November 4, 2016
Volume 60, Issue 44

WI CEOs Say Health Systems Will Continue to Evolve as Market Moves to Value

There is an opportunity, arguably brief, for health systems to get an early start to make the necessary adjustments to move from a fee-for-service to value-based purchasing environment.

“It’s the right thing to do, and it is where the market is moving,” said Aspirus CEO Matthew Heywood, a participant on a Health System CEO panel discussion hosted by Wisconsin Health News (WHN) in Madison November 1.

“While Medicare is more of a penalty-based model, with MACRA and other programs that are coming down the pike, the federal government is moving rapidly (to value-based purchasing) and they are driving change,” Heywood said. “It takes time to do, so you need to start now within the current fee-for-service business model.” 

Heywood was joined by Damond Boatwright, regional president of hospital operations at SSM Health, and Mark Herzog, president/CEO, Holy Family Memorial, Manitowoc. 

Herzog explained that hospitals and health systems are focusing on population health and paying attention to factors influencing health that are outside of the traditional reach of a hospital, such as access to healthy foods, appropriate exercise facilities and housing. 

“Attentiveness to those factors is important,” according to Herzog. “There must be local and regional solutions, and that is our focus.” 

Boatwright said SSM Health is experiencing what all health systems across the country are seeing, and that is a correlation or coincidence with the enrollment increase in BadgerCare and marketplace plans, there has been a decrease in charity care overall.

“As a faith-based not-for-profit we are sensitive to that because our hallmark, our roots in Wisconsin, are in taking care of those with no financial means and bringing them into our hospital,” Boatwright said. “That has caused us to put an emphasis on the linkages to our community health needs assessment and community benefit. It may not be per se in charity care, but it may come in other ways, such as a donation to other community organizations to help in areas that we find need improvement in our community, such as obesity or diabetes. We want to do this proactively before someone seeks out the care, to know where the ‘hot spots’ are for these disease sets.”

While Heywood said Aspirus has also seen a decrease in charity and uncompensated care, they are seeing it start to rise because of high-deductible health plans. It’s starting to be a choice, he said, between making other payments and paying for health care services.

“The incentives in high-deductible plans are misaligned,” according to Heywood. “When you design a product so high for individuals that they do not get preventive care, you are pushing the problem down the road. I have an issue with that, and I think it is a challenge.”

Herzog said Holy Family is seeing a shift from charity care to writing off bad debt, 68 percent of which is traced back to patients who have good insurance, but could not pay their co-pays or deductible.

Asked about the physician shortage, Boatwright said he is pleased Gov. Walker and the state Legislature are working with WHA and other societies to help establish more medical residency programs.

“If we open up more residencies, we will have more physicians stay in Wisconsin after medical school and there is a better chance they will establish a practice in our state,” Boatwright said. “We are doing very innovative and creative things to encourage people to look at the medical profession and to continue their education with an in-state residency program. We need to come up with every single idea to encourage people to go into medicine, whether it is as a physician, nurse or other health care professional.”

Working at the top of their license, whether it is a physician, nurse or other member of the health care team is important, and Heywood believes it should be a priority. 

“How do we make sure we have the right person in the right work and how do we get paid for that is the question,” according to Heywood. “Health care is moving rapidly, and the laws and various rules and payments are not keeping up with the changes.”

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MACRA Final Rule and Alternative Payment Models Focus of Dec. 7 Webinar

On December 7, WHA is offering a complimentary WHA Member Forum webinar focused on MACRA Alternative Payment Models (APMs). “MACRA – Final Rule Update and Pathway Toward Alternative Payment Models (APMs)” will provide an overview of APMs under the Medicare Quality Payment Program (QPP); highlight the difference between the Merit Based Incentive Program (MIPs) and the APMs; review updates included in the final rule, which was released October 14; and describe the requirements for qualifying under APMs. 

Register today. This complimentary webinar is open to all WHA hospital and corporate members, but pre-registration is required. An audio recording of the webinar will be available after the event, but you must pre-register to receive the recording. Content questions can be directed to Joanne Alig at Registration questions can be directed to Kayla Chatterton at

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WI Hospitals State PAC & Conduit Tops $290,000
Still time to disburse funds

The Wisconsin Hospitals State PAC & Conduit saw contributions top the $290,000 mark this week. Three hundred thirty-three individuals have contributed $290,100 as of November 3. This puts the 2016 fundraising campaign at 97 percent of its aggressive $300,000 goal for 2016, a 10 percent increase over 2015. 

“I want to personally thank the 333 individuals who have contributed to this important effort so far,” said WHA President/CEO Eric Borgerding. “This year’s fundraising campaign has already raised more than ever before, but I know we’re not done. We will reach goal. If you have yet to contribute, please consider doing so. All contributions are greatly appreciated.” 

Even though elections are right around the corner, there is still time for Wisconsin Hospitals Conduit account holders to disburse funds to the candidates of their choice. To check your conduit account balance or disburse dollars, contact Nora Statsick at
or call 608-239-4535. To contribute, log onto or call Jenny Boese at 608-268-1816.

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Rose Joins WHA Advocacy Team

Laura Rose will join WHA as vice president of policy development. Rose comes to WHA from the National Council of State Legislatures (NCSL) in Denver where she has served as director of the legislative management program since 2015.

Prior to going to NCSL, Rose served as an attorney with and deputy director of the Wisconsin Legislative Council for many years, providing nonpartisan policy guidance and counsel to Wisconsin state legislators and staff, including staffing several legislative standing committees and Legislative Council Study Committees. She has worked with the Legislature, state agencies and diverse groups of stakeholders on a broad array of issues, specializing in multiple facets of health care.

Rose has both a BA and law degree from the University of Wisconsin-Madison and is well regarded within the health care policy and advocacy world.

“Laura is well known to several of us government relations ‘veterans’ at WHA who have had the pleasure of working with her over the years at the Legislative Council,” said WHA President/CEO Eric Borgerding. “WHA continues to reflect the growth and evolution of our members within by broadening our advocacy mission and expanding our policy agenda. Laura is a great addition to our team as we continue growing our impact and relevance.”

Rose’s first day at WHA is December 5.

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CSB Reports Prescriptions for Controlled Substances Decrease

The recently-released report by the Controlled Substances Board (CSB) revealed that the number of opioid prescriptions issued by Wisconsin providers fell nearly 10 percent compared to the same time last year. Interestingly, the statute that requires usage of the Prescription Drug Monitoring Program (PDMP), Act 267, does not go into effect until April 2017. 

“It is obvious that the incredible attention health care providers, hospitals, elected officials and other key stakeholders have placed on this important health care issue has already begun to significantly impact prescription practices,” states Steven Rush, WHA vice president, workforce and clinical practice. “The entire conversation around this issue is evolving in a very positive direction.” 

Data also collected by the PDMP revealed that although most (72 percent) of the users of the PDMP were satisfied with the online data collection system, the time needed to quickly and readily access the system was listed as the biggest barrier to use. WHA has worked closely with the CSB, hospitals, physicians and other providers, as well as the Department of Safety and Professional Services as an advisor and resource in developing the new “enhanced” PDMP, set to be released January 2017. Interoperability and ease of navigation are two key areas targeted for improvement. 

For more information contact Rush at or 608-274-1820.

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WHA November 16 Conference Focuses on Consumerism, Patient Experience 
Register soon as space is limited!

If Wisconsin is to maintain its national reputation as a state that leads in health care, it is imperative that we attract, retain and mentor the next generation of health care leaders who are working in our systems. On November 16, WHA is offering a one-day learning event designed for those emerging leaders to focus specifically on the issues of consumerism and the patient experience, “Today’s Challenges, Tomorrow’s Opportunities: A Future Leader’s Guide to Wisconsin Health Care.”

The day’s agenda will feature national health care consumerism expert Ryan Donohue of National Research Corporation. Donohue will explore how consumer decision making has become a strategic threat to health care organizations and what the research shows is important to today’s health care consumer. National patient experience expert Kristin Baird will focus on what future leaders can do to improve their organization’s patient experiences and how to bridge the gap between consumers and hospitals/health care systems.

In addition, WHA President/CEO Eric Borgerding will examine the current state of health care in Wisconsin, share thoughts on the possible impact of the new presidential administration on health care, and discuss the Association’s role in shaping public policy on behalf of its members. Seth Teigen, FACHE, regional vice president of ancillary services for SSM Health Care of Wisconsin and president of the Wisconsin Chapter of ACHE Board of Directors, will discuss the importance of emerging leaders advocating on behalf of Wisconsin health care providers.

Have you identified several emerging leaders in your organization and encouraged them to register for important event? There is still time. Forward this online registration link to your rising stars today, and encourage them to attend November 16:

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CMS Removes Pain Control Dimension from Hospital Value-Based Purchasing

The Centers for Medicare & Medicaid Services (CMS) finalized their proposal to remove the pain control questions in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) from the hospital value-based purchasing (VBP) program. Hospitals survey patients using the standardized HCAHPS survey, which includes three questions related to pain control. The results of the survey and responses to the pain control questions, along with other measures of quality, are included in the VBP which applies financial rewards and penalties to hospitals’ reimbursement.

The decision to remove the pain questions is in direct response to input from multiple stakeholders regarding concern about the unintended consequence of the financial payment incentives. Many feel the incentives may place pressure on hospitals to prescribe more opioids in order to achieve higher survey scores. This change will take effect with the HCAHPS survey results collected during 2016 that impact reimbursement beginning October 1, 2017. While the three pain-related questions are being removed from VBP, they will remain in the HCAHPS survey and CMS intends to continue to publicly report them on Hospital Compare.

“WHA is pleased CMS has acted on the input it received from many stakeholders regarding their VBP program and possible interactions with the use of opioids,” said Kelly Court, WHA chief quality officer. “The opioid epidemic is complicated and requires multiple solutions. This change removes a potential barrier hospitals may have to improving their opioid prescribing practices.”

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CMS Releases Final OPPS Rule, Section 603 HOPD Implementation 

On November 1, 2016, the Centers for Medicare & Medicaid Services (CMS) released the final 2017 Outpatient Prospective Payment System (OPPS) rule, including implementation of Section 603 of the Bipartisan Budget Act of 2015 (BBA 2015) related to off-campus, provider-based hospital outpatient departments (HOPDs). 

As a reminder, Section 603 bans new, non-grandfathered, off-campus provider-based HOPDs from using an entire payment system—the OPPS—for reimbursement, and instead will require these locations to be reimbursed under another Medicare Part B payment system. To be considered grandfathered, an HOPD had to have been billing under the OPPS as of November 2, 2015, the date of BBA 2015’s enactment, or be on-campus or within 250 yards, or be a Dedicated Emergency Department. 

“While CMS did make several important adjustments to their original proposal, the final rule is still problematic on a number of levels,” said WHA President/CEO Eric Borgerding. “WHA will continue to review the implications of this rule on our membership and on their ability to locate care where care is needed.” 

Fortunately, CMS did not finalize its earlier idea of providing no payments to non-grandfathered services in 2017. Instead, CMS will allow these non-grandfathered HOPDs to receive payment. The new payment mechanism is the creation of Medicare Physician Fee Schedule rates for the technical component of non-grandfathered items and services. Generally, CMS indicates it will pay HOPDs at roughly 50 percent of the current OPPS rates. CMS indicates non-grandfathered HOPDs will bill for items and services on their institutional claims and use a claim line modifier “PN.” CMS issued this new payment mechanism under an interim final rule with a comment period. 

Secondly, CMS did not finalize its earlier proposal to limit grandfathered HOPDs’ ability to expand services. Therefore, under the final rule, there are no restrictions on the types or volumes of services a grandfathered HOPD may provide in the future. Those will still be reimbursable under the OPPS, but CMS indicates it will monitor this. 

Unfortunately, CMS failed to fully address important issues, including relocations, partial hospitalization programs and mid-build projects. A brief discussion of these issues follows:

Access the final rule at

For questions, contact Jenny Boese, WHA vice president, federal affairs & advocacy, at 608-268-1816 or

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OPPS Final Rule Addresses Meaningful Use & Other Topics

On November 1, the Centers for Medicare & Medicaid Services (CMS) released the 2017 Outpatient Prospective Payment System (OPPS) final rule.

In addition to the ordinary OPPS payment updates and implementation of the site-neutral provisions of Section 603 of the Bipartisan Budget Act of 2015 (see article above), the rule finalizes changes in a variety of other areas, including: The OPPS final rule also contains updates to the Medicare and Medicaid EHR Incentive Programs that create some flexibility for hospitals and physicians seeking to attest to meaningful use and thereby avoid escalating Medicare reimbursement penalties. The updates include the following: For additional information about the OPPS, including a forthcoming summary of the final rule, visit For information regarding the meaningful use provisions of the rule, contact Andrew Brenton, WHA assistant general counsel, at or 608-274-1820.

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Governor’s Task Force on Opioid Abuse Meets in Green Bay
WHA: Need new focus on removing barriers to access to treatment

The Governor’s Task Force on Opioid Abuse held its first of three meetings on October 28 at the Aurora Bay Care Sports Medicine Complex in Green Bay. 

The Task Force, co-chaired by Lt. Governor Rebecca Kleefisch and Rep. John Nygren (R-Marinette), began with briefings from the Drug Enforcement Administration and the state Department of Justice by Attorney General Brad Schimel, and then transitioned to presentations by each of the Task Force members on their vision for next steps that the Task Force could take to further address opioid abuse in Wisconsin. 

“Much has been accomplished in Wisconsin,” said Joan Coffman, president/CEO of HSHS St. Joseph’s Hospital in Chippewa Falls and WHA representative to the Task Force. “Through policy and practice, significant work has occurred in Wisconsin to prevent opioid misuse through education, better surveillance and communication, and changing practices. Likewise, through policy and practice, significant work has occurred to encourage treatment and help save lives during an overdose.” 

But Coffman said now the focus needs to be on access to treatment, a sentiment echoed by others on the Task Force.

“More needs to be done to sustain and expand access to treatment to help those addicted to opioids regain their ability to be effective parents, to become self-sufficient young adults, and to be productive workers and citizens to help Wisconsin continue to grow economically,” said Coffman.

“State regulations on AODA treatment programs, public and private payment policies on AODA treatment programs, workforce challenges for AODA treatment programs, and other policies each have an impact on AODA treatment programs’ ability to sustain and expand access to treatment for opioid addiction,” Coffman explained to the Task Force. “WHA is ready to help the Governor’s Task Force further explore such barriers to addiction treatment and identify potential policy solutions at the Task Force meeting.”

Coffman presented to the Task Force a WHA summary of steps the Task Force could take to help Wisconsin sustain and expand access to treatment for opioid abusers, as well as a summary of education programs, examples of collaboration, and local efforts that hospitals and WHA are undertaking to address Wisconsin’s opioid abuse epidemic. Those summaries and their accompanying memo can be found here.

The next meeting of the Governor’s Opioid Task Force will be November 22 at Ministry St. Clare’s Hospital in Weston, and the final meeting will be December 16 in La Crosse.

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

According to the American Cancer Society, lung cancer is the second most common cancer in both men and women. Lung cancer mainly occurs in older people. About two out of three people diagnosed with lung cancer are age 65 or older, while less than two percent are younger than 45.

The American Cancer Society’s estimates for lung cancer in the United States for 2016 are:

Data from the WHA Information Center found there were 6,599 inpatient admissions and 68,307 outpatient visits in Wisconsin hospitals with a principal or secondary diagnosis of lung cancer in Wisconsin from July 2015 through June 2016.

For more information on lung cancer, visit:

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

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