August 14, 2015
Volume 59, Issue 32

DHS Announces Latest Round of GME Grant RFAs

The Department of Health Services (DHS) has announced the latest round of Request for Applications for its graduate medical education (GME) new program grants. The grants are to be used by hospitals to develop accredited GME programs with substantial rural training experiences for primary care, general surgery or psychiatry specialties.

The maximum grant amount is $750,000, at $250,000 per year for a maximum of three years. Funds are to be used to develop the GME infrastructure. Examples include consultants, program staff, planning meetings, accreditation fees and site visits, faculty and curriculum development, and resident recruitment. 

The grant program was included in the 2013 state budget and was an initiative of the Wisconsin Council on Medical Education (WCMEW) and WHA. Each budget year, $1.75 million is made available for the new program grants. Another $750,000 is available for expansion of existing GME programs.

This is the third round of grant making, with the previous two rounds resulting in six applicants creating programs in family medicine, psychiatry, and general surgery. The table below provides details about the successful applicants.





Total Positions

Grads per Year

Start Date

Gundersen Medical Foundation

Crawford, La Crosse and Vernon

Family Medicine





Monroe Clinic


Family Medicine





North Central Health Care

Langlade, Lincoln, Marathon, Milwaukee, Monroe, Oneida, Portage and Wood






Clement J. Zablocki VA Medical Center

Brown, Calumet, Forest, Green Lake, Milwaukee, Outagamie, and Winnebago






UW Hospital and Clinics

Dane, Grant, Iowa, Sauk, and Winnebago

General Surgery





Mayo Clinic Health System

Barron, Buffalo, Chippewa, Dunn, Eau Claire, Pierce, Rusk, Saint Croix, Trempealau

Family Medicine













“This has been a very successful initiative, and we hope more hospitals and consortiums step forward and take advantage of it,” said George Quinn, executive director, WCMEW. “Creating GME programs is an effective way to alleviate physician shortages in rural areas.”

The deadline for applying for the grant is October 8. Application details can be found at:

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CMS Extends Two Midnight Enforcement Delay

The Centers for Medicare & Medicaid Services (CMS) announced an extension of the partial enforcement delay of its two midnight policy. The enforcement delay now extends through the end of the year. During this period, recovery auditors are prohibited from conducting post-payment patient status reviews for claims with dates of admission through December 31, 2015. 

This is important in light of recent proposed changes by CMS to its two midnight policy, which are expected to take effect January 1, 2016, barring changes during the rulemaking process. The two midnight changes are included in the FY 2016 Outpatient Prospective Payment System (OPPS) proposed rule. Under the rule, CMS proposed to adjust the policy for stays spanning less than two midnights. In these instances, inpatient payment would be appropriate on a “case-by-case basis” based on the medical judgment of the admitting physician. The medical record must document and support the need for inpatient admission in these instances and will be prioritized for medical review. 

However, CMS is also proposing to remove recovery auditors and Medicare administrative contractors from the first line medical review for these shorter stays. Instead, initial reviews of stays of less than two midnights will be done by quality improvement organizations (QIOs). The exceptions to QIO review include instances where a hospital demonstrates a pattern of unnecessary admissions for short stays or fails to improve two midnight policy adherence in spite of QIO education, as examples. In these and other instances, the claims may be sent to recovery auditors for review. 

CMS proposes no changes to its policy for stays spanning longer than two midnights. 

The Wisconsin Hospital Association is pleased to see CMS take these steps to improve the burdensome two midnight policy. WHA also supports CMS action to delay enforcement through the end of calendar year 2015. Doing so harmonizes timelines for enforcement and anticipated policy changes. 

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Guest Column: If You Have to be a Patient...“It is Comforting That We’re Seeking Care in Wisconsin”
By Rebecca Kleefisch, Lieutenant Governor, Wisconsin

I checked into radiology at Froedtert & The Medical College of Wisconsin recently as I often do. My relationship with scans and imaging technology is love/hate. Like a lot of cancer patients, I love the certainty of just knowing what’s going on, but also like a lot of cancer patients, I hate that there’s a reason I always want to know. 

No one really wants to be a patient: it means there’s something wrong. But if you have to be one, it is comforting that we’re seeking care in Wisconsin. Wisconsin is often ranked as having the second best health care in America. It’s a point I note in meetings with site selectors and corporate real estate executives considering our state as an investment site. But it’s also something for which I’m grateful as a patient. 

As Baby Boomers retire and the ranks of Wisconsinites serving in the “Sandwich Generation” grow, more people will appreciate our state’s health care resources. While more sons and daughters navigate the health care questions and complexities of both their parents and their own kids, the accessibility and quality of care in our state will be both a relief and a reassurance. I know. I’ve seen it firsthand. 

A couple of weeks ago I was at Aurora St. Luke’s to meet with a world-renowned neurosurgeon who had pioneered new technology to revolutionize brain surgery. He was so invested in every surgery outcome that as we were watching an operation from an observation room above, he ran downstairs to give some advice in the OR. 

A few months ago I toured UW Hospital Trauma and Life Support Center with my friend Dr. Amy Liepert, assistant professor at UW Medical School. We walked through a victim’s fast-paced trip from the helipad to the ER to the operating room to recovery. I paused by the surgery board and was struck by the sheer number of lives dependent on the talent, dedication, and resources available from the doctors, nurses and support staff. 

Last year the Governor focused our state’s attention on “The Year of A Better Bottom Line,” an initiative promoting job opportunities for people with disabilities. We saw hospitals and health care systems embrace this effort with Project SEARCH, an employment training program for young people who have disabilities. I spoke with both staff and student workers at St. Elizabeth Hospital in Appleton, Ministry St. Joseph’s in Marshfield, Children’s Hospital of Wisconsin in Milwaukee, and Fort Healthcare in Fort Atkinson. At each of these stops, I saw hospitals touch lives—not only patients, but also the young people who were overcoming obstacles to discover the dignity of work and the power of a paycheck.

No amount of reviewing a government health services budget or reading about Medicaid pilot studies can replace real world experience and time spent in the shoes of caregivers and patients. Doctors and nurses see us at our worst with the intention of restoring us to our best. I’m proud of the thousands of medical professionals across Wisconsin. Especially the good folks who dealt with me—yet again—at Froedtert Radiology. I called the department head to tell her I appreciated the good care. Because I do.

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Walker Signs Ambulance Debt Collection Legislation into Law

Gov. Scott Walker recently signed into law legislation providing certain private ambulance services with the ability to utilize Wisconsin’s Tax Refund Intercept Program (TRIP) to recover debt owed by individuals receiving emergency services. The bill, originally authored as Senate Bill 40, was signed into law as 2015 Wisconsin Act 59 and became effective August 8, 2015.

The TRIP program allows a county or municipality to certify certain debt to the State Department of Revenue (DOR), resulting in DOR reducing the size of an individual’s income tax refund to collect on this debt. Under current law, private ambulance services are unable to use the TRIP process even though they are providing emergency services on behalf of a local unit of government. This law allows an ambulance service provider operating pursuant to a contract with a municipality or county to have certain debt owed to that ambulance service certified for collection within the TRIP program.

To see a copy of Act 59, go to:

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President Signs Observation “Notice Act” 
Takes effect 12 months from enactment

On August 6, President Barack Obama signed into law the Notice Act, The Notice of Observation, Treatment and Implication for Care Eligibility Act (HR 876). The legislation was approved by the U.S. House of Representatives in March by a 395-0 vote and by unanimous consent in the U.S. Senate. The legislation takes effect 12 months after enactment. 

Under the Notice Act, hospitals, including critical access hospitals, must provide written and oral notice to Medicare beneficiaries in outpatient observation for more than 24 hours but before 36 hours or discharge, whichever is sooner, about patient status and status implications. In general, notification would need to:

See Public Law 114-42 (HR 876) at

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WRPRAP Now Accepting Proposals for Rural GME Funding

The Wisconsin Rural Physician Residency Assistance Program (WRPRAP) is now accepting applications for rural graduate medical education (GME) funding opportunities. Proposals will be reviewed between August 11, 2015 and March 31, 2016.

Grant proposals may be submitted for early program development, education development (including rural rotations and rural training tracks) and major program development in Wisconsin. WRPRAP will also consider unsolicited proposals for funding needs that fall outside the defined categories.

Visit the WRPRAP website for more details and to access the Applications for Funding. For additional information and to discuss initial intent, contact Kim Bruksch at or call 608-265-5670.

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Last Chance to Register for Complimentary Hospital Foundation Workshop

There’s still time to register for the complimentary one-day program “Prescription for Success: A Workshop for Hospital Foundations,” scheduled August 20 in Neenah. Each year, WHA, the Wisconsin Office of Rural Health and the Rural Wisconsin Health Cooperative partner to offer the staff and leadership of hospital foundations throughout Wisconsin this complimentary program.

This year, the workshop agenda will include a deeper dive into annual giving, major gift giving and planned giving, with a focus on strategies to move donors along the continuum of giving. In addition, a portion of the day’s agenda will focus specifically on the significance of planned giving to an overall successful development program, as well as the elements of a successful planned giving program. 

This annual workshop is available at no cost to hospital and hospital foundation staff, however, pre-registration is required. The workshop is Thursday, August 20 at the Riverwalk Hotel in Neenah. The agenda and online registration are available at

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