Gov. Scott Walker is looking to do things differently in Wisconsin, and that includes how the Medicaid program is funded and operated. Speaking at the December 15 WHA Board meeting in Madison, Walker asked WHA members for their assistance in designing a program that works for the people of Wisconsin and for providers.
"That is part of the challenge as we go forward. Help us think about things from the frontlines on how we would do this, but don’t think about it within the confines of this is how we have always done it," Walker said, "Let’s not limit ourselves. Let’s think big. Let’s ask for the moon or we won’t even get a sliver. Let’s dream big on reforms on Medicaid and how we go about doing that. It will be a big step forward from where we are now."
In introducing the Governor, WHA President/CEO Eric Borgerding noted the long record of partnership between the Walker Administration and WHA and its importance today.
"With Paul Ryan in the Speaker’s chair and (Governor Walker) chairing the Republican Governor’s Association, Wisconsin has a tremendous opportunity to be at the table, to shape and influence the path forward," Borgerding said. "Our partnership with you and your team has probably never been so important as it is now."
Walker said he looks to Paul Ryan’s ideas on Medicaid block grants as a way to reform the program, not as a way to cut costs.
"The block grants afford us an opportunity to do it differently. We want to get something in place that works better for our health systems, for our patients and for our constituents throughout the state," according to Walker. "I view block grants as a way to reform the program and make it work better, not as a way to cut funding or costs."
Walker said while Wisconsin did not take the Medicaid expansion, it did make anyone at 100 percent FPL eligible for the program, while those above the FPL were moved onto the insurance exchange where they could access subsidized coverage. In the past, Walker said, there were folks who were eligible for Medicaid, but state funding was not available (due to enrollment freezes implemented in the Doyle Administration), so they ended up as uncompensated care. "That has essentially created a tax on all the other private payers and employers," Walker added.
"You think of all the top 10 states with low uninsured rates, we are the only one with the lowest uninsured rates in the country that did not take Medicaid expansion," the Governor said. "It’s a great reminder we worked together to do something that worked for Wisconsin. We can do the same with Medicaid reform and transitioning from the ACA."
The Governor added that "access, quality and affordability" all are linked, and when he discusses infrastructure, he always includes quality health care.
On the ACA repeal, Walker said he would not be surprised if Congress votes to repeal the ACA in January, but he thinks it would be best to not let it take "maybe three years to implement" to ensure that there is a smooth transition. "The last thing we want is for people to fall through the cracks," Walker said. Walker asked WHA Board members to give him feedback on how to best implement any changes.
Walker reiterated his support for funding three of WHA’s key priorities—the Disproportionate Share Hospital Program (DSH), graduate medical education (GME) and workforce initiatives.
"Obviously we are going to continue to support DSH payments. It is important, and for the state as a whole, we will continue to make that commitment as we have in the past," Walker said. "And, for the larger workforce needs, we support GME in rural and underserved areas, focusing on the appropriate level of support. Not just to attract physicians, but it is critically important that we keep them in these areas."
The Governor said he is pleased the Medical College of Wisconsin and the UW School of Medicine and Public Health have created campuses and training sites in rural and underserved areas of the state. Where a physician gets a residency is a good indicator of where they will practice, according to Walker.
The Governor voiced his appreciation to WHA members for supporting Project Search, which provides training and jobs for those with developmental disabilities. He said the "lion’s share" of Project Search job sites are in hospitals and health systems.
WHA Chair Report: WHA owns the issues that matter to members
WHA had a very successful year, as documented by WHA 2016 Chair Mike Wallace, president/CEO, Fort HealthCare, in his year-end report. He directed Board members to the Results
document that summarizes WHA’s accomplishments in 2016. (This document will be shared with members later this month).
Wallace said WHA’s advocacy effectiveness is punctuated by the fact that legislators and policymakers listen to WHA and work very well with us. "WHA is nicely aligned with the legislative process to influence things that really matter to us," according to Wallace.
Wallace noted that WHA is more than just "hospitals"; the Association is active in a variety of matters related to the health care delivery system, including those issues that impact physicians working in an integrated health system.
"We’ve accomplished a lot and we’ve done it together," Wallace said. "There are a lot of owners of issues—not renters—that is why we are where we are today."
Wallace also introduced new Board members. See their profiles.
WHA President’s Report: "We won’t rest on our laurels."
In his last report for 2016, Borgerding said WHA’s core deliverable and value is leading on public policy development and advocacy. Expanding on Wallace’s comment about WHA being more than "hospitals," Borgerding said staff has started discussions about broadening WHA’s brand to encompass a wider range of issues related to integrated care delivery systems, a hallmark of Wisconsin health care.
Borgerding said while the 2017 WHA goals are now being drafted and will be presented to the Board for approval at their February meeting, he said "our focus next year will fall into three areas – who we are, what we do and how we do it." As it relates to "what we do," he said staff are already developing an issues framework that includes sustaining Medicaid coverage expansion; post-acute care; expansion of the reimbursement agenda; advanced practice clinician regulatory reforms; and, sustaining and evolving clinical performance improvement.
New partnerships with allied health care organizations will be formed in the months ahead, along with new alliances with employer groups. To do this, Borgerding said WHA will continue to enhance staff capabilities, both internally and externally. He introduced WHA’s newest staff member, Laura Rose, who has a legal background and was deputy director of Wisconsin’s Legislative Council, who will add expertise to and bring considerable experience to her new position as vice president of policy development.
Following the election results November 8, Borgerding said he communicated with WHA members at 8:05 a.m. November 9 to provide initial insights. By the next morning the WHA team had prepared and shared with members a thorough analysis of the potential impact that repealing and replacing ObamaCare would have in Wisconsin. Since then, WHA has been in frequent communication with members, elected officials at the state and federal level, including Paul Ryan and Governor Walker. (See article above on visit with Ryan.)
WHA Continues to Closely Watch Group Insurance Board and Self-Insurance Proposal
WHA Senior Vice President Joanne Alig presented an overview of the recent actions of the Group Insurance Board related to the state’s deliberations regarding self-insuring the state employee health insurance plan. (See full article below.)
Alig also reported on the WHA Medicaid Policy Workgroup, which was charged with developing achievable policies aimed at preserving Medicaid access. The workgroup developed a set of 20 recommendations that will help form WHA’s platform for advocacy work in the 2017-2019 state biennial budget.
President Obama Signs the WHA-supported HOPD Fix into Law
Relief is in sight for some hospital outpatient departments (HOPDs) caught "mid-build" when Section 603 was enacted in late 2015. After aggressive advocacy efforts by WHA and other groups nationally, the President signed a targeted fix into law under Public Law-114-255. Jenny Boese, vice president federal affairs & advocacy, said WHA is pleased to see this fix and that WHA led or participated in several trips to Washington DC on the issue along with other advocacy-related activities.
WHA 2016 Workforce Report Warns of Unprecedented Shortages
Steven Rush, WHA vice president, workforce and clinical practice, provided a preview of the WHA 2016 Workforce Report that will be released December 20. Rush said the report confirms what health care leaders have been anticipating and that is health care is heading toward unprecedented shortages. He outlined the recommendations in the report and responded to questions from Board members. The full report will be released to the media December 20, and a Capitol Briefing on health care-related workforce issues for state legislators will be held that same day.
Wisconsin Hospitals PAC & Conduit Reaches Goal!
WHA Past Chair Therese Pandl, president/CEO, Eastern Wisconsin Division, Hospital Sisters Health System, reported that the Wisconsin Hospitals PAC & Conduit reached its 2016 goal of raising $300,000. In fact, the campaign raised $305,000 from 353 individual contributors, putting it at 12.5 percent over the previous year’s record and the most ever raised in the campaign’s history. The campaign also disbursed more than $347,000 this year, another record. She thanked Board members for their continuing support of WHA’s advocacy efforts. (Read the full report below.)
WHA Foundation Supports Quality, Workforce Initiatives
WHA Foundation Director Jennifer Frank reported on recent programs and projects funded by the Foundation. Focusing on initiatives that have statewide impact in the areas of health care workforce development and quality/safety improvement, Frank said the Foundation’s newest effort was developing and funding a scholarship program for interdisciplinary health care provider teams to participate in clinical simulation training, focusing specifically on OB-related scenarios in 2016. The Foundation also continues to fund scholarships for technical college students in health care-related degree programs, as well as provide start-up funding for both the WHA/RWHC Quality Residency Program and the BSN completion website.
WHA Physician Leaders Council Provides Feedback on Several New Initiatives
Chuck Shabino, MD, WHA chief medical officer, and Matthew Stanford, WHA general counsel, provided a report to the Board on the work of the WHA Physician Leaders Council’s December 7 meeting. Highlights were implementation of prescription drug monitoring database (PDMP) interoperability with EHRs, the creation of a new WHA MACRA education video to help physician leaders explain MACRA to their physicians, and the creation of a new WHA Engagement and Retention Toolkit. They said the new Toolkit would be made available to WHA member CEOs and CMO. It provides a checklist of considerations and resources that can help WHA member organizations review and refine their strategic plans for physician engagement and retention.