October 21, 2016
Volume 60, Issue 42

As Year Winds Down, WHA Staff Considers 2017 Goals

It has been a busy and productive year at the Wisconsin Hospital Association. WHA President/CEO Eric Borgerding noted in his report to the Board October 20 that excellent progress is being made on nearly all of the 17 goals approved by WHA’s Board earlier this year.

“Our 2016 goals are advancing, many of them are already met, so as we look to 2017 we want to define our ‘footprint’ more clearly and focus on elements of the continuum of care WHA can and should impact through public policy and other value-added member services,” Borgerding said. 

In 2017, WHA’s priorities will include expanding its reach in to areas such as dental access and post-acute/discharge care, from an “enterprise,” as opposed to a practitioner, perspective. 

“It is a process of continuously defining, expanding and right-sizing our ‘plate’ to meet and exceed our members’ expectations,” Borgerding added. 

The 2016 WHA Board Planning session was extremely helpful in identifying key priorities for 2017 and beyond. While the Board agreed that WHA should continue to support all current programming, they recognized the need to strategically add staff resources as the scope and complexity of issues continues to grow.

Borgerding said he is looking forward to introducing and implementing a dynamic, forward-looking agenda for 2017, including evaluating the communications strategy because the way WHA communicates to its members must keep pace with the changing nature of our industry. 

“We want our leaders to know the true value of their membership, but we recognize there are many others on the executive team and throughout the organization who will benefit from greater knowledge of WHA and our resources,” he said.

In closing, Borgerding said WHA strives to be:

• Responsive: Listen to the voice of our members
• Relevant: Focused on members’ immediate concerns
• Influential: On both sides of the aisle at the State Capitol and in Washington, DC
• Impactful: WHA has measurable results in maintaining Medicaid funding and increasing support for GME, addressing behavioral health issues, advancing its analytical capabilities, and engaging physicians
• Accountable: WHA’s staff is results driven and focused on delivering a solid return on the investment members make in their Association

In other business, the Board approved the Association’s 2017 budget, with no dues increase.

Nominating Committee Presents Roster of Nominations
The Board accepted the Nominating Committee’s recommendations for WHA Board appointments (see story on page 4), which included two physician leaders, Andy Anderson, MD, chief medical officer, Aurora Health Care, and Mark Thompson, MD, chief medical officer, Monroe Clinic. 

Robert Van Meeteren, president, Reedsburg Area Medical Center, will serve as WHA 2017 chair-elect (see story above), while Catherine Jacobson, president/CEO, Froedtert Health, will chair the Association in 2017.

Wisconsin Joins Michigan, Illinois Hospital Associations to Improve Hospital Quality
Wisconsin, already recognized for delivering high-quality, high-value health care, is joining forces with Michigan and Illinois hospitals in a partnership that unites the quality improvement strengths of the hospital associations in all three states (www.wha.org/greatlakespartnersforpatients10-19-2016.aspx). The Great Lakes Partners for Patients is funded by a Centers for Medicare & Medicaid Services (CMS) Hospital Improvement Innovation Network (HIIN) contract.

WHA Chief Quality Officer Kelly Court said the three-state partnership will provide new resources to WHA members and present new opportunities for interstate collaboration. The objectives are to reduce preventable readmissions by 12 percent and reduce hospital-acquired harm by 20 percent over the next three years. 

Court said in the past, content and education has been delivered through webinars. In the new partnership, a data-driven approach will be used that will involve a more customized and intense approach to improvement work. The popular quality residency will be replicated in the new program as QuEST (quality essential skills training) and will focus on how to use data and the PDSA cycle. 

WHA Wraps Up Candidate Meetings; Governor’s Office at Work on State Budget
After completing more than 50 candidate visits this fall and several HEAT Roundtables with Republican and Democratic state senators, the WHA advocacy team is now focusing on developing WHA’s 2017 legislative agenda and advocacy plan. 

WHA Senior Vice President Kyle O’Brien said the state agencies have submitted their budget requests and the Governor’s office is currently developing the Governor’s proposed budget bill for 2017-2019. The Governor will formally introduce his budget in early 2017, with a state budget address that typically occurs sometime in February. O’Brien discussed recent conversations with the Governor’s office on key budget priorities related to Medicaid and the health care workforce.

O’Brien also updated on the Board on several proposals being developed by rural Wisconsin legislators and WHA to address unique issues impacting Wisconsin’s rural hospitals. The policy proposals, packaged as the Rural Wisconsin Initiative, are designed to sustain rural communities now and into the future by helping to address challenges that health care providers face in rural communities.

Governor Forms Task Force on Opioid Abuse
Gov. Scott Walker formed a Task Force on Opioid Abuse to advise and assist him in a coordinated effort to combat the opioid crisis facing Wisconsin. Matthew Stanford, WHA general counsel, said the Task Force will review what has been done so far in the state to battle the misuse of opioids, look at what other states are doing and identify new ways to combat the problem here in Wisconsin. Stanford said the Task Force presents an opportunity to discuss treatment options, which is a concern for both providers and the public. 

Joan Coffman, president/CEO HSHS St. Joseph’s in Chippewa Falls will represent WHA and its members on the Task Force (read article below). 

Targeting and Prioritization will be Key to WHA Medicaid Policy Agenda
WHA Senior Vice President Joanne Alig told Board members that even though the Department of Health Services projects a budget surplus at the end of 2017, the Medicaid program still requires about $3.5 billion in state GPR dollars each year. Medicaid’s projected “cost to continue” (ie: keep program as is) for the 2017-19 biennium is an additional $450M state GPR. Alig noted this figure includes projected enrollment increases and utilization trends, with no assumed policy changes or rate increases. 

WHA has created a Medicaid workgroup that will focus on issues related to reimbursement, behavioral health, dental access, managed care and administration simplification to help refine and focus its Medicaid-related advocacy priorities. 

WHA Continues to Monitor State Employee Self-Funding Proposal 
The Group Insurance Board (GIB) is expected to hear a presentation on the results of the self-funding request-for-proposals process at a November 30 meeting. The GIB has indicated it then expects to meet in December to vote on whether to move forward with a statewide or regional model for self-funding the state employee health care program. Alig reminded Board members that if it is approved, the GIB must inform the Joint Finance Committee that it intends to issue a contract on a regional or statewide basis. 

“The bottom line with any proposal that the GIB considers is it must preserve Wisconsin’s unique competitive market,” according to Alig. 

WHA Weighs in on CMS Changes to OPPS 
Jenny Boese, WHA vice president, federal affairs and advocacy, said WHA continues to voice concerns about CMS’s proposed policies related to provider-based off-campus hospital outpatient departments (HOPDs) impacted under Section 603 of the Bipartisan Budget Act of 2015. Especially concerning is CMS’s proposed treatment of HOPDs that need to relocate, rebuild and/or expand services among others, all of which would trigger the loss of an HOPD’s grandfathered status. Other issues with CMS’s proposed policies are their failure to provide hospital payments in 2017 for services provided in new off-campus HOPDs. Due to concerns with the proposed rule, Boese alerted the Board that Senator Ron Johnson, chairman of the Senate Committee on Homeland Security and Governmental Affairs, sent a letter to CMS expressing concerns (see article below). Boese also discussed the lame duck session, including the potential to see action on HOPD mid-build legislation (HR 5273) among others.

AHA RPB Report: Sandy Anderson
AHA Regional Policy Board (RPB) representative Sandy Anderson said issues discussed at the last meeting included workplace and community violence, cyber security, physician retention and workforce shortages. She invited WHA members to submit topics to her or Borgerding that they would like included on the RPB agenda and she will report the results back to the Board and requestor. Send suggestions to eborgerding@wha.org

Top of page (10/21/16)

Van Meeteren to Serve as WHA 2017 Chair-Elect
Jacobson will chair Association in 2017

Robert Van Meeteren, CEO of Reedsburg Area Medical Center (RAMC), has been selected by the Wisconsin Hospital Association Nominating Committee to serve as WHA chair-elect in 2017 and chair in 2018. A member of the WHA Board since 2014, Van Meeteren currently chairs the Council on Rural Health and is a member of the WHA Network Adequacy Council, WHA DHS 124 Task Force and the WHA Bylaws workgroup. 

Van Meeteren joined RAMC in 2008 as president. Prior to joining RAMC, Van Meeteren spent four years as CEO of Sleepy Eye Medical Center in Sleepy Eye, Minnesota and four years as clinic administrator at Avera Sacred Heart Hospital in Yankton, South Dakota.

A member of the Boards for the Wisconsin Health & Education Facilities Authority, Rural Wisconsin Health Cooperative and Home Health United, he is also a member of the Reedsburg Community Advisory Committee for Madison College.

Van Meeteren received his Bachelor of Science in Health Administration and Master of Business Administration from the University of South Dakota. An accomplished pilot, his aviation endorsements include: commercial pilot, instrument rating, and flight instructor rating.

Catherine Jacobson, president/CEO of Froedtert Health, will chair the Wisconsin Hospital Association in 2017. A member of the WHA Board since 2013, Jacobson was also a member of the WHA Graduate Medical Education (GME) Task Force. 

Jacobson joined Froedtert Health in 2010 as executive vice president of finance and strategy, chief financial officer and chief strategy officer. She was promoted to president in 2011, and assumed the CEO role in 2012. Prior to joining Froedtert Health, Jacobson spent 22 years at Rush University Medical Center in Chicago in various leadership roles.

Jacobson currently serves on the American Hospital Association’s Section for Metropolitan Hospitals Governing Council, a three-year term ending in 2017. She is a member of the Healthcare Financial Management Association, the American College of Healthcare Executives, the Healthcare Institute and the Healthcare Executives Study Society. She is also a member of the Chicago Network—an organization for women executives, and TEMPO and Professional Dimensions—two Milwaukee-based women’s leadership organizations.

Jacobson is a Certified Public Accountant. She received her Bachelor of Science degree in accounting from Bradley University, Peoria, Ill.

Top of page (10/21/16)

WI Hospitals State PAC & Conduit: Under Three Weeks to Elections—Disburse Dollars Now 
Next contributor list runs October 28

Even though the elections are three weeks away, you still have time to contribute to the Wisconsin Hospitals State PAC & Conduit and disburse your dollars before November 8. 

“Wisconsin Hospitals State PAC & Conduit members statewide are maximizing their impact on the November elections by supporting both Republicans and Democrats who support good health care policy in Wisconsin,” said Nora Statsick, WHA political affairs consultant. “Your contributions in these last three weeks before the elections can help candidates who value hospitals and health systems.”

It’s not too late to make a contribution or disburse dollars from your conduit account. Individuals who contribute to the Wisconsin Hospitals Conduit retain full control over their funds. Once deposited, conduit funds remain until the account holder authorizes the release of those dollars to candidates or party committees of their choosing. 

To check your conduit account balance or release dollars, contact Nora Statsick at any time at nstatsick@wha.org or 608-239-4535. Remember elections matter. Your involvement matters. 

Will You Be On The List? 
To date, the Wisconsin Hospitals State PAC & Conduit campaign has raised over $277,000 from 317 individuals. This puts the effort at 92 percent of the aggressive $300,000 goal, and an average of $6,600 raised per week. There are still 10 weeks left in 2016 and $23,000 left to go. Help the campaign raise $300,000 this year by contributing today at www.whconduit.com or call Jenny Boese directly at 608-268-1816. 

Contribute by October 27 to be included in the next contributor list, which will run in the October 28 edition of The Valued Voice

Top of page (10/21/16)

President’s Column: Telling the WI Health Care Story, Again and Again…

WHA staff has now completed almost 70 member visits in 2016, which means we exceeded our 2016 goal of visiting more than 50 percent of our members. These important onsite visits present an opportunity to learn more about the issues that are “keeping you up at night.” We return to our offices in Madison energized and determined to do what we can to ensure you are able to continue to meet your mission to deliver high-quality, high-value care to the people living in Wisconsin. 

Often while we are meeting with members, we learn about new services and activities related to care delivery. We frequently tour the hospital and campus and are impressed how new technology in the hands of skillful clinicians is making it possible for our residents to receive care locally. 

That local access to excellent care is one more reason employers want to locate to or expand their facilities in Wisconsin. 

WHA is committed to communicating directly with employers in our state to ensure they are aware of the value our health care delivery system brings to them in terms of attracting, and keeping, their own workforce. And if their employees are injured on the job, we provide excellent care that enables them to return to their normal activities, including returning to work. 

A couple of weeks ago, more than 2,800 Wisconsin employers received our new infographic that illustrates how Wisconsin health care is ahead of the curve. By directly communicating with the state’s business leaders we can build positive public opinion and create awareness of our unique stature in the country as a top state for health care. 

In an accompanying letter to the state’s business leaders, I emphasized that it is anything but “business as usual” in our hospitals and health systems as they focus on delivering superior outcomes, while technology and innovation are improving care. This helps Wisconsin employers improve productivity, reduce cost and increase competitiveness. 

In addition, many Wisconsin health systems are forming partnerships that are helping employers control health care costs by assisting, managing or building employer or community-based wellness programs. These relationships will flourish in the years ahead as population health grows in importance and access to quality health care becomes an even greater regional factor in economic development and attracting and retaining employees.

One great example of this partnership was recently featured in a WHA-sponsored video produced by WisconsinEye. We’ve widely shared the video with dozens of business associations and other constituencies, and it’s been very well received…more to come. 

WHA will continue to communicate directly with employers to build awareness of how our high-quality, high-value health care delivery system benefits them and their employees. WHA is proud to share this message with our state’s business leaders because as you know, our success is only possible if Wisconsin businesses remain strong.

Eric Borgerding

Top of page (10/21/16)

WHA Board Approves Nominating Committee Recommendations
Physicians Mark Thompson and Andy Anderson appointed to WHA Board

The Nominating Committee presented their recommendations to the WHA Board October 20. The Board voted and approved the Nominating Committee’s recommendations. The following individuals will serve on the WHA Board of Directors effective January 1, 2017.

David Hartberg
(1st term)
Gundersen Boscobel Area Hospital and Clinic
• Council on Public Policy, 2016
• Council on Rural Health, 2013-2016

Bernie Sherry
(1st term)
Senior Vice President
Ascension Health/Wisconsin Ministry Market Executive

Damond Boatwright
(1st term)
Regional President and CEO
SSM Healthcare of Wisconsin
• WHA Board, 2015-2016 (filled unexpired term)

Physician Leaders to the WHA Board:

Mark Thompson, MD
(1st term)
Chief Medical Officer
Monroe Clinic
• Physician Leaders Council, 2016

Andy Anderson, MD, MBA
(1st term)
Executive Vice President and Chief Medical Officer
Aurora Health Care
Physician Leaders Council, 2016

The WHA Board approved the following AHA Delegates and Alternates:

Edward Harding 
(AHA Delegate, filling unexpired term)
President and CEO
Bay Area Medical Center
• WHA Board, 2008-2015, Chair 2014
• WHA Immediate Past Chair, 2015
• WHA Executive Committee, 2009-2015
• Council on Rural Health, Chair, 2009-2013
• Council on Public Policy, 2002-2008
• Wisconsin Hospitals Issue Advocacy Council, Chair, 2013
• Nominating and Awards Committee, Chair, 2015
• Advocacy Committee, 2015-2016, Chair 2015
• Medicaid Reengineering Group, 2011-2014
• WHA Succession Planning Committee, 2012-2013

Therese Pandl
(AHA Alternate filling unexpired term)
President & CEO
HSHS- Eastern WI Division
• WHA Board, 2012-2016, Chair 2015
• WHA Executive Committee, 2014-2016
• Advocacy Committee, Chair, 2016
• Wisconsin Hospitals Issue Advocacy Council, Chair, 2014
• WHA Enrollment Action Council, Chair 2013-2016
• Nominating and Awards Committee, Chair, 2016
• Council on Public Policy, 2008-2009
• WHA Bylaws Workgroup, 2015
• WHA Budget Committee, 2016

Gordy Lewis
(AHA Alternate filling unexpired term)
Burnett Medical Center
• WHA Board, 2010-2015
• Council on Public Policy, 2009-2016
• Network Adequacy Council, 2014-2016
• Transparency Taskforce, 2015-2016
• Telemedicine Taskforce, 2015-2016

Top of page (10/21/16)

Grassroots Spotlight: Grassroots Spotlight: WHA West Central Region Hosts HEAT Roundtable with Sen. Moulton

WHA’s West Central Region hosted Sen. Terry Moulton October 12 in the latest in WHA’s series of HEAT Roundtable Discussions. These discussions have been hosted by hospitals over the past few months with state senators who are not up for re-election this year. 

The WHA West Central Region held its Annual Trustee Forum at HSHS Sacred Heart Hospital in Eau Clare. Hospital leaders and hospital trustees gathered for dinner and a speaker. Moulton addressed the group of roughly 40 individuals and provided his take on the past legislative session and engaged in dialogue with the group. 

Joan Coffman, president/CEO of HSHS St. Joseph’s Hospital in Chippewa Falls, introduced Sen. Moulton and praised him for his knowledge of health care, work on broadband and his open-door policy. 

“We make a lot of decisions in the state Legislature,” said Moulton of serving his constituents. “It matters that individuals are represented and heard.” 

Moulton specifically highlighted health care policies enacted this past year, including Medicaid Disproportionate Share Hospital funding, which he strongly supported; HOPE legislation; and WHA-supported mental health care bills. 

Amery Hospital & Clinics President/CEO Deb Rudquist thanked Moulton for his support of graduate medical education (GME), as Amery is one of the locations benefitting from the state’s GME funding. Asked whether expanding that program could happen, Moulton indicated, “Yes, I think there is an opportunity to expand on the GME dollars. There’s interest there.” 

Moulton discussed a variety of issues he sees on the horizon and should be addressed. Those included: increased Medicaid funding; labor shortages, including lack of psychiatrists; burdensome regulations and audits; and the drug epidemic. 

Top of page (10/21/16)

Neufelder Receives WHA Distinguished Service Award 

Dan Neufelder, FACHE, president, Ministry Health Care for Ascension Health, received the Wisconsin Hospital Association’s 2016 Distinguished Service Award for his service to the health care industry, community and the Association. 

WHA annually honors individuals who have served the health care community and who have made an exemplary commitment to WHA, to their own organizations, and to the communities they serve. WHA Senior Vice President Joanne Alig presented the award to Neufelder at St. Elizabeth Hospital in Appleton on September 28. 

Neufelder has served on a number of WHA councils and task forces since 2008. He served on WHA’s Board of Directors from 2009-2015, and was chair in 2013. Prior to joining Ministry, Neufelder served as president/CEO of Affinity Health System from 2006-2012; for 12 years as the executive vice president and chief operating officer of Memorial Hospital of South Bend, Indiana; 10 years with the Community Health Network of Indianapolis, with the last four of those years as the executive vice president and chief operating officer of Community Hospital East; one year with St. Vincent Hospital and Healthcare System in Indianapolis, Indiana; and five years as a health care management consultant with Ernst & Young. He has been a member of the WHA Board since 2008.

Throughout his career, Neufelder has volunteered with numerous community-based organizations with special emphasis on serving the sick and poor.

Neufelder received his bachelor’s degree from the University of Southern Indiana in 1979 and his master’s degree in business administration from the University of Indianapolis in 1989. He was the recipient of the 1997 Young Healthcare Executive of Year Award for Northern Indiana. He is a Fellow in the American College of Healthcare Executives (ACHE), and received the ACHE senior–level health care executive award in 2012. Neufelder is also a Certified Public Accountant.

WHA President/CEO Eric Borgerding expressed his regret in being unable to attend, however, in a prepared statement, he said: “WHA is fortunate that our health care leaders are committed to making their communities some of the best in the country for health care, and who have engaged in making WHA one of the state’s leading advocacy voices. Dan Neufelder is one of those leaders. We are grateful to Dan for his investment of time and knowledge into the development the health care leaders of today and tomorrow. He has made a long lasting impact on health care in Wisconsin.”

Top of page (10/21/16)

CMS Finalizes MACRA Rule
2017 Considered a “Transition Year”

On October 14, CMS released a 2,398-page final rule governing Medicare physician payments. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) creates a new physician payment program, which CMS is calling the Quality Payment Program (QPP). 

The final rule takes into account several comments that WHA along with other stakeholders shared with CMS including concerns about the timeline for implementation (see related Valued Voice article). In addressing concerns that full implementation in 2017, which would affect payments beginning in 2019, was aggressive and unrealistic for many organizations, CMS’s final rule allows for a “transition year” for 2017. 

CMS continues to believe that most clinicians will report under the Merit-Based Incentive Payment System (MIPs). Under MIPS, an eligible clinician that does not submit at least one quality measure or activity will receive a full negative four percent adjustment to reimbursement in 2019. Otherwise, clinicians have the opportunity to report the full year, a partial year, or just one measure to avoid a negative payment adjustment and to possibly receive a positive adjustment in 2019. 

The rule finalizes measures, activities, reporting and data submission standards across the four performance categories of quality, cost, improvement activities and advancing care information. Compared to the proposed rule, the weights in the respective categories have changed, with a zero weight assigned to the cost category during the 2017 transition year. The cost category weight will gradually increase, beginning in 2018, to 30 percent by 2021. (CMS finalized the ability for clinicians to participate in MIPS as individuals or in groups and maintained the flexibility to report measures using a variety of reporting options.)

Alternatively, eligible clinicians can participate in Advanced Alternative Payment Models (APMs), and if they meet thresholds for number of patients or amount of payments through the Advanced APM, they can qualify for a five percent bonus incentive payment in 2019. CMS had listed several alternative payment models in the proposed rule, with only six of those qualifying as “advanced.” In a separate rule, CMS has since indicated it is considering adding the Comprehensive Care for Joint Replacement (CJR) bundle to the list of Advanced APMs. In the latest rule, CMS indicates it is also developing a Medicare ACO Track 1+ Model to begin in 2018. The model tests a payment method that incorporates more limited downside risk than is currently present in Tracks 2 or 3 of the Shared Savings Program but sufficient financial risk in order to be an Advanced APM. CMS indicates it will announce additional information about the model in the future. CMS also indicates that it is completing an initial set of Advanced AMP determinations that will be released as soon as possible but no later than January 1, 2017. 

CMS also took note of the many comments, including those from WHA, related to the challenges rural and low volume clinicians could have with the program. The thresholds to exclude low volume clinicians were lowered to less than or equal to $30,000 in Medicare Part B allowed charges, or less than or equal to 100 Medicare patients. Under MACRA, CMS is offering $100 million in technical assistance to MIPS-eligible clinicians in small practices, rural areas, and practices located in health professional shortage areas. 

WHA is continuing to review the rule and will provide more information about MACRA in the webinar “MACRA - Final Rule Update and Pathway Toward Alternative Payment Models (APMs)” December 7, 2016 (see article below). Full information and online registration are available at: https://events.SignUp4.net/MACRA-APM-1207.

A concise executive summary of the rule and fact sheet for clinicians can be found at https://qpp.cms.gov/education

Top of page (10/21/16)

WHA MACRA Webinar Examines Advanced Alternative Payment Models (APMs)

Registration is open for the WHA Member Forum webinar: “MACRA – Final Rule Update and Pathway toward Alternative Payment Models (APMs),” scheduled December 7. The session will provide an overview of APMs under the Medicare Quality Payment Program (QPP); 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. 

Brian Vamstad, federal government relations consultant for Gundersen Health System, and Joanne Alig, senior vice president of policy and research for WHA, will co-present the one-hour complimentary webinar. 

Register today at: http://events.SignUp4.net/MACRA-APM-1207. 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 jalig@wha.org. Registration questions can be directed to Kayla Chatterton at kchatterton@wha.org.

Top of page (10/21/16)

Today’s Challenges, Tomorrow’s Opportunities: A Future Leader’s Guide to Wisconsin Health Care
November 16, 2016 *** Marriott Madison West, Middleton

Register today at https://events.SignUp4.net/16TCTO-1116

Top of page (10/21/16)

Chairman Johnson Letter to CMS on HOPD/OPPS Rule

As chairman of the Senate Committee on Homeland Security and Governmental Affairs, Senator Ron Johnson sent a letter October 20 to the Centers for Medicare & Medicaid Services (CMS) Acting Director Andy Slavitt expressing concerns with CMS’s proposed Outpatient Prospective Payment System rule implementing Section 603 of the Bipartisan Budget Act of 2015. Johnson expressed concern that the proposed implementation framework impacting off-campus provider-based hospital outpatient departments (HOPDs) is “overly complex, and would unnecessarily limit patient’s access to care.”

He indicated that he joined a bipartisan group of United States senators on multiple occasions in writing CMS to request the Agency provide flexibility in its implementation of Section 603 on issues such HOPD relocations, rebuilding, expansion of services, among others. 

“We noted that a narrow interpretation of the statute would not only limit access to care for some of the most vulnerable patient populations in difficult to serve areas, but would also increase instability in the hospital field. I am disappointed and concerned that CMS’s proposed rule did not appear to address these issues,” the Chairman’s letter reads.

Further, the Chairman called out the Agency’s contravention of statute with respect to providing no reimbursement in 2017 to hospitals. “To have no payment mechanism for affected departments in 2017 is a departure from the statutory text.” 

Chairman Johnson then asked CMS to respond to a series of questions for the Committee. Among those questions are key areas of concern for Wisconsin’s hospitals and health systems, including: how did CMS account for the impact its proposal would have on access to care, including in rural settings; did CMS quantify the financial impact on affected sites with respect to providing no reimbursement in 2017; why did CMS fail to address partial hospitalization programs in its rule; and, why did it fail to provide a hardship exemption for sites that were under development. 

“The Wisconsin Hospital Association greatly appreciates Chairman Johnson’s work on this issue and the willingness of the Committee to express its concerns to CMS,” said WHA President/CEO Eric Borgerding. “We look forward to hearing what CMS has to say in response, and to our continued work with Senator Johnson and other Members of Congress on ensuring a fair and flexible policy.” 

Read the Chairman’s letter to CMS at www.wha.org/pdf/RonJohnsonLtrtoCMSreBBA603_10-20-16.pdf.

Top of page (10/21/16)

Exchange Marketplace Open Enrollment Set to Begin
Over 37,000 residents will have to change health plans

The fourth open enrollment period for signing up through the insurance exchange is set to begin November 1, 2016 and runs through January 31, 2017. This year will see several changes in insurance plans participating, which the state’s Insurance Commissioner, Ted Nickel, anticipates will result in 37,160 residents losing their current coverage and needing to choose a new plan according a press release from the Office on October 18. 

Three insurers—United Health Care, Managed Health Services, and Physician’s Plus—have chosen not to participate in the exchange marketplace this year. WPS is no longer selling its WPS Arise Plan, but is offering Aspirus Arise in some counties. Prevea360 Health Plan, underwritten by Dean Health plan, is also no longer participating in the exchange. 

At the same time, Wisconsin’s exchange market will see two new insurers participating. HealthPartners is entering the market in five counties in the western part of the state, and Children’s Health Plan will offer products in six counties in Southeastern Wisconsin. 

Overall, the changes mean fewer health plans in 57 counties across the state, resulting in the need for over 37,000 residents to look for a new plan for 2017. In cases where the current health insurer is leaving the exchange market, the consumer will be automatically enrolled into a new plan by the federal government. However, consumers are encouraged to shop and seek a plan that is best for them. Despite the changes, Wisconsin continues to experience greater competition in the insurance exchange than many other states. In 2017, residents in nearly all counties in Wisconsin will still have a choice of two or more insurers on the exchange. Menominee is the only county in Wisconsin that will have just one insurer. Residents in 30 counties will have a choice of four or more insurers. 

The following link will take you to OCI’s maps of insurers by county for both 2016 and 2017:

In addition, OCI will be holding town hall meetings across the state to educate consumers. The town hall meetings are open to the general public and media. For a list of the town hall meetings, click here:

Top of page (10/21/16)

Upcoming Webinar Series Highlights Critical Issues for CAHs and Clinical Integration Strategies

On November 3, WHA’s Legal & Regulatory Webinar Series will feature “Critical Updates for Critical Access Hospitals.” This webinar will provide an overview of and update on important legal and compliance issues facing rural providers in the Critical Access Hospital (CAH), Rural Health Clinic (RHC) and related provider settings. Topics covered will include CAH Medicare regulatory and payment developments and strategies, provider-based hot topics, RHC requirements, Stark law developments, rural affiliation models, and virtual joint ventures. The session will be presented by David Snow of Hall, Render, Killian, Heath & Lyman, P.C., a WHA gold-level corporate member.

On December 6, the series will feature the webinar “Clinical Integration Strategies in a Changing Payer Environment,” presented by Sarah Coyne and Jon Kammerzelt of Quarles & Brady LLP, a WHA silver-level corporate member. This presentation will address the legal framework incenting clinical integration, the legal hurdles that face networks attempting to demonstrate clinical integration, and practical strategies for surmounting those hurdles. In addition, the Medicare Shared Savings Program (MSSP) requirements applicable to Accountable Care Organizations and the benefits of acceptance into the MSSP program, including deeming and waivers, will be discussed.

Online registration for this session, as well as all other sessions scheduled as part of the Legal & Regulatory webinar series, can be found at https://events.SignUp4.net/16LegalSeries.

There is no registration fee for webinars in this series, but pre-registration is required. The series is intended for WHA hospital and corporate members as a member benefit, and includes a range of topics, each presented by a representative of a WHA corporate member law firm. 

In addition, all previous webinars from this series are available on-demand in the WHA Members-Only portal at https://members.wha.org. For questions on accessing the member portal, contact Tammy Hribar at thribar@wha.org or 608-274-1820.

Top of page (10/21/16)

Member News: Coffman Appointed to Governor’s Task Force on Opioid Abuse 

Joan Coffman, president/CEO of HSHS St. Joseph’s Hospital in Chippewa Falls, was appointed by Gov. Scott Walker this week to serve as the WHA representative to the Governor’s Task Force on Opioid Abuse.

Through its L. E. Phillips - Libertas Treatment Center, HSHS St. Joseph’s Hospital is a major provider of treatment for alcoholism and drug abuse in the upper Midwest having 46 of the 86 dedicated AODA inpatient treatment beds in Wisconsin. Based on a treatment program begun in the 1940s, today the L. E. Phillips – Libertas Treatment Center provides detoxification services, outpatient day treatment, inpatient residential treatment, outpatient treatment and relapse programs. The treatment center, along with Prevea Health and the Libertas Center, Green Bay, were one of three organizations awarded a grant to provide treatment services for opioid addiction in rural, underserved areas in Wisconsin. That grant funding was created as part of the Heroin, Opiate Prevention and Education (HOPE) legislation in 2014. 

Coffman also serves on WHA’s Board of Directors and has been an active and key resource to WHA, providing valuable insight and information on regulatory, insurance, and other factors that can be a barrier to patient access to opioid and other drug and alcohol addiction treatments in Wisconsin. 

The first meeting of the Governor’s Task Force is scheduled October 28.

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