March 4, 2016
Volume 60, Issue 9
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Legislative Panel Confirmed For WHA Advocacy Day, March 30
700 individuals will be entered into our drawing
Advocacy Day 2016 is four weeks away, March 30, and registrations are already at 700. Attendees will hear a state issues discussion when they listen to the always-popular bipartisan legislative panel. Confirmed panelists include: Sen. Leah Vukmir (R-Brookfield), Sen. Jon Erpenbach (D-Middleton), Rep. Jim Steineke (R-Kaukauna) and Rep. Peter Barca (D-Kenosha).
Sens. Vukmir and Erpenbach both serve on the powerful budget-writing Joint Finance Committee and are also members of the Senate Health and Human Services Committee (Sen. Vukmir, Chair). Rep. Steineke is the Assembly Majority Leader and Rep. Barca is the Assembly Minority Leader. Both Steineke and Barca are in leadership roles within their caucus, managing their respective party’s focus and priorities during the legislative session on the floor of the Wisconsin State Assembly.
As always, the panel provides attendees in-depth insight into the issues on the minds of state lawmakers in Wisconsin and an always-interesting debate among legislative leaders on health care-related issues.
Attendees will also hear morning keynote Rick Pollack, president/CEO of the American Hospital Association (AHA). Pollack has been a member of AHA’s advocacy team for the past 33 years and will share his Washington, DC insider’s view of federal issues during this presidential election year. The luncheon will be keynoted by Gov. Scott Walker (invited), and then it’s off to the State Capitol for legislative meetings.
This year WHA is holding a prize drawing for individuals who have registered for Advocacy Day by March 4. Ten of those 700 individuals will receive giveaways in the form of gift cards and grassroots/HEAT gifts for being our early birds! Watch need week’s Valued Voice to see if you’ve won.
Advocacy Day is one of the best ways hospital advocates can make an important, visible impact in the State Capitol. Make sure you’re registering your hospital groups today. Register now at http://events.SignUp4.net/16AdvocacyDay0330.
For Advocacy Day questions, contact Jenny Boese at 608-268-1816 or email@example.com. For registration questions, contact Jenna Hanson at firstname.lastname@example.org or 608-274-1820.
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Worker’s Compensation Bill Signed Into Law
On February 29, Gov. Scott Walker signed into law this session’s bill for worker’s compensation including provisions agreed to by management and labor representatives of the Worker’s Compensation Advisory Council. This is the first bill on worker’s compensation signed into law in two sessions. Last session, the proposed bill included a fee schedule for medical services, which received opposition from the health care community and the entire bill failed to pass.
The new law, Wisconsin Act 180, importantly does not include a fee schedule for medical services, and it maintains an injured employee’s ability to choose their care provider. The law also includes a set fee for electronic copies of medical records. Originally proposed at just $10, the final bill increased that amount to $26 after health care liaisons to the Council objected to the lower amount and requested it be increased. The $26 amount is consistent with other programs, and although it is a lesser amount than the actual cost, it at least would provide some administrative simplicity.
The new law also includes several other notable changes to the worker’s compensation program in Wisconsin, including reducing the statute of limitations for traumatic injuries from 12 years to 6 years, and creating a medical advisory committee to review minimum permanent partial disability ratings. For more details, see the state Department of Workforce Development summary at: www.wha.org/pdf/2016workcompsummary3-2.pdf.
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President’s Column: Health System Performance Good News for Milwaukee
The recent story in the Journal Sentinel (February 22) about health system performance is good news for Milwaukee. That’s because Milwaukee’s health systems are a foundational element of southeastern Wisconsin’s economic and social infrastructure and key to the area’s future. Here’s why:
Journal Sentinel published WHA’s Letter to the Editor on this February 29,
2016. Find at: www.jsonline.com/news/opinion/letters-b99677009z1-370433181.html
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CMS Issues Network Adequacy Standards, Policy Changes Impacting Hospitals
Allows flexibility for hospitals to meet patient safety requirements
In what has now become an annual occurrence, on February 29, CMS finalized a proposed rule implementing standards governing health insurers and the health insurance exchange marketplaces for benefit year 2017. That same day, CMS finalized a “letter to issuers” which further delineates how the provisions of the final rule will be implemented by the agency. The rule governs several policies of interest to hospitals and health systems.
Provider Network Requirements
In the final rule, CMS overturned its original proposal that would have required states to have specific minimum quantitative standards for network adequacy or be subject to a federal “default” standard. Although the rule does not provide a minimum, in the letter to issuers, CMS indicates it will use specific maximum time and distance standards for various types of providers, including hospitals, when reviewing if health plans operating in the federally-facilitated exchange are providing reasonable access to covered services.
As an example, the plan must provide access to at least one hospital within 75 minutes or 60 miles in rural areas for at least 90 percent of enrollees. Separate time and distance standards are also delineated for counties categorized as large, metro, micro and counties with extreme access considerations. In its comment letter, WHA had argued against such specific time and distance standards being established at the national level, with no time for consideration of appropriate standards for each state.
CMS also indicated it will develop ratings of quality health plan networks to provide an indication to consumers of the breadth of the plan. For example, CMS will use terms such as basic, standard and broad as a means for consumers to compare plans within the same geographic area.
Finally, CMS took a step to address surprise bills to consumers resulting from out-of-network providers who provide care at in-network facilities. CMS will require plans to count enrollee cost sharing for an essential health benefit provided by an out-of-network provider toward the enrollee’s annual limitation on cost sharing beginning in 2018. Alternatively, health plans will have to provide enrollees with a written notice in advance of receiving a service that provides sufficient information on the implications and costs to the enrollee if they choose to receive care from an out-of-network provider.
Quality and Patient Safety Standards
The ACA implemented new requirements for hospitals with more than 50 beds working with qualified health plans beginning January 2017. CMS adopted important flexibilities in how these requirements are met. The options for meeting the requirement include membership in a patient safety organization, or participation in an evidence-based initiative to improve health care quality through the collection, management and analysis of patient safety events that reduces all-cause preventable harm, prevents hospital readmission or improves care coordination. Examples of evidence-based initiatives include work with a hospital engagement network, quality improvement organization or other local, state or national reporting programs. WHA had encouraged this flexibility, as it helps to better ensure local needs for quality and patient safety are being addressed.
Certified Application Counselors
Many Wisconsin hospitals have employed certified application counselors (CACs) to help patients understand the health insurance exchange and enroll in a qualified health plan. CMS will now require certified application counselors to provide performance data including the number of CACs and information about the consumer assistance being provided by the organization to the federal exchange upon request.
Open Enrollment for 2017
The rule also establishes the open enrollment period for the 2017 benefit year as November 1, 2016 through January 31, 2017.
More details and other provisions included in the rule can be found in the CMS Fact Sheet.
To view the final letter to issuers, go to www.wha.org/pdf/Final-2017-Letter-to-Issuers-2-29-16.pdf.
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Lt. Governor Kleefisch Visits HSHS Western Wisconsin Hospitals
On February 22, Lt. Governor Rebecca Kleefisch visited two HSHS Western Wisconsin hospitals—Sacred Heart in Eau Claire and St. Joseph’s in Chippewa Falls—to celebrate her recovery from cancer and her five year milestone being cancer free.
“This week I had my chance to say thanks to doctors and staff from Hospital Sisters Health System and Marshfield Clinic while visiting the Cancer Treatment Center at Sacred Heart Hospital, Eau Claire. At every point along the tour, I stopped to connect with people—women and men in white lab coats or hospital gowns—to say a word of appreciation or encouragement…On Thursday, I spent time with patients fighting a variety of diseases at St. Joseph’s Hospital….,” wrote Kleefisch in her e-newsletter.
The Lt. Governor has publicly shared her personal story with colon cancer and has frequently expressed her appreciation to the health care providers who have helped care for her through the battle. Her visit to HSHS Sacred Heart Hospital was to express appreciation for all of Wisconsin’s health care professionals who provide care and support to those fighting cancer.
“We were blessed to host Lt. Governor Kleefisch,” said Julie Manas, president and CEO of HSHS Sacred Heart Hospital in Eau Claire. “She went out of her way to speak with cancer survivors, staff, and every volunteer she encountered in the hallway, even sharing a particularly emotional private moment with one of our cancer patients.”
Later that same week the Lt. Governor visited HSHS St. Joseph’s Hospital in Chippewa Falls. During her time at the hospital on February 25, she was able to discuss a variety of other health care issues, including mental health and employee wellness among others, and to tour related programs.
“Lieutenant Governor Kleefisch’s visit and open forum with representatives from our hospital colleagues, medical staff and community health providers was a meaningful opportunity for all to discuss and share concerns about our state’s health care with focus on poverty, mental health, chemical dependency and addiction, medical wellness and the homeless,” said Joan Coffman, president/CEO of HSHS St. Joseph’s Hospital in Chippewa Falls. “The Lieutenant Governor was genuinely interested in hearing from providers and the patients we serve and assured all that access to the quality health care that Wisconsin is known for nationally will always be a priority.”
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Grassroots Spotlight: Monroe Clinic Hosts DHS Secretary Rhoades, Rep. Novak
Discuss importance, impact of GME funding
On February 22, Monroe Clinic hosted Wisconsin Department of Health Services Secretary Kitty Rhoades and State Rep. Todd Novak.
During their time at the hospital, leaders including President/CEO Mike Sanders and Chief Medical Officer Mark Thompson, MD, reviewed the hospital’s new Family Medicine Residency program.
“We were very excited to share with Sec. Rhoades and Rep. Novak the development of our new Family Medicine Residency program and thank them personally for the grant support the State of Wisconsin has provided for rural training programs,” said Sanders.
Monroe Clinic’s new residency program was, in part, funded through a $5 million grant program in Gov. Scott Walker’s 2013-15 budget bill to expand graduate medical education (GME) in Wisconsin. WHA worked with the Walker Administration to develop this proposal and strongly supported it throughout the Legislature’s deliberation of the budget bill. Since 2013, 73 additional residency slots have been created in 34 counties across the state, including Monroe.
“I’m very impressed with the work and dedication the staff puts into the new Family Medicine Residency program,” said Novak. “The Monroe Clinic is a leader in my district for their commitment to rural health care and the community.”
Rhoades and Novak also toured the hospital and visited a department visual huddle board, which is part of Monroe’s lean process improvement work.
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WHA to Host Symposium on Patient and Family-Centered Care and Engagement
Mark your calendar for May 20 when WHA will host the day-long event, “WHA Symposium for Patient and Family-Centered Care and Engagement.” WHA is excited to announce this Symposium will feature faculty from The Institute for Patient- and Family-Centered Care (IPFCC), widely recognized as a leader in advancing the understanding and adoption of patient and family-centered care.
This is a rare opportunity for staff from Wisconsin hospitals to learn practical strategies of patient and family-centered care to enhance quality, safety and the experience of care directly from the IPFCC staff. Hospital managers, front-line nursing staff, nursing leaders, physicians, executive leaders, patient/family advisors and volunteers will benefit most from participating in this Symposium, and hospital staff are encouraged to attend as a team.
The event is scheduled May 20 at Glacier Canyon Lodge at The Wilderness Resort in Wisconsin Dells. There will be a very minimal registration fee to attend this Symposium, thanks to funding provided by the Wisconsin Office of Rural Health. Registration will be available in mid-March for this event, so save the date and watch for more information. For questions about the Symposium’s content, contact Tom Kaster at email@example.com or 608-274-1820.
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Nygren Reflects on his Heroin, Opiate, Prevention and Education (H.O.P.E.) Successes and Urges “Cultural Conversations” to Continue
In a Wisconsin Health News Newsmaker Event, Rep. John Nygren, R-Marinette, placed the large body of work he has supported around opioid reduction into a greater cultural context.
When asked if the overabundance of pain pills in Wisconsin is a widespread problem, or rather the result of a few “bad actors,” Nygren responded, “Culturally, I go back to how we got to where we are. The United States is 4.6 percent of the world population, yet we take 80 percent of the opioid drugs. This is not a repudiation of doctors or the hospitals or anyone in general. It is a repudiation of our society. This is more of the cultural conversation we need to have.”
When asked if his bill that makes usage of the Prescription Drug Monitoring Program (PDMP) mandatory will deny access to patients who legitimately need controlled substances to manage their pain, Nygren explained that it will not. “Giving them (providers) more information about their patients, I don’t see that as a barrier to access to people who truly need the pain medicine,” responded Nygren, “I see that simply as more information and as a better tool for them to better understand what their patients truly need.”
Nygren challenged those in health care to strike a balance between adequate pain control and the overuse of opioids.
Nygren also discussed existing barriers that he and fellow policymakers still need to address regarding the opioid epidemic. Lack of qualified addiction medicine providers, counselors and treatment centers all were listed by Nygren. Reimbursement for detox and treatment were also mentioned.
“Medicaid reimbursement for anything, quite honestly, is a barrier for a lot of treatment,” said Nygren in response to a question about the impact of Medicaid payment and payment policies for treating heroin and opiate addiction. Nygren said his office has already begun to have conversations with DHS about Medicaid policies in order to make it easier to access treatment.
In response to a question from the audience about the lack of availability for counseling services while using medication-assisted treatments like Suboxone to treat heroin and opioid addiction, Nygren said he is aware of these shortages, and that he and his staff have discussed “incentives for people going into addiction treatment or counseling, because we have similar shortages with certain professions, for example, in psychiatric care,” said Nygren. Nygren said the workforce shortage we face for psychiatry is a statewide problem.
Nygren thanked the leadership of every group he has worked with on his H.O.P.E legislation, including the Wisconsin Hospital Association. He also noted that of the 17 different H.O.P.E. bills he has introduced, all have passed through the Legislature unanimously and with strong bi-partisan support. Nygren referenced working with WHA on several opioid initiatives, including meeting with the Health Care Leaders Opioid Initiative the week prior.
For further information on WHA’s opioid abuse reduction efforts, contact Steven Rush, WHA vice president, workforce and clinical practice, at firstname.lastname@example.org.
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Registration Open for WHA Community Benefit/Pop Health Summit May 5
Registration is now open for the WHA Community Benefit/Population Health Summit May 5 in Madison at the Sheraton Madison Hotel.
WHA has made it a priority to help our member hospitals and health systems meet the requirements of the ACA related to Schedule H and the CHNA planning and implementation process. The statewide Summit will feature state and national experts who will share their expertise in the areas of compliance, the CHNA process along with best practices.
Topics and speakers include:
“Creating and Sustaining Local Partnerships that Improve Community Health”
Karen Timberlake, Director, UW Population Health Institute
“Wisconsin State Health Plan: Working Together Toward a Healthier State”
Karen McKeown, RN, MSN, State Health Officer and Administrator of Public Health
“Building Collaborative Relations Across County Lines”
Kevin Stranberg, Director of Public Relations, Memorial Medical Center, Ashland
“Get on the Bus: From CHNA to Action!”
Paula Morgen, Community Health Manager, ThedaCare
Kurt Eggebrecht, Director and Public Health Officer, Appleton Health Department
“Schedule H, CHNAs and Implementation Plans: An Update on Collection and Reporting Requirements”
Trina Hackensmith, Vice President, Lyon Software
“WHA Update: Collecting and Reporting Community Benefits”
Jenna Hanson, Community Benefits Liaison
Mary Kay Grasmick, Vice President, Communications
WHA members are encouraged to invite public and community health partners and participate in this Summit as a team. The fee for the Summit is $150. A small room block is available at the Sheraton Madison Hotel; call 608-251-2300 for reservations. Online registration is available at: https://events.SignUp4.net/16CBSummit0505
For questions about the Summit, contact Mary Kay Grasmick at email@example.com. Direct registration questions to Kayla Chatterton at firstname.lastname@example.org.
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White House Recognizes Milwaukee for High Marketplace Enrollment Rate
Milwaukee’s five health systems were in attendance at President Barack Obama’s visit to Milwaukee March 3 to celebrate the area’s win of the White House Healthy Communities Challenge. The Milwaukee area had the highest rate of Marketplace enrollments among 20 metropolitan areas competing in the challenge, and awarded a visit from the President. Hundreds turned out for the event in support of the Affordable Care Act and the organizations who helped achieve this national recognition.
Through the Milwaukee Health Care Partnership, Aurora Health Care, Children’s Hospital and Health System, Columbia St. Mary’s, Froedtert Health, and Wheaton Franciscan Healthcare have been active members in the Milwaukee Enrollment Network (MKEN), a collaborative organized to reach out and enroll Milwaukee County residents in health care coverage, with a focus on underserved populations.
Elizabeth Cliffe Kucharski, director, government relations and advocacy at Wheaton Franciscan Healthcare and chair of the MKEN health systems workgroup, said, “It was wonderful to celebrate with colleagues from all Milwaukee’s health systems at the President’s event. We’ve been working together for over three years to cultivate effective ways to reach out to our vulnerable patients and support them in getting health coverage. Sharing that experience with so many health care and community partners was very rewarding.”
“The Milwaukee health systems have had a strong commitment to securing health care coverage for all those who are eligible for many years,” according to Joy Tapper, Milwaukee Health Care Partnership executive director. “Thanks to Milwaukee Mayor Tom Barrett’s leadership in accepting the White House Challenge, and the outstanding collaboration of nearly 100 MKEN members, our community has much to celebrate in bringing more individuals into coverage—and better health.”
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CMS Extends Meaningful Use Hardship Exception Deadline
On February 26, the Centers for Medicare and Medicaid Services (CMS) extended to July 1, 2016, the deadline for hospitals and physicians to apply for a hardship exception from the 2015 meaningful use requirements of the Medicare EHR Incentive Program. The previous deadlines were April 1 for hospitals and March 15 for physicians.
CMS’s announcement follows the posting of new hardship exception application forms and instructions on the CMS website. CMS updated its application forms after the enactment late last year of the Patient Access and Medicare Protection Act, which made it easier for some hospitals and physicians to apply for, and for CMS to batch process, such applications. CMS’s updated application forms and instructions may be found at: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/PaymentAdj_Hardship.html.
As previously reported in The Valued Voice, CMS has already extended to March 11, 2016, the deadline for hospitals and physicians to attest to the meaningful use requirements of the Medicare EHR Incentive Program for the 2015 reporting period.
For additional information, contact Andrew Brenton, WHA assistant general counsel, at email@example.com or 608-274-1820.
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WHA Webinar Shares Wisconsin Best Practices in Tackling Opioid Abuse Issue
On March 17, WHA is offering the WHA Member Forum webinar: “Wisconsin Best Practices in Tackling the Opioid Abuse Issue,” as the next in the series focused on the health care leader’s role in addressing this growing issue. During this webinar, 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 for this March 17 webinar, visit: https://events.SignUp4.net/WIBestPrac-Opioids.
If you participated in the first webinar of the series on February 25, you will need to also register for the other webinars individually.
Wisconsin Best Practices in Tackling the Opioid Abuse Issue
March 17 – To register: https://events.SignUp4.net/WIBestPrac-Opioids
Drug Diversion from the Health Care Workplace: A Multiple Victim Crime
April 5 – To register: https://events.SignUp4.net/drugdiversion-opioids
Navigating Wisconsin’s Prescription Drug Monitoring Program and Controlled Substances Board
April 27 – To register: https://events.SignUp4.net/PDMP-CSB-Opioids
There is no fee for WHA hospital and corporate members to participate in any of these WHA Member Forum webinars, but pre-registration is required. For more information or to register for any of these WHA Member Forum webinars, visit www.wha.org. For more information, contact Jennifer Frank at firstname.lastname@example.org or at 608-274-1820.
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DHS Investigates Bacterial Bloodstream Infections
The Wisconsin Department of Health Services (DHS), Division of Public Health (DPH) is currently investigating an outbreak of bloodstream infections caused by bacteria called Elizabethkingia.
“The Elizabethkingia infection has been detected in 44 patients located in southeastern and southern Wisconsin. The majority of patients are over the age of 65 years, and all have serious underlying health conditions,” said State Health Officer Karen McKeown. “As soon as we were notified of the potential outbreak, Wisconsin’s disease detectives began working immediately to identify the source.”
Illness associated with Elizabethkingia typically affects people with compromised immune systems or serious underlying health conditions, and can lead to death. While 18 patients who tested positive for the Elizabethkingia infection in this outbreak have died, it has not been determined if the cause is the bacterial infection, or the patients’ other serious health conditions, or both.
DPH was first notified of six potential cases between December 29, 2015 and January 4, 2016 and set up statewide surveillance on January 5, 2016. DPH then alerted health care providers, infection preventionists, and laboratories statewide of the presence of the Elizabethkingia bacteria, and provided information as well as treatment guidance, which has led to a rapid identification of cases and appropriate treatment.
“Determining the source of the bacteria affecting patients in Wisconsin is a complex process,” McKeown added. “While we recognize there will be many questions we cannot yet answer, we feel it is important to share the limited information we have about the presence of the bacteria, as we continue our work to determine the source.”
A team of epidemiologists and laboratory partners from the Centers for Disease Control and Prevention (CDC) is on site assisting with the investigation. DHS is also working closely with state and local partners including the Wisconsin State Laboratory of Hygiene, infection preventionists, and clinicians in Wisconsin to determine the source of the bacteria and contain the outbreak.
DHS will continue to offer updates as information is available, to help ensure the health and safety of those who may be vulnerable to bloodstream infections caused by the Elizabethkingia bacteria.
For more information go to: https://www.dhs.wisconsin.gov/disease/elizabethkingia.htm.
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Member News: Wheaton Franciscan Becomes Part of Ascension Wisconsin
Wheaton Franciscan Healthcare announced the signing of an agreement making Wheaton’s Southeast Wisconsin operations and related corporate services part of Ascension Wisconsin, effective March 1, 2016. Based in St. Louis, Ascension is the largest Catholic and not-for-profit health care delivery system in the nation.
Wheaton is one of four regional health care systems that are part of Ascension Wisconsin, joining Columbia St. Mary’s, Ministry Health Care and Affinity Health System.
Wheaton, which has been sponsored by the Wheaton Franciscan Sisters and Felician Sisters in Southeast Wisconsin, has a presence throughout the region with eight hospital campuses, 330 medical group physicians, outpatient centers, transitional and long-term care facilities, home health and hospice, and nearly 11,000 associates.
“We are pleased to become part of Ascension Wisconsin. This relationship will support our commitment to deliver high-quality, compassionate and personalized care in the communities we serve,” said John Oliverio, president/CEO, Wheaton Franciscan Healthcare.
Ascension and Wheaton Franciscan Healthcare share a common mission of serving all, with special attention to persons living in poverty and those most vulnerable. Both organizations are committed to promoting community and the common good, and advocating for a compassionate and just society.
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