February 12, 2016
Volume 60, Issue 6

WHA Webinars Focus on Leaders’ Role in Tackling the Opioid Abuse Issue

WHA is providing a series of complimentary webinars, as part of a WHA Member Forum, focused on assisting hospital and health system administrative and clinical leaders understand the growing public health issue caused by the misuse and abuse of opioids. The WHA webinars will clarify the health care leaders’ role in addressing the issue and creating a culture of change in their own organizations that is responsive to this growing epidemic. These webinars are being offered as an important part of WHA’s high-level, multipronged initiative to battle opioid abuse and misuse. Unveiled in November 2015, WHA’s Health Care Leaders Opioid Initiative also includes a regular convening of key stakeholders from throughout the state to develop system-level approaches that create real and sustainable culture change in Wisconsin hospitals and health care systems.

"A majority of health care providers practice in or are closely aligned with hospitals and health systems. WHA has focused its education and communication efforts at the health care leader level to ensure that as information is shared, education is available and systematic plans to address opioid abuse and misuse are developed, and health care leaders understand the critical role they have in the success of all these efforts," according to Steve Rush, WHA vice president, workforce and clinical practice. "That is why WHA’s primary education focus is at the hospital and health system level."

The first webinar, "A Hospital Leader’s Role in Tackling the Opioid Abuse Issue," is scheduled February 25. This webinar will focus on the importance of hospital leaders fostering the culture change among their prescribers to examine their own prescribing habits. The efforts of a fellow hospital leader in addressing the issue and culture change within his own organization will be featured, and additional resources and next steps from WHA on this issue will be discussed. To register, visit: https://events.SignUp4.net/HospitalLeaderRole-Opioids.

The next webinar, "Wisconsin Best Practices in Tackling the Opioid Abuse Issue," is scheduled March 17. Participants will learn about two of the many Wisconsin hospital best practices in getting opioid prescribing initiatives implemented in their organizations and getting prescribers to be engaged in the efforts as well. Julie Doniere, MD, will share initiatives implemented in Wheaton Franciscan Healthcare’s emergency departments to address patients with acute pain who present in the emergency room. Michael McNett, MD, will share initiatives implemented by Aurora Health Care to address patients with chronic pain. To register, visit: https://events.SignUp4.net/WIBestPrac-Opioids.

The third webinar in the series, "Drug Diversion from the Health Care Workplace: A Multiple Victim Crime," will be held April 5. Keith Berge, MD, head of Mayo Clinic’s drug diversion prevention efforts nationally at all Mayo sites, will discuss the efforts Mayo Clinic has found to be effective in preventing, detecting and intervening on drug diversion. Participants will leave with a roadmap to improving drug controls within their facilities and combating drug diversion from the health care workplace. To register, visit: https://events.SignUp4.net/drugdiversion-opioids.

The fourth webinar, "Navigating Wisconsin’s Prescription Drug Monitoring Program and Controlled Substances Board," scheduled April 27, will focus on the role and purpose of the Wisconsin Department of Safety and Professional Services Controlled Substances Board (CSB) and of Wisconsin’s Prescription Drug Monitoring Program (PDMP). Chad Zadrazil, director of the PDMP and executive director of the CSB, will describe the member composition of the CSB, the rule-writing authority of the Board, regulatory oversight this important Board has in Wisconsin, and the implications of recently-passed and pending legislation for the PDMP, as well as the CSB. To register, visit: https://events.SignUp4.net/PDMP-CSB-Opioids.

There is no fee for WHA hospital and corporate members to participate in WHA Member Forum webinars, but pre-registration is required. For more information or to register for any of the previously mentioned WHA Member Forum webinars, visit www.wha.org. For more information, contact Jennifer Frank at jfrank@wha.org or at 608-274-1820.

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WHA, Hospital Leaders Meet with Speaker Ryan
Discuss need to fix site neutral provision

The Wisconsin Hospital Association and several hospital leaders were able to meet personally with U.S. House of Representatives Speaker Paul Ryan to discuss Section 603 of the Bipartisan Budget Act of 2015 (BBA, 2015). This "site neutral" provision was unveiled and enacted into law last fall within the span of seven days and is causing significant issues for a sub-set of Wisconsin hospitals.

Under the BBA’s provision, new off-campus provider-based hospital outpatient departments (HOPDs) are prohibited from using an entire payment system—the outpatient prospective payment system (OPPS)—for Medicare reimbursement. During the meeting, the group highlighted how this prohibition is particularly problematic for projects that were under development but not yet completed and billing under the OPPS by the required November 2, 2015 date.

Meeting attendees detailed examples of how the rapid enactment of this policy failed to take into consideration the months, if not years, of operational and financial planning that went into these projects and how this provision upended that within the span of a week. The group went on to discuss the provision’s impact on hospitals’ ability to relocate current HOPDs into communities where care is most needed and limits the ability to locate graduate medical education slots, especially primary care, into new outpatient locations. Further, attendees also discussed the hurdle this provision creates for creating new partial hospitalization programs, which would provide much-needed comprehensive outpatient psychiatric services.

"The Wisconsin Hospital Association and our hospital members appreciated the opportunity to discuss this important issue personally with Speaker Ryan," said WHA President/CEO Eric Borgerding. "We will continue to work with the Speaker and his office on pursuing a bipartisan fix to this policy."

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Exchange Enrollment Reaches 239,000 in Wisconsin for 2016
New special enrollment period announced

The third open enrollment period for obtaining health insurance coverage through the health insurance exchange ended January 31 with over 239,000 people in Wisconsin selecting a health plan, about 32,000 more than in 2015. Nationwide, about 12.7 million people signed up for health care coverage, almost 1 million more than in 2015.

The Wisconsin number is more than 15 percent higher compared to last year’s 207,000 people who selected an exchange plan. However, it will be some time before data is available on the number of people who actually "effectuated enrollment"—that is, paid their premium and are actually receiving coverage. In 2015, while over 207,000 Wisconsinites originally selected a plan through the exchange, by September we learned that 175,000 had actually effectuated and maintained their enrollment.

The federal Department of Health and Human Services (HHS)’ data on exchange enrollment is released in a somewhat piecemeal fashion as the data becomes available. What has been released so far are statewide numbers and numbers for specific Metropolitan Statistical Areas. Numbers for Wisconsin include:

County-level data for 2016 has not yet been released, nor have final state tabulations of the number of people who are eligible for an advanced premium tax credit, total number of new enrollees vs. those returning from last year, and other details. Preliminary data from January, however, shows that 83 percent of Wisconsin enrollees are eligible for financial assistance.

Special Enrollment Periods

On February 5, the federal government announced the opportunity for additional sign-ups through a special enrollment period for individuals who were denied 2016 coverage because they did not reconcile their advanced premium tax credits from 2014. While the Centers for Medicare and Medicaid Services (CMS) indicates this opportunity will affect a relatively small number of applicants, it has been estimated that more than 1.4 million households nationally did not properly file their taxes and reconcile their advanced premium tax credits by the end of October 2015. A copy of the CMS letter on this policy can be found here: www.wha.org/pdf/specialEnrollmentPeriod2-5-16.pdf.

The new special enrollment period comes just a few weeks after CMS announced new guidance clarifying and eliminating some of the special enrollment periods that had been in place since the implementation of the insurance exchanges in 2014. In part, CMS is reviewing the allowance of special enrollment periods in response to insurer concerns that the special periods allow consumers to wait until they need particular medical services to enroll, which drives up overall premium costs. In January, CMS announced the elimination of six special enrollment periods that the agency deems are no longer necessary as the exchange marketplace has evolved, and it is expected that CMS will continue to review and possibly make changes to their policy on this issue.

For more details on the special enrollment period, view the CMS blog at: https://blog.cms.gov/2016/01/19/clarifying-eliminating-and-enforcing-special-enrollment-periods.

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President Releases Proposed Budget Request

On February 9, President Barack Obama released his proposed FY 2017 budget request to Congress. The budget request contains almost $420 billion in cuts to Medicare payments to providers over 10 years. Republican leaders, such as U.S. House Speaker Paul Ryan, have not responded positively to the budget proposal. It is unlikely the document will gain traction in Congress. The Wisconsin Hospital Association continues to oppose the inclusion of multiple, ill-advised Medicare and Medicaid cuts.

Among the proposed Medicare and Medicaid cuts to hospitals are:

The budget proposal also includes multiple other Medicare changes:

While there are far more cuts than funding increases, the budget proposal does:

Review the FY 2017 budget document at: https://www.whitehouse.gov/sites/default/files/omb/budget/fy2017/assets/budget.pdf.

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President Asks Congress for Zika Funding

This week, President Barack Obama announced his administration will ask Congress for more than $1.8 billion in emergency funding to enhance the United States’ ongoing efforts to prepare for and respond to the Zika virus, both domestically and internationally. The federal government has been monitoring the Zika virus and working with its domestic and international public health partners to alert health care providers and the public about Zika, provide public health laboratories with diagnostic tests and detect and report cases both domestically and internationally.

The Pan American Health Organization reports 26 countries and territories in the Americas with local Zika transmission. While we have not yet seen transmission of the Zika virus by mosquitoes within the continental United States, Puerto Rico and other U.S. territories in warmer areas with Aedes aegpyti mosquito populations are already seeing active transmission. In addition, some Americans have returned to the continental U.S. from affected countries in South America, Central America, the Caribbean and the Pacific Islands with Zika infections. The Centers for Disease Control and Prevention reports 50 laboratory-confirmed cases among U.S. travelers from December 2015 to February 5, 2016. As spring and summer approach, bringing with them larger and more active mosquito populations, we must be fully prepared to mitigate and quickly address local transmission within the continental U.S., particularly in the Southern United States.

The Administration said requested resources will build on ongoing preparedness efforts and will support essential strategies to combat this virus, such as rapidly expanding mosquito control programs; accelerating vaccine research and diagnostic development; enabling the testing and procurement of vaccines and diagnostics; educating health care providers, pregnant women and their partners; improving epidemiology and expanding laboratory and diagnostic testing capacity; improving health services and supports for low-income pregnant women, and enhancing the ability of Zika-affected countries to better combat mosquitoes and control transmission.

WHA created and continues to add resources to a webpage dedicated to Zika at www.wha.org/zika.aspx. Of particular interest is a PowerPoint presentation that can be used to explain this disease to hospital and health system staff and the public. It was developed by Jon Temte, MD.

Direct questions related to Zika to Steve Rush, WHA vice president, workforce and clinical practice, at srush@wha.org or 608-274-1820.

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Member News: Dr. Alan Kaplan Named Chief Executive Officer of UW Health

Alan S. Kaplan, MD, has been selected as the new chief executive officer of UW Health. He is expected to start in May and succeeds Jeff Grossman, MD, who has served as interim CEO since July 2015.

Kaplan currently serves as executive vice president and chief clinical transformation officer for UnityPoint Health in West Des Moines, Iowa. He is the founder and president/CEO of UnityPoint Clinic, providing leadership for 1,300 providers. Kaplan also serves as president/CEO of UnityPoint at Home, a provider of home care, palliative, hospice and home infusion services.

Kaplan is board-certified in emergency medicine. Prior to joining UnityPoint Health in 2009, he served as vice president and chief medical officer at Edward Health Services Corp. (EHSC), a health-care system based in Naperville, IL.

Kaplan received his medical degree from Rush University in Chicago in 1985 and a master’s in medical management from Carnegie Mellon University in 2000. He is a fellow of the American College of Healthcare Executives and a fellow of the American Association of Physician Leadership, where he had previously served as chairman of the board.

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