April 17, 2015
Volume 59, Issue 15

Lt. Governor Kleefisch: “I Care Deeply About Health Care in Wisconsin”
Cites WI’s current Workers Comp program as an economic strength

Lt. Governor Rebecca Kleefisch addressed the WHA Board at its April 16 meeting and recounted her own health care journey. As a recipient of excellent care, she expressed the deep impact it had on her. That experience is replicated every day in hospitals and health systems statewide and is an asset for the state. 

“Wisconsin has high quality care. That’s a great story to tell businesses looking to relocate to Wisconsin,” Kleefisch said. “We’ve got to be able to say ‘we can keep your employees and families healthy,’ and we can say that.” 

Kleefisch provided an example of an out-of-state company specifically relocating to Wisconsin because of the Worker’s Compensation system here, citing “some of the lowest Worker’s Compensation costs in the country.” 

In turning to the state budget bill, the Lt. Governor pointed out how past and current budgets have allowed Wisconsin to focus efforts on growing physician residencies. Beginning in 2016, Wisconsin will see 60 new residency slots through this state’s investment of dollars. WHA President/CEO Eric Borgerding put it this way: “GME is probably one of the best examples in recent years of the private sector identifying a problem and working collaboratively with government on crafting solutions.” 

Kleefisch also noted the state Medicaid program was fully funded in the Governor’s budget and that $30 million was invested into the Disproportionate Share Hospital program (DSH). During the Medicaid discussion, Kleefisch was asked about the potential impact of an adverse decision in the U.S. Supreme Court case of King v. Burwell. At issue in this case is whether individuals in states such as Wisconsin are permitted subsidies on the federal health insurance exchange. If not, 89 percent of Wisconsinites on the federal exchange will lose subsidies. The Lt. Governor indicated, “We know this is a federal problem, and that the federal government has to fix it.” 

In closing, Kleefisch touched back on the importance of hospitals and health care to the state. 

“Thank you,” she told the Board, “for your contributions to Wisconsin’s economy, and also for what you do every day for your communities.” 

King v. Burwell Impact Disproportionately Large in Wisconsin
The U.S. Supreme Court decision in the case of King v. Burwell, which will decide whether or not individuals enrolled in a federal insurance exchange are eligible to receive tax credits to partially offset the cost of health insurance coverage looms large in Wisconsin. WHA President/CEO Eric Borgerding reported the impact of a decision in favor of the plaintiff would have a disproportionately larger impact in Wisconsin compared to most other states, since 89 percent of those in Wisconsin with exchange coverage receive a tax credit. The average Wisconsin premium is $440 per month, with an average tax credit of $315. If the Supreme Court finds that individuals and families enrolled in exchange health plans are no longer eligible for tax credits, they would either have to pay the full price of insurance or they would become uninsured. 

While Congress continues to talk about developing a contingency plan, the political calculation must include whether or not the President will sign any Republican bill into law. State lawmakers from both parties have expressed concerns with the potential impact of this decision, especially on the plan for coverage expansion in the last budget proposed by Gov. Scott Walker and passed by Republicans in the state Legislature. The Supreme Court decision is expected in early summer, with the timing of implementation currently unknown, leading to uncertainty and a sense of urgency for all stakeholders. 

State Still Reviewing ETF Self-Funding Proposals
Joanne Alig, WHA senior vice president, policy & research, summarized a recent study commissioned by the State to review cost savings in the state employee health program. In the report by Segal Consulting, a benefits consulting group, several recommendations for cost savings were identified, including a suggestion that the State could save $50 million to $70 million annually by self-insuring State employees. The Segal report comes just over 18 months after the state procured two separate analyses from Deloitte Consulting, both of which indicated significant risks of self-funding, including that the current managed competition model is providing savings to the State that could be lost by moving to a self-funding model. Deloitte estimated that the state could save up to $20 million, but also could incur costs of up to $100 million by self-insuring state employees.

In the meantime, the Governor’s proposed biennial budget documents would require ETF to find $25 million in state savings but isn’t prescriptive in how they accomplish those savings. Segal has several recommendations, short of a self-funding option, that could achieve more than $60 million in savings over the biennium, including higher deductibles and copayments for medical costs and for prescription drugs; increases in out-of-pocket maximums; and increases in the amount the state contributes to Health Savings Accounts to incent employees to use the high-deductible health plan option. 

A second report with more details on the self-funding proposal is expected in May. 

Transparency Task Force
WHA President/CEO Eric Borgerding thanked Steve Little, President/CEO, Agnesian HealthCare, for chairing WHA’s new Transparency Task Force. As patients face increased exposure to health care costs, WHA’s members recognize the need for meaningful information on price, quality and access. For more information on this new task force which held its first meeting just after the Board met on April 16, see story below.

State/Federal Advocacy Update
Jenny Boese, WHA vice president, federal affairs & advocacy, updated the Board on the final resolution of the Sustainable Growth Rate (SGR) legislation, H.R. 2. After weeks of intense negotiations, both the U.S. Senate and U.S. House overwhelmingly voted to replace the failed SGR and replace it with a new system of stable payment updates and ways to incent value in Medicare physician reimbursements. The package also included extension of the CHIP program and important Medicare policies, such as the Medicare Dependent Hospital program and Low Volume Adjustment, among others. Wisconsin Sens. Baldwin and Johnson and Reps. Ryan, Kind, Moore, Ribble, Duffy and Pocan voted in support. Reps. Sensenbrenner and Grothman voted against. WHA supported H.R. 2 and believed the final negotiated package “as a whole fulfills a hard-fought effort to achieve a very important, long-term goal.” 

WHA Continues to Advance Legislative Agenda
Kyle O’Brien, WHA senior vice president, government relations, provided an overview of the current biennial budget process and advocacy work in support of WHA’s legislative goals for 2015. O’Brien stressed the importance of building support for a permanent and/or increased Medicaid Disproportionate Share Hospital (DSH) program among the rank-and-file caucus membership in each chamber of the Legislature. 

“There is growing support within the Legislature for DSH, and that has developed through a deliberate advocacy strategy that has been taking place over the last 10 months,” said O’Brien. 

As of the end of April, every member of the Joint Finance Committee will have had a large district meeting at one of their local hospitals. To date, that has included 14 meetings with more than 100 hospital leaders, clinicians and volunteers. Since the beginning of session in January 2015, WHA’s government relations team has had over 90 individual meetings in the Capitol asking specifically for more investments in Medicaid and the DSH program.

The Governor’s budget also proposed eliminating funding provided through the Critical Access Hospital (CAH) assessment for the Wisconsin Rural Physician Residency Assistance Program (WRPRAP) and the Health Care Provider Loan Assistance Program (HPLAP). In early March, WHA President/CEO Eric Borgerding sent a letter to Gov. Scott Walker requesting this provision be addressed in the Department of Administration’s (DOA) errata letter. This letter is sent to the Finance Committee after the Governor has proposed his budget to clarify any changes that might have been overlooked. DOA did submit an errata letter to the Committee and stated that funding for WRPRAP was inadvertently eliminated. WHA will continue to work to ensure this funding stays in the budget and that the UW System is required to implement both WPRPAP and HPLAP. 

O’Brien also reported on other areas of the budget that WHA is monitoring, including changes to the administration of the state’s Worker’s Compensation program, proposed changes to Family Care and reimbursement for federally qualified health centers. 

WHA Staff Outlines Progress on Behavioral Health Agenda, Physician Licensure Compact 
WHA General Counsel Matthew Stanford provided updates on WHA’s behavioral health agenda, including WHA proposals on psychiatrist workforce and behavioral health payment reform pilots, and on progress on advancing the Interstate Physician Licensure Compact in Wisconsin. Rep. Nancy VanderMeer (R-Tomah) and Sen. Sheila Harsdorf (R-River Falls) are working with WHA and a coalition of organizations to move the Compact bill forward, which would remove regulatory red tape and improve health care access by creating an optional, expedited process for physicians with clean practice histories to receive a medical license in Wisconsin. 

Physician Compass Offers PQRS Reporting Solutions 
Physician Compass is the new joint venture between WHA and the Wisconsin Collaborative for Healthcare Quality, which will provide PQRS reporting and other data management services related to quality. The new company will be targeting customers within and outside of Wisconsin. Brian Potter, WHA senior vice president, and Kelly Court, chief quality officer, introduced the Board to Chris Kleine, who is the product director for the new company. The Board was also provided an update on Physician Compass product lines and marketing efforts. Organizations that would like more information about how to sign up for PQRS reporting should contact Kleine at ckleine@physiciancompass.org. A link to the Valued Voice article about the new company can be found at www.wha.org/Data/Sites/1/pubarchive/valued_voice/WHA-Newsletter-4-10-2015.htm#1.

Council Reports
Public Policy Council: Eric Borgerding summarized outcomes from the March 23 meeting. Key state policy items were discussed, including the state budget, Worker’s Compensation and implementation of the rewrite of DHS 124/state hospital regulations. Rep. Amy Loudenbeck (R-Clinton), a new member of the Joint Committee on Finance, spoke to the Council about the state budget and other timely state public policy issues. The meeting marked the first for Tim McKevett, President/CEO of Beloit Health System, as the new Council chair.

Physician Leaders Council: Recognizing the contribution physician professional satisfaction makes to creation of an environment supporting physicians/organizational engagement, the Council discussed initial findings of the recent Wisconsin Medical Society’s Physician Satisfaction Survey. Additional data analysis was suggested in an effort to identify satisfiers and strategies to enhance them and conversely identify dissatisfied physicians and mitigate their concerns. This inquiry will continue at the June 11 Physician Leaders Council meeting.

Audit Committee: The WHA Board approved the 2014 Audit Report as presented by John Russell, chair of the WHA Audit and Investment Committee.

Council on Rural Health: Chair Bob Van Meeteren reported that the Council has created another excellent lineup of speakers and topics for the upcoming Rural Health Conference. He thanked WHA’s Jennifer Frank for her help in leading the Council through the conference agenda development process. Finally, he stated that the Rural Health Conference is always well attended and again this year, includes a governance track so he encouraged hospital leaders to attend and to invite their board members.

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Medicaid in the Spotlight

Over the past weeks of our “Spotlights,” we’ve highlighted the dismal Medicaid program underfunding which has led to unreimbursed costs for Wisconsin hospitals in the amount of an annual $960 million “hidden health care tax.” Despite the Medicaid program not paying the actual cost of care, hospitals continue to work to control costs. Our Infographic sums all this up. 

In order to begin to address these issues, Wisconsin needs to address its Medicaid reimbursement. One way is through the Disproportionate Share Hospital (DSH) program. The DSH program is important to communities all across the state and needs to be made permanent. 

A link to the infographic is here: www.wha.org/pdf/HHCTinfographic.pdf

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It’s Over: Congress Finally Repeals SGR

On April 14, the U.S. Congress took the last step in repealing the Sustainable Growth Rate, SGR. The U.S. Senate voted 92-8 in support of H.R. 2. Their vote followed the equally overwhelming vote in the U.S. House on March 26 of 392-37. Wisconsin’s Congressional Delegation voted as follows: Yes: Sens. Baldwin and Johnson, and Representatives Duffy, Kind, Moore, Pocan, Ribble and Ryan; No: Reps. Sensenbrenner and Grothman. 

“The Wisconsin Hospital Association appreciates the tireless work by Congress over the past few years to once and for all repeal Medicare’s Sustainable Growth Rate (SGR),” said WHA President/CEO Eric Borgerding after the historic vote. “The replacement package, H.R. 2, passed by the Congress this week closes the door on a long, painful policy for health care providers and for Congress. WHA is pleased the issue has been put to rest once and for all.” See WHA’s full statement at: www.wha.org/statement4-15-15sgr.aspx.

H.R. 2 repeals the SGR formula and replaces it with a series of stable updates over the next few years. In addition it begins to move Medicare physician payments along the lines of value, including: 

Beyond the physician payment-related issues, the negotiated package includes a variety of other provisions of importance of the Wisconsin Hospital Association and providers. Those include: The biggest stumbling block over the years has been how to offset (pay for) the cost of SGR’s repeal. In the end, $70 billion of the estimated $210 billion of the cost was offset. The $70 billion is split equally between beneficiary changes (ex: upper income means testing) and provider cuts (ex: PPS coding/documentation payments). While provider cuts were certainly not perfect, WHA believes other deleterious cuts were kept out of the package, including site neutral and bad debt. On balance, WHA believes the overall package is a positive movement forward and puts an end to a very difficult issue. 

“Over the years, Wisconsin hospitals have absorbed millions in cuts to pay for previous 'patches' to the SGR formula. While the hospital-focused funding offsets specific to H.R. 2 are not ideal, in the context of a truly permanent solution to the SGR, WHA believes the package as a whole fulfills a hard-fought effort to achieve a very important, long-term goal,” said Borgerding. 

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WHA Continues its Tradition and Commitment to Transparency 
Board member Steve Little agrees to Chair Transparency Task Force

Wisconsin has been ahead of the curve on transparency, but regulatory changes and health care market changes mean we must continue to lead and play a proactive role in advancing policy in this area. Steve Little, president/CEO, Agnesian HealthCare, has agreed to lead WHA’s new Transparency Task Force and efforts to meet the needs of patients as they face increased exposure to health care costs and are seeking meaningful and transparent information on their actual costs and access to quality providers. The Task Force was created to help meet one of WHA’s goals for 2015. The group held its first meeting April 16 and is scheduled to meet several more times this year.

“This is an issue I am deeply committed to,” said Little. “We recognize that we have a responsibility to our patients, and we know we cannot do it alone. We hope other stakeholders will join us as we work to enhance what we already do to be even more transparent when it comes to price, access, and quality.”

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Wisconsin Hospitals Top National Rankings in Patient-Centered Quality Measure
No hospital in Wisconsin received less than three stars out of a five star rating

Wisconsin was one of the top five states on hospital satisfaction scores based on a new five-star rating system on Hospital and Consumer Assessment of Healthcare Providers and Systems (HCAHPS) by the Centers for Medicare and Medicaid Services (CMS). CMS publicly released the new star ratings April 16 on Hospital Compare with the goal of making it simpler for consumers to understand hospital quality scores.

The star ratings are based on HCAHPS survey data for patients discharged between July 1, 2013 and June 30, 2014. WHA’s CheckPoint incorporated a three-star rating for hospital care, including patient satisfaction, late in 2014. Both methods for calculation of the ratings are based on the same satisfaction measure, but each uses a different method for aggregating the scores. However, the distribution of scores is similar.

Wisconsin had a very high percentage of hospitals that scored four and five stars. Twenty five of the 251 hospitals in the country that received a five-star rating were in Wisconsin. 

“Hospitals in our state have always valued patient satisfaction as part of their commitment to quality,” according to Kelly Court, WHA chief quality officer. “These results are just one more demonstration of the patient-centered care that has earned Wisconsin a national reputation as a high-quality, high-value health care state.”

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Good and Bad in CMS’s Changes to Stage 1 & 2 of Meaningful Use

On the heels of its release of proposed rules for Stage 3 of the EHR meaningful use program, the Centers for Medicare and Medicaid Services (CMS) released on April 10 an additional set of proposed rules that modifies the EHR meaningful use requirements for Stage 1 and Stage 2 in years 2015 through 2017. While the proposed rule contains several modifications that, if finalized, would afford providers with much-needed flexibility, it also contains concerning provisions that would add reporting requirements and potentially cause confusion and burden for Stage 1 and Stage 2 providers, who are now subject to Medicare payment penalties for failure to meaningfully use certified electronic health record (EHR) technology.

Under the proposed rule, the 2015 reporting period would be shortened to a 90-day period (instead of a full year). This change would be a welcome relief for hospitals and physicians that are struggling with delays in the availability of EHR technology that meets relevant certification criteria. In addition, CMS proposes to align the EHR reporting period for all providers with the calendar year starting in 2015. (This means that hospitals would no longer use the federal fiscal year as their EHR reporting period for the meaningful use program.)

Other positive proposals would adjust certain meaningful use objectives and measures that penalize providers for actions that are beyond their control, whether due to patient behavior or to EHR technology issues. Thus, the proposed rule would reduce the number of patients that must view, download, or transmit their health information in a reporting period from five percent of all patients to one patient. In addition, CMS proposes to remove the requirement that five percent of patients send and receive a secure electronic message and replace it with a requirement that the provider attest to having the capability for patients to send and receive a secure electronic message.

Concerning, however, are certain proposals to dramatically change meaningful use requirements by eliminating the distinction between core and menu objectives, eliminating certain measures deemed redundant or no longer necessary, and requiring (subject to several important exceptions) that all Stage 1 and 2 providers attest to the remaining Stage 2 objectives beginning in 2015. What this means is that if the rule is finalized, all Stage 1 and 2 hospitals would have eight required objectives, and all Stage 1 and 2 physicians would have nine required objectives. Because the remaining Stage 1 and 2 menu objectives would become required under the proposed rule, electronic prescribing, which is currently a menu objective, would become a requirement for hospitals beginning in 2015 (though beginning in 2016 for Stage 1 hospitals).

Comments on this proposed rule are due June 15. In the coming weeks, WHA will be soliciting input from members regarding this proposed rule, as well as the other recently-proposed rules related to Stage 3 of the meaningful use program, to help guide WHA’s comment letter to the federal Department of Health and Human Services. (For a previous Valued Voice article on those Stage 3 proposals, see www.wha.org/Data/Sites/1/pubarchive/valued_voice/WHA-Newsletter-3-27-2015.htm#12.) 

If you have questions or comments on the proposed rules or other meaningful use or EHR issues, contact Andrew Brenton, WHA assistant general counsel, at abrenton@wha.org, or Matthew Stanford, WHA general counsel, at mstanford@wha.org or 608-274-1820.

The proposed rule can be found here: https://www.federalregister.gov/articles/2015/04/15/2015-08514/medicare-and-medicaid-programs-electronic-health-record-incentive-program-modifications-to.

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WisDOT Offers New Online Service to Certify Disabled Parking Eligibility

Doctors, advanced practice nurses, chiropractors and other specialists can now easily certify their patients’ eligibility status for disabled parking through the Wisconsin Department of Transportation’s (WisDOT) new online process at https://app.wi.gov/disabledparking.

Streamlining the certification process for health care specialists means medical professionals can go online to certify the renewal and issuance of disabled parking cards and plates. This helps patients get their disabled parking cards within days and reduces paperwork. By avoiding a trip to a DMV service center or the need to mail an application to WisDOT, the new system is a tremendous timesaver all around.

Health care specialists are required to complete and sign an Eligibility Certification every four years for a patient to receive permanent disabled parking privileges. This new online service simplifies the process and improves customer service.

There is no fee to renew permanent disabled parking cards, although a counter service fee will be included if renewed in person at a DMV service center. Customers will now receive their corresponding renewal stickers within 3-4 business days after their health specialists complete the online Eligibility Certification. Traditional paper verification can take up to 7-10 business days.

When accessing transportation-related forms, only websites with .gov extension are from official state websites. Others with .org and .com are not official and may have extra charges for forms or list information that is outdated or incorrect. 

For more information, contact Cody Castillo, lead worker, Special Plates Unit, at 608-264-7288 or cody.castillo@dot.wi.gov.

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Member News: SSM Health Names Rozenfeld President of St. Mary’s Hospital

SSM Health announced that Jon Rozenfeld is returning to the organization as president of St. Mary’s Hospital in Madison beginning May 26. Rozenfeld replaces long-time president Dr. Frank Byrne who retired in January. 

Rozenfeld brings 25 years of executive leadership to SSM Health and is no stranger to St. Mary’s. He served as executive vice president/chief operating officer at the hospital from 2006 to 2012. Most recently, Rozenfeld was chief operating officer for Alexian Brothers Health System, located in the Chicago metro area. In addition, Rozenfeld served on the board of the Alexian Brothers Accountable Care Organization.

Rozenfeld received his bachelor’s degree from the University of Pennsylvania and a Master of Business Administration from The Wharton School at the University of Pennsylvania. He is active in numerous community and professional organizations.

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Fast Facts from the WHA Information Center: April 17, 2015 is World Hemophilia Day

According to the National Hemophilia Foundation:

• Hemophilia results from a missing or deficient protein needed for blood clotting. The two main forms are hemophilia A (factor VIII deficiency) and hemophilia B (factor IX deficiency).
• Hemophilia A occurs in 1 in 5,000 live male births. Hemophilia A is about four times as common as hemophilia B. The number of people with hemophilia in the United States is estimated to be about 20,000 individuals.
• The worldwide incidence of hemophilia is not well known, but estimated at more than 400,000 people. Approximately 75 percent of people with hemophilia around the world still receive inadequate treatment or have no access to treatment.

According to the WHA Information Center, from October 1, 2013 through September 30, 2014 in Wisconsin hospitals and ambulatory surgery centers there were 3,884 inpatient discharges, 723 outpatient surgeries, 1,640 ER visits, 363 observation visits, and 6,056 ancillary services visits for patients with a primary or secondary diagnosis of hemophilia. 

Data provided by the WHAIC (www.whainfocenter.com). The WHA Information Center is dedicated to collecting, analyzing and disseminating complete, accurate and timely data and reports about charges, utilization, quality and efficiency provided by Wisconsin hospitals, ambulatory surgery centers and other health care providers.

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