January 15, 2016
Volume 60, Issue 2

Voters Say Health Care Important to Economy, Rank Health Care Value High 

Wisconsin voters are generally optimistic about the future of their personal finances and the state’s economy, according to a new poll released by Wisconsin Manufacturers and Commerce (WMC). More than 90 percent of likely voters said they have access to high-quality health care. About 60 percent said their health care costs have increased, while 30 percent said they have stayed about the same. The cost increases were likely attributable to the implementation of the Affordable Care Act (ACA), according to WMC’s news release.

While respondents said they were concerned about health care costs, 59 percent said they were getting good value for their dollar; 33 percent said they were not. On the question of importance to Wisconsin’s economy, 73 percent said health care was important to the state’s economy. (See the President’s Column in this issue for Eric Borgerding’s perspective on the poll results.) 

WMC, Wisconsin’s chamber of commerce, commissioned the poll of 500 voters December 14-16. The poll was conducted by the Tarrance Group of Washington, D.C. and has a margin of error of plus or minus 4.5 percent. Here is a link to the survey results: https://www.wmc.org/wp-content/uploads/WMC-Voter-Poll-January-2016.pdf.

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Medicaid Access Rule Requires State to Review Provider Payments

The Centers for Medicare and Medicaid Services (CMS) issued a final rule with comment due in January 2016 on Medicaid Methods for Assuring Access to Covered Medicaid Services. The long-awaited final rule comes four and a half years after the proposed rule was issued in May 2011 and after the Supreme Court decision in Armstrong v. Exceptional Child Center, Inc., which found that Medicaid providers cannot contest state-determined Medicaid payment rates in federal court. 

The final rule requires states to submit plans to monitor access to care for Medicaid beneficiaries. The rule requires that states review the following core services at least once every three years: primary care services, physician specialist services, behavioral health services, pre- and post-natal obstetric services (including labor and delivery), home health services, and any additional types of services where rates have been reduced or restructured or for which the state or CMS has received a higher-than-usual volume of access complaints. 

In addition, the state must establish new review procedures for proposed rate changes in the Medicaid fee-for-service program and requires that states develop a process to ensure beneficiary access to core services is not affected before CMS will approve a state’s plan to cut or restrict provider rates. 

Although WHA is disappointed CMS chose not to include hospital services in the core services, WHA is very pleased that there is now a process to review provider rate reductions and their impact on access to care. Given that Wisconsin Medicaid pays hospitals approximately 67 percent of the cost of providing care to Medicaid patients, it is critical the state review any potential rate reduction to hospitals and other health care providers. 

In WHA’s comment letter to CMS, WHA President/CEO Eric Borgerding noted, “hospitals experience severe payment shortfalls when treating Medicaid patients. In Wisconsin, the Medicaid payment shortfall amounted to over $900 million in 2014, the most recent year for which data are available.” He added it is important to “help ensure that changes to Medicaid payments to providers do not result in problems accessing care for this vulnerable population.”

Importantly, the rule excludes Medicaid managed care. WHA and the American Hospital Association have encouraged CMS not to exclude Medicaid managed care, and to consider how access to care can be assessed for Medicaid managed care patients. CMS noted in the final rule they are addressing access in Medicaid managed care through a separate rule, which was proposed in June 2015. WHA commented on several provisions in the proposed Medicaid Managed Care rule, and will review the final rule, which is currently expected to be released by July 2016.

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2016 Advocacy Day: Register Today!
March 30, 2016 *** Monona Terrace, Madison

Make an impact in Madison for your hospital by attending Advocacy Day 
March 30, 2016. 
Register today at: http://events.SignUp4.net/16AdvocacyDay0330.

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Worker’s Compensation Bill Receives Support 

On January 14, the Senate Committee on Labor and Government Reform held a public hearing on Senate Bill (SB) 536, the bill that contains the provisions agreed to by the Worker’s Compensation Advisory Council (WCAC) in December (see previous Valued Voice article). While SB 536 includes several changes to the Worker’s Compensation program, it does not include the controversial medical fee schedule, which was opposed by WHA and defeated in the last legislative session. The agreed-to legislation also does not include any provision related to “directed care,” which would limit an injured worker’s choice of health care providers. 

All testimony received by Committee members at the hearing was in support of the bill. Speaking as the Labor Caucus Chair of the WCAC, Stephanie Bloomingdale urged the Committee to support the bill and noted that the provisions in the bill came about after tough negotiations between labor and management. Bloomingdale highlighted the very positive aspects of the current worker’s compensation system in Wisconsin, including low costs, less litigation than other states, premiums that are stable and low, and that Wisconsin injured workers heal faster and return to work quicker than in other states. One key provision in the bill would reduce the statute of limitations for filing a claim from 12 years to six years, and Bloomingdale urged the Committee not to reduce this time period any further. 

Jeff Beiriger, the management caucus chair of the WCAC described the Advisory Committee process as thoughtful and deliberate, adding that what works in other states may not work in Wisconsin. He said that worker’s compensation remains dynamic as employment continues to change and evolve in the state. After describing the many provisions included in the bill that were proposed by management, Beiriger noted “I think this is the best package of reforms management has put forward in my 21 years on the Council.” 

Also speaking in support of the bill were Chris Reader and James Buchen, representatives from Wisconsin Manufacturers and Commerce. Reader encouraged the Committee to pass the bill saying that it is “a strong reform package” that warrants support. 

The Senate Committee is expected to vote on the bill in Executive Session Tuesday, January 26.

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President’s Column: What WMC’s Voter Poll Tells Us About Health Care

According to a recent poll released by the state’s chamber of commerce, Wisconsin Manufacturers and Commerce (WMC), Wisconsin voters overwhelmingly believe they have access to high-quality health care that provides good value. At WHA, we’ve been saying that for years, and the message is getting across. 

WMC has conducted similar voter polls in the past, but rarely with this much focus on health care, and the findings are noteworthy:

A closer look reveals several important takeaways embedded in the numbers, and I hope our elected officials are paying attention: Polls of voters are essentially a set of instructions for elected officials—dos and don’ts from their constituents about issues they hold dear. Reading between the lines, this poll contains both a warning and an opportunity for legislators, the Governor, our Congressional delegation and other elected leaders: Eric Borgerding,

(To view the entire poll, visit WMC’s webpage)

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WI Board of Nursing Considers Several Important Changes to Practice Rules

At the January 14 Wisconsin Board of Nursing (BON) meeting, several items relating to nursing practice were discussed. The first agenda item was a public hearing on Clearinghouse Rule 15-099 related to renewal, reinstatement and standards of practice. Related to license renewal and reinstatements, the sections of N2.40 and N 2.41 have been revised to address issues related to late fees, license renewals after five years of last licensure (lapsed license), evidence of a refresher course, and the granting of a limited license in order to allow the licensee to complete the clinical portion of the refresher course. Related to standards of practice, sections of Chapter 6 were revised to clarify the ability of an LPN to receive a delegated act from an RN. It also clarified that a “provider” means a physician, podiatrist, dentist, optometrist or advanced practice nurse provider. Additionally, 6.02 (11) was amended to read “R.N.” means a registered nurse licensed under ch. 441, Stats. or a nurse who has a privilege to practice in Wisconsin under s. 441.50 Stats. The same was done for LPN language. This clarifies that nurses may be working in Wisconsin as a part of the compact, and their actual license is issued through another state.

The next agenda item resulted in considerable time and discussion. This item was follow-up discussion and possible revision to the November 12, 2015 draft text which amended N8, relating to advanced practice nurse prescribers. BON Chair Jeff Miller initiated the discussion by sharing that he had met with key stakeholders over the past month, including WHA, WMS, Wisconsin Academy of Family Medicine, and Rep. John Nygren’s office. The three areas of N8 Miller identified as needing additional consensus were 1) the ability of APNPs to order stimulant medications (Ritalin, Adderall, etc.) for the treatment of ADHD, 2) the language allowing APNPs to order treatments, therapeutics, and testing, and 3) the language around collaborative agreements between an APNP and MD.

1) ADHD discussion: This revision adds to the list of exceptions for APNPs to prescribe the meds, within the existing language where it currently states it may be done for the treatment of hyperkinesis, including ADHD (added language). Miller explained further this is not increasing or expanding what an APNP can prescribe, but clarifying that it is already being done under the hyperkinesis exception. 

2) Treatment, therapeutics and testing: Miller explained that in his discussions with stakeholders that he did not identify any major concerns or objections with this change (broadening of language to allow for more general terms of treatments and therapeutics.)

3) Collaboration agreements: Miller explained to the Board that it was never the intent of the Board to remove the collaboration process, or agreements, but the feedback he has received from stakeholders is that it might appear so. Miller recommended to the Board that the existing N8 language around collaborative agreements be maintained.

Steven Rush, WHA vice president, workforce and clinical practice, spoke at the meeting, saying, “WHA thanks the Board of Nursing for including us with other key stakeholders in these very important discussions. With the expanding and increasing roles NPs serve on the health care team, it is important to preserve the collaborative agreements, perhaps now more than ever. Collaboration is a cornerstone of any team, and any attempt to eliminate or weaken that collaboration could negatively impact our WHA member’s ability to deliver the high-quality care that currently is being delivered across the state.” 

Chairman Miller called for a vote, and the Board voted unanimously to accept the revisions that reflected the input from stakeholders. Miller anticipates that a public hearing on these changes will occur at the March 10, 2016 Board of Nursing meeting.

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Nygren HOPE Legislation Passes Assembly with WHA-Backed Amendments

A package of legislation authored by Rep. John Nygren (R-Marinette) and several other state lawmakers to address opiate addiction passed the full state Assembly January 12. The bills, which are included as part of Nygren’s second round of Heroin, Opiate, Treatment and Prevention (HOPE) legislation, passed the state Assembly on a unanimous voice vote. The bills now are sent to the state Senate for approval before moving to Gov. Scott Walker’s desk.

The HOPE legislation received thorough review by the WHA Physician Leaders Council, which discussed challenges with the current operation and function of the state’s Prescription Drug Monitoring Program (PDMP). One piece of legislation in the package, Assembly Bill 364, would require that prescribers review the PDMP prior to prescribing any monitored drug. 

This discussion at the Physician Leaders Council led to WHA pursuing an amendment with Nygren that would ensure any requirement by a prescriber to review the PDMP is only in effect once the Secretary of the Department of Safety and Professional Services deems the PDMP “operational” and “able to electronically transmit records to practitioners.” Based on feedback from the Council, the goal of this amendment is to ensure the PDMP is efficiently accessible to providers and that the PDMP takes steps to be interoperable with electronic health record programs.

WHA also worked with Nygren to amend AB 364 to include a three-year sunset on the PDMP prescriber review mandate. Both WHA-backed changes to the bill were adopted by the full Assembly January 12 and are expected to be adopted by the state senate in the coming weeks.

The Prescription Drug Monitoring Program, housed at the Department of Safety and Professional Services, is expecting to publicly announce an updated version of the current PDMP data query tool by January 2017.

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Feb. 25 WHA Webinar Focuses on Leader’s Role in Tackling Opioid Abuse

Recognizing that Wisconsin hospitals have an important role in addressing the growing public health issue of the misuse and abuse of opioids, in December 2015, the WHA Board of Directors unanimously passed a resolution recognizing the issue and encouraging hospitals to develop specific strategies to address it while creating a culture of change responsive to this growing epidemic. To support the efforts of WHA members, WHA is offering a series of webinars in 2016 to assist hospital leaders in understanding the issue, clarifying their role in addressing it and sharing tools to help them address it.

This first, complimentary WHA Member Forum webinar, scheduled February 25, will focus on the importance of hospital leaders vocalizing the importance of this issue and leading the culture change among their prescribers to examine their own prescribing habits. During this webinar, participants will hear from Peter Holden, president/CEO of Beth Israel Deaconess Hospital in Plymouth, Massachusetts, as he shares his experience in addressing the issue and culture change within his own organization, as well as championing the effort in hospitals throughout Massachusetts in his role as chair of the Massachusetts Hospital Association. In addition, this webinar will include information on the genesis of WHA’s efforts to assist hospital leaders with tackling this issue and additional resources and next steps WHA will take on this issue.

This WHA Member Forum webinar will be held February 25 from 11:30 a.m. to 12:30 p.m. There is no fee for WHA hospital and corporate members to participate, but pre-registration is required. An audio recording will be available for those who cannot participate in the live program, but pre-registration is required for that option as well. Full information and online registration are available at http://events.SignUp4.net/HospitalLeaderRole-Opioids. For more information, contact Jennifer Frank at jfrank@wha.org or 608-274-1820.

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WHA Adds CDC Opioid Guidelines to WHA.org Resources

The Centers for Disease Control (CDC) has created several new resources related to opioids, including their new “Guideline for Prescribing Opioids for Chronic Pain.” The CDC guidelines are now available on WHA’s dedicated online webpage at www.wha.org/opioid.aspx. Patient educators and physicians may also find an infographic created by the National Safety Council regarding opioids.

WHA has been reviewing, collecting and organizing existing information related to opioid use and adding it to WHA.org. The WHA opioid resource page is is under "Health Care Issues." In addition, WHA staff has been working with its members to offer a new opioid-related series of WHA webinars.

“WHA recognizes Wisconsin hospitals play an important role in addressing this public health issue and we support the efforts of both Rep. John Nygren and Attorney General Brad Schimel,” said WHA President/CEO Eric Borgerding. “We will continue to work with all our partners to develop tools and resources that will assist our hospitals in addressing issues related to opioid abuse.” 

For more information, contact Steven Rush, WHA vice president, workforce and clinical practice, at 608-274-1820 or srush@wha.org.

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PSC Announces Application Period for Medical Telecommunications Grants 

The Public Service Commission (PSC) of Wisconsin is now accepting applications for Medical Telecommunications Equipment Grants for Fiscal Years 2016 and 2017. The Medical Telecommunications Equipment Grant Program provides funding to nonprofit medical clinics, hospitals or public health agencies for the purchase of specialized telecommunications equipment designed to augment or enhance the delivery of medical services. 

“The investments funded through Telemedicine Grants improve access and health outcomes in cost effective ways,” said Commission Chair Ellen Nowak. “Remote visits, immediate access to health care professionals, real-time access to data and health monitoring capabilities are critical to our health care system.”

Former recipients have used funding to purchase video conferencing equipment to allow patients in rural locations to meet with medical specialists without having to travel to a distant clinic, or purchase home health monitoring devices to permit patients to record and report their health status from their home. 

Former grant recipient Community Memorial Hospital in Suring, WI reports that exam turnaround times have gone down and signed reports form the radiologist are available much sooner as a result of electronic availability of images minutes after they are acquired. Image quality has also improved with the new technology. Similarly, St. Clare Hospital in Baraboo, WI, reported that a pathologist utilizing the VisionTek M6 system has indicated that the digital microscope has outperformed optical microscopy with ease of software and the ability to view multiple slides at the same time. 

The Commission may award one or more grants that, in aggregate, do not exceed an annual total of $500,000 during Fiscal Year 2016, and an additional $500,000 in Fiscal Year 2017. Applications are due March 31, 2016. Application instructions and additional information may be found at the PSC website.

Questions about the application process can be directed to Dennis Klaila, program and policy analyst, Division of Business and Program Management, at dennis.klaila@wisconsin.gov or 608-267-9780.

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Member News: Turkal Will Chair AHA Section

Nick Turkal, MD, president and CEO of Aurora Health Care in Milwaukee, will chair the AHA constituency section in 2016 for Health Care Systems Governing Council. Turkal served on the council from 2012-2014. His chair officer term runs from 2015-2017.

The Health Care Systems Governing Council includes leaders who represent some of the country’s premier health systems. Members of the council govern the AHA’s health care systems activities through its Section for Health Care Systems Governing Council. This council actively advises AHA from a systems perspective during decision-making phases on advocacy positions, public policy issues and member service strategies.

As chairman, Turkal will bring to the council the perspective of Aurora’s 30,000 caregivers, including 1,500 employed physicians, who provide care across the continuum in two tertiary-care centers, 12 community hospitals, one mental health inpatient facility, 159 clinics, 70 retail pharmacies, the Aurora Visiting Nurse Association and Aurora Family Service.

Turkal has been very engaged with the Wisconsin Hospital Association. He served on the WHA Board from 2006-2011 and became WHA Chair in 2011. He has served on numerous WHA councils and committees, including the Council on Medical and Professional Affairs, which he chaired from 2004-2006. Turkal also served on and has chaired the WHA Executive Committee, the Advocacy Committee and the Nominating and Awards Committee.

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