June 5, 2015
Volume 59, Issue 22


WHA Member Forum Examines Advanced Practice Clinician Hospitalist Programs

The use of advanced practice clinicians (APCs) in hospitalist programs in Wisconsin hospitals will be the focus of a complimentary WHA Member Forum, offered in partnership with the WHA corporate member Quarles & Brady, LLP. This three-part webinar series will examine and discuss a variety of practical and legal issues that must be considered when implementing such a program. 

The first session, offered August 5, will focus on the various legal parameters relevant to an APC hospitalist program and challenges hospitals face when considering use of APCs as hospitalists. The second session September 2 will discuss ways to structure hospitalist programs in critical access hospitals, the limitations of using APCs in PPS hospitals, and the potential risks involved with these programs and viable mitigation strategies. The third and final session October 6 will examine the practical steps hospitals need to take to implement an APC hospitalist program. All programs will be presented by the Health Law Group attorneys of Quarles & Brady.

There is no fee for WHA hospital and corporate members to participate, but pre-registration is required. This WHA member forum webinar series is intended for and limited to staff of WHA hospital and corporate members only, as a member benefit.

Health care executive leaders, nursing leaders, chief financial officers, chief operating officers, hospital and health system in-house counsel and others interested in learning more about the issues to be considered for developing an APC hospitalist program should plan to participate. Attendees are encouraged to participate in this webinar series as a team. While attendees are encouraged to attend all three sessions, the option exists to register for individual sessions as well.

A brochure is included in this week’s packet, which describes each of the three sessions in more detail. Online registration is also available at http://events.SignUp4.net/2015APHospWebSeries.


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Budget Committee Preserves Rural Physician Training Program
WRPRAP, loan assistance programs remain funded in Joint Finance version of budget


As the Joint Finance Committee comes closer to wrapping up their work on the biennial state budget, the Committee recently took up major changes proposed in the Governor’s budget to the UW System. The proposed bill would have converted the UW System from a state agency into a “public authority” and would have provided the UW System with more autonomy to make programmatic decisions that were previously required by state law. 

The bill, as introduced, would have also eliminated the requirement that the UW System implement the Wisconsin Rural Physician Residency Assistance Program (WRPRAP), the Physician and Dentist Loan Assistance Program and the Health Care Provider Loan Assistance Program. Instead, the bill would have left that decision up to the UW System Authority.

The entire WRPRAP program and portions of the loan assistance programs are funded through the critical access hospital assessment. The introduced budget bill would have also eliminated funding for these programs in the second half of the biennium (FY 2016-17).

WHA and the Rural Wisconsin Health Cooperative (RWHC) engaged early on in the budget process with the Governor and the Legislature to ensure that these programs were protected into the future. WHA President/CEO Eric Borgerding sent a letter to Governor Walker in early March requesting that the funding be preserved in the Department of Administration’s errata letter which follows the introduction of the budget and clarifies the Administration’s intentions. 

In his letter, Borgerding commended Governor Walker’s “unprecedented proposal” in the 2013-15 biennial budget to fund a WHA-endorsed proposal that provided $5 million to expand graduate medical education opportunities in Wisconsin. Borgerding also stated that “the state’s critical access hospitals have previously stepped up to pay for a rural physician training and loan forgiveness program” through the critical access hospital assessment and recommended that this funding be protected in the errata letter.

The errata letter submitted on April 13 to the Finance Committee indicated that the elimination of this funding was done “inadvertently” but still left the decision to implement the programs up to the UW System Authority.

A list of provider organizations, including WHA, RWHC, and many WHA member organizations, sent two letters to the members of the Joint Committee on Finance encouraging the Committee to protect funding for these physician training and recruitment programs.

The Finance Committee decided on May 29 to make significant changes to the Governor’s proposed UW System Authority model, including rejecting the Authority proposal and maintaining the System as a state agency. The Committee’s changes included restoring funding for the WRPRAP and health care provider loan assistance programs. The Committee also chose not to adopt the Governor’s recommendation to make the implementation of these programs optional for the UW System.

The budget bill is currently awaiting final action in the Joint Finance Committee. After the Committee finishes its work, the bill moves on to both chambers of the Legislature for their approval and finally onto the Governor’s desk for his signature and any partial vetoes he may make to the bill.

To see a copy of the letters sent to the Joint Finance Committee, go to: www.wha.org/pdf/WRPRAPfunding5-28-15.pdf.

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Guest Column: Health Care Providers Play Vital Role in Combatting Opioid Abuse
By Attorney General Brad Schimel


Over the past decade, the number of accidental opiate overdose deaths has more than quadrupled. So have the number of emergency department visits for opiate poisonings. So have the administrations of the overdose antidote Narcan. And so have the number of needles exchanged—well over 700,000 needles every year in southeastern Wisconsin alone. The number of heroin submissions to the Wisconsin Crime Lab has more than quadrupled, as well. 

In Milwaukee County in 2014, more people died from heroin overdoses than car crashes. Opiate overdose deaths outpace traffic deaths in many Wisconsin counties. Hundreds of people, mostly in their late teens and early 20s, had their life taken by heroin and other opiates in 2014. The numbers for the first few months of 2015 show Wisconsin is on track for setting another tragic record. In the U.S., the No. 1 cause of accidental death is a drug overdose and three-quarters of those overdoses are caused by opiates. The Centers for Disease Control estimates that Wisconsin has over 163,000 intravenous drug abusers. 

We do not have a fraction of the treatment opportunities necessary to address that need.

Our most recent statewide drug take-back day collected over 39,000 pounds of unused prescription drugs, and that number does not include Milwaukee or Madison. Are we, perhaps, a bit over-prescribed? We must be ready, as public safety and public health professionals, to finally ask ourselves what we are prepared to do about it.

At the Wisconsin Department of Justice, I have made the state’s heroin and opiate epidemic my top priority. This fall, we will debut a powerful new public awareness campaign, targeting not only teens and young adults, those most prone to becoming addicted, but all Wisconsinites. We are training law enforcement to attack this more effectively. We are working on substantial upgrades to the Prescription Drug Monitoring Program. We are advocating for treatment courts and other efforts to help those who are trapped in addiction. We are working with school districts statewide to raise awareness, and much more.

We are working tirelessly in the enforcement community, but we cannot just arrest our way out of this. The opiate epidemic is driving dramatic increases in virtually every type of crime. Initially, users typically pay for drugs by stealing from family members and friends. They then move on to commit crimes against others to finance their habit. 

Almost no one starts with heroin. Prescription opioids sell on the street for about $1/mg and they are the gateway to heroin. Those who do not die from opioids will eventually find the prescription pills too hard to find and to afford as their tolerance and daily need builds. They then turn to heroin as a less expensive and readily accessible alternative. 

If we don’t address this problem, the cost to the community will continue to grow, not only in lost lives but in treatment and recovery, medical examination and toxicology, street crime and law enforcement and judicial costs. Our best bet to end this scourge is prevention. Health care providers play a vital role.

I am asking you, our valued medical providers, to change the conversation you have with patients. I am asking you to have a frank discussion with them about the dangers of prescription opiate abuse. I am asking you to join me in a battle for our children, our loved ones and our community.

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WHA Urges CMS to Postpone Finalizing Stage 3 Meaningful Use Rule

On May 29, WHA submitted a comment letter to the Centers for Medicare & Medicaid Services (CMS), recommending that the federal agency refrain from finalizing proposed Stage 3 requirements for meaningful use of electronic health records (EHRs) at this time. Instead, WHA encouraged the agency to continue to evaluate the experience of Stage 2 while accelerating the availability of mature standards to support meaningful use requirements in accordance with clinical needs.

“Wisconsin hospitals and health care systems have made their investments in EHR technology and other HIT as a means to enable their provision of higher quality and lower cost health care to citizens in Wisconsin,” wrote WHA President Eric Borgerding. “WHA believes that by critically assessing what is working and what is not working with Stage 2 before enacting Stage 3 regulations, health care providers and patients can be better assured that the investments made and costs to meet the Stage 3 requirements will yield a ‘return on investment’ in the form of higher quality and more cost-efficient health care.” See WHA’s Stage 3 comment letter..

WHA submitted a separate comment letter May 29 to the Office of the National Coordinator for Health Information Technology (ONC), urging the ONC to finalize proposals in the 2015 Edition rule to increase the transparency and reliability of certified health IT through robust testing, increased surveillance of products in the field, and increased disclosure requirements on vendors.

“To date, providers and CMS have invested enormously in EHR products, and WHA is concerned that some of the direct and indirect costs associated with meaningful use are not yielding commensurate benefits in efficiency and improved patient outcomes,” Borgerding wrote. “WHA believes that additional vendor transparency and product reliability will be valuable to protecting our investments.” See WHA’s 2015 Edition comment letter.

As emphasized in the two comment letters, WHA believes that both federal policymakers and the Wisconsin provider community share the same goal of widespread hospital and physician adoption and use of EHRs in ways that improve health care quality and positively impact patient care. Especially for a state like Wisconsin that is already focused on providing high-value health care, WHA wants to see the meaningful use program and the accompanying certification criteria assist our efforts rather than inhibit them.

If you have questions on the proposed rules, WHA’s comments on the proposed rules, or other meaningful use or EHR issues, contact Andrew Brenton, WHA assistant general counsel at abrenton@wha.org, or General Counsel Matthew Stanford at mstanford@wha.org, or 608-274-1820.

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Federal: RAC Changes Supported by U.S. Senate Finance Committee

On June 3, the U.S. Senate Finance Committee approved proposed modifications to audit programs, like the Recovery Audit (Contractor) Program. The AFIRM Act—the Audit & Appeal Fairness, Integrity, and Reforms in Medicare Act of 2015—includes proposed changes that revolve around two central areas. The first area of changes are to begin to address the significant backlog in appeals at the federal Office of Medicare Hearings and Appeals (OMHA). The second set of changes target audit programs themselves. Read WHA’s summary of AFIRM Act changes.

WHA appreciates the efforts of the U.S. Senate Finance Committee to listen to providers regarding ongoing problems with federal audit programs and to make improvements through the AFIRM Act. At the same time, WHA continues to support comprehensive legislation, known as the Medicare Audit Improvement Act (HR 2156), which goes further than the AFIRM Act. WHA thanks U.S. Reps. Reid Ribble and Glenn Grothman for cosponsoring the Medicare Audit Improvement Act and encourages other Wisconsin House Members to do likewise. 

As a reminder, if you or a member of your staff would like to receive periodic WHA RAC updates, contact Jenny Boese, WHA vice president, federal affairs & advocacy, at jboese@wha.org to be added to the RAC email update list.

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House Ways and Means Committee Identifies ICD-10 Recommendations 

In a letter to the Centers for Medicare and Medicaid Services (CMS) June 1, 2015, the House Ways and Means Committee urged the agency to make information available to providers and the broader public that helps to address concerns associated with the implementation of ICD-10. In the letter, the Committee recommended CMS:

Transparency was an underlying theme throughout the letter. The committee requested a “timely response” from CMS regarding these concerns to instill confidence among providers that the October 1, 2015 ICD-10 implementation will not cause widespread disruption.


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Reminder: Last Chance to Register for the 2015 Wisconsin Rural Health Conference
Glacier Canyon Lodge at The Wilderness Resort, Wisconsin Dells June 17-19, 2015


More information and online registration are available at: http://events.signUp4.net/15Rural

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Rural Seminar Focus on Community Health, Economic Development

The Federal Reserve Bank of Chicago is hosting a one-day seminar July 1 at the University of Wisconsin-Platteville to discuss issues related to population health and economic development in rural communities. The daylong event provides an opportunity to explore community initiatives that can improve health, create prosperity, and develop resilience in rural communities. National speakers and local leaders in community and economic development and community health improvement work will share examples of successful community integration among the disciplines from the perspectives of policy, practice and financing.

The audience will dialogue on how different sectors can work together more effectively to make the rural Midwest region healthier and more prosperous. Additionally, appropriate follow-up activities that continue to shape new solutions will be discussed and planned.

Co-collaborators include the University of Wisconsin Population Health Institute, Robert Wood Johnson Foundation, Fort HealthCare, Forward Community Investments, Madison Region Economic Partnership, Rural Wisconsin Health Cooperative, Southwestern Wisconsin Community Action Program, and the Wisconsin Partnership Program to plan and organize the summit.

Pre-registration is required. No onsite registration will be accepted. Click for more information and to register

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Nearly 30,000 ER Visits in Wisconsin are Related to Migraines
June is National Migraine and Headache Awareness Month


Migraine is an extraordinarily common disease that affects 36 million men, women and children in the United States. Almost everyone either knows someone who has suffered from migraine, or has struggled with migraine themselves. American employers lose more than $13 billion each year as a result of 113 million lost work days due to migraine.

According to the WHA Information Center, in 2014 there were 11,535 inpatient discharges, 9,923 outpatient surgery records, 28,377 emergency department visits, 3,058 observation care visits, and 31,065 hospital outpatient clinic and ancillary services visits for the primary or secondary treatment of migraines. 

Data provided by the WHAIC (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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