The discussion centered around WHA Member priorities, planning for the upcoming biennial budget session, and WHA’s strategic agenda at last week’s Board meeting.
State agencies are already planning for the 2019-21 biennial budget and so is WHA, focusing on issues of ongoing and emerging importance to hospitals and health systems across the continuum of care. WHA President/CEO Eric Borgerding noted WHA’s upcoming biennial budget and legislative priorities reaffirm the sentiments heard in the December 2017 Member CEO Survey:
1. Workforce shortage
2. Uncertainty in the insurance market
3. Government underpayment
GME Program Focus in Upcoming Budget The Graduate Medical Education (GME) program will again be a budget priority to help address Wisconsin’s physician shortage now and in future, particularly as our population over the age of 65 is expected to double by 2030.
“In 2011, WHA authored a report ringing the alarm bell that we will need 100 new physicians each year—and that alarm bell is still very much ringing,” said Borgerding. “GME is a great example of how WHA and our many valuable partners use public policy to address and solve workforce challenges, and it will again be a priority for us in the state budget. We’ll be looking at strategies to better target dollars for greatest impact while ensuring long-term sustainability of funding.”
Linda McCart from DHS’ Office of Policy and Budget Initiatives was a guest at the meeting to discuss the GME program. She noted the initiative is having a significant impact already in the state:
- Wisconsin will have 133 more residents in the pipeline by 2020. Compare that to 2013 when there were zero new residents in the pipeline.
- The GME psychology program will produce four new psychiatrists per year starting in June 2021. The first psych residents started in July 2017 to complete their four-year residency. In June 2024, Wisconsin will reach its goal of having 16 new psychiatrists—with the majority of their training done in rural clinical settings.
DHS is also implementing new, WHA-backed clinical training grants in rural hospitals and clinics. Two new programs, which focus on training physician assistants, advanced practice registered nurses, and other high-demand professions, such as CNAs, are now up and running.
“WHA makes a great partner. We needed someone to help get this program off the ground, and we have been very successful in a very short period of time,” said McCart.
McCart encouraged those interested in participating in any of these new, matching grant funded training programs to contact her directly at firstname.lastname@example.org
Public Policy Agenda Report
The WHA team continues developing its proactive advocacy agenda in several areas of importance to members.
- Medicaid Policy Work Group. Lisa Ellinger, WHA vice president, public policy, noted the group is holding six meetings throughout the summer with a focus on the topics of reimbursement; managed care and population health; behavioral health; telehealth; workforce; dental access; and postacute care. The group will put together its final recommendations in August. WI DHS Medicaid Director Heather Smith joined the work group in May, and said the agency’s goals in the upcoming 2019-21 biennial budget include behavioral health and opioids, workforce, telehealth and dental access. Ellinger indicated the work of the WHA Medicaid policy group is aligning with many of DHS’ priorities.
- Physician Leaders Council. WHA Chief Medical Officer Charles Shabino, MD, and General Counsel Matthew Stanford discussed WHA’s emerging “top of license” agenda aimed at reducing regulatory burdens that stand in the way of physicians and other clinicians spending more time with patients and less time with paperwork.
- Post-Acute Work Group. WHA’s Post-Acute Work Group recently finalized its report. WHA Vice President, Public Policy Laura Rose summarized key findings, including:
WHA will distribute a white paper about the findings in July. The information will also be discussed with the Medicaid Policy Work Group to help determine WHA’s budget request on behalf of its members.
- Post-acute care provider challenges
- Lack of access to post-acute options for challenging patients
- Barriers to team-based care in post-acute settings
- Technology can be used to improve post-acute care
- Lack of social supports after discharge, including transportation
- Critical need for collaboration and communication during patient transitions
AHA Regional Policy Board (RPB 5) Report
- Telemedicine. Andrew Brenton, WHA assistant general counsel, provided the Board with an update on WHA’s 2018 telehealth advocacy agenda, which is broadly aimed at expanding access to telehealth services by facilitating sustainable telehealth reimbursement and by removing regulatory barriers that prevent hospitals and health systems from maximizing use of telehealth. WHA will advocate for expanded coverage of telehealth services under Medicaid by adding Medicare-covered telehealth services, as well as removing distinctions between how Medicaid covers and pays for telehealth services vs. how Medicaid covers and pays for analogous in-person services. The WHA Telemedicine Work Group will continue to meet throughout the year, and has been instrumental in helping WHA develop its agenda for telehealth expansion.
One of the more significant topics for Wisconsin that was discussed at the recent American Hospital Association (AHA) RPB 5 meeting was health care price transparency.
Wisconsin is ahead of the curve with PricePoint (www.wipricepoint.org), but Wisconsin RPB attendees noted more needs to be done to provide information that is consumer-facing. “Wisconsin has a lot to contribute to this issue and discussion,” said Borgerding. “Transparency is a disruptor, and it’s something we must continue to advance proactively, while making sure all payers are involved and at the table.”
Due to the way health care is paid for and structured, including co-pays, deductibles and narrowing networks, this is an issue that involves insurance companies as much or more than providers, according to WHA. Next month, WHA’s Transparency Task Force will resume its work seeking proactive solutions and improvements to various aspects of health care transparency.
“We also need to do a better job of explaining prices, but also a better job of educating people about what hospitals do for the community 24/7,” said AHA Delegate Edward Harding, president/CEO, Bay Area Medical Center.