Public Policy Council Discusses Budget, Post-Acute and Insurance-Related Issues
Rep. Sara Rodriguez brings hospital, health system administrator perspective to state Legislature
Members of the Wisconsin Hospital Association’s (WHA’s) Public Policy Council (PPC) were joined by freshman Democratic lawmaker Rep. Sara Rodriguez (D-Brookfield) on May 5 to discuss the upcoming state budget, recently enacted COVID-19 legislation and challenges hospitals face in discharging patients to post-acute care facilities.
As a former health system executive in population health, Rodriguez discussed the unique perspective that she brings to the Legislature. “It’s helpful to have someone in the Legislature that is not just a clinician, but also can provide an administrator’s perspective,” said Rodriguez.
“As someone who worked in care management, I know how difficult it was to find the right skilled nursing facility, rehab facility or rehab hospital that was appropriate for the patient. It was a constant challenge,” said Rodriguez.
PPC members from Froedtert Health, Children’s Wisconsin and Marshfield Clinic Health System all reiterated challenges their respective health systems face in discharging patients to appropriate settings, while thanking Rodriguez for her support of COVID-related legislation that provides payments to hospitals when they cannot find a post-acute care placement for a Medicaid patient. One member said her organization needs to utilize out-of-state post-acute care providers due to a lack of suitable facilities in state, but now even those out-of-state providers are reporting that they are full, leaving the hospital with no reasonable options for patient discharge.
As a former nurse working in Baltimore, Rodriguez discussed the challenges she experienced firsthand in finding appropriate placements for patients. “Sometimes I feel like we have the same conversations, we need to do a better job solving these things,” she noted. “When I was working in a hospital emergency department in Baltimore, we continued to have this problem, and it is something that we need to address here in Wisconsin.”
Rodriguez enumerated her priorities as a state legislator, which include responding to and serving her constituents; making sure that people have equitable access to health care, regardless of their zip code; and looking ways health care intersects with green technology and healthy communities. Rodriguez supports Medicaid expansion based upon the outcomes she has seen in other states and the potential use of additional federal money to fund Wisconsin’s health care priorities, including Medicaid reimbursement.
Hospitals Engage Alongside WHA on Upcoming State Budget
WHA Senior Vice President of Government Relations Kyle O’Brien updated the council on recent advocacy work of the association regarding the state budget, including testimony provided at all four public hearings held by the Joint Finance Committee and a letter signed by 108 hospital and health system leaders asking the committee to reauthorize the Medicaid Disproportionate Share Hospital (DSH) program and avoid a $100 million all funds cut to hospitals in the next biennium. O’Brien said that the WHA team expects the Joint Finance Committee to act in the coming weeks on the Medicaid portion of the state budget.
WHA’s Post-Acute Care Agenda Front and Center
WHA Policy Counsel Laura Leitch provided an update on WHA’s post-acute care agenda, starting with recognition of hospital participation in WHA’s post-acute care workgroup. Leitch provided a summary of trends in the state’s post-acute care capacity, highlighting data reflecting the long-standing challenge of delayed discharges from hospitals to post-acute care facilities.
Priority issues for the post-acute workgroup include complex patient placement and care; post-acute care payment options; and guardianship. Leitch described the "triad of complexities" for post-acute care and the workgroup's goal of addressing those issues
to support providing the right care in the right place at the right time. WHA will continue to meet with the Wisconsin Department of Health Services and Wisconsin nursing home associations to explore additional solutions to post-acute care challenges.
WHA President and CEO Eric Borgerding reflected that WHA began purposefully engaging in post-acute care discussions four years ago, and the topic has gained increasing urgency in light of COVID.
Insurance Related Challenges Addressed Through Advocacy Work
In response to concerns raised by several WHA members over the last few months, WHA Senior Vice President of Public Policy Joanne Alig reported on the partnership between WHA and the Rural Wisconsin Health Cooperative (RWHC) to request the Office of the Commissioner of Insurance (OCI) review various practices by insurance companies that have negative impacts on patients and providers in the middle of the benefit year. These include special programs that would change the network and impose greater cost sharing on enrollees. WHA and RWHC are encouraged that OCI is reviewing these practices and working to ensure that any modifications are not only within the law and regulations, but also are communicated to both enrollees and providers in an easily understood manner.
Alig also provided an overview of the No Surprises Act, most provisions of which go into effect on Jan. 1, 2022. Among several other provisions, in cases where an out-of-network provider and plan cannot agree on reimbursement for services provided to a patient, Alig explained, resolution is handled through “baseball-style arbitration.”
Council members expressed appreciation for WHA’s leadership on these issues that impact hospitals and patients directly.
This story originally appeared in the May 13, 2021 edition of WHA Newsletter