When WHA launched their newly redesigned pricing website, WiPricePoint.org October 10, it included changes recommended by the Board earlier in the summer and incorporated feedback from consumers.
“We released PricePoint with some great changes, as suggested by the Board, consumers and our own staff,” WHA President/CEO Eric Borgerding told the WHA Board at their October 23 meeting. “PricePoint has evolved to an increasingly consumer-facing resource that helps them ask the right questions and connects them to the answers, including facilitating communication with their insurance provider.”
Borgerding said PricePoint and WHA’s quality public reporting site, WiCheckPoint.org, have helped keep Wisconsin at the forefront of health care transparency.
WHA has been promoting the recent accolades and rankings. Wisconsin’s health care delivery system and its hospitals have been recognized as the best in the country based on quality by the federal Agency for Health Care Quality (AHRQ) and Wisconsin’s critical access hospitals were the best in their class for quality improvement and public reporting. WHA purchased newspaper ads , radio ads and digital ads to promote the fact that Wisconsin’s health care is the best in the country. Elected officials are also picking up on the message, including Gov. Scott Walker who consistently touts Wisconsin’s high-quality care as an asset.
Borgerding said more than 50 legislators and their staff attended a recent WHA-sponsored briefing at the state capitol. The briefing focused on the value Wisconsin’s high-quality care has for not only the health of the state’s residents, but also to the health of our communities. The work of several WHA members related to care coordination was also showcased at the briefing. Rep. Joe Sanfelippo presented the welcome at that event.
WHA’s 2017 Workforce Report will be released later in October. Borgerding said the report garners a lot of media attention, but more importantly, it serves as WHA’s primary guidebook to its workforce agenda.
“We comment a lot about what we are seeing in the health care workforce in the report, which also serves as our primary agenda-setting tool,” Borgerding said.
The workforce report from prior years drove the team-based care regulatory reform package. Most recently, WHA has been working on legislation that will update Medicaid regulations related to co-signatures required for orders made by other providers. The workforce report was also used to document the importance of passing the enhanced Nurse Licensure Compact and supporting the Rural Wisconsin Initiative that can be used to fund clinical training for advanced practice clinicians and allied health professionals.
Borgerding said WHA staff, with help from members, are making excellent progress in meeting the 2017 goals. As is the case with nearly every other year, some of the goals will carry over into 2018 because of how the legislative session is scheduled, but also because many are perennial issues.
Another issue that is new to the goals document but not novel to WHA members is working on issues related to dental access for people with special needs. Behavioral health issues are also evolving, and that workgroup will begin meeting again soon.
Immediately following the President’s report, WHA COO Brian Potter presented the WHA 2018 budget, which the Board approved, with no dues increase.
Borgerding announced that Debbie Rickelman, former vice president of the WHA Information Center, passed away October 12. She is greatly missed by staff and members alike. A memorium to Debbie can be found below.
Borgerding said Kelly Court, WHA chief quality officer, is retiring soon (see story), and he introduced her successor, Beth Dibbert, to the Board.
WHA joins coalition to oppose medical fee schedule in worker’s comp program
The push to enact government price controls for medical care delivered to injured workers is facing strong opposition from a coalition armed with the facts. And the facts do not support the allegations that are being used to support the latest effort to reduce provider rates in the worker’s compensation program, according to WHA Senior Vice President Kyle O’Brien.
O’Brien said a coalition comprised of WHA, along with the Wisconsin Chiropractic Association, Wisconsin Medical Society and the Wisconsin Physical Therapy Association, have joined publicly to highlight the fact that effective October 1, Wisconsin employers experienced a significant reduction in worker’s compensation premiums for the following year, all without implementing a government fee schedule for health care services.
“Worker’s comp is an asset in Wisconsin for job creation, not a liability,” according to O’Brien. “Workers injured on the job in Wisconsin receive some of the highest quality care in the nation. Because of that, they use fewer medical services, are more satisfied with their care, initiate fewer litigated claims and return to work faster than every other state in the nation. Wisconsin’s health care providers are delivering value to our work comp program.”
The State Budget and Fall Session
In his report, O’Brien said Gov. Scott Walker signed into law Wisconsin’s 2017-19 biennial state budget September 21, which lays out the state’s $76 billion spending plan through June 30, 2019. The budget bill Walker signed includes nearly all of WHA’s budget priorities this session, including a significant increase in the state’s Medicaid Disproportionate Share Hospital (DSH) program and investments for our state’s rural health care workforce.
Wisconsin’s Medicaid DSH program was increased by over $60 million, taking Wisconsin’s total Medicaid DSH program up to $134 million over the two-year budget. In addition, the Joint Finance Committee (JFC) recognized rural hospitals who do not qualify for DSH because of a federal law criteria that requires the hospital to provide OB services. The JFC provided $1.2 million to support these rural hospitals who treat the same level of Medicaid patients as Medicaid DSH hospitals.
Wisconsin’s governor has strong partial veto authority to strike specific items from an appropriation bill while enacting the rest of the bill into law. The governor used this power 99 times in the budget and used it to strike one provision WHA lobbied for that created a pilot program for intensive care coordination services provided to Medicaid beneficiaries by hospitals and health systems. Since learning of the veto, WHA has already been in communication with Walker’s senior staff about the need to continue discussing the role hospitals and health systems can and should have in better managing care for patients who are significant utilizers of hospital emergency departments.
WHA activities supporting members’ integrated physician enterprise
The Board discussed and approved an assessment of how WHA can best support its members’ integrated physician and clinic enterprise now and in the future. The assessment was a culmination of work by the WHA Physician Leaders Council and the Board at its July planning session.
“As WHA’s members’ focus has evolved beyond the traditional ‘walls’ of the hospital to a presence as local and regional integrated health systems, WHA’s focus has similarly evolved,” said WHA Chief Medical Officer Chuck Shabino, MD. “This assessment does not represent a new space for WHA, but the assessment brings WHA’s integrated physician and clinic-focused efforts and initiatives into a single summary and guiding document.”
Mark Thompson, MD, chief medical officer, physician integration, SSM Health–Wisconsin Region and at-large physician leader WHA Board member, praised the assessment. “We need leaders, physicians and CEOs to work to support our physicians,” said Thompson. “The right people are in this room to support that work.”
Federal Update: Repeal and Replace
Joanne Alig, WHA senior vice president, policy and research, reviewed the latest developments on federal efforts around health care reform. Alig emphasized WHA’s top priorities continue to be sustaining coverage and market stabilization. Alig said WHA supported the provisions in the Graham/Cassidy/Heller/Johnson bill in late September that recognized Wisconsin’s partial expansion, and by various estimates would have provided added funding to Wisconsin for health care. She noted, though, some concerns about the bill, including sustainability of Medicaid funding and overall HHS authority versus state flexibility.
Alig also provided an overview of the Murray-Alexander efforts this week, which would fund the cost sharing reduction subsidies for another two years, among other provisions to help stabilize the market in the short term. She noted the exchange open enrollment period starts November 1 and ends December 15 for benefits for the 2018 calendar year. As reported in The Valued Voice last week (see story), premiums overall are higher, in part to make up for the anticipated loss of the CSRs, and there are fewer insurers in the exchanges in 2018. Alig also noted some challenges with enrollment this year, including a shorter enrollment period, system outages for maintenance and lack of federal outreach. As some in Congress are seeking stability through legislative proposals, Alig said WHA encourages the Walker administration and the state Legislature to seek ways to improve and stabilize the markets at the state level as necessary.
WHA State PAC & Conduit Report
WHA Advocacy Committee Chair Mike Wallace, president/CEO, Fort HealthCare, informed the Board that during the first three quarters of the year, fundraising for the Wisconsin Hospitals State PAC & Conduit is at 83 percent of its 2017 goal of raising $312,500. The campaign hit the $258,000 mark this week with contributions from 270 individuals. (See full article below.)
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Damond Boatwright, regional president/CEO, hospital operations, SSM Healthcare of Wisconsin, has been selected by the Wisconsin Hospital Association (WHA) Nominating Committee to serve as WHA chair-elect in 2018 and chair in 2019. A member of the WHA Board since 2015, Boatwright currently serves on the WHA Board Subcommittee on Health Care Reform.
Prior to joining SSM, Boatwright was president/CEO of Overland Park Regional Medical Center and Lee’s Summit Medical Center. A 350-bed acute-care hospital and one of the busiest in the Greater Kansas City metropolitan area, Boatwright helped shape patient-centered care delivery there from October 2011 to February 2014. He started his health care career with the Medical University of South Carolina in 1995 and has served in various capacities, including associate administrator I/II and chief operating officer in several hospitals throughout the southeast.
Boatwright is originally from Charleston, South Carolina. He graduated from The Citadel with a degree in business administration and was also a scholarship football player at the military college in Charleston. Afterward, Boatwright earned his master’s degree in health administration and health sciences from the Medical University of South Carolina - Charleston and went on to complete a health services management fellowship at Duke University Medical Center.
Robert Van Meeteren, president, Reedsburg Area Medical Center (RAMC) will chair the Wisconsin Hospital Association in 2018. A member of the WHA Board since 2014, Van Meeteren has chaired WHA’s Council on Rural Health and is a member of the WHA Network Adequacy Council, and he served on the WHA DHS 124 Task Force and the WHA Bylaws workgroup.
Prior to joining RAMC, Van Meeteren spent four years as CEO of Sleepy Eye Medical Center in Sleepy Eye, Minnesota and four years as clinic administrator at Avera Sacred Heart Hospital in Yankton, South Dakota.
A member of the Boards for the Wisconsin Health & Education Facilities Authority, Rural Wisconsin Health Cooperative and Home Health United, he is also a member of the Reedsburg Community Advisory Committee for Madison College.
Van Meeteren received his Bachelor of Science in health administration and Master of Business Administration from the University of South Dakota. An accomplished pilot, his aviation endorsements include: commercial pilot, instrument rating, and flight instructor rating.
The Wisconsin Hospitals State PAC & Conduit fundraising campaign hit the $258,000 mark, putting it at 83 percent of its 2017 goal of raising $312,500. Two hundred seventy individuals, including 40 first-time givers, have contributed to date this year. See the full list of contributors on page 11.
“Thank you to the 270 individuals who are already supporting this important initiative through their personal contributions to the Wisconsin Hospitals State PAC or Conduit,” said Mike Wallace, WHA Advocacy Committee chair. “There is still ground to make up to reach this year’s fundraising goal, which is why I am asking to you make your contribution today at www.whconduit.com.”
To help close the fundraising gap in the last quarter of 2017, the Wisconsin Hospitals State PAC & Conduit urged individuals to band together and contribute “$50K in 50 Days.” The mini-campaign will run between October 5 and November 24.
“The good news is that over $17,000 has been raised in the first 14 days of the ‘$50K in 50 Days’ campaign,” said Wallace. “If you have yet to contribute, I urge you to make your contribution now.”
Log on to www.whconduit.com to contribute or call WHA’s Jenny Boese directly at 608-268-1816 or Nora Statsick at 608-239-4535.
The Nominating Committee presented their recommendations to the WHA Board October 19. The Board voted and approved the Nominating Committee’s recommendations. The following individuals will serve on the WHA Board of Directors effective January 1, 2018.
Two important steps were taken this week to maintain Wisconsin’s status as a nurse licensure compact state. During a meeting of the Senate Health and Human Services Committee October 17, WHA Vice President, Workforce and Clinical Practice Ann Zenk and Board of Nursing (BON) Chair Sheryl Krause testified in support of Senate Bill 417, and the next day, compact legislation, Assembly Bill 500 passed the Assembly Health Committee on a unanimous vote.
Since 2000, Wisconsin has been a part of an interstate nurse licensure agreement, which reduces regulatory burden on nurses looking to practice in Wisconsin and provides nurses with license portability to treat patients in other states. In 2015, the compact was updated and quickly adopted by 26 states—initiating the process for states in the current nurse licensure compact to transfer to the enhanced Nurse Licensure Compact (known as the eNLC).
“High-quality health care attracts high quality professionals, and Wisconsin health care is ranked at or near the top by many national measures,” said Zenk to members of the Committee. “Sustaining membership in a nurse licensure compact by joining the enhanced compact will benefit high-quality health care by making it easier for patients to access care by Wisconsin nurses and removing regulatory barriers for nurses successfully recruited to work in Wisconsin’s high-quality health care facilities.”
Krause noted, “After hearing positive feedback from nurses across the state, and organizations like the Wisconsin Hospital Association, the Organization of Nurse Executives, the Wisconsin Nurses Association and various health systems, during the Board of Nursing hearing, the Board unanimously voted to support joining the enhanced nurse licensure compact.” Krause, who also serves as the emergency department director at Fort HealthCare said, “Enactment of this bill must be expedited to ensure a smooth transition into the new compact.”
WHA has been working closely with the BON, the Department of Safety and Professional Services and several health care and nursing organizations to enact this legislation before the end of 2017. The eNLC will be effective January 19, 2018, requiring the Legislature to enact a bill before that time to ensure nurses in Wisconsin can continue to take advantage of this important interstate licensing agreement.
Senate Bill 417 and Assembly Bill 500 are authored by Sen. Howard Marklein and Rep. Nancy VanderMeer. The bill has a total of 96 lawmakers either coauthoring or sponsoring the legislation, thanks to the efforts of WHA’s legislative partners and our HEAT grassroots network. After receiving committee hearings and committee votes, the legislation will move to the floor of the full state Assembly and Senate. Those two chambers meet for the last time in 2017 from October 31 through November 9. WHA expects the eNLC to pass through the Wisconsin Legislature before the end of this fall floor period.
For additional information on Wisconsin’s eNLC legislation, contact Ann Zenk at 608-274-1820 or firstname.lastname@example.org. Individuals who want to stay up to date on this and other important legislation as well as take action on those issues should contact WHA’s Jenny Boese at email@example.com or join WHA’s grassroots advocacy program, HEAT, at www.wha.org/heat-grassroots-advocacy.aspx.
See WHA’s testimony and the BON’s testimony.
On October 16, WHA submitted comments to the federal Center for Medicare and Medicaid Services (CMS) on a proposed rule issued by CMS in August, in which CMS signaled its intent to implement flexibilities within value-based payment programs. WHA expressed support for the partial conversion of mandatory bundled payment models into voluntary programs, as voluntary participation in program innovation is always preferable to a mandate. However, WHA also noted how value-based payment programs have spurred innovation in our state
In late 2015, hospitals in both the Madison and Milwaukee Metropolitan Statistical Areas (MSAs) were selected to be mandatory participants in CMS’s Comprehensive Care for Joint Replacements (CJR) bundled payment program. Wisconsin’s high-performing health systems have generally embraced the challenges presented by the mandatory CJR bundle, and many are experiencing positive results from years 1 and 2 of the CJR.
In the proposed rule, CMS announced plans to prospectively make participation voluntary for all hospitals in approximately half of the geographic areas in the CJR model, including hospitals in Wisconsin. The rule also proposes several technical refinements and clarifications for certain CJR model payment, reconciliation, and quality provisions, and a change to the criteria for the Affiliated Practitioner List to broaden the CJR Advanced Alternative Payment Model (APM) track to additional eligible clinicians. Additionally, the rule proposes to cancel the Episode Payment Models (EPMs) and the Cardiac Rehabilitation (CR) incentive payment model, established by the Center for Medicare and Medicaid Innovation (Innovation Center). These were scheduled for implementation in 2018.
If the changes in the proposed rule are finalized, hospitals in Wisconsin that are currently participating in CJR will be able to make a choice about continuing to participate. Many of these hospitals will continue to do so because they have already made invested time, infrastructure and resources with very positive results for improved care coordination and overall quality. This includes markedly improved coordination of care both within the organizations and with outside entities such as post-acute care providers.
With a new direction evident at CMS, what’s next for bundled payments? Bundled Payments for Care Improvement (BPCI), another CMS program which will expire in 2018, has been successful and will likely be followed soon by a new, voluntary bundled payment program, BPCI-Advanced. CMS expects a high amount of interest in BPCI-Advanced because it will qualify as an APM, which exempts participating physicians from potential payment reductions they could face under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
CMS has also issued a Request for Information (RFI) for feedback on a new CMS direction to promote patient-centered care and to test market-driven reforms that “empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, reduce costs, and improve outcomes.”
WHA will submit feedback to this RFI by November 20. For further information, contact Laura Rose, WHA vice president, policy development, at firstname.lastname@example.org.
WHA staff and members lost a trusted colleague and dear friend this week with the passing of Debbie Rickelman, former vice president of the WHA Information Center. Debbie passed away peacefully, surrounded by her family, October 12, 2017, at Agrace HospiceCare, Fitchburg. She was born Nov. 11, 1955, in Fort Madison, Iowa, one of seven daughters.
Debbie joined the WHA Information Center (WHAIC) in its early development and returned in 2010 to lead the organization as it continued to mature and expand into new areas. Her knowledge of how to manage health information, along with her leadership and organizational skills, were tremendous assets in growing WHAIC into the organization it is today.
On March 30, 2016, Gov. Scott Walker signed the Wisconsin Health Care Data Modernization Act into law. The bill included a number of changes and updates to Ch. 153 of the Wisconsin statutes that were Debbie’s ideas, aimed at streamlining health care data collection and improving its utility. Debbie was unable to attend the bill signing, but received one of the pens Governor Walker used to make her bill law.
Brian Potter, WHA chief operating officer, worked closely with Debbie. He remembered her as a very dedicated person who cared deeply about health care, and about the WHA team. “Even as she was going through her battle with cancer, she would stop in the office to see everyone and to ‘talk shop,’” according to Potter. “Her positive attitude and approach to a very difficult situation was an inspiration to all of us.”
“Debbie will be greatly missed by her friends here at WHA and many colleagues across the country. She was kind to all, soft-spoken, but always heard. She was a respected leader in her field,” said WHA President/CEO Eric Borgerding.
Debbie’s passing was felt across the country as her colleagues from other hospital associations sent their messages to WHA remembering Debbie as a “a great resource to many of the associations over the years with her significant data and coding knowledge. Most importantly, Debbie was a joy to be around with a great warmth and a great friend to many of us at Iowa Hospital Association.” Debbie was a “special lady that we all cared deeply about and someone we just loved spending time with,” as noted by New Jersey Hospital Association. Many other hospital associations conveyed similar condolences and all sent their thoughts, prayers and condolences to her family and friends.
“On behalf of the WHA team and our members, we send our deepest condolences to Debbie’s husband, Ed, and to her children, Ben and Emma, and all her family and friends,” Borgerding said.
Memorials may be directed to UW Carbone Cancer Center or Agrace HospiceCare. To view and sign her guestbook, please visit www.ryanfuneralservice.com.
The Great Lakes Partners for Patients (GLPP) Hospital Improvement Innovation Network recently marked its one-year anniversary of the (HIIN) contract.
In September 2016, the Wisconsin Hospital Association, Michigan Hospital Association Keystone Center and Illinois Health and Hospital Association signed a two year, with optional third year, contract as part of a Centers for Medicare & Medicaid Services (CMS) Hospital Improvement Innovation Network.
The partnership has united the quality improvement strengths of three statewide hospital associations and 318 engaged, member hospitals across Wisconsin, Michigan and Illinois with a common goal: reduce hospital-acquired conditions by 20 percent in 11 areas of harm as well as achieve a 12 percent reduction in all-cause readmissions.
Thanks to the hard work and dedication of GLPP HIIN hospitals, there has already been a 20 percent reduction in eight areas of harm, including: central line-associated bloodstream infections (CLABSI) in both intensive care units (ICUs) and hospital-wide, catheter-associated urinary tract infections (CAUTI) in the ICU, and surgical site infections (SSI) following hysterectomies.
In addition, GLPP HIIN hospitals are currently at the halfway mark and have achieved a 10 percent reduction for seven areas of harm in the following categories: adverse drug events (ADE) related to anticoagulants, CAUTI hospital-wide, SSIs following colon surgeries and total knee replacements, and probable ventilator-associated pneumonias (PVAP).
These improvement efforts have resulted in an estimated cost savings of $17,811,400 as well as a significant reduction in avoided harm.
Kelly Court, WHA chief quality officer, attributes the success to the GLPP HIIN members’ commitment to seeking continuous improvement and participating in numerous educational offerings, such as Quality Essential Skills Training (QuEST) sessions, Improvement Action Networks (IANs), webinars and coaching calls. Attendees have been able to learn how to utilize data to drive improvement, improve and advance high reliability within their organizations, reduce costs, and minimize institutional risk for both patients and providers.
“Over the past year, we have seen fantastic reductions in patient harm,” said Court. “With 318 hospitals participating in the Great Lakes Partners for Patients across Wisconsin, Michigan and Illinois, these improvements have a meaningful impact on improving care and saving lives across the Great Lakes region.”
The American Hospital Association (AHA) has developed an online resource center to help hospitals and health systems connect consumers to information about open enrollment.
Open enrollment will run from November 1 to December 15 in most states. Because enrollment will end earlier this year than in previous years, it will be important to help consumers understand the timeline for enrollment and the options available to them. View more information on other ways in which this year is different and what hospitals need to know as they engage with members of the community, including AHA’s digital toolkit.
Here are some of the resources available from AHA:
All of this information is accessible on the AHA’s dedicated Get Enrolled page.