WHA Physician Leaders Council Discusses Regulatory Reform, MACRA

Council provided guidance on potential new WHA physician-focused resources

September 16, 2016

As health care evolves, the WHA Board of Directors, which includes broad representation of WHA’s members across the state, has directed WHA to engage in issues that impact not just the hospital, but also physicians and other clinicians as part of the overall continuum of care. The WHA Physician Leaders Council is a key part of that engagement. The Council met September 14 and focused on several physician and clinical practice-related items:
 
  • WHA team-based care regulatory reform package
  • MACRA implementation and education
  • 2016 Physician Workforce Report
  • Development of a WHA Physician Quality Residency Program
  • WHA Physician Retention Toolkit
  • MED 24 telemedicine rulemaking
WHA team-based care state regulatory reform package in development
WHA’s members continue to develop new integrated and team-based models of care that utilize non-physician health care professionals in ways that leverage those professionals’ expertise in a team-based care setting. Although models of care are evolving, licensure and scope of practice laws don’t always keep pace.

WHA General Counsel Matthew Stanford said WHA is developing a package of reforms to Wisconsin’s various non-physician licensure laws that can help WHA’s members further advance emerging integrated and team-based models of care. Stanford sought input and ideas from the Council on specific changes to Wisconsin laws that could reduce barriers to team-based care their organizations are currently facing. 

WHA’s MACRA agenda
Physician payment reform under Medicare and CHIP Reauthorization Act of 2015 (MACRA) was the focus of a discussion led by Joanne Alig, WHA senior vice president for policy and research, and Kelly Court, WHA chief quality officer. 

Alig informed the Council that WHA continues to advocate for flexibility in MACRA implementation (see September 9, 2016 Valued Voice article) and is closely analyzing the impact the new quality payment program for physicians will have on WHA members. Alig walked through the two paths for clinician reimbursement beginning in 2019—Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). 

As part of its effort to educate members, Alig explained that WHA is offering two webinars on the topic. The first webinar took place August 25, when more than 150 people heard details about the MIPS path presented by Court and Brian Vamstad, federal government relations consultant, Gundersen Health System. A second webinar focusing on APMs will be hosted by WHA later this fall. 

Stanford and Chuck Shabino, MD, WHA chief medical officer, also sought input from the Council on the potential development of a targeted WHA resource that could help physician leaders educate their physicians in advance of and during their organizations’ implementation of MACRA. The concept was well received by the Council, and WHA will continue to pursue and develop it.

WCMEW 2016 Physician Workforce Report
Wisconsin Council on Medical Education and Workforce (WCMEW) Executive Director George Quinn provided an overview of the WCMEW 2016 physician workforce report released in August. 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.

More information about the 2016 physician workforce report can be found in the August 26 Valued Voice article.

Potential WHA Physician Quality Residency Program
WHA and the Rural Wisconsin Health Cooperative have established a Quality Residency Program for hospital quality managers to help orient new quality managers to important issues in their job. Court told the Council that WHA is considering offering a similar program for physicians with an assigned quality role. Court sought the Council’s input on the potential demand for such a program and how a program could best meet the needs of WHA members. 

The Council was enthusiastic about a program for physicians, identified a broad demand for it, and encouraged WHA to pursue development of a quality residency program for physician leaders.

WHA Physician Retention Toolkit
Dr. Shabino and Stanford provided an update on the development of a WHA physician retention toolkit. Shabino said the development of the toolkit is a 2016 WHA goal that builds on WHA advocacy efforts to address physician supply needs at the state level. They said this member value-related goal stemmed from four staff observations: 
  • Wisconsin’s high level of integration – 70-80 percent of Wisconsin’s physician workforce is employed by or contract closely with WHA member health systems. This is much higher than the national average.
  • Physician retention is a strategic priority for WHA members – Integrated care models are particularly dependent on organizational-level physician retention.
  • Physician satisfaction and burnout concerns – WHA members are aware of physician satisfaction and burnout concerns being raised by professional organizations. 
  • Availability of relevant organizational-level strategies to maintain/improve satisfaction – Does Wisconsin’s advanced integrated environment create unique needs for organization-level physician satisfaction strategies and guidance? 
Shabino and Stanford said work on drafting of the toolkit will continue with the Council between now and the end of the year, with a goal of presenting a recommended toolkit to the WHA Board in December. 

MED 24 Telemedicine Rulemaking
Steven Rush, WHA vice president for workforce and clinical practice, provided an update to the Council on the Medical Examining Board’s (MEB) MED 24 telemedicine rulemaking. Responding to concerns raised by WHA that the original draft could result in the unintended consequences of impeding safe and efficient telemedicine practice already in place, Rush said the new draft developed by a specially created MEB Telemedicine Subcommittee proposed a much more streamlined version. 

Rush reported that WHA’s Telemedicine Task Force at its August meeting generally agreed that the current draft of MED 24 reflects the input of WHA and the Task Force. The draft will be presented to the full MEB later in September, with a public hearing expected in October.
  

This story originally appeared in the September 16, 2016 edition of WHA Newsletter