November 20, 2015
Volume 59, Issue 46
Top of page (11/20/15)
WHA Continues Push to Amend Site-Neutral Prohibition
Sends letter to Congressional Delegation, will travel to DC in December
As previously reported in The Valued Voice, the Bipartisan Budget Act of 2015 was signed into law by President Barack Obama November 2, 2015 and included several Medicare cuts to hospitals. One of those cuts prohibits new off-campus provider-based hospital outpatient departments (HOPDs) from using the Outpatient Prospective Payment System (OPPS). WHA is aware of multiple situations in Wisconsin where this unexpected site-neutral prohibition will impact projects already in motion.
“WHA is very disappointed with the last-minute inclusion of the site-neutral policy and strongly objects to having the long-term strategy and operational decisions of our providers upended within the span of a week by this surprise Congressional action,” said WHA President/CEO Eric Borgerding in a letter to Wisconsin’s Congressional Delegation.
Under the site-neutral provision, off-campus means a location not on the main campus (or a remote location of the hospital) and more than 250 yards from it. “New” is considered to be an entity that had not been billing Medicare under the OPPS prior to November 2, 2015 unless it is a dedicated emergency department. If an entity is a provider-based HOPD and has billed Medicare under the OPPS prior to the date of enactment (November 2, 2015) then it should be grandfathered in.
WHA is advocating Wisconsin’s Congressional Delegation support and work to quickly pass an amendment that will also grandfather relocated facilities or facilities under development at the time the law was enacted.
“Due to the incredibly short timeframe before the BBA 2015 was enacted, our hospitals and systems were unable to comment, let alone plan for or adjust construction projects and care strategies already in the pipeline,” Borgerding continued. “At a minimum, WHA believes Congress must immediately fix Section 603 for providers that have already based their planning and construction decisions on current law,” he said.
WHA will continue advocacy and grassroots efforts on this amendment, including traveling to Washington, DC in early December to meet with Congressional offices. With Congress in recess during the Thanksgiving holiday, it is a perfect opportunity to discuss the need for this amendment personally with Members of Congress when they are back home in their Wisconsin districts. WHA strongly encourages you to do so.
If you believe your hospital/system may be impacted or if you have other questions, contact Jenny Boese at 608-268-1816 or firstname.lastname@example.org.
Read the full letter at: www.wha.org/pdf/SpeakerRyanSiteNeutralAmdt11-20-15.pdf.
Top of page (11/20/15)
Wisconsin Hospitals Conduit & Wisconsin Hospitals PAC Campaign Update: $20,000 Left to Reach Year-End Goal
In the last two weeks, $20,000 in contributions has come in from across the state raising the total contributions to over $250,000. There are just six weeks left in the calendar year of the Wisconsin Hospitals Conduit & Wisconsin Hospitals PAC Campaign and there is now under $20,000 to go to reach the goal. The Campaign is at 92 percent of the annual goal to raise $270,300 by the end of the year.
The average contribution is $838. So far, 298 individuals have joined together to support this year’s annual campaign. Thank you to those listed below by name and affiliated organization in amount category. The next publication of the contributor list will be in the December 4 edition of The Valued Voice. For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.
Top of page (11/20/15)
|Contributors Ranging from $1 - $499|
|Aittama, Craig||Ministry - St. Michael's Hospital|
|Alstad, Nancy||Fort HealthCare|
|Anderson, Phil||Sacred Heart Hospital|
|Appleby, Jane||Aurora Health Care|
|Arnett, Eugene||Aurora Health Care|
|Ballentine, Anne||Wheaton Franciscan Healthcare|
|Bayer, Tom||St. Vincent Hospital|
|Bard, Jeffrey||Aurora Medical Center - Oshkosh|
|Bisterfeldt, Joan||Wheaton Franciscan Healthcare|
|Bollig, Dale||SSM - St. Mary's Hospital|
|Braun, James||Flambeau Hospital|
|Brenny, Terrence||Stoughton Hospital|
|Brisch, Donald||Holy Family Memorial|
|Bunten, Sherry||Aspirus Langlade Hospital|
|Cardinal, Lori||Agnesian HealthCare|
|Carlson, Dan||Aurora - Bay Area Medical Center|
|Carter, Shane||Aurora Medical Center - Oshkosh|
|Clark, Julie||HSHS - St. Joseph's Hospital|
|Clark, Renee||Fort HealthCare|
|Cliffe Kucharski, Elizabeth||Wheaton Franciscan Healthcare|
|Collins, Sherry||Wisconsin Hospital Association|
|Colman, Gerard||Aurora Health Care|
|Coniff, Barbara||HSHS - St. Mary's Hospital Medical Center|
|Coopman, Dianne||St. Mary's Janesville Hospital|
|Cormier, Laura||Bellin Hospital|
|Culotta, Jennifer||St. Clare Hospital & Health Svcs|
|Curran-Meuli, Jane||Holy Family Memorial|
|Danner, Forrest||Aspirus Wausau Hospital|
|Davidson, Lisa||Wisconsin Primary Health Care Association|
|Dettman, Amy||Bellin Hospital|
|Donlon, Marcia||Holy Family Memorial|
|Dube, Troy||Chippewa Valley Hospital|
|Dux, Larry||Froedtert & MCW Community Mem. Hosp|
|Dwyer, Maxine||SSM - St. Mary's Hospital|
|Evans, Kim||Bellin Hospital|
|Ewald, Sandra||Aurora Health Care|
|Feeney, John||Community Health Network, Inc.|
|Fielding, Laura||Holy Family Memorial|
|Freitag, Vanessa||Our Lady of Victory Hospital|
|Gagnon, Annette||HSHS - Eastern Wisconsin Division|
|Grundstrom, David||Flambeau Hospital|
|Gullicksrud, Lynn||Sacred Heart Hospital|
|Gutsch, Mike||Cumberland Healthcare|
|Hafeman, Paula||St. Vincent Hospital|
|Halida, Cheryl||HSHS - St. Joseph's Hospital|
|Harasim, Edward||Wheaton Franciscan Healthcare|
|Harrington, Kathleen||Mayo Health System - Eau Claire|
|Helgeson, Jason||HSHS - Eastern Wisconsin Division|
|Hernandez, Terri||HSHS - St. Joseph's Hospital|
|Herzog, Sarah||Wheaton Franciscan Healthcare|
|Hofer, John||Bay Area Medical Center|
|Hupf, Angela||Aspirus Medford Hospital & Clinics, Inc.|
|Jelle, Laura||St. Clare Hospital & Health Services|
|Kaufmann, Marilyn||Holy Family Memorial|
|Kelsey Foley, Kathy||Aspirus Wausau Hospital|
|Kempen, Jacob||Aspirus Wausau Hospital|
|King, Vivian||Aurora Health Care|
|Klay, Chris||HSHS - St. Joseph's Hospital|
|Klay, Lois||HSHS - St. Joseph's Hospital|
|Knutzen, Barbara||Agnesian HealthCare|
|Koebke, Troy||Bellin Hospital|
|Krueger, Kari||St. Mary's Janesville Hospital|
|Kruse, Joe||Mayo Health System - Franciscan Healthcare La Crosse|
|LaBarge, Margie||Ministry Health Care|
|Lampman, Sandra||St. Mary's Hospital|
|Leschke, John||Mercy Medical Center|
|Lineberry, Timothy||Aurora BayCare Medical Center - Green Bay|
|Lynch, Sue||Mayo Health System - Franciscan HC|
|Maurer, Mary||Holy Family Memorial|
|Mays, Laura||Stoughton Hospital Association|
|McArdle, PeggyAnn||Agnesian HealthCare|
|McMeans, Scott||Holy Family Memorial|
|Mercer, Carla||Reedsburg Area Medical Center|
|Merrick, Marianne||SSM - St. Mary's Hospital|
|Miller, Thomas||Children's Hospital of Wisconsin|
|Monahan, Jane||Monroe Clinic|
|Nevers, Rick||Aspirus, Inc.|
|Nicklaus, Todd||Aspirus, Inc.|
|Norell, Brett||Children's Hospital of Wisconsin|
|O'Hara, Tiffanie||Sundial Software|
|Olson, Bonnie||Sacred Heart Hospital|
|Ordinans, Karen||Children's Hospital of Wisconsin|
|Ostrander, Gail||HSHS - Eastern Wisconsin Division|
|Palecek, Steve||HSHS - St. Joseph's Hospital|
|Peck, Lori||Aspirus, Inc.|
|Peiffer, Susan||Sacred Heart Hospital|
|Pempek, Kalynn||Aspirus Wausau Hospital|
|Penovich, Carrie||Aurora Medical Center - Two Rivers|
|Pritchard, Paul||Prevea Health/HSHS|
|Radke, Chad||Aspirus Wausau Hospital|
|Range, Bonnie||Holy Family Memorial|
|Revnew, Dorothy||ProHealth Care - Oconomowoc Memorial Hospital|
|Richman, Tim||Affinity Health - Calumet Medical Center|
|Riddle, Roberta||Rusk County Memorial Hospital|
|Risley-Gray, Ruth||Aspirus, Inc.|
|Rocheleau, John||Bellin Health|
|Roethle, Linda||Bellin Memorial Hospital|
|Roundy, Ann||Columbus Community Hospital|
|Rudquist, Debra||Amery Hospital & Clinic|
|Schaetzl, Ron||SSM - St. Clare Hospital & Health Services|
|Schneider, David||Aspirus Langlade Hospital|
|Schubring, Randy||Mayo Health System - Eau Claire|
|Sciuti, Jennifer||Aurora Health Care|
|Selle, Ginger||St. Clare Hospital & Health Services|
|Sheehan, Heather||Hayward Area Memorial Hospital|
|Sio, Tim||Wheaton Franciscan - All Saints|
|Statz, Darrell||Rural Wisconsin Health Cooperative|
|Stelzer, Jason||St. Clare Hospital & Health Services|
|Strobel, Victoria||Marshfield Clinic|
|Swanson, Kaitlin||HSHS - Eastern WI Division|
|Tandberg, Ann||HSHS - St. Joseph's Hospital|
|Tapper, Joy||Milwaukee Health Care Partnership|
|Theiler, Brian||Gundersen Tri-County Hospitals & Clinics|
|Thornton, Eric||SSM - St. Mary's Janesville Hospital|
|Van Abel, Lois||Bellin Hospital|
|Vergos, Katherine||Agnesian - Ripon Medical Center|
|Voelker, Thomas||Aspirus Wausau Hospital|
|Waldoch, Timothy||Columbia St. Mary's Inc.|
|Walker, Troy||St. Clare Hospital & Health Services|
|Werkheiser, Cindy||Monroe Clinic|
|Wheeler, Susan||St. Nicholas Hospital|
|Whitinger, Margaret||Agnesian HealthCare|
|Wipperfurth, Kay||Fort HealthCare|
|Wold, Gwen||Amery Regional Medical Center|
|Contributors Ranging from $500 - $999|
|Bagnall, Andrew||St. Nicholas Hospital|
|Bailet, Jeffrey||Aurora Health Care|
|Deich, Faye||HSHS - Sacred Heart Hospital|
|Dexter, Donn||Mayo Health System - Eau Claire|
|Dicus-Johnson, Coreen||Wheaton Franciscan Healthcare|
|Dietsche, James||Bellin Hospital|
|Dolohanty, Naomi||Aurora Health Care|
|Elmer, Paula||Monroe Clinic|
|Ericson, Allen||Froedtert & MCW HSHS - St. Joseph's Hospital Campus|
|Frangesch, Wayne||Wheaton Franciscan Healthcare|
|Freimund, Rooney||Bay Area Medical Center|
|Furlong, Marian||Hudson Hospital & Clinics|
|Gille, Larry||HSHS - St. Vincent Hospital|
|Golanowski, Marie||Aurora St. Luke’s Medical Center|
|Goldberg, David||Froedtert & MCW Community Memorial Hospital Campus|
|Graebner, David||Aurora Sheboygan Memorial Medical Center|
|Graul, Mark||Children’s Hospital of Wisconsin|
|Gullingsrud, Tim||Hayward Area Memorial Hospital & Nursing Home|
|Gustafson, Andy||SSM Health Care-Wisconsin|
|Hamilton, Mark||UW Hospitals and Clinics|
|Heaney, Dwight||Fort HealthCare|
|Jablonski, James||Children's Hospital of Wisconsin|
|Jacobson, Terry||St. Mary’s Hospital of Superior|
|Jensema, Christine||HSHS-Eastern Wisconsin Division|
|Kersten, Juliet||Children's Hospital of Wisconsin|
|Kingston, Mary Beth||Aurora Health Care|
|Kirsch, Jennifer||Gundersen Health System|
|Kneiser, Patti||Froedtert & The Medical College of Wisconsin|
|Korom, Nancy||Children's Hospital of Wisconsin|
|Kostroski, Sharon||Ministry - St. Joseph's Hospital|
|Lange, George||Westgate Medical Group, CSMCP|
|Larson, Margaret||Mercy Medical Center|
|Latta, Richard||Godfrey & Kahn, SC|
|May, Carol||Sauk Prairie Memorial Hospital|
|McNally, Maureen||Froedtert & MCW|
|Mugan, James||Agnesian HealthCare|
|Mulder, Doris||Beloit Health System|
|Nelson, James||Fort HealthCare|
|O’Day, Thomas||Godfrey & Kahn, SC|
|Oland, Charisse||Rusk County Memorial Hospital|
|Ose, Peggy||Riverview Hospital Association|
|Peterson, Douglas||Chippewa Valley Hospital|
|Pollard, Dennis||Froedtert & The Medical College of Wisconsin|
|Quinn, George||Wisconsin Hospital Association|
|Reardon, Brian||Hospital Sisters Health System|
|Richards, Theresa||Ministry - St. Joseph's Hospital|
|Richardson, Todd||Aspirus, Inc.|
|Rocole, Theresa||Wheaton Franciscan Healthcare|
|Roesler, Bruce||The Richland Hospital|
|Rohrbach, Dan||Southwest Health Center|
|Rude, Nels||The Kammer Group|
|Rutkowski, Jennifer||Grant Regional Health Center|
|Sczygelski, Sidney||Aspirus Wausau Hospital|
|Seitz, Verna||ProHealth Care, Inc.|
|Selberg, Heidi||HSHS-Eastern Wisconsin Division|
|Shabino, Charles||Wisconsin Hospital Association|
|Shorter, Tom||Godfrey & Kahn, SC|
|Sisney, Mary||Children's Hospital of Wisconsin|
|Smith, Gregory||Wheaton Franciscan Healthcare|
|Spencer, Paul||Froedtert & The Medical College of Wisconsin|
|Stern, Robert||Wheaton Franciscan Healthcare|
|Strasser, Kathy||Aspirus, Inc.|
|Stuart, Philip||Tomah Memorial Hospital|
|Teigen, Seth||St. Mary’s Hospital|
|Thurmer, DeAnn||Waupun Memorial Hospital|
|Van Court, Bernie||Bay Area Medical Center|
|Van Meeteren, Bob||Reedsburg Area Medical Center|
|Yaron, Rachel||Ministry St. Clare’s Hospital|
|Zenk, Ann||Ministry St. Mary’s Hospital|
|Contributors Ranging from $1,000 - $1,499|
|Ashenhurst, Karla||Ministry Health Care|
|Bagemihl, Katherine||Froedtert & The Medical College of Wisconsin|
|Bakkum, Kyle||Vernon Memorial Healthcare|
|Bedwell, Elizabeth||Children's Hospital of Wisconsin|
|Bowers, Brenda||Wheaton Franciscan Healthcare|
|Brenton, Andrew||Wisconsin Hospital Association|
|Colpaert, Gary||Froedtert & The Medical College of Wisconsin|
|Connors, Larry||St. Mary's & St. Vincent Hospital|
|Cullen-Schultz, Jeannie||JP Cullen & Sons|
|Garcia Thomas, Cristy|
|Geraghty, Tricia||Children's Hospital of Wisconsin|
|Gorelick, Marc||Children's Hospital of Wisconsin|
|Gunn, Veronica||Children's Hospital of Wisconsin|
|Gutzeit, Michael||Children's Hospital of Wisconsin|
|Hanus, Andrew||Aurora Health Care|
|Just, Lisa||Aurora Health Care-South Region|
|Killoran, Carrie||Aurora Health Care|
|Lentz, Darrell||Aspirus Wausau Hospital|
|Lepore, Michael||Wheaton Franciscan Healthcare|
|Lewis, Jonathan||St. Mary's Hospital|
|Lindberg, Steve||Mayo Clinic Health System - Red Cedar|
|McCawley, Thomas||Beloit Health System|
|McGowan, Kathryne||Aspirus, Inc.|
|Nelson, David||HSHS Sacred Heart Hospital|
|Punzenberger, Lindsay||Children’s Hospital of Wisconsin|
|Radoszewksi, Pat||Children's Hospital of Wisconsin|
|Rakowski, Mark||Children's Hospital of Wisconsin|
|Reynolds, Sheila||Children’s Hospital of Wisconsin|
|Rickelman, Debbie||WHA Information Center|
|Robertstad, John||ProHealth Care - Oconomowoc Memorial Hospital|
|Roller, Rachel||Aurora Health Care|
|Rush, Steven||Wisconsin Hospital Association|
|Sanders, Robert||Children's Hospital of Wisconsin|
|Sato, Thomas||Children’s Hospital of Wisconsin|
|Schafer, Michael||Spooner Health System|
|Schmidt, Cheryl||Affinity Health - St. Elizabeth Hospital|
|Shanahan, Thomas||Children's Hospital of Wisconsin|
|Simaras, Jim||Wheaton Franciscan Healthcare|
|Swanson, Kerry||St. Mary’s Janesville Hospital|
|White-Jacobs, Mary Beth||Black River Memorial Hospital|
|Woleske, Chris||Bellin Hospital|
|Wolf, Edward||Lakeview Medical Center|
|Zenk, Ann||Ministry - Sacred Heart-St. Mary's Hospital|
|Contributors Ranging from $1,500 - $1,999|
|Anderson, Layton||Ministry - St. Joseph's Hospital|
|Bloch, Jodi||Wisconsin Hospital Association|
|Clapp, Nicole||Grant Regional Health Center|
|Coffman, Joan||HSHS - St. Joseph's Hospital|
|Court, Kelly||Wisconsin Hospital Association|
|Decker, Michael||Divine Savior Healthcare|
|Dotson, Jason||Beloit Health System|
|Frank, Jennifer||Wisconsin Hospital Association|
|Grasmick, Mary Kay||Wisconsin Hospital Association|
|Heywood, Matthew||Aspirus, Inc.|
|Harding, Edward||Bay Area Medical Center|
|Martin, Jeff||Ministry - Saint Michael's Hospital|
|McKevett, Timothy||Beloit Health System|
|Mohorek, Ronald||Ministry Health Care|
|Natzke, Ryan||Marshfield Clinic|
|Nauman, Michael||Children's Hospital of Wisconsin|
|Olson, David||Froedtert & The Medical College of Wisconsin|
|Rozenfeld, Jon||St. Mary’s Hospital - Madison|
|Russell, John||Columbus Community Hospital|
|Schulze, Connie||Ministry Health Care|
|Sexton, William||Crossing Rivers Health Medical Center|
|Sheehan, John||UW Hospitals and Clinics|
|Wallace, Michael||Fort HealthCare|
|Contributors Ranging from $2,000 - $2,999|
|Alig, Joanne||Wisconsin Hospital Association|
|Andersen, Travis||Columbia St. Mary's|
|Anderson, Sandy||St. Clare Hospital & Health Svcs|
|Boese, Jennifer||Wisconsin Hospital Association|
|Duncan, Robert||Children's Hospital & Health System|
|Geboy, Scott||Hall, Render, Killian, Heath & Lyman|
|Hanson, Gail||Aurora Health Care|
|Herzog, Mark||Holy Family Memorial|
|Hilt, Monica||St. Elizabeth Hospital|
|Kachelski, Joe||WI Statewide Health Info Network|
|Kief, Brian||Ministry - St. Joseph's Hospital|
|Leitch, Laura||Hall Render|
|Levin, Jeremy||Rural Wisconsin Health Cooperative|
|Lewis, Gordon||Burnett Medical Center|
|Meyer, Daniel||Aurora BayCare Medical Ctr Green Bay|
|Oliverio, John||Wheaton Franciscan Healthcare|
|Pandl, Therese||HSHS-Eastern Wisconsin Division|
|Potter, Brian||Wisconsin Hospital Association|
|Potts, Dennis||Aurora St. Luke’s Medical Center|
|Sanders, Michael||Monroe Clinic|
|Sliwinski, Ron||UW Hospitals and Clinics|
|Stanford, Matthew||Wisconsin Hospital Association|
|Troy, Peggy||Children’s Hospital of Wisconsin|
|Contributors Ranging from $3,000 - $4,999|
|Boatwright, Damond||SSM Health Care-Wisconsin|
|Jacobson, Catherine||Froedtert & The MCW|
|Kammer, Peter||The Kammer Group|
|Kerwin, George||Bellin Hospital|
|Little, Steve||Agnesian Health Care|
|Mettner, Michelle||Children’s Hospital of Wisconsin|
|Neufelder, Dan||Ministry Health Care|
|Normington, Jeremy||Mercy Medical Center|
|O’Brien, Kyle||Wisconsin Hospital Association|
|Standridge, Deb||Wheaton Franciscan Healthcare|
|Starmann-Harrison, Mary||Hospital Sisters Health System|
|Turkal, Nick||Aurora Health Care|
|Contributors Ranging from $5,000 - $9,999|
|Borgerding, Eric & Dana||Wisconsin Hospital Association|
|Brenton, Stephen||Wisconsin Hospital Association|
|Size, Tim||Rural Wisconsin Health Cooperative|
|Contributors Ranging $10,000+|
|Tyre, Scott||Capitol Navigators, Inc.|
Top of page (11/20/15)
WHA Submits Comments on MACRA Request for Information
WHA member-employed and affiliated physicians impacted
On November 17, WHA submitted comments to the federal Department of Health and Human Services in response to their Request for Information (CMS-3321-NC) on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The law, which was enacted in April 2015, repealed the sustainable growth rate (SGR) payment system for physicians and in its place created regular physician fee schedule updates along with value-based payment programs for physicians and other professionals.
Wisconsin is known for its regional and local integrated delivery systems, and increasingly physicians are employed by or closely affiliated with WHA’s member hospitals and health systems. WHA has also played a strong role in the past several years on quality improvement strategies and ways to deliver better care for patients. While WHA’s role has largely been in the area of hospital quality measurement, the new physician payment program is an aspect of quality and value that will also have implications for hospitals and health systems as work with member-employed and affiliated physicians continues to evolve and becomes even more integrated.
The SGR was an outdated system that was in an annual crisis situation and forced the federal government and Legislature each year to find cuts elsewhere—often from hospitals—to pay for physician payment increases. WHA was pleased to see it repealed, and is closely watching the implementation of the alternative payment system that was created under MACRA.
MACRA creates a new Merit-Based Incentive Payment System (MIPS) and incentive payments for participating in Alternative Payment Models (APMs). MIPS payment adjustments and APM incentive payments will begin in 2019, based on MIPS performance or APM participation in a prior performance period.
WHA commented on several aspects of the MIPS and APM programs, including quality measures and performance standards. WHA now has several years of experience with the hospital value-based purchasing program and other measurement reporting to drive improvement, and comments focused on ways to implement these programs while recognizing the administrative complexities and capabilities of larger and smaller practices. WHA also suggested that CMS use the same method of setting standards and measuring improvement as is used in the hospital value-based purchasing program, allowing providers to receive credit for improvement and achievement.
WHA’s comment letter can be found here: www.wha.org/pdf/WHAresponseMACRARFI11-17-15.pdf.
For more detailed information on the MIPS and APM programs, visit the CMS website at:
Top of page (11/20/15)
ETF Consultant Recommends Phasing in Self-Funding the State Employee Health Plan
A regional model that narrows plan choice recommended for first phase
On November 17, Segal Consulting, a benefits consulting group hired by the State, released a report estimating the state could save $40 to $50 million annually by self-insuring state employees. This estimate is down from their previous report which estimated savings at $50 to $70 million annually. The report, presented to the State Employee Trust Funds’ (ETF) Group Insurance Board November 18, recommended a phased-in approach to the self-funded model with the state gathering additional data in 2017, and beginning to transition to the self-funded model after that “on a timeframe that is most advantageous to the program and allows ETF staff to manage the transition in a thoughtful manner.”
When asked by a Board member why the state shouldn’t self-fund immediately if there are savings, the consultants responded that there is a need for the Department to ensure it has the expertise and staff to administer the model, that there is uncertainty and going slow would allow time for additional data and information to be obtained, and that it would be a lot for the state to handle to implement any sooner.
A previous report by Deloitte Consulting estimated that a move to self-funding was risky and could cost the state up to $100 million in part due to the loss in existing provider discounts and care management that occurs with the provider-owned health plans. Segal noted they believe provider discounts can be maintained even in a self-funded model. However, Segal also notes that their information on provider discounts came from a request for information, and that “the information submitted with the RFI is not ETF specific and the results could vary if the analysis were conducted using ETF claims and utilization patterns.”
The Segal report provides several other recommendations that could be done separately from, or as a precursor to, self-funding. These recommendations include narrowing plan choice by establishing three regions in the state and contracting with up to two health plans per region, alongside a single statewide health plan. Segal recommends marketing these regional plans for 2018. Segal claims there is an opportunity for ETF to save between $45 and $70 million in medical costs from this approach without sacrificing provider access.
Other recommendations in the report include improving benefit design by contracting with health plans that implement tiered provider networks, reference-based pricing, and centers of excellence. ETF has recently engaged a separate consultant to analyze these concepts and their use in the state employee health plan. These options, Segal recommends, can be implemented in 2018 along with the regional approach.
The report also includes suggestions for improving incentives for employees to participate in wellness and disease management activities, pharmacy changes, and implementing a data warehouse. Each of these would involve procurements, and it is unclear how these procurements and vendors would be funded. Finally, the report makes recommended changes to the state program for retirees.
In 2016, the ETF and the Group Insurance Board made several changes to the group health program that Segal estimates have saved the state $89 million for 2016. These changes include: higher deductibles; modifications to copayments for medical and prescription drugs; increasing the incentive for employees to participate in the high deductible health plan; increasing the out-of-pocket maximum; and improvements in the negotiation process with participating health plans.
The state group health plan covers over 245,000 lives, including 69,000 active state employees and their dependents, 26,000 retired employees and their dependents, and 15,000 active and retired local employees and their dependents. The Group Insurance Board reviews and approves changes to the group health plan. The Board’s next scheduled meeting is in February 2016, but members discussed meeting prior to that date in a special session specifically so members could learn more and ask additional questions about the report.
In the meantime, a bill that would give the Joint Finance Committee review of a self-funded model has now been approved by the Legislature and will be sent to Governor Walker (see related article below.)
Top of page (11/20/15)
Worker’s Comp Council Moves Closer to Labor-Management Bill Draft Completion
On November 19, the Worker’s Compensation Advisory Council (WCAC) met to review draft bill language that reflects the proposals agreed to by labor and management at their last meeting in October. The agreed-to proposals are still expected to move forward without a fee schedule, but also without the pilot for “directed care” (see previous Valued Voice article at www.wha.org/pubarchive/valued_voice/WHA-Newsletter-10-23-2015.htm#1). The Council agreed to some minor technical changes in the draft bill language and is expected to review and approve those changes in the next few weeks.
At the beginning of the meeting, Council members heard from guest speaker State Rep. John Spiros (R-Marshfield). Spiros is the lead author of AB 501, a bill that was introduced November 10 and would make various changes to Wisconsin Worker’s Compensation law. Many of the provisions in the WCAC proposal are similar to provisions included in AB 501, including the fact that both do not include a fee schedule. Spiros noted his ongoing interest in driving out waste, fraud and abuse, and emphasized to the Council that his goal is to protect both employees and employers in the Worker’s Compensation system.
The Worker’s Compensation Advisory Council agreed-to bill will be referred to the Legislature for consideration in the next few weeks, once the Council votes to approve the final language.
Top of page (11/20/15)
Grassroots Spotlight: U.S. Rep. Grothman Tours Columbia St. Mary’s
U.S. Rep. Glenn Grothman recently visited Columbia St. Mary’s Ozaukee Campus. During his time there he had the opportunity to talk with leadership and staff about key issues, such as addressing rising drug prices and protecting the federal “340B” drug discount program.
Grothman also heard more about the importance of the “MEND Act,” the Making the Education of Nursing Dependable for Schools Act. This legislation is needed in order to fix conflicting federal requirements that hospital-based nursing programs currently face through no fault of their own. Grothman agreed to cosponsor this legislation. He also toured the electrophysiology lab.
Top of page (11/20/15)
Support Statewide Health Care Initiatives with Contribution to WHA Foundation
Each year, the WHA Foundation supports a variety of initiatives that have statewide impact on health care in the areas of workforce development, quality and patient safety and community collaboration. In 2015, those initiatives include scholarships for 20 hospital teams to participate in clinical OB simulation training, support for the third cohort of the Transforming Care at the Bedside (TCAB) initiative, and maintenance of the BSN completion program website, http://BSN.WHA.org.
In order to continue supporting initiatives like these and others in 2016, the WHA Foundation has officially kicked off its annual fundraising campaign, asking WHA hospital and corporate members to consider supporting the WHA Foundation by making a contribution this month.
Funds raised in the current campaign will be used to continue some of its most successful and long-standing initiatives, including the Global Vision Community Partnership Awards and the annual scholarships to graduating technical college students in health-related programs, and give the Foundation the opportunity to consider new initiatives for funding in 2016.
Each WHA hospital member executive has received a direct appeal for the fundraising effort. A contribution form is included in this week’s packet for anyone who would like to make an individual contribution or one on behalf of your organization. For more information on the WHA Foundation’s annual fundraising campaign, contact Jennifer Frank at 608-274-1820 or email@example.com.
Top of page (11/20/15) Top of page (11/20/15)
CMS Finalizes Mandatory Medicare Hip/Knee Bundle Model
Multiple Wisconsin hospitals required to participate
On November 16 the Centers for Medicare & Medicaid Services (CMS) finalized a new, mandatory model to bundle payments to hospitals for hip and knee replacement surgeries. The model is referred to as the Comprehensive Care for Joint Replacement (CJR) and is mandated in 67 different geographic areas, including in Milwaukee and Madison. The Wisconsin Hospital Association believes 22 Wisconsin hospitals will be impacted.
Under the proposed model, hospitals would bear financial risk for the entire episode of care, beginning with the anchor hospitalization and extending 90 days post-acute care. In general, CMS will set a target episode price for each hospital to meet. Should a hospital fail to meet that amount, it would be required to pay Medicare back. If a hospital performs better than that benchmark and meets quality requirements, it will receive savings back. The model will run five years. Hospitals will not bear financial risk in year one, but then will do so in years two through five.
When CMS first proposed the model this summer, WHA submitted comment indicating two primary areas of concern—hospitals bearing full financial responsibility without the ability to coordinate care and the quality requirements. WHA is pleased that CMS addressed several of these concerns in its final model.
Key elements of the CJR model are listed below:
WHA priorities pass Legislature in final days of session, Governor set to sign
The state Assembly concurred with the Senate’s recent action on two WHA legislative priorities during an extraordinary floor session November 16. Assembly Bill 253 and Assembly Bill 394 both previously passed in the Assembly, but Senate action amending the legislation required that the Assembly approve the bills one last time. Both bills were concurred on unanimously by the State Assembly and will now be sent to Gov. Scott Walker for his signature.
Assembly Bill 253, which adopts the Interstate Medical Licensure Compact into law in Wisconsin, passed the state Assembly in September with a vote of 95-1 and passed the Senate, as amended, with a vote of 31-1 in early November. The legislation was amended in the Senate Committee on Health and Human Services by Sen. Leah Vukmir (R-Wauwatosa). Vukmir’s amendment would require the Compact be reauthorized by the Legislature four years after the effective date of the bill. Gov. Walker is expected to sign this amended version of the legislation before the end of the year, making Wisconsin the 12th state to become a member of the Interstate Medical Licensure Compact.
The Medical Examining Board (MEB), in a meeting November 18, selected Board Chair Kenneth Simons, MD, of the Medical College of Wisconsin, and MEB Executive Director Tom Ryan to serve as Wisconsin’s two representatives to the Interstate Medical Licensure Compact Commission once Walker signs AB 253 into law. As part of Vukmir’s amendment to the bill, the Wisconsin MEB’s appointments to the Commission would require confirmation by the full State Senate.
The Assembly also concurred with a Senate amendment to Assembly Bill 394, legislation that would require the Joint Finance Committee review actions taken by the Group Insurance Board (GIB) impacting the state employee health insurance program. The amended version of this bill would limit the scope of the Joint Finance Committee’s review and approval authority to those actions taken by the GIB to “execute a contract to provide self-insured group health plans on a regional or statewide basis to state employees.”
While Walker had previously indicated he would veto Assembly Bill 394 if it were to reach his desk, his spokesperson has now indicated the Governor will sign AB 394 as amended by the Senate and Assembly.
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Register Now for WHA 2016 Physician Leadership Conference in Kohler
One of the most difficult transitions for a new physician leader is the move from working autonomously and focusing on clinical issues to leading a team with a new approach to managerial decision-making and problem solving. The WHA 2016 Physician Leadership Development Conference will focus on the tools, techniques and skills to assist both new and seasoned physician leaders in making that transition.
The 2016 conference, scheduled Friday, March 11 and Saturday, March 12 at The American Club in Kohler, will be led by Stacy Nelson, MEd EdD. He will focus on ways physician leaders can lead strategic conversations and influence change within the organization. In addition, Michael Guthrie, MD, MBA, FACPE, will share best practices for running effective meetings and use group dynamics to build support and decision-making. Both Nelson and Guthrie are nationally-recognized faculty from the American Association for Physician Leadership (ACPL), formerly the American College of Physician Executives.
Registration is now open online at http://events.SignUp4.net/16PLD, with a discounted “early bird” registration fee available to those registering by January 15. Additionally, a “host” registration option is available for senior-level hospital representatives (non-physicians) who accompany one or more of their physicians to the conference but do not need CME credit. ACPL is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. ACPL designates this live activity for a maximum of 10 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Clinicians, Educators, Health Care Managers Attend WCMEW Conference
Nearly 100 clinicians, health educators, and health care managers attended the Wisconsin Council on Medical Education and Workforce (WCMEW) 2015 Team-Based Care Summit “Transforming Concepts Into Reality” November 12 in Appleton.
Charles Shabino, MD, WCMEW chair, started by summarizing the WCMEW team-based care priorities. Sarah Sorum, PharmD, vice president, professional & educational affairs, Pharmacy Society of Wisconsin and lead for WCMEW’s Team-Based Care Workgroup, spoke about the workgroup’s goals and activities. Gina Dennik-Champion, executive director of the Wisconsin Nurses Association, presented an overview of a Wisconsin-centric definition of team-based care.
The introductory remarks were followed by two keynotes. Kathy Kerscher, leader of operations of primary care for Bellin Health, spoke on “Achieving Population Health Through Team-Based Care,” focusing on how Bellin Health has redefined primary care, the steps to achieve population health and core concepts for team-based care.
This presentation was followed by a panel discussion on “Payer Perspectives on Team-Based Care,” led by George Quinn, WCMEW executive director. Gregory Long, MD, chief medical officer of ThedaCare, provided an overview of ThedaCare’s “Complex Patient Care Redesign,” focusing on provider and payer perspectives in redesign, and on how current payment and delivery models need to be disrupted to achieve enhanced value. Terry Bolz, CEO of Unity Health Plans, presented on “How Payers And Providers Can Work Together,” saying that the greater degree of convergence between payers and providers—both in terms of goals and functions—the greater the likelihood of success.
After a working lunch where attendees reviewed eight poster presentations, two concurrent sessions were held. Andy Anderson, MD, CMO of Aurora Healthcare, presented “The Importance of Metrics to Drive Continuous Improvement.” William Hueston, MD, senior associate dean for academic affairs, Medical College of Wisconsin, led a panel discussion with Kimberly Edlis, PhD, program director, Bellin College, who spoke on “Transforming Education/Transforming the Future,” and Joseph Zorek, PharmD, assistant professor, UW Madison School of Medicine and Public Health, discussing “The Historical Roots Shaping Today’s Interprofessional Practice and Learning Landscape.”
The day closed with two concurrent sessions. Dennik-Champion led a panel discussion on “A How-To Guide: Managing Workflows, Developing Protocols, Expanding Roles.” Kerscher and Rob MacNeil of Bellin, and Lynda Gruenewald Schultz, Wheaton Franciscan Health Care, gave perspectives from their organizations.
“Our goal for this year’s Summit was to provide interprofessional learning and dialogue about team-based care, and to describe tools and techniques for implementing team-based care in Wisconsin,” said Quinn. “We are gratified that so many stakeholders engaged in these discussions.”
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Building Materials Sales Tax Legislation Passes Senate, Assembly
Senate Bill 227 allows contractor exemption for nonprofit, tax-exempt construction projects
The State Assembly passed legislation November 16 that would allow contractors to purchase certain materials for nonprofit organization construction projects without being charged sales and use tax at the time of purchase. The legislation, introduced by Sen. Howard Marklein (R-Spring Green) and Rep. Bob Kulp (R-Stratford), would allow contractors to purchase materials directly instead of being required to purchase these construction products through the nonprofit organization.
Currently, when a contractor purchases certain building products directly, they are not eligible for a sales tax exemption even when the contractor’s customer is a nonprofit, tax-exempt entity. The contractor must then develop a separate process to ensure that the nonprofit doesn’t pay sales tax that is not owed to the state of Wisconsin or must require the nonprofit to purchase these building products directly.
Marklein testified before the Senate Committee on Revenue, Financial Institutions, and Rural Issues that the bill will streamline the building material exemption for nonprofit organizations and eliminate the current complicated process for purchasing construction materials by a contractor.
The bill has now been passed by both the Senate and the Assembly and awaits the Governor’s signature. The Governor vetoed a similar provision in the state budget, but indicated he would sign standalone legislation that was more limited in scope. The Governor is expected to sign SB 227 into law before the end of the year.
To see the bill’s final language, go to: http://docs.legis.wisconsin.gov/2015/related/enrolled/sb227.pdf.
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