November 7, 2014
Volume 57, Issue 45

Fiscal Bureau Staff Reviews Medicaid, State Budget Process for WHA Council

The Wisconsin Legislative Fiscal Bureau (LFB) is held in high regard for the quality of the work products it produces for the Governor and state legislators. Considered by many to the “gold standard” when they are released, the LFB researches and releases summary documents and budget papers that provide detailed descriptions and background on bills, proposals and issues for legislators.


The LFB staff, including Program Supervisor Charlie Morgan and Fiscal Analysts Sam Austin, Stephanie Mabrey, and Jon Dyck, were guests at the November 6 WHA Public Policy Council meeting in Madison, chaired by Mike Wallace, president/CEO, Fort HealthCare. The LFB provides research and analytical services to the State Legislature and the Governor on the state budget, bills, proposals and programs.


Austin explained the LFB’s role in the state budget process and presented an overview of the Medicaid budget. Enrollment in the Medicaid program has steadily increased over the past decade, from 741,000 average enrollees per month in 2004-05, to over a million average enrollees each month in 2013-14. Austin said growth in the Medicaid caseload, especially among childless adults, is driving increases in the Medicaid budget above expectations.


WHA Executive Vice President Eric Borgerding complimented the LFB, saying their issue and background papers are considered the “gold standard” based on the thoroughness, credibility and unbiased nature of their work. Borgerding said the LFB’s work is extremely important to the state budget, a process that starts in February and doesn’t end until the end of June in every odd-numbered year. The LFB provides background research and discussion points for lawmakers to consider when deliberating the budget. The LFB said they greatly appreciate their longstanding relationship with WHA’s government relations and public policy teams. 


When state budget discussions start after the first of the year in the Legislature, Borgerding said advocating for Medicaid funding will be one of WHA’s top priorities. The Association will continue to aggressively seek adequate payment in this historically underfunded program. Joanne Alig, WHA senior vice president, policy & research, said WHA is developing a package of achievable policy initiatives aimed at improving access to care for low income populations, both in urban areas and statewide, that can be advanced in the state legislature during the 2015-16 legislative session.


The Council also discussed legislation being drafted by the Wisconsin Nurses Association that would make changes to Wisconsin’s statutes regarding advance practice registered nurses, and explored how changes to those statutes could impact organizations that employ or privilege advance practice registered nurses.


Eric Templis, director of government relations, Gundersen Health System, and Matthew Stanford, WHA vice president, policy and regulatory affairs, and associate counsel, briefed the Council on issues related to interstate medical licensure. Changes in the delivery and organization of health care, as well as workforce needs and the growing use of telemedicine, are driving new discussions of ways to streamline the medical licensing process for physicians who practice across state lines. The Council reviewed and provided feedback on the establishment of an Interstate Medical Licensure Compact that would allow physicians to choose a process for obtaining an expedited medical license in states that join the Compact.


WHA will now turn its attention to the state budget process, according to Kyle O’Brien, WHA vice president, government relations. The summary O’Brien presented is below in this issue of The Valued Voice.


As the meeting closed, Borgerding acknowledged Chair Mike Wallace’s service to the Public Policy Council and announced that Wallace has been elected to serve as WHA Chair Elect in 2015. Borgerding said Wallace’s leadership on the PPC and his keen understanding of the important role of advocacy to the Association will be an asset to WHA’s members in the years ahead.  

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California Voters Overwhelmingly Reject Effort to Increase Medical Liability Cap


Missed in many post-election headlines this week was an important vote in California. By a 2-1 margin, California voters rejected an attempt to increase that state’s cap on noneconomic damages, or pain and suffering, in medical liability cases. The initiative, Proposition 46, would have increased California’s cap from $250,000 to $1.1 million. Like in the 35 other states that have caps on noneconomic damages, California voters understood the caps help stabilize their medical liability system. The proponents of California’s current cap explained that an unstable medical liability environment increases costs for all health care consumers and can cause patients to lose their trusted doctors—especially in high risk specialties and in underserved areas—to states with a stable system.


WHA Executive Vice President Eric Borgerding noted Wisconsin is fortunate to be one of the states with a stable medical liability environment, which attracts quality physicians even in the highest risk specialties.


“A stinging defeat for trial lawyers, no question about it—and in all places California,” said Borgerding.  “Here in Wisconsin, our balanced system is carefully designed to provide fair compensation to patients injured by medical negligence while maintaining a stable medical liability environment that helps our hospitals retain and attract the best and brightest physicians and other health care practitioners.”


In Wisconsin, because of its strong Injured Patients and Families Compensation Fund, and unlike many other states, patients injured by medical negligence receive all of their economic damages, including lost wages and medical bills. Non-economic damages are capped at $750,000, one of the highest caps in the country.


“Despite efforts by the trial lawyer lobby to demonize Wisconsin’s balanced system, the truth is it is one of the fairest, most balanced in the country, and it is working as intended. It must be protected, not assailed,” Borgerding emphasized.


WHA’s Chief Medical Officer Charles Shabino, MD, stressed the significance of the issue to the efforts to increase the number of physicians in Wisconsin, saying, “In its report 100 New Physicians a Year: An Imperative for Wisconsin, WHA identified an impending shortage of physicians in this state. We have been working with our coalition partners on a number of strategies to address the need. Maintaining Wisconsin’s stable medical liability environment is a crucial piece of the puzzle.” 


Borgerding agreed, “I am confident the Wisconsin Legislature understands the importance of our well-balanced system.”  

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Walker, Schimel and Legislative Republicans Win in 2014


In what appeared to be a tight battle leading up to Election Day, Gov. Scott Walker won his third election in four years to continue serving as Governor of Wisconsin. He defeated former Trek Bicycle Executive Mary Burke, with a margin of 5.7 percent. The Governor won in 56 counties and received 52.3 percent of the vote statewide.


In the race to replace retiring Attorney General J.B. Van Hollen, both the Republican and Democratic candidates remained relatively unknown to voters. In the end, Waukesha County District Attorney Brad Schimel, the Republican, defeated Jefferson County District Attorney Susan Happ, the Democrat, in a race that very closely mirrored the gubernatorial election results. Schimel received 51.7 percent of the vote while Happ received 45.4 percent of the vote.


Both Walker and Schimel have been elected to four-year terms and will need to seek re-election in 2018 to keep their posts.


Republicans Strengthen Majorities in State Assembly and Senate


Legislative Republicans dominated the November 4 election results, winning with large margins of victory in key battleground districts. The Senate will come back with a stronger Republican majority than last session, gaining one seat to put their chamber at 19 Republicans and 14 Democrats. Assembly Republicans also gained more control, with likely 63 Republicans and 36 Democrats. According to WisPolitics, this could be the largest Republican majority in the state Assembly since 1957.


In the Senate, there were three races that both Republicans and Democrats focused on: the 17th Senate District in southwestern Wisconsin (formerly Sen. Dale Schultz’s seat), the 19th Senate District in the Appleton/Fox Valley area (formerly Sen. Mike Ellis’ seat) and the 9th Senate District in the Sheboygan and Manitowoc area (formerly Sen. Joe Leibham’s seat).


In the 9th Senate District, Republican Devin Lemahieu beat his Democratic opponent by a margin of nearly 20 percent. The closest race was between sitting State Rep. Howard Marklein and Democrat Pat Bomhack in the 17th Senate District, but Marklein garnered 55 percent of the vote in a district that typically leans Democratic. Republican Roger Roth, a former State Representative and small business owner, beat sitting Rep. Penny Bernard Schaber in the 19th Senate District with 57.2 percent of the vote.


In the Assembly, Republicans protected vulnerable incumbents, specifically in the Eau Claire/Chippewa Falls and Wisconsin Rapids areas. Both Rep. Kathy Bernier (R-Chippewa Falls) and Rep. Scott Krug (R-Wisconsin Rapids) won reelection by six percent and 12 percent, respectively.


Assembly Republicans also defeated several Democratic incumbents. In Wisconsin’s 75th Assembly District, Republican candidate Romaine Robert Quinn of Rice Lake defeated sitting State Rep. Stephen Smith (D-Shell Lake). Second-time Republican candidate Nancy Vandermeer of Tomah defeated sitting State Rep. Amy Sue Vruwink (D-Milladore) in the 70th Assembly District.


Dave Heaton, a Republican candidate in Wausau is leading sitting State Rep. Mandy Wright (D-Wausau) in the 85th Assembly District. With 100 percent of precincts reporting, Heaton is up by 86 votes but the press still counts this race as too close to call. This race could result in a recount.


The same situation exists for an open seat in Wisconsin’s 51st Assembly District, where Republican Todd Novak leads Democratic candidate Dick Cates by 59 votes.


What does the 2014 election mean for health care policy in the next legislative session?


Medicaid Reimbursement - Cutting Wisconsin’s Hidden Health Care Tax

WHA’s key agenda item in 2015-2016 will be increasing Medicaid reimbursement for Wisconsin hospitals. Chronic underpayment in Wisconsin’s Medicaid program is exacerbating a hidden health care tax on Wisconsin employers. In 2013, this has amounted to $960 million in unpaid hospital costs from Wisconsin’s Medicaid program that must be cost-shifted to employers that pay for health insurance premiums.


Over the last several months, WHA’s government relations team has been on the road meeting with nearly 70 candidates one-on-one and talking about this issue. There will be increased competition for state tax resources between investments in infrastructure (health care, education, and transportation) and potential income and property tax cuts.


Health Care Workforce

Governor Walker continues to focus on growing Wisconsin’s workforce. His prevalent campaign message was, “We won’t stop until everyone who wants a job, can find a job.” That’s why WHA continues to move forward with a proactive health care workforce agenda that can meet the evolving health care demands of today and the future. WHA staff, along with the Wisconsin Council on Medical Education and Workforce, has worked side-by-side with the Walker Administration to invest in Wisconsin’s health care workforce and identify areas of need. Last session, based on recommendations outlined in WHA’s report, “100 Physicians a Year: An Imperative for Wisconsin,” the Governor provided an unprecedented $5 million investment in graduate medical education. The Legislature adopted this recommendation and, today, millions of dollars have already been awarded to residency programs statewide.


WHA plans to continue this successful partnership with the Walker Administration and the Legislature to meet WHA members’ workforce needs in all areas of practice. This next session, WHA will pursue gathering additional licensure survey data from key health care professionals, strengthen partnerships between hospital/health system employers and higher education and look to make additional investments for health care workforce training.


Behavioral Health

Coming off the heels of a package of mental health legislation last session (a cornerstone of which was the HIPAA Harmonization/Mental Health Care Coordination legislation championed by WHA), lawmakers are expected to continue their focus on supporting mental health care delivery and treatment. The Assembly Republicans have already issued an agenda for next session called Forward for Wisconsin’s Future that includes a section stating they will “continue to promote understanding and provide resources for those affected by mental illness” stating that it “is vital for policymakers to continue moving forward on this issue.”


WHA will continue to be a key resource for Wisconsin lawmakers in this area of health care policy, including ways that the state can help support innovative care delivery models such as telemedicine.

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Nearly 200 Members Attend WHA Leadership Conference Featuring Jamie Orlikoff


Not everyone agreed with everything Jamie Orlikoff said on November 5, but there was no arguing with his basic premise that consumers will have a profound impact on health care as they assume a larger share of the cost. That fact, more so than the passage of the Affordable Care Act (ACA), is quickly reshaping the health care landscape, according to Orlikoff, who is considered one of the foremost thought leaders in the country.


“Change is not being driven by the Affordable Care Act. Health care will not return to ‘normal’ because it never has been normal,” according to Orlikoff. “The bubble around health care is bursting because of trends that were in motion prior to its passage. The ACA is a symptom of change in health care, not the driver.”


Nearly 200 WHA members gathered in Wisconsin Dells for the first of what will be a series of seminars aimed at developing skills of emerging health care leaders, presented by WHA, the Wisconsin Forum for Healthcare Strategy (WFHS) and the WHA Foundation. In the opening presentation, WHA Executive Vice President Eric Borgerding listed the five biggest challenges to Wisconsin hospitals and health systems as: Medicare; ObamaCare; physician supply; doing more with fewer resources; and, the move from volume to value.


“Our state is well-positioned to thrive amidst these challenges. We have a highly-integrated system of care, and a healthy, pluralistic insurance market,” Borgerding said. “We are well prepared for where we are today, but we know we have to be even better prepared for tomorrow.”


If it is going to be competitive with other states, Wisconsin must have a healthy, thriving economy and attract and retain employers. Borgerding emphasized the role health systems and hospitals have in maintaining that environment by continuing to provide high-quality, accessible and affordable health care.


“As an organization, WHA recognizes the dynamics that are in play in our communities,” said Borgerding. “In addition to the tens of thousands of jobs they provide, equally or more important is the commitment by Wisconsin’s hospitals and health systems to increase our efficiency, raise quality and deliver high-value care so local employers can grow and prosper.”


The day’s agenda included a panel discussion moderated by Orlikoff that featured three Wisconsin health care leaders. They included: Nicole Clapp, president/CEO of Grant Regional Health Center in Lancaster; Dan Neufelder, senior vice president and COO for Ministry Health Care; and Mike Wallace, president/CEO, Fort HealthCare in Fort Atkinson. The panelists shared their experiences in addressing challenges they have faced during their career and how they are preparing their organizations to stay ahead of the curve in a fast-changing environment. All three said collaboration among hospitals and health systems is a strength in Wisconsin.


“The spirit of collaboration in Wisconsin is outstanding. If someone here is doing something you need to know about, WHA as well as Wisconsin HFMA and other organizations, promote communication and collaboration,” according to Neufelder. “As a leader, you need to master the art of collaboration, not just competition.”


WHA, in partnership with WFHS and the WHA Foundation, is working on the next seminar in the leadership development series. Watch for details early next year.

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WCMEW Explores Graduate Medical Education in Northwest Wisconsin


The Wisconsin Council on Medical Education and Workforce (WCMEW) and the Wisconsin Department of Health Services (DHS) held a meeting in Chippewa Falls October 29 to explore interest in establishing a graduate medical education (GME) presence in Northwest Wisconsin, an area with little current GME activity, and one with an acute shortage of physicians. Representatives of health systems in Northwest Wisconsin and Eastern Minnesota, GME program directors, the Medical College of Wisconsin, and the University of Wisconsin School of Medicine and Public Health attended the meeting.


During the meeting, attendees heard from DHS, the Rural Wisconsin Health Cooperative and the Wisconsin Rural Physician Residency Assistance Program about available funding opportunities in Wisconsin, and examples of how GME programs have taken advantage of the funding to create or expand their programs.


Attendees discussed existing barriers to expanding GME in Northwest Wisconsin, and suggested possible solutions, including the creation of a GME consortium and a faculty development program for teaching physicians. WCMEW and DHS staffs were tasked with researching and “fleshing out” the suggestions, which will be discussed at a follow-up meeting to be held in the spring of 2015.


“It was exciting to see the interest and creative thoughts expressed by everyone,” said George Quinn, executive director of WCMEW. “This is the kind of initiative where WCMEW can be the catalyst in bringing together the various stakeholders in GME. We will continue to work to pursue an expansion of GME in this needed area of the state.”  

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WHA Partnering with WI Psychiatric Association on Education Program


WHA has partnered with the Wisconsin Psychiatric Association (WPA) to extend an invitation to WHA members to attend the WPA Fall Conference December 5 at the American Club in Kohler.


The full-day educational program will focus on behavioral health care developments and strategies, with an emphasis on emerging integrated behavioral health models underway with the Mayo Clinic Health System, UW Health and Vanderbilt Behavioral Health. Other topics will include the role of physician extenders in psychiatric teams, electronic health records and quality improvement measures in psychiatry.


WHA members are eligible for reduced rates to attend the program. For information and to register for the program, go to: For WHA members to receive the reduced registration rate, members should register as a non-member and then enter the promo code WHA (all caps).

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CMS Releases the 2015 Final Outpatient PPS Rule


CMS has released the display version of the 2015 final OPPS rule which can be found online at: The rule will be published in the Federal Register November 10.


Most of the changes announced in the 2015 proposed outpatient PPS rule were adopted as final. The major components of the final rule are as follows:


·         The final CY 2015 OPPS market basket and ACA offsets are 2.9 percent and -0.7 percent respectively, for a net update factor of 2.2 percent

·         The final CY 2015 OPPS national conversion factor is $74.144 — a 2.0 percent increase over the final CY 2014 rate.  (This is 0.1 percent lower than the amount published in the proposed rule and is due to budget neutrality adjustments.)

·         The final CY 2015 OPPS wage indexes will be exactly the same as for the final FFY 2015 inpatient PPS.

·         The final CY 2015 OPPS outlier threshold is $2,775, which is lower than the 2014 threshold and lower than the proposed threshold.

·         The rural SCH and EACH add-on is retained at 7.1 percent

·         CMS has made some modest revisions to the Comprehensive APCs (C-APCs), eliminating three of the proposed 28 C-APCs (now 25) and modifying the complexity adjustment criteria.

·         CMS has made some revisions to the OQR program measures for CYs 2016, 2017 and 2018

·         There are no changes to the ED or critical care APCs


WHA is working on a more detailed analysis of the rule which will be coming out in the near future. All completed PPS rule summaries can be found on the WHA website at  WHA will also be preparing hospital specific analysis on the fiscal impact of the 2015 Outpatient PPS final rule in the next couple of weeks. As a reminder, hospital-specific impact reports can be obtained on the WHA member portal at  

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WHEPP Region 5 Hosts Ebola Symposium; Hospital Planning Efforts Continue


More than 200 representatives from Wisconsin hospitals and health systems in southern Wisconsin participated in the Wisconsin Hospital Emergency Preparedness Program (WHEPP) Region 5 symposium on Ebola held November 4 in Madison. Speakers representing EMS, health systems, the Department of Health, the Division of Public Health and infectious disease specialists presented on and addressed questions related to the processing and handling of patient samples, infection control measures and the donning and doffing of personal protective equipment (PPE).


The Wisconsin Hospital Association is working closely with DHS and Public Health Officer Karen McKeown to facilitate the communication of information that is critical to planning efforts and patient and worker safety.


WHA updates its Ebola webpage continuously, including weekends and after hours. Check it frequently for general information and guidance documents ( and webcasts (


Any questions related to Ebola can be directed to Mary Kay Grasmick, WHA, 608-274-1820, 608-575-7516 or or to Andrew Brenton, WHA, at or 608-274-1820.

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