Assembly Health Committee Hears Legislation Removing Barriers to Team-Based Care

WHA-supported bill allows APCs, alongside physicians, to activate patient advanced directives

October 24, 2019

“I was sitting in my office getting a number of phone calls from numerous hospitals and clinics in our system – providers in our system who were expressing a great sense of frustration that despite the fact we had individuals who had prepared the health care power of attorney, who had had their discussions with their family members – they couldn’t get those activated.” So began powerful testimony from Paul David, assistant general counsel at Aspirus Health System, regarding Assembly Bill 287 in the Assembly Committee on Health Oct. 16. “They couldn’t get into place the very thing we had hoped would be there to help in those situations,” David said.

State Assembly Rep. Pat Snyder (R-Schofield) and a host of physicians, advanced practice clinicians and health care attorneys testified in support of legislation that would allow advanced practice clinicians to be one of two health care providers required to make a determination of incapacity or make a diagnosis of terminal condition or persistent vegetative state in order to carry out a patient’s wishes through their previously-established medical power of attorney or living will documents. Snyder is the lead Republican legislative author in the Assembly, joined by Rep. Steve Doyle (D-Onalaska). Sens. Howard Marklein (R-Spring Green) and Janis Ringhand (D-Evansville) are lead authors in the Senate.

“Patients in rural communities are having their hospice care delayed because they can’t get two physicians to make a determination of incapacity,” David said. “Not only geis there a delay; a decline in the medical condition of this patient can result in an ambulance coming to the patient’s house, taking them to an emergency department, admitting the patient into a hospital and resulting in health care services being provided that the patient has already told their family they do not want.

“We will be taking a significant step in allowing people to have what they have decided for themselves, to be implemented,” David said. “This is the greatest, most efficient tool for doing that.”

David was one of several individuals testifying in support of the bill. Hilary Bingol, MD, Mayo Clinic Health System medical director of Hospice and Southwest Wisconsin Chair of the Department of Palliative Medicine, said the legislation brings Wisconsin in line with our neighboring states and will reduce the administrative burden placed on physician providers while improving care for patients.

“It is my strongest recommendation that this bill pass expeditiously so that we are able to come in line with our neighboring states, provide the best and most comprehensive care to our patients and continue to support the decrease in administrative burden on our care teams so that we may instead dedicate this time to direct patient care,” Dr. Bingol said.

Testifying on behalf of and with WHA included WHA General Counsel Matthew Stanford; Fort Healthcare’s Emergency Department Director and former Board of Nursing Chair, Sheryl Krause, CNS; and Jamie Silkey, PA-C from Froedtert. Stanford reminded the committee about current law requirements as well as provisions in the proposed legislation ensuring that only individuals who have appropriate training, education and experience would be allowed to make decisions to enable an individual’s advance directive.

“In inpatient and outpatient settings, these situations play out every single day,” Krause said. “What occurs in daily practice is that you have advanced practice clinicians on the medical unit who know those patients very well, they have studied their history, they have spoken with their families, they have examined those patients, they are intimately familiar with the patient’s wishes, the family dynamics, the medical condition and have already made all of those assessments. But now, they are forced to step back and are not able to make the determination that they are very capable of making.”

Jamie Silkey, PA-C, outlined core training competencies and experiences for all physician assistants practicing in Wisconsin and spent time discussing the rigorous facility credentialing processes that are currently in place, ensuring that providers of all types with appropriate credentials, training and competency can deliver care to patients – including decisions regarding capacity and diagnoses that include terminal illness or persistent vegetative state.

Having received a public hearing, Assembly Bill 287 is scheduled for a committee vote Oct. 30, and if approved will be eligible for a full Assembly vote later this session.

Contact Matthew Stanford or WHA Senior Vice President of Government Relations Kyle O’Brien for more information.

This story originally appeared in the October 24, 2019 edition of WHA Newsletter