Physician Edition

01-03-2018


January 3, 2018

Volume 6-Issue 1


President's Message: WHA 2017 Report Illustrates WHA’s Impact and Relevance

This week our senior executives received a hard copy of WHA’s 2017 Results publication, which documents not only another year of impressive results, but as importantly, the growing breadth of WHA’s agenda.  As our members know, we measure success not only by the slate of accomplishments, but also the tangible impact of delivering our agenda.  In other words, the relevance of WHA’s work - delivering on our ambitious agenda within a constantly changing and dynamic health care environment - is what defines our value proposition.  Looking back on 2017, I believe the value of WHA to our members is stronger than ever.  

While many of the initiatives in 2017 aligned closely with executing our ambitious annual goals, we also responded quickly to the shifting environment at both the state and federal level.  Despite the best laid plans, over the course of a year unanticipated issues (both challenges and opportunities) arise that must be addressed.  WHA responded to each of these as they arose, both at the state and federal level to ensure our members’ voices were heard in Washington and Madison.

2017 was also a banner year for our members and their sustained pursuit of some of the best quality care in the country.  Wisconsin was recognized by the Agency for Healthcare Research and Quality (AHRQ), which placed Wisconsin first in the nation based on the quality of our health care. Wisconsin’s critical access hospitals were recognized as the best in their peer group, while our state was dubbed the best place for physicians and nurses to practice. All these accolades were well deserved in a state that consistently raises the bar on clinical excellence.  Our advocacy, our agenda, is focused on creating  and achieving sound public policy that enables our members to continue delivering superior care.

The “Results” speak for themselves, but they simply would not be possible without the tremendous engagement by and support from our members – truly our best partner and our most valuable asset.  We are also anxious to expand our partnerships with elected officials and the many other health care stakeholders dedicated to ensuring our citizens continue to have access to the highest quality care in the  nation. We look forward to working with you all in 2018!

WHA is proud to represent Wisconsin health care, proud to be the voice of the nation’s leading hospitals and health systems.  The WHA team wishes you all a happy and safe New Year.

Eric Borgerding, President/CEO

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Early Bird Registration Open: WHA Physician Leadership Development Conference

Register today for WHA’s 13th annual Physician Leadership Development Conference, scheduled March 9-10, 2018 at The American Club in Kohler, and take advantage of the early bird discount.

Information about this year’s conference and online registration can be found directly at www.cvent.com/d/ktql9j. Discounted registration is available to those registering by January 15, 2018.

The conference will include a full-day session with presenter Allison Linney called “A Leader’s Guide to Resolving Conflict,” focusing on the skills needed to resolve conflict productively. In addition, a half-day session called “Putting High Reliability Organizing (HRO) to Work,” led by Craig Clapper, will focus on the physician leader’s role in shaping performance culture, discussing the principles of high reliability organizing and demonstrating various skills physician leaders can use to shape culture. Continuing medical education credits are available again this year.

For questions about the annual Physician Leadership Development Conference, contact Jennifer Frank at jfrank@wha.org or 608-274-1820.

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Lawmakers in Assembly, Senate Say Workers Comp Fee Schedule Unlikely to Pass

In back-to-back news reports this week, a spokesperson for Senate Labor Chairman Steve Nass (R-Whitewater) and Speaker Robin Vos (R-Rochester) both indicated that passage of a bill enacting a workers compensation fee schedule in Wisconsin is unlikely this session.

Nass, as chairman of the Senate Labor and Regulatory Reform Committee, called for a rare procedural move known as Committee introduction of the bill, requiring a vote of the Committee to introduce the legislation on behalf of that Committee rather than by one single lawmaker. The move was seen by many as a way to allow the bill to be heard in the Senate Labor Committee even though the legislation, which was developed by the Workers Compensation Advisory Council, has received little to no support in the state capitol.

A spokesperson for Nass told WisPolitics.com the procedural move “by no means” indicates the bill would be moving out of the Committee. Nass’ spokesperson said that “[Senator Nass] will not be scheduling the bill for a vote as long as the fee schedule is in it.”

WHA President/CEO Eric Borgerding applauded Nass’ firm opposition to government rate setting for medical care provided to those injured at Wisconsin businesses. “We thank Chairman Nass, who has heard from constituents that a government fee schedule is the wrong approach to lowering workplace injuries and reducing overall costs in our state’s workers compensation program,” said Borgerding.

After Nass’ announcement, Speaker Robin Vos subsequently told several media outlets that a workers compensation fee schedule is one of a handful of proposed policies he does not see passing the Assembly this session. In an interview with WisPolitics.com, Vos stated that workers compensation premiums have dropped for the second year in a row, saving businesses in Wisconsin $170 million in 2017 alone according to the Department of Workforce Development, which has “raised questions for him” on whether a fee schedule is needed.

“If there’s not a crisis, the groups should find a consensus and come to us with a solution, not expect that we’re going to try to do one through the process we utilize,” Vos told WisPolitics.com in the interview.

WHA President/CEO Eric Borgerding said, “Speaker Vos understands the position of his caucus, which is overwhelmingly opposed to implementing a government-imposed medical fee schedule in our state’s workers compensation program. As other states look to Wisconsin’s workers comp system with envy, point to it as a model, some here would have policymakers believe we are in some sort of crisis. The broader facts tell a much different story, and WHA applauds the Republicans and Democrats in both houses who understand this, and are increasingly unwilling to rubber stamp all-or-nothing proposals coming out of the Workers Compensation Advisory Council.”

WHA has joined several other groups to oppose price setting for health care delivered to those injured at Wisconsin businesses. Many of those same groups are optimistic that alternative bills will emerge from within the Legislature, proposals that will further improve care for those injured in the workplace while streamlining the multi-layered bureaucracy that has evolved around the workers compensation industry.

“The job of developing workers compensation legislation should not be solely within the purview of an advisory council, nor should making progress on improving workers compensation be held up by controversial fee schedules,” Borgerding said. “We are anxious and looking forward to working with legislators and a broad coalition of groups to support an actual agreed to bill that will advance sound reforms.”

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Congress Passes Tax Reform Package, Sends to President

PABs protected, individual mandate penalty repealed

This week the U.S. Senate and U.S. House of Representatives approved sweeping tax legislation, sending it to the President for his signature. The President is not expected to sign the legislation into law until early 2018, negating the imminent threat of sequester cuts due to PAYGO rules until 2019.

The good news is that the final legislation does not include a provision removing the current tax exemption afforded to private activity bonds (PABs), as the Wisconsin Hospital Association had advocated (see article at www.wha.org/wha-newsletter-12-15-2017.aspx#s1). However, the bad news is the legislation does repeal the tax exemption on advance refunding bonds, and, more importantly, repeals the individual mandate penalty.

“WHA is pleased Congress preserved tax-exempt financing tools for non-profit hospitals, a position advocated by WHA, our members, Governor Walker, Congressman Gallagher and many others from both sides of the aisle,” said WHA President/CEO Eric Borgerding. “However, we are concerned several provisions in the package will negatively impact Wisconsin health care, including the repeal of the individual insurance mandate. With this provision, we see the latest step in the piecemeal deconstruction of Obamacare, but with nothing to replace it, nothing to bridge or transition. This will result in fewer people insured, starting next month, and will most certainly result in higher uncompensated care costs for hospitals and health systems.”

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DHS Publishes New Increased Outpatient Behavioral Health Rates

The Department of Health Services (DHS) formally published new Medicaid reimbursement changes for outpatient behavioral health services in the December 2017 ForwardHealth Update No. 2017-41. Gov. Scott Walker and DHS Secretary Linda Seemeyer announced in October an approximately $17 million investment, including $7 million in state funding, to raise Medicaid reimbursement rates for professionals providing outpatient mental health and substance use disorder services.  

Effective for dates of services on and after January 1, 2018, the December ForwardHealth Update makes three changes to current Medicaid reimbursement for outpatient mental health and substance abuse services:

  • Reimbursement Rates - New higher Medicaid reimbursement rates are listed for those services outlined in the Outpatient Mental Health and Outpatient Substance Abuse service areas of the Forward Health Online Handbook.
  • Rate Structure – There will be two sets of fees per procedure depending upon the provider’s professional licensure rather than four sets of fees per procedure.  For example, previously, psychotherapy services provided by a physician psychiatrist were paid at a higher rate than a Ph.D. psychologist; under the new rate structure, services provided by a physician psychiatrist and a Ph.D. psychologist are paid the same rate.
  • New Substance Abuse Claims Submission Requirements – Under the Update, certain substance abuse codes will now represent 15 minutes of service per one unit rather than 60 minutes of service per one unit.

The ForwardHealth Update did not include any reimbursement changes for evaluation and management (E/M) codes now commonly used by psychiatrists and APNP-psych providers following national coding standard changes in 2013 that deleted dedicated psychiatric evaluation codes. In comments submitted by WHA to DHS in November, WHA noted member feedback that E/M codes now make up at least 80 percent of psychiatrists’ outpatient visits for Medicaid visits and recommended that DHS include E/M codes used by psychiatrists and APNP-psych providers in its outpatient behavioral health reimbursement increase.  

“WHA applauds Governor Walker’s leadership in making investments in Medicaid reimbursement rates to make outpatient behavioral health services more financially sustainable and accessible,” said Eric Borgerding, WHA president/CEO.  “Increasing the Medicaid reimbursement rate for outpatient behavioral health services billed as E/M codes by psychiatrists will be a priority for WHA, and we look forward forward to working with DHS, the administration, and legislators in that effort.”

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WHA Quality Forum: Medical Staff Quality, March 6

On March 6, WHA is offering a one-day session focused on key strategies for identifying, engaging and retaining physician champions for clinical quality improvement and performance management. Faculty includes Beth Dibbert, WHA chief quality officer, Bobby Redwood MD, WHA physician improvement advisor, and Shelly Egstad, director of quality, risk and compliance for Tomah Memorial Hospital.

“Medical Staff Quality” is the second session in WHA’s Quality Forum, a series of day-long education events that address high-priority topics for hospital quality leaders and others involved in quality improvement in Wisconsin hospitals and health systems. In 2018, the series will include topics such as survey readiness, meeting external reporting requirements and more; and presenters for each will share topic expertise and best practice applications.

Online registration and information on all of the WHA Quality Forum sessions can be found at
www.cvent.com/d/f5qhb9. Registration at each session will be limited, so those interested should register as soon as possible.

For registration questions, contact Kayla Chatterton at kchatterton@wha.org. Contact Beth Dibbert at bdibbert@wha.org, for questions about the content of these sessions.

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2018 Advocacy Day: Register Today!

March 21, 2018 *** Monona Terrace, Madison

Make an impact in Madison for your hospital by attending Advocacy Day on March 21, 2018. 

Register Today at: www.whareg4.org/2018AdvocacyDay.

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New WHA Legislative and Regulation Summaries on WHA Member Portal

WHA is adding new summaries of WHA priority bills that were recently enacted into law as well as a new regulatory update to the Act Summary section of the WHA Member’s Only portal. The new summaries include:

  • 2017 Act 135 – Enhanced Nurse Licensure Compact 
  • 2017 Act 119 – Clarification to Wisconsin health care providers that DHS’s Medicaid program covers services prescribed or ordered by physicians and non-physicians alike when the order is made within the provider’s scope of practice
  • Regulatory Update – Status of Computerized Physician Order Entry (CPOE) reporting under EHR Meaningful Use and MACRA/MIPS

The new regulatory update regarding CPOE is a result of discussions at the WHA Physician Leaders Council regarding physician time spent utilizing CPOE technology and confusion regarding regulatory requirements of CPOE usage under the meaningful use program. In short, the summary reviews the current treatment of CPOE under the meaningful use and MACRA/MIPS programs and explains that hospitals and physicians are no longer required to report CPOE in order to avoid Medicare penalties.

The summaries are for WHA members only and will not be generally available on the WHA website. The summaries are posted in the member’s portal, which is accessible by clicking the “WHA Member’s Only” icon located on the home page at www.wha.org. Once in the WHA member portal, the summaries can be found in the dropdown menu under the “Legal Resources” tab. This section of WHA.org is a secure location and requires a first-time user to obtain a username and password. If you do not have a member account, go to members.wha.org and click on “Register” to create an account. If you have questions about how to register, contact Tammy Hribar at thribar@wha.org or 608-274-1820.

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WHA will feature Annual Impact Report Stories in Social Media
Stories illustrate how WI hospitals, health systems support community health

Over the next several weeks, WHA will share stories that illustrate our members’ commitment to creating healthier communities. The stories that will be featured on WHA’s Facebook and Twitter accounts are from the WHA 2017 Annual Community Impact Report (http://www.wha.org/data/sites/1/pdf/2017cbReport.pdf). WHA received more than 100 submissions for the report in 2017.

For more than a decade, WHA has published an annual report that highlights the critical role that hospitals and health systems have in ensuring that people living in the communities they serve have access to the care they need, when they need it.

Wisconsin hospitals use their resources to support a broad range of services that include providing financial assistance, funding free clinics, sponsoring health education opportunities, partnering with local employers to increase access to care, and working with other community organizations on complex socioeconomic issues.

“Wisconsin hospitals commit financial and human resources to improve the overall health status of the citizens of our state by providing essential services in their communities,” according to WHA President/CEO Eric Borgerding. “If they were not doing this, many of these services simply would not exist or would place a much greater burden on our state and local governments. Wisconsin’s hospitals and health systems provide the health care ‘safety net’ across the state, ensuring our most vulnerable populations receive the care they need.”

WHA will notify the hospital or health system PR team when their stories are shared. If you have questions, contact Mary Kay Grasmick, WHA vice president, communications, mgrasmick@wha.org.