March 23, 2018

Volume 62-Issue 12

Nearly 1,000 Hospital Advocates Attend WHA’s Advocacy Day

Hundreds descend on the Capitol to lobby legislators against worker's comp fee schedules, other key issues

Nearly 1,000 people filled an exhibit hall at Madison’s Monona Terrace March 21 to attend WHA’s 2018 Advocacy Day and hear keynote addresses from Lieutenant Governor Rebecca Kleefisch and Mara Liasson, correspondent for NPR and contributor to Fox News Channel. Over half of the attendees also ventured up to the state capitol in Madison to meet with their state senator and representative on issues impacting Wisconsin’s hospitals, including Medicaid reimbursement and a proposal to implement a government fee schedule in Wisconsin’s worker’s compensation program.

Advocacy Day 2018 crowdBob Van Meeteren, WHA Board chair and president/CEO of Reedsburg Area Medical Center, welcomed attendees to Advocacy Day. “Every year that I’ve attended Advocacy Day, I am so impressed by the number of people who gather for this event and the passion you all have for your community hospitals, and this year is no different,” said Van Meeteren.

To kick off Advocacy Day, Van Meeteren introduced a video message from Gov. Scott Walker, recorded in advance at the Governor’s residence in Madison. In his remarks, Walker thanked everyone in attendance for contributing to Wisconsin’s achievement as the best state in the country for high-quality health care.

“On behalf of our citizens, I want to say thank you! We are so proud that our health care systems in Wisconsin are ranked number one in the nation for quality. That is so important to individuals and families all over the state, as our health is a top priority. It is also a great recruiting tool for top talent and new employers to the state,” said Walker.

The Governor told the crowd he is “proud to have such a great working relationship with WHA staff and members,” and highlighted several accomplishments achieved by working together.

“We’ve made major investments in Medicaid to keep our systems strong and to care for those in need. We even added more through the Disproportionate Share Hospital (DSH) program,” said Walker, referring to the last budget he signed into law, which increased Wisconsin’s DSH program by $25 million in state funds. The Governor went on to talk about additional investments in the state’s health care workforce, medical education campus expansion, eliminating the waiting period for children’s long-term care services and recent legislation—signed into law at Tomah Memorial Hospital—to create a reinsurance program in Wisconsin to help stabilize the individual health insurance market.

“Together, we will continue to reinforce Wisconsin’s reputation as a national leader in health care. Thank you for your service to your system, your community and to our state.”

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Liasson Commends States for Taking the Lead on Public Policy, Despite National Political Polarization

Following American politics today is like riding a roller coaster in the dark—there is no way to know where it’s going to turn next. This dramatic ride is exacerbated by increasing polarization in both our political system and social communities. Those are just a few of the many takeaways left by journalist and political pundit Mara Liasson, political correspondent for National Public Radio (NPR) and regular contributor on the Fox News Channel, when she addressed the crowd at WHA’s Advocacy Day 2018.

Liasson said today’s political polarization is “the biggest and most important dynamic in American politics today,” and that it can be seen most clearly in Congress where conservative Democrats and liberal Republicans used to come together in the center to make deals and move legislation forward. However, today, we have congressional gridlock, which has led to stagnation on a myriad of legislative issues from gun control to immigration to tariffs and, of course, health care.

Because of this, people are turning to their state governments to get things done, particularly when it comes to health care in the wake of failed attempts to repeal the ACA.

“What your health care looks like depends on where you live,” Liasson said. “Blue states are going to have systems more like the ACA, and red states are going to have systems more like pre-ACA.”

Liasson made note of state governments that are innovating and taking the lead, including what has been accomplished here in Wisconsin. “You’ve been able to bring your uninsured rate down, and even if you haven’t expanded Medicaid, you’ve been able to get more people on Medicaid,” she said. “You are using the tools of the ACA to shape the system to your own needs. And that is the trend we’ll see continuing—more and more states taking the lead.”

Despite national polarization, she noted Gov. Scott Walker’s approach to health care saying, “Look at your own Governor. He’s found bipartisan solutions for some of these problems, and I think [it’s] possible.”

When looking ahead to the November elections, Liasson predicts an increased focus on local issues, furthering this look to state governments for progress. While midterm elections are traditionally seen as a referendum on the majority party and incumbent president, no single issue will dominate the national conversation this fall. Rather, the hot issues will depend on where you live and what matters locally, such as gun control in Florida.

Liasson doesn’t see our national polarization going away anytime soon, but does sense a change in engagement. “There is a tremendous upsurge in basic, ordinary, day-to-day citizenship,” with more people paying attention and running for office at all levels of government.

Top of page (3/23/18)

Kleefisch Praises WI Hospitals’ Engagement in Project SEARCH, HOPE Agenda

Rebecca Kleefisch with WHA officersLieutenant Governor Rebecca Kleefisch addressed advocates at WHA’s Advocacy Day in Madison March 21. As a cancer survivor who has experienced first hand the world-class health care available in Wisconsin, she applauded the group for their hard work and commitment to their patients.

“When you go through a health care event like that, you don’t forget that you live in a state with the greatest health care around. I am living proof of that.”

Kleefisch acknowledged Wisconsin hospitals’ very active role in Project SEARCH, an initiative giving employment opportunities to individuals with disabilities in all sectors of the economy, as well as the administration’s Heroin, Opiate, Prevention, and Education (HOPE) Agenda.

She referenced Wisconsin’s record unemployment rate saying, “We need everyone engaged in our economy. The members of the Project SEARCH family are given extraordinary opportunities by people like you to get engaged in the economy.” Several Wisconsin hospitals and systems participate in Project SEARCH.

Kleefisch co-chairs the Governor’s Task Force on Opioid Abuse with Rep. John Nygren, and she commended Wisconsin hospitals for their efforts in combatting opioid abuse, leading the nation by example.

“In what we have seen, the medical community and hospitals across Wisconsin in taking a stand against an epidemic, a true crisis, is very impressive. Thank you for your work.”

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Advocacy Day Legislative Panel Shows Disagreement, Consensus on Key Health Care Issues

Health care policy leaders in the Wisconsin state Legislature participated in a panel during WHA’s 2018 Advocacy Day March 21, disagreeing on the approach states should take to provide Medicaid coverage for low-income Wisconsin residents but agreeing that the state’s worker’s compensation program is working well, showing opposition to a proposal currently languishing in the state Legislature to implement a medical fee schedule.

The panel, moderated by WHA’s President/CEO Eric Borgerding, included a bipartisan group of lawmakers: Sen. Jon Erpenbach (D-Middleton), Rep. Debra Kolste (D-Janesville), Rep. Joe Sanfelippo (R-New Berlin), and Sen. Pat Testin (R-Stevens Point).

Advocacy Day 2018 legislative panelBorgerding tied the panel's conversation around the top three issues facing hospital leaders in Wisconsin, including workforce, insurance stability and reimbursement from government payers.

Reinsurance program receives bipartisan support from panel; Medicaid expansion still heavily debated

While the first question from Borgerding was referring to the Governor’s recent reinsurance proposal signed into law to stabilize the individual health insurance market, the panel quickly began to debate Wisconsin’s decision to expand Medicaid coverage only for people living below the poverty line and not to those living between 100 percent and 133 percent of the federal poverty line (FPL).

Sen. Jon Erpenbach, a member of the state’s powerful budget-writing Joint Finance Committee and ranking Democrat on the Senate Health and Human Services Committee, reacted first to the question. “Yes, it’s a good step the Governor took, but it’s essentially the Governor—quoting a colleague of mine – putting out a fire that he started. Nothing will create instability more than the leaders of our state saying ‘Obamacare is going to go—it’s gone—it’s going to go.”

“Certain politicians in Wisconsin have yet to embrace that Obamacare is the law of the land,” said Erpenbach. “Medicaid expansion is still available, despite what the Governor has said and others have said that it is not or won’t be available.”

“The instability that we have seen here in Wisconsin is not unique to Wisconsin, so I don’t think it is fair to blame it on the direction that we took. To say that we didn’t do Medicaid expansion in Wisconsin is not correct; we did do a Medicaid expansion, we just chose to fund it differently,” said Assembly Health Committee Chairman, Rep. Joe Sanfelippo. “As a result, the Kaiser Family Foundation reported that Wisconsin is the only state in the country that does not have a gap in coverage even compared to states that did take the federal expansion.”

Sanfelippo continued by comparing Wisconsin’s experience with experiences of Medicaid programs in other states. “Taking the federal expansion is not the golden parachute that some say that it is, because the states that did take it are having as much—or greater—problems in their market than what we are seeing in Wisconsin.”

“Whether you agree with the Affordable Care Act or not, we can all agree on two things. One, the ACA has created a market and insurance rates that are unaffordable and unsustainable for a lot of our families here, and the other thing is that the ACA has provided coverage for a lot of people who did not have it before, so the last thing we want to do is to see that we roll that back,” said Sanfelippo.

Medicaid reimbursement concerns causing lawmakers to “think outside the box”

Wisconsin’s Medicaid reimbursement rates are the second worst in the country, only covering 65 percent of cost, said Borgerding. “Quite honestly, I think that number would be worse, except for the fact that hospitals in Wisconsin are doing a very good job controlling their costs.” Borgerding asked panelists what more can be done to address Medicaid reimbursement for Wisconsin’s hospitals and health care providers.

“This is obviously an issue that we hear quite a bit about—Medicaid reimbursement. We should look at how to increase payment as much as we possibly can within the confines of what we are able to do. A lot of it boils down to needing to think outside the box, do more on the preventive side, because an ounce of prevention is worth a pound of cure,” said Sen. Pat Testin.

Borgerding recognized Sanfelippo’s leadership on looking at new ways to deliver better care for patients in the Medicaid program, including a WHA-supported piece of legislation that Sanfelippo authored to create a care coordination pilot program for Medicaid enrollees, which received strong bipartisan support in the Legislature. Assembly Bill 871 was approved by the Senate March 20 and will now head to the Governor’s desk for his signature.

Borgerding also asked the panel their thoughts on a waiver from the Walker administration that would require Medicaid enrollees to take on additional cost-sharing requirements, including co-pays and premiums.

“You are not alone with your concerns regarding Medicaid reimbursement,” said Democratic Health Committee Ranking Member, Rep. Debra Kolste, “Regarding the waiver, I’m concerned that if we move forward with this even more people will be taken off the Medicaid rolls. When you take people off of Medicaid rolls without changing some of the other dynamics, there are just going to be increases in costs for uncompensated care.”

Lawmakers believe additional federal support for Medicaid should be used to fund health care

Borgerding asked those that supported Medicaid expansion to 133 percent FPL, rather than the Medicaid expansion Wisconsin did to 100 percent FPL, what EXACTLY they would do with any additional funding from the federal government resulting from changing Medicaid eligibility.

Erpenbach said he would “plug some holes” where the Legislature has taken money from to put into Medicaid, but “at the same time, I would plow most of that back into reimbursement.”

“Reimbursement rates are important and I would spend a significant amount on reimbursement rates,” said Kolste. “But we can also use this for training to get more people to come back into the health care workforce. I think it is important to use this to increase reimbursement rates.”

But Sanfelippo cautioned attendees on this question, “We are talking about this as if in states that have taken Medicaid expansion it is chocolate and roses and it’s not. They’re having the same problems. In fact, they are having them to a greater extent than what we are having here in Wisconsin.”

“Well maybe Wisconsin should show every other state how it should work and how it can work,” responded Erpenbach to Sanfelippo’s comments. “We should at least try, and the fact that we have not at least tried goes against everything Wisconsin stands for.”

“I think we are. Wisconsin is the only state in the country without a coverage gap—the only state—even when comparing those that took the expansion,” said Sanfelippo. “You can’t say we aren’t leading the way—we are.”

In asking the question, Borgerding noted that many legislators who have supported full expansion in the past have been more interested in using the federal dollars for other state spending, not for Medicaid.

Panel: Worker’s comp program working well right now; panelists express opposition to fee schedule

Borgerding then asked the panel about a proposed medical fee schedule in Wisconsin’s worker’s compensation program, a proposal that has been before the Legislature now two times—never getting enough support to even move out of a Senate or Assembly Committee. The legislation would have government set reimbursement rates rather than having those reimbursement rates negotiated between a health care provider’s and worker’s compensation insurance carrier.

“I haven’t seen anything that leads me to believe that we need a fee schedule,” said Sanfelippo, garnering applause from the Advocacy Day audience.

“I don’t support it,” responded Testin.

“I’m a scientist, I’m driven by data and results. There is nothing currently that says we should change the system; it’s been working. If you change the levers in a system something will go out of whack,” said Kolste.

“We have a national model here in Wisconsin, and there’s absolutely no reason in the world to change it at all – right now or into the foreseeable future,” said Erpenbach. “This is one of those change for the sake of change things that is just way off target.”

Erpenbach continued, recognizing that this year’s fee schedule proposal failed to even have one single legislator put their name as an author or sponsor of the legislation. “There is a reason why legislators are not putting their names on this, and there is a reason why legislators will continue to not put their names on this; we don’t need to make a change at all.”

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Fort HealthCare Receives WHA 2018 Advocacy All-Star Award

Eric Borgerding and Mike WallaceFort HealthCare of Fort Atkinson received WHA’s 2018 Advocacy All-Star Award at the Association’s annual Advocacy Day in Madison March 21.

Mike Wallace, president/CEO of Fort HealthCare accepted the award. WHA recognizes one hospital or health care system each year that exemplifies dedication to grassroots advocacy.

“We are active because it works,” Wallace said. “Public policy has a tremendous impact on our ability to provide high-quality health care, and if we are not engaged in the process, we are left behind. Through our efforts, we have learned lawmakers want to hear from us and welcome feedback on how particular issues affect the industry.”

“We are honored to accept this award, and proud to work alongside, in collaboration with, all Wisconsin hospitals in this effort.”

In presenting the award, WHA President/CEO Eric Borgerding said Fort HealthCare is an exemplary advocate on health care issues, both federal and state. In his remarks, Borgerding highlighted Fort HealthCare’s engagement with the Wisconsin Congressional delegation during the debate over Obamacare and their meetings with state legislators in successfully opposing a medical fee schedule in Wisconsin’s worker’s compensation program. He also noted Fort Healthcare CEO Mike Wallace’s record of service with WHA, including chairing the organization’s Council on Public Policy and its Council on Advocacy, as well as serving as chair of the WHA Board of Directors in 2016.

“In Washington and Madison, Fort HealthCare has been a voice not just for their hospital, but for all Wisconsin hospitals,” said Borgerding. “They have been an advocate and ally in every possible way—an example of a leader in every possible sense.”

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Sen. Howard Marklein Receives WHA’s 2018 Health Care Advocate Award

Sen. Howard MarkleinState Senator Howard Marklein (R-Spring Green) received the Wisconsin Hospital Association (WHA) Health Care Advocate of the Year Award March 21 at WHA’s Advocacy Day event in Madison. Bob Van Meeteren, WHA Board chair and Mike Wallace, past WHA Board chair, presented this year’s award to Marklein in recognition of his partnership with WHA in supporting issues that enable the delivery of high-quality, high-value health care in Wisconsin. Van Meeteren is president/CEO of Reedsburg Area Medical Center and Wallace is president/CEO of Fort HealthCare in Fort Atkinson.

“It comes as no surprise to many of us at Fort HealthCare that Howard is standing before us today to receive this well-deserved recognition for his commitment and service to our state’s hospitals,” said Wallace.

During his tenure in the Legislature, Marklein has advanced policies that reduce unnecessary regulatory burden for hospitals, streamlined licensure processes for physicians and nurses, strengthened health care workforce investments in rural communities and increased reimbursement for Wisconsin’s hospitals serving Medicaid patients. Marklein was the lead author of the Wisconsin Health Care Data Modernization Act, which was signed into law by Gov. Scott Walker in front of over 1,000 hospital advocates at WHA’s 2016 Advocacy Day.

“Throughout his time in the Legislature, Howard has championed several key laws in partnership with WHA that have helped reduce unnecessary regulatory burden for hospitals and provided additional resources to increase access for patients,” said Van Meeteren.

Marklein’s dedication to Wisconsin’s hospitals precedes his time in the Legislature, previously serving as hospital board chair at Fort HealthCare and on the UW Hospital Authority board in Madison. Marklein has also worked hard to establish relationships with the nine hospitals he serves in Wisconsin’s 17th Senate District.

“I’m aware of the contribution you all make to not only the health care of our communities, but the economies of our communities,” said Marklein after receiving the award. “Thank you for this award, but thank you, more importantly, for all that you do in your communities.”

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Hospital Advocates Visit With State Legislators to Discuss Health Care Policy

An important component of WHA’s Annual Advocacy Day event is not just hearing speeches about the current state of affairs in politics and health care, but making the voice of Wisconsin’s hospitals heard loud and clear in the state capitol with a unified message. Advocacy Day attendees had the opportunity to do just that following a legislative issues briefing from WHA Senior Vice President, Government Relations, Kyle O’Brien. Over 120 state lawmakers and legislative staff received visits from nearly 600 hospital advocates after Advocacy Day.

“While your WHA government relations team is in contact with state policymakers on a daily basis, today is your opportunity to tell the personal stories that you are best at telling. Use today as your opportunity to remind legislators how important your hospital is to you, your family and your community,” said O’Brien during the briefing.

O’Brien reminded Advocacy Day attendees that their presence will truly make a difference, as it did when the topics WHA lobbied on during Advocacy Day in 2017 were enacted into law in the last state budget.

O’Brien asked those visiting with lawmakers to make three main points during their visit: remind legislators that high-quality, high-value health care is an asset to Wisconsin’s economy because it helps to attract great talent for all industries; thank lawmakers for investments in hospital Medicaid reimbursement, but remind them more needs to be done to further cut the Hidden Health Care Tax; and, ask lawmakers to stand with their hospital and health care providers in opposition to a government fee schedule in Wisconsin’s nation-leading worker’s compensation program.

For more photos and coverage of the legislative visits, see the WHA Advocacy Day 2018 In Review.

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Save-The-Date: June 5 - Statewide Post-Acute Care Conference, Appleton

The Wisconsin Hospital Association (WHA), in collaboration with LeadingAge Wisconsin and the Wisconsin Association for Home Health Care (WiAHC), is planning a statewide conference intended to bring together partners in the continuum of care to share best practices for transitions of patients to post-acute care settings.

Mark your calendar for Tuesday, June 5, 2018, and plan to attend “Post-Acute Care: Working Together Across the Care Continuum for Positive Patient Outcomes.” Nationally known transitions-of-care expert Eric Coleman, MD, MPH, professor of medicine and head of the Division of Health Care Policy and Research at the University of Colorado, will provide the opening keynote presentation.

In addition, this important, one-day conference will include representatives from throughout the continuum of care—hospitals, skilled nursing facilities, and home health care providers—as presenters on the day’s agenda, sharing innovative strategies for overcoming obstacles that can impede successful care transitions and result in positive outcomes for discharged patients.

This conference is a direct result of the efforts of the WHA Post-Acute Care Work Group, convened in 2017 and tasked with identifying policies that may improve the ability of hospitals and health systems to provide or locate post-acute care for their patients. One specific issue examined was how hospitals and health systems work with post-acute providers to improve outcomes for discharged patients, and was the inspiration for the framework for this conference.

Again, mark your calendar for June 5 and plan to join us in Appleton for a day of valuable information sharing among providers across the continuum of care. Full conference information and online registration will be available in early April. Content questions can be directed to Laura Rose at lrose@wha.org or call 608-274-1820.

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Member News: Stoughton Hospital Names DeGroot as President/CEO

Dan DeGrootDan DeGroot has been named president/CEO of Stoughton Hospital. DeGroot, who officially begins work May 7, 2018 at Stoughton Hospital, has more than 35 years of experience in health care.

Most recently, DeGroot worked at St. Clare Memorial Hospital in Oconto Falls, Wisconsin, owned by Hospital Sisters Health System (HSHS), where he served as chief operating officer for a 25-bed community hospital. DeGroot has an additional 20 years of administrative experience, having held leadership roles with Marshfield Clinic, Allina Hospital and Clinics and Bellin Health System.

DeGroot received a Master of Business Administration from the University of Wisconsin-Milwaukee and his undergraduate degree from the University of Wisconsin-Green Bay. He is a member of the American College of Healthcare Executives, the Wisconsin Rural Health Cooperative and the Wisconsin Hospital Association. DeGroot currently serves on WHA’s Council on Rural Health, Council on Public Policy, Advocacy Committee and Transparency Task Force.

DeGroot replaces Terry Brenny, who will retire June 1, 2018 after 28 years of dedicated service.

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