May 13, 2016
Volume 60, Issue 19

WHA Provides Online Resources to Help Members Understand CMS Payment Rules

Recently, the Centers for Medicare & Medicaid Services issued proposed prospective payment system (PPS) rules for hospital inpatient, long-term care hospital, inpatient rehab facilities and skilled nursing facilities for fiscal year 2017. It also released a new Medicare Part B payment proposed rule.

These are the first of many proposed and final Medicare payment rules that are generally released from now through October of each year.

WHA has excellent resources on its website to help members understand these important Medicare payment rules, by providing detailed rule summaries and hospital-specific analysis on the financial impact of the changing rules. 

All completed PPS rule summaries can be found on the WHA website at Once there, see the left hand side of the webpage for the PPS topic you are interested in.

The hospital-specific fiscal analysis of the Medicare PPS payment rules and the Medicare Part B drug payment rule can be obtained on the WHA member portal at Currently, the hospital inpatient PPS and the Medicare Part B drug payment rule analyses are available. Others are being developed and will be available soon.

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Schimel: Employers Lose $26 Billion per Year as a Result of Opioid Abuse

Wisconsin Attorney General Brad Schimel unveiled his next focus of the “Dose of Reality” campaign at WHA’s May 12 Council on Workforce Development meeting. Phase two of his opioid abuse public awareness campaign will focus on the impact this growing epidemic has on Wisconsin’s workforce. 

“Four out of five employers have had to deal with prescription opioid addiction in the workplace,” shared Schimel. Assisting employees to “get the help they need” is the “right thing to do, but for those who need further convincing, the monetary losses to a business are huge.” Continued Schimel, “Employees can intervene early. If we wait until they lose their jobs, we have lost an opportunity to help.”

Schimel shared with the Council printed and web-based resources his office plans to release to the public next week that are intended to be used by human resource departments and other employers. He also asked Council members to remember it is not just the employee who might need direct assistance, but that a family member or friend of the employee may the person experiencing opioid addiction and misuse. Schimel stated that when an employee’s family member struggles with heroin or opiate abuse, the employee may be less productive at work due to the stress and concern about their family member’s well-being.

Schimel made the following recommendations to the Council:

“The employee who calls in sick might be doing so because they are caring for a family member who is struggling with opioid addiction. The employee who is on the phone might be calling home to make sure their son or daughter is still alive. How productive can an employee be in that situation?” cautioned Schimel.

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WHA Submits Comment Letter to CMS on Proposed Part B Drug Model

On May 9 the Wisconsin Hospital Association (WHA) submitted comments to the Centers for Medicare and Medicaid Services (CMS) on its proposed Part B drug payment model. CMS proposes a two-phased model. During Phase I, reimbursements for most drugs paid for under Part B would be reduced from the current Average Sales Price (ASP) plus 6 percent to the ASP plus 2.5 percent and a flat fee. CMS indicates Phase I will reduce reimbursement by approximately 2.3 percent overall. Phase II is still yet to be fully defined, but CMS indicates it could include options such as reference pricing among others. CMS indicates the full intention under Phase II is to find savings for the Medicare program. 

While continuing to support a movement from paying for volume to paying for value in the Medicare program, WHA’s comment letter provided several cautions to CMS, including concerns with the scope, breadth and impact of the proposed model.

“We appreciate that the Part B model demonstrates a recognition by CMS of the growing concern over the cost of pharmaceuticals,” WHA’s letter read. “However, for CMS to undertake this large of a model without having some sense of the model’s implications on both providers and patients is risky.”

WHA also expressed concerns with the disproportionate impact this model would have to certain drugs, like oncology and behavioral health, and certain types of providers or locations, such as hospital outpatient departments (HOPDs) and specialists. 

“While CMS takes pains to indicate the Part B model is budget neutral during Phase I, in truth the model will still be redistributive during this phase. Many HOPDs and specialty providers, like oncology and rheumatology, will see more reimbursement cuts under this proposed model. One study shows some 60 percent of HOPDs will see reimbursement reductions in Phase I,” said WHA.

With respect to certain higher cost drugs, WHA indicated, “Studies have shown that seven of the top 10 higher cost drugs are for cancer care. Unfortunately, this model does not take into consideration that there is not always a lower cost, clinically comparable drug alternative to a higher cost drug, nor will that drug always be readily available or viable in each situation.”

WHA recommended that if CMS pursues this model, it should limit the scope of Phase I and delay Phase II until Phase I impacts can be fully understood. 

WHA closed its letter with a reminder to CMS about ongoing sequester cuts. “All Medicare providers are still under congressionally-mandated sequester cuts and would continue to see these Medicare reimbursements reduced by two percent on top of the drug payment reductions under the Part B drug model.” 

Read WHA’s letter at:

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AHA to Host Rural Hospital Policy Forum in DC
WHA will participate, coordinate Hill visits

The American Hospital Association (AHA) will host a rural hospital policy forum in Washington, D.C. June 23. Morning speakers will include members of Congress and the Administration. The remainder of the day will be for attendees to schedule time to meet with members of Congress. 

The Wisconsin Hospital Association (WHA) plans to travel to DC and participate in this day. WHA will coordinate meetings with Wisconsin Members of Congress for any health care leaders who plan to participate. If you plan to attend, contact WHA Vice President, Federal Affairs & Advocacy Jenny Boese at or 608-268-1816. 

Access AHA Rural Hospital Policy Forum event details at

Register for the AHA Rural Hospital Policy Forum at

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Rural Conference Keynote Focuses on What Makes Health Consumers Tick

The 2016 Wisconsin Rural Health Conference will kick off with a keynote presentation by Ryan Donohue of the National Research Corporation. Donohue is a national thought leader in the realm of health care consumerism, conducting extensive research over the last decade on the effects of consumerism on the U.S. health care industry. Donohue will share what’s important to health care consumers as they make decisions, why consumers are not connecting with hospitals and health systems, and how rural health care providers can use the information to improve that relationship with past, current and future patients.

In addition, this year’s event will include a plenary session presented by Toby Freier, president of New Ulm Medical Center in New Ulm, Minnesota; the ever-popular state of Wisconsin health care session presented by the leaders of the Wisconsin Hospital Association and the Rural Wisconsin Health Cooperative; and an inspirational closing session by Sgt. Keni Thomas, former U.S. Army Ranger and Bronze Star Medal for Valor recipient.

Register today to join your colleagues at the 2016 Wisconsin Rural Health Conference. Scheduled June 29-July 1 at The Osthoff Resort in Elkhart Lake, make attendance at this year’s conference a priority by registering today. Online registration and conference information are available at

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Grassroots Spotlight: Rep. Hutton Tours Children’s Hospital of Wisconsin Dental Clinic

Recently Rep. Rob Hutton was able to tour Children’s Hospital of Wisconsin dental clinic. During his time there, he had an opportunity to discuss the clinic with leaders and hear about the valuable services provided.

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WHA Webinar Aims to Debunk Myths on Opioid Prescribing, HCAHPS 

On June 1, WHA will offer the webinar: “HCAHPS, Patient Satisfaction & Opioid Prescribing: Debunking the Myths,” as the next in the series focused on the health care leader’s role in addressing this growing issue. 

Kelly Court, WHA chief quality officer, will present data that debunks the common myths of HCAHPS patient satisfaction scores related to pain management on physician compensation. 

In addition, Tim Gullingsrud, CEO of Hayward Area Memorial Hospital, will be joined by three staff members—Patti Patefield, quality director; Alison Farley, pharmacist; and Trina Sjostrom, medical surgical nursing manager—to share their journey of significantly improving their HCAHPS score on pain management with methods entirely other than prescription medication. To register for this June 1 webinar, visit:

There is no fee for WHA hospital and corporate members to participate in this WHA Member Forum webinar, but pre-registration is required. For more information or to register for any WHA Member Forum webinars, visit For more information, contact Jennifer Frank at or at 608-274-1820.

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WHA Members Celebrate National Hospital Week 

This week, the Wisconsin Hospital Association (WHA) joined our member hospitals in celebrating National Hospital Week. WHA President/CEO Eric Borgerding was an invited guest at a May 9 celebration at Tomah Memorial Hospital (TMH). He recognized the important role that each and every employee has in ensuring safe, high-quality patient care.

“People speak fondly of the hospital in their community. But it is not the 'hospital' they remember,” Borgerding told the TMH employees. “It’s people who make a hospital memorable. And it’s the people who build its reputation.”

In addition to its own Facebook posts and Twitter, WHA also reposted member social media posts. 

WHA staff is honored to work with Wisconsin’s hospitals and health systems and proud of the high-quality, high-value care they provide in every community in our state.

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Governor Walker Continues Listening Sessions Across State
Hears from health care leaders in Rusk County 

Gov. Scott Walker continued his swing of listening sessions across the state to gather input from a variety of individuals about a Wisconsin 20-year vision. On May 6, he was in Rusk County. 

“As for my perspective, the brainstorming session the Governor led garnered input regarding what is exceptional about the state of Wisconsin and what the future would look like,” said Charisse Oland, CEO at Rusk County Memorial Hospital, Ladysmith. “Among the areas highlighted for the future, especially for rural areas, were the importance of economic development, improving health, protecting Critical Access Hospitals and providing communication infrastructure.” 

A priority targeted during the discussion was the need to meet broadband and other communication infrastructure requirements that would level the economic development playing field for rural areas. Further, Oland added that attracting business and industry is essential long-term and is directly associated with maintaining a healthy population in order to improve Rusk County’s health ranking of 66 out of Wisconsin’s 72 counties. 

Oland also discussed the importance of maintaining the rural health care infrastructure, including Critical Access Hospitals like Rusk County Memorial.

“Critical Access Hospital funding is essential to sustain rural health care services in the 20-year vision. Our recent hospital investment in electronic medical records, for example, will require thousands of hospital dollars in order for us to gain communication access to a fiber network specific for meeting our own data transmission needs,” Oland said. “Government can play an important role by funding communication and other infrastructure and by reducing regulatory barriers to business development.”

The listening session also highlighted the positive impact new rural health training and residency programs for medical doctors will have; however, adequate funding is still needed for programs that respond to social determinants of health, such as personal care services, job transition assistance, early intervention services for children, behavioral health services, and drug and alcohol dependency programs. 

“The Governor described that he has seen similar issues in other rural communities and will incorporate these findings into his strategic plans for the future,” said Oland about the listening session. “I appreciated his genuineness and the opportunity to have this input.”

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