Physician Edition


January 18, 2017

Volume 5-Issue 1

President's Column: WHA 2016 Results: Accountable to Our Members

WHA ad for WisPolitics 2017 AlmanacIt’s hard to believe that after years of massive realignment in health care, 2016 could become the year known as the calm before the (another) storm. After nearly a decade of continuous change, November’s elections are triggering another wave of uncertainty across the health care landscape. To quote one of my favorite writers: "No changes are permanent, but change is." So true!

While the future may be cloudy, what’s immensely clear is the critical role of advocacy in both Madison and Washington. The challenges faced by health care seem to proliferate and become more complex each year, and given this continuous state of change and angst comes an even greater need for WHA’s strong and expanding advocacy voice…and value.

Looking back at 2016 and ahead to the future, I believe there are five characteristics that will continue defining WHA’s value proposition for our members, partners and stakeholders: Responsive, Relevant, Influential, Impactful and Accountable. This week, all our senior executives received a hard copy of WHA’s 2016 Results. Our work in 2016 is highlighted by the successes we had in the state Legislature in passing legislation that continues to support the delivery of high-quality, high-value health care in Wisconsin, in influencing federal policy by directly meeting with our Congressional Delegation, and in the proactive policy and program activities the WHA staff led with the guidance of our volunteer leaders. Our Results show our team’s laser focus to deliver on the value definition that is the hallmark of the Wisconsin Hospital Association.

But perhaps our best example of meeting and maybe exceeding our members’ expectations came at 8:05 a.m. November 9, just hours after the election, when WHA shared with members our initial insights. This was very quickly followed by a thorough analysis of the potential impact of repealing and replacing Obamacare in Wisconsin. And since election night we have been in frequent communication with our members and elected leaders at both the state and federal level, including Speaker Paul Ryan and Governor Scott Walker. This is what we do, and what you should expect from your WHA team.

Indeed, it was another remarkable year for WHA made possible by an exceptional team, which at its foundation includes our engaged members who participate in our councils and task forces, attend dozens of meetings with elected officials and comprise our incredibly supportive Board of Directors. Health care will remain in a continuous state of change, and it is because of this outstanding team that WHA is able to not only face these challenges but embrace them as opportunities to expand our value proposition—to lead.

Thank you for your support in 2016. The WHA team is looking forward to working with you in 2017.

Happy New Year!

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Register Today for WHA Physician Leadership Development Conference

Early bird discount expires January 15

Take advantage of the Early Bird discount by registering for the 2017 WHA Physician Leadership Development Conference before January 15.

This year’s conference, scheduled March 10-11 at The American Club in Kohler, will include a full day with Kevin O’Connor focusing on the skills needed to elicit connection, communication and cooperation from fellow medical professionals, in a session titled "Emotional Intelligence: The Final Frontier." In addition, a half-day discussion led by Jennifer Grebenschikoff will focus on the physician leader’s role in strategic physician recruitment and retention. Continuing medical education credits are available again this year.

Online registration is available at or directly at

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President’s Column: Unwind Obamacare with Caution

WHA President/CEO Eric Borgerding wrote the following opinion editorial. To date, it has appeared in several Wisconsin dailies and nationally in an online edition of USA Today.

After six years of upheaval and realignment in health care, the 2016 election has, again, left many asking "What’s next?"

The immediate answer seems certain with the coming inauguration of a president who will sign a repeal of Obamacare. The real uncertainty, the real high stakes, comes in the "when" and "how" the Affordable Care Act is replaced.

Republicans now occupy center stage in this ongoing saga, moving from antagonist to protagonist in a role reversal that brings great expectations and new accountability. Objective observers agree that Obamacare is in need of repair if not overhaul, but while it still exists, its flaws remain the property of its namesake.

Repealing it, however, means owning what comes next, a shift that should underscore how serious a policy and political undertaking replacing Obamacare will actually be. Because for all its warts, the quandary that is Obamacare has given something to nearly a quarter of a million (and growing) Wisconsinites that they and their families do not want to lose—health insurance.

Love it or hate it, it is an undeniable fact that Obamacare has extended health insurance to millions of people across the country, in congressional districts both red and blue. In increasingly red Wisconsin, our already low uninsured rate dropped another 38 percent since Obamacare kicked in, the result of Gov. Scott Walker’s strategy of combining Wisconsin-style Medicaid expansion with Obamacare’s premium subsidized insurance exchanges.

Wisconsin’s successful hybrid approach could be a national model going forward and proves that expanding health insurance coverage is a bipartisan aim. The differences come in the means of achieving this goal and, more importantly today, sustaining Wisconsin’s gains.

The fact is there’s simply too much here to quickly unwind and political leaders from both parties know this. The challenge is a complicated (and politically risky) one of scale, pace and effectively translating campaign pledges into post-election policy, all against a backdrop of growing Obamacare enrollments, falling uninsured rates and teetering exchanges.

Indeed, the "how" of replacing Obamacare is as important as the "what." Our health care delivery and insurance systems have seen massive upheaval and realignment during the past few years. While Wisconsin health care is a national quality and value standout, its leaders forward-looking, nimble and adaptive, an abrupt U-turn could backfire, causing even greater dissatisfaction and frustration than already exists.

This means replacing Obamacare will not happen overnight. Ample time must be allowed to implement and transition, or "bridge," any major changes. Ironically, Congress may need to fix Obamacare before it can fully replace Obamacare.

Wisconsin’s low uninsured rate coupled with high-quality care means we have much to either gain or lose in the coming debate. If Obamacare is repealed, the 225,000 people it now helps cover in Wisconsin will need a better alternative.

There’s a lot at stake in replacing the law that delivered that coverage. Fortunately, Wisconsin could be in a strong position. With Congressman Ryan in the speaker’s chair and Gov. Walker now leading the Republican Governors Association, no other state should be as well positioned to shape "what’s next" and sustain the coverage gains we have achieved in the process.

Bottom line is we should be prepared for more changes coming to health care, along with the imperative that we engage in defining "what’s next" for Wisconsin. It’s a task the Wisconsin Hospital Association and our member hospitals and health systems are prepared to undertake in partnership with our elected leaders.

Eric Borgerding,

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Retirements, Aging Population Fuel Health Care Workforce Shortages

Recommendations include investing in training, clinical rotations

2016 WHA Workforce Report coverWorkforce has been one of WHA’s top priorities for more than a decade. Over that time, WHA has dedicated staff resources to identify the priority issues and then work with like-minded partners, including our state legislators, to formulate solutions. WHA has played a leadership role in the State Capitol advocating for funding programs and initiatives aimed at ensuring Wisconsin has an adequate and highly skilled workforce ready to join our hospitals and health systems to deliver the highest standard of clinical excellence in the country.

On December 20. WHA released its 13th annual Health Care Workforce Report. See the infographic and press coverage.

The press release follows.

WHA 2016 workforce infographicMADISON (December 20, 2016) ---- Following years of relatively flat vacancy rates, a new report warns that the health care workforce market is heading toward a crisis. Vacancy rates for key health care professionals employed in hospitals are increasing dramatically. Some have more than tripled over the past four years, according to the Wisconsin Hospital Association 2016 Health Care Workforce Report.

Retirements are up significantly over prior years, leaving a higher than usual number of positions unfilled in hospitals. Wisconsin hospitals employ more than 100,000 people; more than half of the state’s 87,000 nurses are working in hospitals. Vacancy rates have nearly doubled since 2012 for registered nurses (RNs) and certified nursing assistants (CNAs), while the vacancy rates for hospital-based dietitians and surgical technicians have more than tripled since 2012. More than one-third of all RNs in the state are over the age of 55, and a little more than 40 percent of Wisconsin nurses indicated on their state re-licensure survey that they plan to leave the workforce within the next ten years.

"Retirements are outstripping hospitals’ ability to fill the vacant positions they leave behind. Wisconsin could soon see an unprecedented shortage of key health care professionals," according to Steven Rush, WHA vice president, workforce and clinical practice. "It persists for several reasons, but primarily because the demand for health care is increasing as baby boomers approach retirement. It’s like a double whammy: The age of our workforce is a direct reflection of the average age of our population."

The demand for nurse practitioners (NPs) and physician assistants (PAs) continues to grow. There was a staggering and unprecedented 150 percent increase in the number of PAs in just one year (4.3 in 2014 to 10.8 in 2015). The vacancy rate at 11.2 percent for NPs remains one of the highest of all professionals working in Wisconsin hospitals.

The current workforce supply is strained, and that is a major impetus for re-evaluating current workforce and health care delivery models, according to WHA President/CEO Eric Borgerding. Wisconsin hospitals and health systems are rapidly moving toward team-based care models that are patient centered, condition defined and community appropriate.

"Wisconsin has some of the highest quality care in the country. This is possible because our health care delivery system is highly integrated—hospitals and health systems provide a continuum of care starting at the initial point of patient contact, sometimes continuing through the hospital and all the way through rehabilitation and into the home, if necessary," said Borgerding. "For team-based care to be successful, health care professionals must be able to practice at the top of their license. That requires an understanding of how regulatory issues, such as billing and reimbursement, must keep pace with the changing dynamics of our patient care models."

As health reform initiatives transform how health care is delivered, the ability to quantify the supply of and the demand for health care professionals is essential. The need for accurate, timely and comprehensive workforce data has never been greater. Apart from Wisconsin’s nursing workforce data that is collected from nurses when they renew their licenses, no standardized data collection exists for all other health care workers. The data in the WHA report is collected from hospitals only, and it does not reflect the demand by other health care employers, such as extended care and skilled nursing facilities.

"Wisconsin health care employers, policymakers and our college and university system need workforce data to assist them in allocating scarce resources and providing education opportunities for the next generation of health care professionals," according to Rush.

Rush added that the shortage of nursing faculty is contributing to the current nursing shortage. The average age of a nurse educator is 52.

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WHA Hosts Legislative Briefing on Health Care Workforce Reports

More than 60 lawmakers, legislative staff attend briefing on key workforce issues

Legislative briefing photo
Leaders from the Senate and Assembly Health Committees hosted a legislative briefing featuring the Wisconsin Hospital Association (WHA) and the Wisconsin Council on Medical Education and Workforce (WCMEW) in the State Capitol December 20. More than 60 legislators, policymakers and health care leaders attended the briefing to learn more about health care workforce-related issues.

Following introductory remarks from Assembly Health Committee Chairman Joe Sanfelippo, Steven Rush, WHA, vice president, workforce and clinical practice, presented WHA’s 2016 Health Care Workforce Report. Rush provided an overview of the health care workforce challenges facing Wisconsin, including record hospital vacancies for nurse practitioners and physician assistants. Proposed recommendations outlined in the report include incentives that would expand opportunities for clinical rotations and training for advanced practice clinicians and allied health professionals.

Steve Rush, George Quinn, Joe SanfelippoRush discussed key hospital vacancy rates for various health care professions, education pipeline strategies, including clinic rotations and the importance of collecting data from a wide range of health care professionals that could be used to more accurately forecast and proactively respond to future workforce needs.

"Wisconsin hospitals have a long-standing history of high-quality, high-value health care. We must always keep that in the forefront as we consider strategies regarding workforce. We do not want a solution that jeopardizes the high-quality care that our hospitals and health systems deliver in our state," Rush said in response to a comment on Wisconsin hospitals’ reputation for high-quality health care.

While Rush’s presentation focused on the larger health care workforce, WCMEW Executive Director George Quinn targeted issues associated with maintaining and attracting an adequate physician workforce.

Quinn reported on the Council’s publication "A Work In Progress," which predicted a shortage of as many as 4,000 physicians by 2035. Quinn said much progress has been made since the 2011 physician report, including the GME grant program that has led to 79 new residency slots across the state, and the expansion of medical school positions by the Medical College of Wisconsin and the UW Medical School.

Quinn said that despite the solid progress, more needs to be done. WCMEW recommends expansion of GME programs in Wisconsin, more "build out" of our health care education and training structure, gaining a better understanding of how health care is being transformed and a greater focus on retention for health care professionals.

"As we create policy, let’s remember that the more we create opportunities for students and trainees with Wisconsin backgrounds, the more likely we will see them stay and practice here," Quinn said.

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