep. John Spiros (R-Marshfield). Spiros is the lead author of AB 501, a bill that was introduced November 10 and would make various changes to Wisconsin Worker’s Compensation law. Many of the provisions in the WCAC proposal are similar to provisions included in AB 501, including the fact that both do not include a fee schedule. Spiros noted his ongoing interest in driving out waste, fraud and abuse, and emphasized to the Council that his goal is to protect both employees and employers in the Worker’s Compensation system. 

The Worker’s Compensation Advisory Council agreed-to bill will be referred to the Legislature for consideration in the next few weeks, once the Council votes to approve the final language.

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Grassroots Spotlight: U.S. Rep. Grothman Tours Columbia St. Mary’s 

U.S. Rep. Glenn Grothman recently visited Columbia St. Mary’s Ozaukee Campus. During his time there he had the opportunity to talk with leadership and staff about key issues, such as addressing rising drug prices and protecting the federal “340B” drug discount program.

Grothman also heard more about the importance of the “MEND Act,” the Making the Education of Nursing Dependable for Schools Act. This legislation is needed in order to fix conflicting federal requirements that hospital-based nursing programs currently face through no fault of their own. Grothman agreed to cosponsor this legislation. He also toured the electrophysiology lab.

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Support Statewide Health Care Initiatives with Contribution to WHA Foundation 

Each year, the WHA Foundation supports a variety of initiatives that have statewide impact on health care in the areas of workforce development, quality and patient safety and community collaboration. In 2015, those initiatives include scholarships for 20 hospital teams to participate in clinical OB simulation training, support for the third cohort of the Transforming Care at the Bedside (TCAB) initiative, and maintenance of the BSN completion program website, http://BSN.WHA.org

In order to continue supporting initiatives like these and others in 2016, the WHA Foundation has officially kicked off its annual fundraising campaign, asking WHA hospital and corporate members to consider supporting the WHA Foundation by making a contribution this month. 

Funds raised in the current campaign will be used to continue some of its most successful and long-standing initiatives, including the Global Vision Community Partnership Awards and the annual scholarships to graduating technical college students in health-related programs, and give the Foundation the opportunity to consider new initiatives for funding in 2016.

Each WHA hospital member executive has received a direct appeal for the fundraising effort. A contribution form is included in this week’s packet for anyone who would like to make an individual contribution or one on behalf of your organization. For more information on the WHA Foundation’s annual fundraising campaign, contact Jennifer Frank at 608-274-1820 or jfrank@wha.org.

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CMS Finalizes Mandatory Medicare Hip/Knee Bundle Model
Multiple Wisconsin hospitals required to participate

On November 16 the Centers for Medicare & Medicaid Services (CMS) finalized a new, mandatory model to bundle payments to hospitals for hip and knee replacement surgeries. The model is referred to as the Comprehensive Care for Joint Replacement (CJR) and is mandated in 67 different geographic areas, including in Milwaukee and Madison. The Wisconsin Hospital Association believes 22 Wisconsin hospitals will be impacted. 

Under the proposed model, hospitals would bear financial risk for the entire episode of care, beginning with the anchor hospitalization and extending 90 days post-acute care. In general, CMS will set a target episode price for each hospital to meet. Should a hospital fail to meet that amount, it would be required to pay Medicare back. If a hospital performs better than that benchmark and meets quality requirements, it will receive savings back. The model will run five years. Hospitals will not bear financial risk in year one, but then will do so in years two through five. 

When CMS first proposed the model this summer, WHA submitted comment indicating two primary areas of concern—hospitals bearing full financial responsibility without the ability to coordinate care and the quality requirements. WHA is pleased that CMS addressed several of these concerns in its final model. 

Key elements of the CJR model are listed below: 

While not addressing every item WHA recommended CMS address, WHA believes CMS has made valuable, warranted improvements.

 

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Physician Licensure Compact, GIB Oversight Clear Final Legislative Hurdle
WHA priorities pass Legislature in final days of session, Governor set to sign


The state Assembly concurred with the Senate’s recent action on two WHA legislative priorities during an extraordinary floor session November 16. Assembly Bill 253 and Assembly Bill 394 both previously passed in the Assembly, but Senate action amending the legislation required that the Assembly approve the bills one last time. Both bills were concurred on unanimously by the State Assembly and will now be sent to Gov. Scott Walker for his signature.

Assembly Bill 253, which adopts the Interstate Medical Licensure Compact into law in Wisconsin, passed the state Assembly in September with a vote of 95-1 and passed the Senate, as amended, with a vote of 31-1 in early November. The legislation was amended in the Senate Committee on Health and Human Services by Sen. Leah Vukmir (R-Wauwatosa). Vukmir’s amendment would require the Compact be reauthorized by the Legislature four years after the effective date of the bill. Gov. Walker is expected to sign this amended version of the legislation before the end of the year, making Wisconsin the 12th state to become a member of the Interstate Medical Licensure Compact.

The Medical Examining Board (MEB), in a meeting November 18, selected Board Chair Kenneth Simons, MD, of the Medical College of Wisconsin, and MEB Executive Director Tom Ryan to serve as Wisconsin’s two representatives to the Interstate Medical Licensure Compact Commission once Walker signs AB 253 into law. As part of Vukmir’s amendment to the bill, the Wisconsin MEB’s appointments to the Commission would require confirmation by the full State Senate.

The Assembly also concurred with a Senate amendment to Assembly Bill 394, legislation that would require the Joint Finance Committee review actions taken by the Group Insurance Board (GIB) impacting the state employee health insurance program. The amended version of this bill would limit the scope of the Joint Finance Committee’s review and approval authority to those actions taken by the GIB to “execute a contract to provide self-insured group health plans on a regional or statewide basis to state employees.”

While Walker had previously indicated he would veto Assembly Bill 394 if it were to reach his desk, his spokesperson has now indicated the Governor will sign AB 394 as amended by the Senate and Assembly.

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Register Now for WHA 2016 Physician Leadership Conference in Kohler

One of the most difficult transitions for a new physician leader is the move from working autonomously and focusing on clinical issues to leading a team with a new approach to managerial decision-making and problem solving. The WHA 2016 Physician Leadership Development Conference will focus on the tools, techniques and skills to assist both new and seasoned physician leaders in making that transition.

The 2016 conference, scheduled Friday, March 11 and Saturday, March 12 at The American Club in Kohler, will be led by Stacy Nelson, MEd EdD. He will focus on ways physician leaders can lead strategic conversations and influence change within the organization. In addition, Michael Guthrie, MD, MBA, FACPE, will share best practices for running effective meetings and use group dynamics to build support and decision-making. Both Nelson and Guthrie are nationally-recognized faculty from the American Association for Physician Leadership (ACPL), formerly the American College of Physician Executives.

Registration is now open online at http://events.SignUp4.net/16PLD, with a discounted “early bird” registration fee 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. ACPL is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. ACPL designates this live activity for a maximum of 10 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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Clinicians, Educators, Health Care Managers Attend WCMEW Conference

Nearly 100 clinicians, health educators, and health care managers attended the Wisconsin Council on Medical Education and Workforce (WCMEW) 2015 Team-Based Care Summit “Transforming Concepts Into Reality” November 12 in Appleton.

Charles Shabino, MD, WCMEW chair, started by summarizing the WCMEW team-based care priorities. Sarah Sorum, PharmD, vice president, professional & educational affairs, Pharmacy Society of Wisconsin and lead for WCMEW’s Team-Based Care Workgroup, spoke about the workgroup’s goals and activities. Gina Dennik-Champion, executive director of the Wisconsin Nurses Association, presented an overview of a Wisconsin-centric definition of team-based care.

The introductory remarks were followed by two keynotes. Kathy Kerscher, leader of operations of primary care for Bellin Health, spoke on “Achieving Population Health Through Team-Based Care,” focusing on how Bellin Health has redefined primary care, the steps to achieve population health and core concepts for team-based care.

This presentation was followed by a panel discussion on “Payer Perspectives on Team-Based Care,” led by George Quinn, WCMEW executive director. Gregory Long, MD, chief medical officer of ThedaCare, provided an overview of ThedaCare’s “Complex Patient Care Redesign,” focusing on provider and payer perspectives in redesign, and on how current payment and delivery models need to be disrupted to achieve enhanced value. Terry Bolz, CEO of Unity Health Plans, presented on “How Payers And Providers Can Work Together,” saying that the greater degree of convergence between payers and providers—both in terms of goals and functions—the greater the likelihood of success.

After a working lunch where attendees reviewed eight poster presentations, two concurrent sessions were held. Andy Anderson, MD, CMO of Aurora Healthcare, presented “The Importance of Metrics to Drive Continuous Improvement.” William Hueston, MD, senior associate dean for academic affairs, Medical College of Wisconsin, led a panel discussion with Kimberly Edlis, PhD, program director, Bellin College, who spoke on “Transforming Education/Transforming the Future,” and Joseph Zorek, PharmD, assistant professor, UW Madison School of Medicine and Public Health, discussing “The Historical Roots Shaping Today’s Interprofessional Practice and Learning Landscape.”

The day closed with two concurrent sessions. Dennik-Champion led a panel discussion on “A How-To Guide: Managing Workflows, Developing Protocols, Expanding Roles.” Kerscher and Rob MacNeil of Bellin, and Lynda Gruenewald Schultz, Wheaton Franciscan Health Care, gave perspectives from their organizations.

“Our goal for this year’s Summit was to provide interprofessional learning and dialogue about team-based care, and to describe tools and techniques for implementing team-based care in Wisconsin,” said Quinn. “We are gratified that so many stakeholders engaged in these discussions.”

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Building Materials Sales Tax Legislation Passes Senate, Assembly
Senate Bill 227 allows contractor exemption for nonprofit, tax-exempt construction projects


The State Assembly passed legislation November 16 that would allow contractors to purchase certain materials for nonprofit organization construction projects without being charged sales and use tax at the time of purchase. The legislation, introduced by Sen. Howard Marklein (R-Spring Green) and Rep. Bob Kulp (R-Stratford), would allow contractors to purchase materials directly instead of being required to purchase these construction products through the nonprofit organization. 

Currently, when a contractor purchases certain building products directly, they are not eligible for a sales tax exemption even when the contractor’s customer is a nonprofit, tax-exempt entity. The contractor must then develop a separate process to ensure that the nonprofit doesn’t pay sales tax that is not owed to the state of Wisconsin or must require the nonprofit to purchase these building products directly.

Marklein testified before the Senate Committee on Revenue, Financial Institutions, and Rural Issues that the bill will streamline the building material exemption for nonprofit organizations and eliminate the current complicated process for purchasing construction materials by a contractor.

The bill has now been passed by both the Senate and the Assembly and awaits the Governor’s signature. The Governor vetoed a similar provision in the state budget, but indicated he would sign standalone legislation that was more limited in scope. The Governor is expected to sign SB 227 into law before the end of the year.

To see the bill’s final language, go to: http://docs.legis.wisconsin.gov/2015/related/enrolled/sb227.pdf.

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