WHA Staff Shares MACRA Overview with Board, Reports on 2016 Goal Progress

Wallace receives AHA Grassroots Champion Award

June 10, 2016

The WHA Board heard a number of pertinent reports related to some of WHA’s highest priorities in 2016 at their June 9 meeting in Madison. To start, WHA President/CEO Eric Borgerding reported steady progress toward meeting WHA’s aggressive goals set earlier this year.

One of WHA’s goals in 2016, to engage physician leaders more closely in activities related to payment and policy issues, has been particularly successful, according to Borgerding. The WHA Physician Leaders Council (PLC) meets regularly and continues to expand not only in participation and membership, but also in their engagement with WHA on key issues including MACRA. At their last meeting, the Board approved adding two physicians from the Physician Leaders Council to the WHA Board, which received an enthusiastic response from both chief executives and physician leaders.

In his goals update, Borgerding noted that WHA will convene the Medicaid Workgroup this summer as WHA prepares for the 2017-2019 legislative session. A workgroup will also be created later this year to address issues related to WHA members’ ability to access appropriate post-acute care for their patients.

WHA Chair-Elect Cathy Jacobson, president/CEO, Froedtert Health, previewed the upcoming Board Planning Session. Larry Walker, who is highly-respected in the field of strategic planning and governance, will facilitate. The discussions will focus on identifying the critical issues that are facing hospitals and health systems and explore how WHA can develop responses to those issues that will be of high value to our members. Jacobson will preside over the day-and-a-half-long session, which will be held in Madison.

MACRA Implementation High Priority for WHA

WHA Senior Vice President Joanne Alig and WHA Chief Quality Officer Kelly Court provided an overview of the new quality payment program for physicians created under the Medicare and CHIP Reauthorization Act (MACRA) of 2015. MACRA creates two paths for clinician reimbursement beginning in 2019—Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).

The Centers for Medicare & Medicaid Services (CMS) expects the majority of eligible clinicians to be on the MIPS path in 2019, but hopes that over time more will participate in alternative payment models. The challenge, however, is that the vast majority of the current payment models won’t qualify as "advanced" and thus eligible for reimbursement under the APM path. WHA will encourage CMS to seek ways to expand the options for APMs and additionally for development of new APMs that can be focused on rural areas.

Alig noted a key takeaway is that the timeline for understanding the complexities of the law and proposed rules is short, let alone to begin to implement processes for improvement. The performance year for MIPS and APMs begins January 1, 2017, and the rule isn’t expected to be final until around November of this year.

Court provided details about MIPS, which has four components. MIPS replaces the existing Physician Quality Reporting System and calls for providers to report on six quality measures. Providers will also be required to report Clinical Practice Improvement Activities (CPIA), choosing from a list of 90 options. The program also includes cost measures, which will be calculated by CMS using Medicare claims. Finally, MIPs includes a component called "Advancing Care Information," which will replace the existing Medicare meaningful use program.

Hospitals and providers were encouraged to continue to report through existing quality and electronic health record programs until MIPS takes effect. They can also review the quality and CPIA measures with clinicians to begin preparing for the selection of measures and improvement work to ensure high performance. The proposed measures to select from can be found in the appendices of the proposed rule at  https://www.federalregister.gov/articles/2016/05/09/2016-10032/medicare-program-merit-based-incentive-payment-system-mips-and-alternative-payment-model-apm.

Comments on the proposed federal rule are due June 27. WHA will be heavily engaged in MACRA implementation and encouraging CMS to continue to allow flexibility and options for clinicians to do what is best to drive improvement within their practices. (See previous Valued Voice article on MACRA implementation.)

Redefining Hospital Community Benefit to Capture Broader Impacts

Borgerding introduced the Board to a new initiative in development by WHA staff related to redefining community benefit to capture broader impacts. Wisconsin was one of the first states in the nation to survey its member hospitals to collect data related to their health improvement activities. While WHA collects and reports the costs that hospitals incur related to community benefit, the survey does not account for the broader, downstream benefits these services have on the health of a community.

"It’s time to broaden this definition so we can tell the whole story about the ripple impacts of Wisconsin hospitals and health systems," said Borgerding.

Mary Kay Grasmick, WHA vice president, communications, said WHA has worked closely with its members on issues related to community benefit reporting, Schedule H and public reporting. Hospitals have grown increasingly sophisticated in how they approach the community health needs assessment and in their implementation of programs and services that improve health status in their regions. However, these efforts are often seen in isolation and not in context to the benefit they bring in terms of reducing health care costs, causing measurable gains in overall community health which increases worker productivity, and supporting public health.

"Hospitals and health systems provide essential services that, if we were not providing them, would fall to government or other organizations, or just not be available," Grasmick said. "The bottom line is we want to identify and quantify the financial and societal impact our work is having in communities across Wisconsin."

Grasmick said WHA has identified a number of in-state experts in the area of population health, economics and public health to help explore the feasibility of developing the methodology necessary to quantify the impact of community services, programs and health initiatives. In addition, WHA would create the tools necessary for member hospitals to run their own impact statements and then message the results to the appropriate local audiences.

AHA Recognizes Wallace, Fort HealthCare for Advocacy Efforts

The American Hospital Association (AHA), in partnership with WHA, awarded Mike Wallace, president/CEO of Fort HealthCare, the "Grassroots Champion" award for Wisconsin.

As an award honoree, Wallace was recognized for his exceptional leadership in generating and being personally involved in grassroots activity on important hospital and health care issues.

"Mike is an outstanding and effective advocate in delivering the hospital message to his elected officials," said WHA President/CEO Eric Borgerding. "His knowledge, commitment and involvement in advocacy efforts should be viewed as a model by his peers. He is well-deserving of this award."

"I am deeply honored to receive this award on behalf of Fort HealthCare. WHA makes it easy to be engaged in advocacy; it’s a team effort," Wallace said. "You move us in the right direction."

The Grassroots Champion Award was created by AHA to recognize hospital leaders who most effectively educate elected officials on how major issues affect the hospital’s vital role in the community and who are tireless advocates for hospitals and patients.

WCMEW Previews Next Physician Workforce Report

Wisconsin Council on Medical Education and Workforce (WCMEW) Executive Director George Quinn provided a preview of the WCMEW 2016 physician workforce report. Quinn said the projections in the 2016 report were based on a methodology that is similar to that used in the 2011 report; however, the data used in 2016 is more specific to Wisconsin.

Wisconsin has made progress in addressing the physician shortage, however, Quinn said efforts to expand graduate medical education (GME) and to attract and retain physicians in the state must continue at the current pace in order for Wisconsin to meet its goal of having an adequate supply of physicians to meet the growing demand for care.

Quinn said the full report will be released later this summer.

State Advocacy Report

With the fall elections just around the corner, Borgerding reported that WHA will again partner with WisconsinEye to sponsor its interviews of candidates for state offices. WisconsinEye will post those interviews on their website in a video player format. WHA is again a major sponsor of this coverage and as such, WHA’s logo will be prominently displayed as a clickable link in the sponsorship space. The video player will also appear on JSOnline and the Gannett Wisconsin newspaper online websites in partnership with WisconsinEye, which will significantly broaden the reach of the programming.

Borgerding said in addition to the candidate interviews, WisconsinEye will be live-streaming coverage of the Joint Finance Committee meetings, which draws a large audience.

As of June 1, candidates for state and federal legislative office were required to file nomination papers to be listed on the ballot for 2016. WHA Senior Vice President Kyle O’Brien reminded the Board of the goal to meet with at least 50 candidates for state office as well as host ten meetings with state senators not up for re-election in 2016.

O’Brien reminded the Board that WHA has prepared summaries of recently-enacted bills that may impact hospitals or health care systems. These summaries are located in the WHA members-only portal, which is accessible by clicking the "WHA Member’s Only" icon located on the home page at wha.org. Once in the WHA member portal, the summaries can be found in the dropdown menu under the "General" tab. This section of WHA.org is a secure location and requires a first-time user to obtain a username and password. If you do not have a member account, go to members.wha.org and click on "Register" to create an account. If you have questions about how to register, contact Tammy Hribar, thribar@wha.org or 608-274-1820.

O’Brien said that even though the Legislature is out of session, lawmakers are already working on proposed bills for next session. This includes a second round of legislation from the Rural Wisconsin Initiative, focusing on education, health care, workforce and technology investments in rural communities. Legislators have looked to WHA for input on the development of their "2.0" agenda.

WHA solicited member feedback related to broadband investments, availability of volunteer emergency service providers, economic development, housing, physician/provider recruitment and workforce development. O’Brien told the Board this feedback will help staff make recommendations to lawmakers who are developing the Rural Wisconsin Initiative.

A Legislative Council Study Committee on Rural Broadband was created this year. WHA nominated three members to serve on this Committee. O’Brien said he expects the Committees to be established soon and WHA staff will support the members selected to serve on this study Committee over the summer.

O’Brien also updated the Board on the results of WHA’s advocacy work related to new regulations being proposed for physicians practicing telemedicine. O’Brien told the Board that the original proposed rule was, at times, duplicative of and/or even contradicted existing regulation—which has the potential of creating unnecessary confusion. In a letter to the Medical Examining Board (MEB) from members of WHA’s Telemedicine Task Force and several other chief medical officers from across the state, WHA encouraged the MEB to work with stakeholders to first identify any needs for regulation before promulgating rules.

In a subcommittee meeting in mid-May, the MEB has now put forward a new proposal that is much more limited and focused on those areas of need. O’Brien reported that WHA’s Telemedicine Task Force continues to examine the rule.

State Self-Insurance Plan Savings Debatable

The Employee Trust Fund (ETF) continues to be interested in evaluating a model for self-insurance. Joanne Alig, WHA senior vice president, policy & research, reported that at a recent forum, the risk to the state from changing the current competitive model for providing health insurance to State employees was debated. (Read the article on page 3).

Alig reviewed the timeline the ETF is following, noting that a draft of the full Request for Proposal (RFP) is expected to be released soon. The components of the RFP, as outlined by ETF staff at a recent meeting, are expected to be:

  • Administrative service capability;
  • Experience with "high value" networks, disease management data analytics, predictive modeling, technology, patient engagement, provider engagement, quality improvement, pay for performance, payment/reimbursement reform models, provider tiering, reference pricing, centers of excellence; and,
  • Performance metrics including treatment compliance, clinical outcomes, as well as operational performance.

Alig said ETF has continued to express interest in evaluating various models, including both statewide and regional. She shared a map that outlines the five regions currently under consideration, along with the number of enrollees in the top health plans in each of those regions. Alig noted, though, that ETF’s consultants recently said that if a regional model is ultimately chosen, the five regions could be consolidated further depending on the responses to the RFP. The consultants’ most recent report also indicates their recommendation that under a regional model, the State limit the number of health plans participating in each region. The map is posted here.

Federal Advocacy Report: HOPD

Jenny Boese, WHA vice president, federal affairs and advocacy, reported to the Board the WHA continues to work on and see progress on legislation providing flexibility for certain hospital outpatient department (HOPD) projects caught up in a prohibition enacted last year under the Bipartisan Budget Act of 2015 (BBA 2015). The legislation, HR 5273, was recently introduced and passed by the U.S. House. While a step in the right direction, WHA is continuing to seek improvements (see related story below). Boese also highlighted that WHA will be in Washington, DC with several Wisconsin Critical Access Hospital leaders for the American Hospital Association’s rural forum June 23.

Wisconsin Hospitals State PAC & Conduit Report

Therese Pandl, chair of WHA’s Advocacy Committee, said the 2016 campaign is now launched, and she encouraged individuals on the Board to participate. To date over $137,000 in contributions have been raised by 146 contributors. Pandl discussed new activities in 2016, such as the upcoming special invite-only event with Charles Franklin (see related story).

This story originally appeared in the June 10, 2016 edition of WHA Newsletter