August 21, 2015
Volume 59, Issue 33


WHA Testifies in Support of Medical Licensure Compact Bill
Sen. Harsdorf: Lengthy licensure process is “unacceptable” for WI communities


On August 18, the Assembly Health Committee held a hearing on a WHA legislative priority—Wisconsin’s adoption of the Interstate Medical Licensure Compact. The bills, Assembly Bill 253 and Senate Bill 196, would create an alternative, voluntary, expedited process for qualified physicians licensed in other states to receive a Wisconsin medical license. 

“This legislation is one important tool for Wisconsin to address its significant physician shortage,” said WHA General Counsel Matthew Stanford. “The Compact will enable highly-qualified physicians to receive a Wisconsin license much more quickly, and thus enable them to begin serving patients in Wisconsin communities much more quickly.”

Rep. Nancy VanderMeer (R-Tomah) and Sen. Shelia Harsdorf (R-River Falls), lead authors for the bill, provided testimony explaining how the bills would cut regulatory red tape, increase access to care and maintain Wisconsin’s autonomy to fully regulate the practice of medicine in Wisconsin. 

“Essentially, the patchwork of state-by-state medical licensing application requirements is presenting a costly and time-consuming barrier to the practice of medicine,” said VanderMeer. “This bill seeks to address that regulatory burden.”

“Hiring a physician to come to a community and then not being able to have them start working while they have to wait six months to get a Wisconsin license is simply unacceptable,” according to Harsdorf. “Health care providers and others in my district have over the years repeatedly stressed the importance of doing whatever we can to expedite the licensure process.” 

Gordy Lewis, CEO of Burnett Medical Center, a critical access hospital in Grantsburg, explained the physician supply issues facing rural communities and the beneficial impact the Compact will have on rural communities’ local access to physician services. 

“The Compact is an elegant and timely solution whose time has come and can help address the challenges before us,” said Lewis. “In rural areas, the Compact will help to provide care close to home in the traditional face-to-face way, but also through the growing use and promise of telemedicine as well.”

Eric Templis, Gundersen Health System; Donn Dexter, MD, Mayo Clinic Health System and Wisconsin Medical Society; Mark Grapentine, Wisconsin Medical Society; and, Kenneth Simons, MD, Medical College of Wisconsin, also provided testimony expressing their organizations’ strong support for the Compact.

“We have an opportunity as states and with the leadership of the states’ medical examining boards to come up with a state solution at a critical time for the practice of medicine,” said Templis. He explained that Gundersen physicians are increasingly directly seeing patients in clinics in multiple states, but the increasing use of telemedicine to provide specialized local care will also necessitate that physicians hold licenses in multiple states. 

Stanford, as well as Simons, who chairs Wisconsin’s medical licensing board, also addressed various misnomers about Wisconsin’s Compact adoption bill:
WHA is working with the chair of the Health Committee to advance the bill for a vote in the full Assembly this fall.


Top of page (8/21/15)


Rep. Czaja: Rural Legislators “Really Pushed” DSH, Proposed 30 Budget Motions
Czaja / Vukmir support legislation to address barriers to behavioral health services access


Rep. Mary Czaja (R-Irma) is deeply concerned about health care access and cost, and her efforts in the Legislature reflect how important she feels these issues are not only in her district, but across the state. 

Even in a challenging budget year, Czaja, who is a member of the Joint Finance Committee (JFC), said funding and making the Disproportionate Share Hospital (DSH) program permanent was a priority for her. In addition, she noted that 30 of her colleagues also requested that DSH be made a permanent line item in the state budget. 

Czaja told Council members, “Your rural legislators really, really pushed to make DSH happen.”

Speaking at the WHA Public Policy Council meeting August 20 held in a Senate committee room at the State Capitol, Czaja spoke passionately about issues related to health care. As the former owner of an insurance agency and a small business owner, Czaja is knowledgeable about health care and is committed to improving health care access not just in northern Wisconsin, but across the state.

Czaja’s commitment to and concern about behavioral health-related issues prompted her to work with Sen. Leah Vukmir (R-Wauwatosa) to create a behavioral health-related legislative package designed to better coordinate care for individuals suffering from mental illness. The package includes testing alternative payment models for psychiatric consultations, developing a pilot program that would incentivize care coordination within a health system for super utilizers of care and create an online mental health bed tracker for hospital staff to use when looking for a psychiatric bed. 

Initially, Czaja said she will suggest that some of the pilot programs need to be in more urban areas where it would be easier to monitor the progress of patients and coordinate their care. 

Council Chair Tim McKevett, president/CEO, Beloit Health System, thanked Czaja for her service and mentioned how important it is to his hospital that Wisconsin join the Interstate Physician Licensure Compact, stating that 50 percent of Beloit Health System physicians hold an Illinois license. 

Czaja responded by saying, “We need to be better at making licensing easier...we’re supposed to be open for business and less regulation.” 

Czaja also discussed her motivation to require some additional legislative oversight over the state employee health plan, which she believes is necessary. She described the current governing structure as “handing over our credit card” to the Group Insurance Board (GIB), with no say in what happens. Since the Legislature must pass a budget that includes changes made by the GIB, she feels it is necessary that the Legislature be involved in that process. Czaja said there are currently no legislators or representatives of the Legislature as sitting members on the GIB. 

Czaja said that her biggest fear of a policy decision by the GIB is “a move to self-insurance,” which could result in cost increases to the state.

WHA’s government relations team provided a brief overview of the enacted state budget and recounted the extensive grassroots and advocacy efforts that were necessary to accomplish key priorities, such as making the Medicaid Disproportionate Share Hospital (DSH) program a permanent appropriation. WHA Senior Vice President of Government Relations Kyle O’Brien said those accomplishments were the result of a year-long multifaceted advocacy plan that depended on broad grassroots engagement, member interactions with legislators back in their districts and direct lobbying in the state capitol.

WHA President/CEO Eric Borgerding briefed the Council on a new Workers Compensation proposal being offered by the Wisconsin Manufacturers and Commerce and that was recently reviewed by the WHA Board. Among the proposal’s components would be creation of a new governmental entity known as the Worker’s Compensation Medical Cost Management Council and another called the Discount Dispute Resolution Panel. The new entities would be given powers to collect data from providers, determine reimbursement for care, levy fines and charge fees. The proposal, which also includes components related to directed care, improved administrative technology and treatment guidelines, was submitted to the Worker’s Compensation Advisory Council in May, and is expected to be debated at upcoming WCAC hearings.

Public Policy Council members were highly skeptical of those elements of the proposal that would create new mandates and fees and add additional regulatory structures to an already extremely complicated Workers Compensation system. WHA and others have instead called for reforms that reduce the complexity of the system by streamlining claims processes, improve payer-provider communication, and reduce the layers of middlemen the occupy the Workers Compensation system. Council members felt other elements of the proposal that need more information, while other agreed-upon provisions should be pursued this legislative session—especially the adoption of a technology platform that would help streamline claims processing, improve communication and reduce cost.

O’Brien also provided the Council with an overview of two other key WHA proactive priorities for this fall legislative session. The first is legislation adopting an interstate physician licensure compact in Wisconsin, which will streamline the licensure process for those physicians choosing to be licensed in Wisconsin and other compact states. Currently, 11 states have joined the compact including Illinois, Iowa and Minnesota. Responding to a question from Council Chair Tim McKevett, O’Brien said he expects the compact licensure process to be operational by January 1, 2017 for those states that enact legislation implementing the compact in their state.

The Interstate Physician Licensure Compact legislation, which has already been introduced in Wisconsin as Assembly Bill 253 and Senate Bill 196, received a hearing before the Assembly Health Committee on August 18. WHA General Counsel Matthew Stanford and Burnett Medical Center CEO Gordy Lewis testified in favor of the proposal at that hearing (see related story in this issue). O’Brien also noted that adding co-sponsors to the legislation was a 2015 WHA Advocacy Day priority, which resulted in dozens of legislators adding their name to the bill and a total tally of 76 legislators as co-sponsors of the measure.

O’Brien reported that WHA is a strong supporter of the package of behavioral health legislative proposals crafted by Czaja and Vukmir, described earlier in this article. He said WHA has met with members of the Assembly Health, Senate Health and Assembly Mental Health Reform Committees to garner support for the plan and he expects broad, bipartisan support once the package is circulated for co-sponsorship. O’Brien said he expects the legislation to be released in the coming weeks.

WHA General Counsel Matthew Stanford facilitated a Council discussion to obtain input on potential changes to Wisconsin’s nursing home bed cap and approval process. In signing the state budget into law, Gov. Walker directed the Department of Health Services to reexamine Wisconsin’s complex regulatory process for moving skilled nursing facility beds from one county to another. 

Council members indicated that Wisconsin hospitals and nursing homes have been “ahead of the curve” in strategically pairing their hospitals with local skilled nursing facilities to provide short-term transitional care services as a means to reduce hospital readmissions. The Council noted that Wisconsin’s local nursing homes are providing such transitional care services for hospitals, and that a shortage of licensed beds to provide such services has not been perceived by hospitals.

Some Council members indicated that the ability of hospitals to find placement following discharge for Medicaid patients is a primary concern and must be considered when contemplating changes to the regulation of skilled nursing facilities. Like hospitals, nursing homes have to rely upon cost shifting to subsidize rates that are below the cost of providing care. The Council was concerned that policy changes resulting in the addition of skilled nursing facilities that do not serve Medicaid will endanger the viability of those facilities that do accept Medicaid. Ultimately, that impact would result in either fewer skilled nursing facilities that accept Medicaid hospital discharges.

WHA Vice President of Federal Affairs & Advocacy Jenny Boese provided the Council with a federal legislative and regulatory update. One area she focused on was guidance from the Health Resources & Services Administration (HRSA) regarding the federal drug discount program known as “340B.” HRSA’s guidance is expected any day and Boese highlighted several potential areas for change that may be included in the guidance. 

Boese also discussed Medicare proposed payment rules of interest for hospitals and health systems, including: the Inpatient and Outpatient Prospective Payment Systems (PPS) proposed rules; Physician Fee Schedule; and long-term care proposed rule. Boese also provide a high level look at the Centers for Medicare & Medicaid Services’ proposed Comprehensive Care for Joint Replacement (CCJR) bundled payment model. PPS hospitals located in 75 metropolitan statistical areas (MSAs) nationally will be mandated to participate in this proposed hip/knee model. Two of the 75 MSAs are in Wisconsin, including: Madison MSA, comprised of Dane, Columbia, Green and Iowa counties, and Milwaukee MSA, comprised of Milwaukee, Ozaukee, Washington and Waukesha Counties. WHA is aware of 22 Wisconsin PPS hospitals in these eight counties that would be required to participate in the CCJR model.

Top of page (8/21/15)


Grassroots Spotlight: Lt. Gov Kleefisch Visits Memorial Medical Center (Ashland)

Lt. Gov. Rebecca Kleefisch visited Memorial Medical Center (Ashland) recently to tour the facility and learn more about health care in northwestern Wisconsin.

Top of page (8/21/15)


Wisconsin MEB Begins Rule Making Process Addressing Telemedicine

The Medical Examining Board (MEB) took a step at its August 19 meeting toward drafting new rules regarding telemedicine in Wisconsin, when it voted to approve an initial scope statement prepared by the Department of Safety and Professional Services (DSPS). The objective of the proposed rule, according to DSPS, will be to provide greater clarity for physicians with regards to the practice. 

The MEB directed DSPS to define telemedicine, explain how the physician-patient relationship can be established in a telemedicine setting and identify technology requirements for physicians using telemedicine.

The MEB’s approval of the scope statement signifies the beginning of the rulemaking process. Once the statement is approved by the Governor’s office, the MEB can begin drafting the proposed language. A public hearing would then be held seeking stakeholder input. WHA will be engaged throughout this process, and will be seeking member input on the MEB’s development of the rules impacting physicians, clinics, hospitals, and patients. If you have questions or comments, contact Steve Rush, WHA vice president, workforce and clinical practice, at srush@wha.org.

Top of page (8/21/15)


WHA Quality Team Learns from Members in Collaborative Design Initiatives

WHA has recently partnered with member hospitals in a new way. Over the past three years, hospitals have worked with WHA on a variety of quality improvement initiatives. Typically, WHA uses a well-researched and designed toolkit from the Agency for Research and Healthcare Quality, the Centers for Disease Control (CDC) or other leading organizations. WHA then creates a framework of webinars and coaching calls to engage hospital staff in learning and implementing the recommended approaches.

However, at times there is a rapidly-emerging topic or a need to take a different approach, which would require learning from leading hospitals and then sharing with all hospitals in a different way. Starting this past April, hospitals volunteered to participate in several Collaborative Design Initiatives. This approach differs in that local expertise in hospitals helps create the framework for adopting new approaches. WHA improvement advisors convene clinicians in a series of virtual forums to discuss the nuances and pitfalls of working in these less defined areas. 

Here is a synopsis of these new Collaborative Design Initiatives:

Antimicrobial Stewardship –  Convened by Jill Hanson, WHA quality improvement manager, this group is developing an approach to the March 2015 National Action Plan for Combating Antibiotic-Resistant Bacteria, which states by 2020 an antibiotic stewardship program will be established in all acute care hospitals in all health care settings. WHA, MetaStar and the Pharmacy Society of Wisconsin are leading this work. As a result, hospital and clinic pharmacists, infection preventionist leaders, quality staff, and Pharmacy Society members from across the state are working together to develop an enhancement tool for the CDC Checklist for Core Elements of Hospital Antibiotic Stewardship Programs. This tool will provide additional strategies to use in establishing an antimicrobial stewardship program.

The group’s recommendations will be presented at the Pharmacy Society’s annual meeting in September. 

Patient and Family Centered Care and Engagement – Convened by Tom Kaster, WHA quality coordinator, exemplar hospitals in Patient and Family Centered Care and Engagement, including UW Health, Gundersen Health Systems, Bellin Health, and Froedtert & The Medical College of Wisconsin, have been meeting monthly since December 2014 to focus on pooling existing resources in Wisconsin to develop a strategy and structure for facilitating the spread of Patient and Family Centered Care and Engagement through education, consultation, collaboration, training.

What is unique about this initiative is that each hospital has invited one to two of their experienced Patient and Family Advisors to share their perspectives on potential improvements in hospital care. 

“Having the patients’ voice imbedded in this important work has made all the difference. We have been very fortunate that these organizations and their volunteer advisors are willing to invest the time to help other hospitals in our state with this topic,” said Kaster.

The advisory committee members have volunteered to present on several webinars and have shared stories of their hospital experiences at conference panel discussions. Most importantly, patients have assisted WHA with identifying and organizing best practices and resources that will help other hospitals adopt patient and family centered practices. 

Process for Efficiently Adopting a Protocol or Bundle – Convened by Stephanie Sobczak, WHA quality improvement manager, hospital quality leaders provided input on a method to rapidly close practice gaps by designing a defined change management strategy that is completed in 30, 60, or 90 days. The approach was developed with the assistance of Tomah Medical Center, Memorial Medical Center in Ashland and several others. With an emphasis on efficiency, hospital leaders and key stakeholders come together in a series of six one-hour meetings and work through gap analysis, small test of change design, and implementation steps with the key work conducted in the clinical units, between meetings. 

This approach will be launched as part of the CMS Hospital Engagement Network 2.0 this fall.

“We are never surprised by the drive and creativity of our members to stay ahead of the curve. Even when the pathway isn’t clear, hospitals always step up to contribute to quality improvement work for the benefit of all Wisconsin patients and hospitals,” said WHA Chief Quality Officer Kelly Court. “Hospitals know if they collaborate with one other and with organizations such as the Pharmacy Society, they can improve faster than if they do it alone. This willingness to collaborate to improve quality sets Wisconsin apart from other states.”

Top of page (8/21/15)


Hospitals Support Central WI Health and Economic Development Summit 

More than 150 people attended the inaugural Central Wisconsin Health and Economic Development Summit – “Growing Vital Communities” –was held August 11 in Green Lake, Wisconsin. 

The Central Wisconsin Health Partnership (CWHP) covers a six-county region including Adams, Green Lake, Juneau, Marquette, Waupaca, and Waushara Counties. The Summit helped facilitate linkages across multiple sectors to identify strategic partnerships and initiatives that improve both the economic and health outcomes in rural communities of Central Wisconsin. 

The Summit was supported by the Adams County Family Foundations Home Visiting Grant through the Wisconsin Department of Children and Families as well as sponsors that included: Moundview Memorial Hospital; Berlin Memorial Hospital; Mile Bluff Medical Center; the Rural Wisconsin Health Cooperative; and the UW Carbone Cancer Center. 

“Economic stability is foundational in allowing individuals to seek out the care that they need. Because the health of the community is our number one priority, supporting this summit was another great opportunity for Mile Bluff to further contribute to the overall wellness of the population we serve,” said James O’Keefe, president/CEO, Mile Bluff Medical Center. 

The Partnership is committed to distilling large, long-term goals into tangible objectives that can be implemented over time that positions Central Wisconsin as a vibrant and healthy rural community of the future.

“We know that the work we will do together to create economically healthy and vibrant communities is the same work that helps our community achieve better health. I am not surprised by the enthusiasm for the Summit. Our leaders genuinely care for their communities,” noted CWHP Co-Chair Sarah Grosshuesch, MPH.

Top of page (8/21/15)


2016 Updates for the Chargemaster Focus of November 13 Seminar

Get ready to prepare your hospital’s chargemaster for 2016 at WHA’s one-day seminar “Preparing the Chargemaster for 2016,” scheduled November 13 in Wisconsin Dells.

Back by popular demand, presenter Glenda Schuler will lead attendees in an overview of all 2016 reporting requirement updates and CPT and HCPCS coding revisions. Schuler will focus on updating the chargemaster as well as on strategies for department staff education. 

Chargemaster/APC coordinators, chief financial officers, controllers, decision support managers, office managers, compliance auditors, coding staff, pharmacy directors, material managers/purchasing directors, and other directors and managers responsible for the charge generation process are encouraged to attend this event.

Again, this seminar will be held at the Wintergreen Resort and Conference Center in Wisconsin Dells November 13. A brochure with registration form is included in this week’s packet, and online registration is available at http://events.signup4.net/15Chargemaster1113. For registration questions, contact Jenna Hanson at 608-274-1820 or email jenna.hanson@wha.org.

Top of page (8/21/15)


Wisconsin Society for Healthcare Risk Management Fall Conference

The Wisconsin Society for Healthcare Risk Management (WSHRM) invites hospital risk managers, quality improvement and safety managers and staff to attend the 2015 WSHRM Fall Conference “End of Life Care: Risks and Responsibilities.” The conference will be held September 17 and 18 at Glacier Canyon Lodge at the Wilderness Resort in Wisconsin Dells. 

This year’s conference will focus on palliative and hospice care, the unique aspects of this practice area, trends and emerging risks in hospital and physician professional liability. Physicians and other practitioners, state association, legal counsel and other experts will address resources, practice and legal issues surrounding end-of-life care. The conference will conclude with an update on legislative and court actions that impact health care providers and an update from the Injured Patients and Families Compensation Fund.

This event will be submitted to the American Society for Health Care Risk Management (ASHRM) for CEU credit and to the Wisconsin Bar Association for CLE credit.

The agenda and registration information can be found at www.wshrm.org.

Top of page (8/21/15)