The December WHA Board meeting presents an opportunity for members and staff to look back on the year, but set their sights on the issues that will carry forward and on those that are just taking shape for 2018.
Cathy Jacobson, president/CEO, Froedtert Health, reflected on her term as she presided over her last Board meeting as chair December 7 in Madison.
“A year goes by fast,” Jacobson noted. “Leading this Board was a fantastic opportunity marked by key accomplishments by the Board and staff.”
Jacobson noted WHA’s legislative priorities were accomplished early in the state budget deliberation process. However, it was a protracted session this year, which meant WHA had to defend those gains as other state priorities were debated.
“Sometimes the citizens, payers and employers do not appreciate what they have here in Wisconsin,” Jacobson said. “Sometimes we as members take WHA for granted, figuring they will be successful in the capitol. WHA’s influence and effect should not be taken for granted.”
Later in the meeting, Jacobson was recognized by WHA President/CEO Eric Borgerding for her leadership on the Board and for her continuing service to the Association.
“Our WHA team and I, personally, have been fortunate to have Cathy’s counsel and leadership as she moved through the ranks on our Board,” Borgerding said. “Cathy is a tremendous and engaged leader for us, and she has always made herself available to provide incredibly valuable input and advice.”
Presidents Report: WHA achieves impressive results in 2017
WHA set aggressive goals in 2017, documented in WHA’s Annual Results report, which was shared with Board members. As Borgerding presented the outcomes, he noted that achieving WHA’s typically large plate of priorities was a monumental accomplishment made possible with assistance and input from the members.
As health reform proposals surfaced throughout the year, Borgerding noted that Sen. Ron Johnson included a provision in the Senate’s ACA replacement legislation that would have recognized Wisconsin’s unique approach to coverage expansion. According to some estimates, the bill, including Johnson’s provision, would have delivered a net increase of $5 billion in Medicaid funding for Wisconsin by 2026. Though the legislation failed, it was “welcome recognition of the funding inequities for non-expansion states that are baked into the ACA,” Borgerding said.
Protecting Medicaid funding in the state budget was one of WHA’s most significant accomplishments in 2017. Again this year, the budget Gov. Scott Walker signed into law did not include any Medicaid cuts while increasing Disproportionate Share Hospital (DSH) funding by $64 million over the biennium. The budget also included $1.5 million in additional Medicaid reimbursement for safety net rural hospitals, $2 million in new grants for hospitals that train heath care professionals and another $1.5 million to expand the WHA-backed Wisconsin graduate medical education (GME) program. All were top priorities for WHA in 2017.
WHA continued to define its integrated physician agenda, with input and advice from the Physician Leaders Council (PLC). A strategic plan was finalized that will provide a framework for addressing issues related to physicians who are working within an integrated health system.
Borgerding said WHA’s 2017 advocacy agenda also included seeking reforms that will enable team-based care. To that end, WHA was successful in enacting legislation that clarified Medicaid’s policy acknowledging both physician and advanced practice clinician orders as valid.
Using the effective blueprint set out for establishing state matching grant programs to fund graduate medical education for physicians, WHA replicated that process for other allied health professionals in the 2017-2019 state budget. It was a first step, according to Borgerding, which he said WHA plans to continue in state budgets going forward.
Two new task forces were launched in 2017 to address dental access and post-acute care. These task forces have met several times, and they will continue to define the issues, identify partners and develop policy recommendations.
Borgerding summarized by saying, “The 2017 goals were driven by our members. Our agenda incorporates our members’ input and I think the reason we remain relevant is because we listen to you, understand your needs and we translate that into impactful public policy.”
The 2018 proposed goals will be presented at the February WHA Board meeting.
WHAIC wraps up a successful 2017
Brian Potter, WHA chief operating officer and senior vice president, presented a year-end summary of the WHA Information Center’s (WHAIC) activities. Potter said WHAIC’s goal is to continue to add value to the data they provide including developing better ways for members to turn data into actionable information. WHAIC’s data visualization and analytics tool, Kaavio, continues to evolve to better serve the needs of health care data users.
Implementation activities around the WHA-supported Health Care Data Modernization Act of 2016 continued in 2017. Hospitals and ambulatory surgery centers (ASCs) attended multiple trainings and have been submitting test files in the 837 standard submission format described in the Act. Hospitals and ASCs will officially begin submitting data using the new format in the first quarter of 2018.
State update: eNLC, Medicaid issues, licensure
With 96 cosponsors—72 percent of the entire state Legislature—a bill was passed that will allow Wisconsin to join the enhanced Nurse Licensure Compact (eNLC). WHA led a coalition of health care organizations to move the Compact forward. Kyle O’Brien, WHA senior vice president, government relations, said Wisconsin will be the 27th state to join the eNLC when it is signed. The bill will be signed into law by Gov. Scott Walker at Southwest Health in Platteville.
WHA worked closely with Board of Nursing (BON) Chair Sheryl Krause, who commended WHA’s leadership during a BON meeting for quickly moving this bill through the process. Ann Zenk, WHA vice president, workforce and clinical practice, and Krause testified together in both the Assembly and Senate Committee hearings. Senior leaders from Southwest Health in Platteville joined in providing testimony to the Committee—as nearly 20 percent of their nurses live in Iowa.
O’Brien said WHA appreciated the support of Sen. Howard Marklein and Rep. Nancy VanderMeer who played key roles in moving the bill forward.
For nearly two years, WHA has engaged with members, lawmakers and the Wisconsin Department of Health Services (DHS) to enact a clarifying policy that eliminates concerns/questions about the necessity to receive a physician co-signature for orders made by other providers.
In August 2017, DHS—after several discussions with WHA—drafted legislation to clarify the policy Medicaid has been following for years by acknowledging both physician and non-physician orders as valid orders.
This clarification was swiftly introduced by Rep. John Nygren and Sen. Leah Vukmir as AB 529. Legislation was initially drafted by DHS at WHA’s request. WHA led a group memo to the Senate and Assembly Health Committees in support of the bill, including physician, physician assistant and nursing organizations. AB 529 was signed by Walker as 2017 Act 119 on November 30.
On November 9, a bipartisan piece of legislation providing additional regulatory certainty to hospitals and medical providers passed the state Assembly. It addresses issues raised during testimony from WHA and WHA members October 24 in support of Assembly Bill 538 at the Assembly Mental Health Committee hearing. This bipartisan, WHA-led bill reconciles Wisconsin’s emergency detention law with federal EMTALA (Emergency Medical Treatment and Active Labor Act) requirements for appropriate transfers of patients and provides additional liability clarity for health care providers treating patients during a mental health crisis. This long-awaited legislation is expected to be enacted in 2018.
O’Brien also briefed the Board on the latest developments around the Wisconsin Manufacturers & Commerce effort to impose price setting on health care providers caring for injured workers. WHA continues to strongly oppose this proposal and is working with a coalition of health care providers to stop it from advancing.
WHA reconvenes Network Adequacy Council; OCI considers 1332 waiver
The Wisconsin Office of the Commissioner of Insurance (OCI) sent to select stakeholders, including WHA, a preliminary bill draft intended to address network adequacy, according to Joanne Alig, WHA senior vice president, policy and research. OCI is also taking the opportunity to modify other provisions of the insurance statute with the goal of streamlining the regulatory structure.
Alig said the preliminary bill draft includes some significant changes and modifications that will take some time to fully analyze for their overall impacts on providers. While the draft is similar to a model act from the National Association of Insurance Commissioners, the language must be reviewed to ensure it is appropriate for Wisconsin.
Alig also provided the Board with an update on the current exchange enrollment process and numbers. In Wisconsin, as of December 2, 100,228 people had signed up for exchange coverage. With just two weeks left for open enrollment, which ends December 15, it remains to be seen whether Wisconsin will reach the same number of enrollees as it has in the past.
Alig discussed options available to states looking for ways to stabilize their markets, including the use of 1332 waivers. The 1332 waiver process can be used to make modifications to the state’s markets, within certain parameters. Alig reported that OCI is looking at options within the 1332 waiver process and is seeking a contractor to help them craft a proposal. Because currently the federal law requires that 1332 waiver proposals be approved in state law, the timeline for developing a proposal is short. To affect the 2019 benefit year, a proposal would have to pass the state Legislature in March and be submitted to the federal government by April. OCI will seek input from stakeholders as they move forward in developing a possible 1332 waiver proposal.
Board provides input on WHA’s APRN Modernization Bill advocacy
In early October, a coalition of nursing groups introduced the APRN Modernization Bill which would change licensure law governing advance practice nurses. Matthew Stanford, WHA general counsel, and Ann Zenk, WHA vice president, workforce and clinical practice, led a Board discussion on WHA’s proactive work on alternative bill language to reduce confusion regarding the licensure of nurse practitioners (NPs), certified registered nurse anesthetists (CRNAs), certified nurse midwives (CNMs), and clinical nurse specialists (CNSs) and to remove regulatory barriers to the practice of advanced practice nurses in a team-based care setting.
Zenk discussed how important APRNs are to integrated care delivery for WHA’s members and provided an overview of WHA’s proposal to explicitly recognize NPs, CRNAs, CNMs and CNSs as separately licensed professionals with their own established licensed scope of practice.
The Board reaffirmed the feedback and principles that WHA had received from individual member leaders and multiple WHA councils of the importance of having a clear but broad scope of practice in the statutes for APRNs, and that Wisconsin APRN licensure laws need to be consistent with the federal CMS Medicare payment rules requiring basic collaboration for nurse practitioners. The Board also reaffirmed the importance of ensuring that regardless of any practitioner’s licensed scope of practice, hospitals and employers must maintain the right to determine the scope of their relationship with that practitioner.
Stanford said there is confusion and mischaracterization of Wisconsin and federal rules regarding APRN collaboration requirements, and he provided a detailed review and comparison of current and former laws. The Board agreed and suggested a need for additional education opportunities in 2018, regardless of whether legislation advances.
Federal issues: 340B, PABs, year-end funding bills
In early November, the Centers for Medicare & Medicaid Services (CMS) finalized the 2018 Outpatient Prospective Payment System (OPPS) rule, which included significant cuts to certain 340B providers. In response, the American Hospital Association, Association of American Medical Colleges, America’s Essential Hospitals and three health care providers filed suit against CMS (AHA v. Hargan). A preliminary hearing on the lawsuit will be held December 21. Jenny Boese, WHA vice president, federal affairs & advocacy, said WHA is joining dozens of other state hospital associations across the country that will be filing an amicus brief in support of the health care providers.
Boese said both Chambers of the U.S. Congress have been moving rapidly on major tax policy legislation. Several provisions in those packages impact tax-exempt organizations, including hospitals. WHA is particularly concerned with a provision included in the House tax package related to private activity bonds (PABs). PABs are currently tax exempt for certain entities, including qualified 501(c)(3) organizations. Under the House legislation, the tax exemption is removed, which means interest on newly issued PABs would be included in income and thus subject to tax. If enacted, the provision would be effective for bonds issued after 2017. WHA opposes removal of tax-exemption status for these PABs and has relayed its opposition to the Wisconsin Delegation. WHA supports the Senate position on PABs. Boese said WHA, along with members, were in Washington recently to meet with Wisconsin’s Congressional Delegation to express their opposition to the cuts in the 340B program and the elimination of tax exemption for PABs.
Boese also highlighted year-end funding legislation that Congress must still pass in order to fund the CHIP program, extend important Medicare policies—among other programs.
WHA’s quality improvement work continues under new leadership
Kelly Court, WHA chief quality officer, presented what will be her final report as she is set to retire at the end of the year. Her co-presenter, Beth Dibbert, will assume Court’s position. Dibbert has been leading the Hospital Innovation Improvement Network (HIIN) and will capably move into her new leadership role.
Court reviewed Wisconsin hospitals’ CMS star ratings, which were the third highest (best) in the nation and detailed the progress WHA member hospitals have made in reducing infections and in decreasing hospital-acquired conditions, but noted there is still work to do in reducing preventable readmissions.
In 2017, 82 hospitals enrolled in the HIIN. The goals of that program are to reduce harm 20 percent, reduce readmissions by 12 percent, institute antimicrobial stewardship programs, facilitate patient and family engagement and become a high reliability organization.
Dibbert and Court delivered Quality Essential Skills Training (QUEST) to more than 600 people in Wisconsin, Michigan and Illinois. In Wisconsin, the training attracted middle managers, infection prevention specialists and project leaders.
Court initiated a Quality Academy aimed at quality managers, and then replicated that successful program in creating a Physician Quality Academy.
Gov. Scott Walker issued a proclamation in honor of her service at WHA.
“Kelly has put Wisconsin on the map. The work she has done with CheckPoint is unequalled in the country,” Borgerding said. “Wisconsin is the first state in the country to have all the quality measures dynamically reported. Kelly has done a lot here that earned WHA the AHA’s Dick Davidson Award that recognizes hospital associations that are setting the pace for quality improvement. We will miss her, and we wish her all the best.”
Wisconsin Hospitals PAC & Conduit tops $300,000, approaches goal!
WHA Past Chair Mike Wallace, president/CEO, Fort HealthCare and current WHA Advocacy Committee Chair, told the Board the Wisconsin Hospitals State PAC & Conduit is very close to meeting its 2017 goal of raising $312,500. To date, the campaign raised $302,500 from 320 individual contributors, putting it at 97 percent of goal. Wallace thanked Board members for their continuing support of WHA’s advocacy efforts. (Read the full article below.)
In other actions, the Board approved the following actions:
- Council and Committee rosters
- WHA Foundation report
- WHA Information Center 2018 budget
- Nominees to the WHA Nominating and Awards Committee
The following members were recognized for their service on the Board:
- Catherine Jacobson, President/CEO, Froedtert Health
- Mike Wallace, President/CEO, Fort HealthCare
- Sandy Anderson, Regional Vice President, Ascension/Ministry Health Care
- Terry Brenny, President/CEO, Stoughton Hospital Association
- Nicole Clapp, President/CEO, Grant Regional Health Center
- Susan Edwards, President/CEO, ProHealth Care, Inc.