Physician Edition

03-07-2018


March 7, 2018

Volume 6-Issue 5


Gov. Walker Signs Health Care Stability Reinsurance Bill at Wisconsin Hospitals

A key priority for WHA—keeping care affordable and accessible


Gov. Scott Walker signed Senate Bill 770 into law February 27 during stops at Tomah Memorial Hospital and HSHS St. Mary’s Hospital Medical Center in Green Bay. The legislation, Act 138, is aimed at keeping local health care accessible and affordable by creating a state reinsurance program to stabilize rising health care premiums on the individual health insurance market.

According to the Governor, the bill became necessary after leaders in Washington failed to act on health care reform. WHA President/CEO Eric Borgerding echoed those comments. “WHA not only watched, but vigorously engaged with our federal elected officials over the past year as debate about the repeal and replacement of the Affordable Care Act ebbed and flowed in Washington, D.C. Along with a diverse coalition of Wisconsin business and health care organizations, WHA called on Congress to act as the individual market became more unstable. We were disappointed when nothing was done to address these concerns.”

The legislation will allow the state Office of the Commissioner of Insurance to request a State Innovation (1332) Waiver to stabilize rising health care premiums in the individual market. The Governor’s administration estimates it will reduce premiums for those in the individual market by 13 percent in 2019 and 12 percent in 2020 using a combination of approximately $50 million state and $150 million in federal funds. The original bill provided state funding through a mandatory lapse from the Medicaid program.

WHA successfully lobbied the Joint Finance Committee (JFC) to remove this mandatory Medicaid lapse from the original bill. The non-partisan Legislative Fiscal Bureau stated the Department of Health Services had few ways to achieve these proposed savings necessitated by a mandatory lapse, but could resort to provider reimbursement cuts to find additional revenue to meet the lapse requirements. WHA applauded the JFC’s actions in a memo to state lawmakers supporting passage of the final bill.

In his remarks prior to signing SB 770, the Governor highlighted his recent visits to local hospitals where he spoke with patients about the importance of receiving quality, affordable care in their own communities. “By driving premiums down, it’ll make it more accessible for folks who had it, a number of whom even under the Obamacare exchange said they just couldn’t afford not just the premiums, but the copay. So this will help not only premiums go down, but it will bring more choices back in, more competition back in, and that’s really about access points to health care out there,” said Walker.

“WHA believes everyone should have access to high-quality, affordable health insurance, but it is clear that we cannot rely on solutions from the nation’s capital. We must take action at the state level to mitigate premium increases and ensure choice and affordability in the individual market,” said Borgerding. “We applaud Governor Walker’s leadership in developing, and the Legislature’s bipartisan support in passing, SB 770, which creates a reinsurance program aimed at sustaining coverage expansion in Wisconsin—a key priority for WHA in Madison and in Washington, D.C.”


Top of page (3/2/18)

Advocacy Day Legislative Leadership Panel Confirmed

Over 700 registered already and counting!

The Wisconsin Hospital Association is pleased to announce an outstanding legislative panel is confirmed for 2018 Advocacy Day. Confirmed panelists include legislators in both the state Senate and state Assembly: Sen. Patrick Testin (R-Stevens Point), Sen. Jon Erpenbach (D-Middleton), Rep. Joe Sanfelippo (R-New Berlin) and Rep. Debra Kolste (D-Janesville).

Sen. Testin is the Majority Caucus vice-chair, and Sen. Erpenbach serves as a member of the Joint Committee on Finance. On the Assembly side, Rep. Sanfellipo serves as the chair of the Committee on Health, while Rep. Kolste is the ranking Democrat on the Committee on Health. As always, the panel will provide attendees in-depth insight into the issues facing health care in our state.

WHA strongly believes the afternoon’s legislative meetings are the most important part of the day and encourages attendees to register for Advocacy Day with a legislative visit. To prepare attendees for their meetings, WHA schedules all meetings, provides an issues briefing at Advocacy Day and an optional pre-event webinar on legislative visits.

Make sure you assemble your hospital contingent for 2018 Advocacy Day set for March 21, 2018, at the Monona Terrace in Madison. Registration is now open at: www.whareg4.org/2018AdvocacyDay. For registration questions, contact Kayla Chatterton at kchatterton@wha.org or 608-274-1820.

Top of page (2/23/18)
 

Guest Column: Provider Care Coordination Shows “Tremendous Potential” in Reducing ED Use

By Rep. Joe Sanfelippo (R-New Berlin)

The biggest challenge in health care today is balancing how to provide patients with access to the highest quality of care possible against the costs associated with providing that care. That’s why addressing gross inefficiencies in health care is of paramount importance. One of the most glaring issues is that of “high utilizers.” These are patients who repeatedly end up visiting emergency departments for care. Nationally, around five percent of patients account for about a quarter of all emergency department (ED) visits annually. According to the Wisconsin Hospital Association, over 10,000 Medicaid patients in Wisconsin visited an ED seven or more times in 2016. That represents roughly 111,000 ED visits. Over 3,000 patients in the state ended up in an ED seven or more times in both 2015 and 2016. All told, these repeated visits cost the Wisconsin Medicaid program over $52 million annually. These are staggering numbers; yet, they represent a massive opportunity for improvement.

That’s why Representative Jessie Rodriguez, Senator Alberta Darling, and I have introduced Assembly Bill (AB) 871, which passed the Assembly this week with unanimous support. In talking to hospitals and health systems throughout Wisconsin about the high utilizer problem, we’ve learned about the tremendous potential that care coordination has for significantly reducing the repeated use of emergency rooms by Medicaid recipients. The problem stems from the fact that many of these patients are visiting the ED for non-emergent reasons and they are, essentially, using the ED in lieu of primary care. No one wants to discourage people from seeking care in an actual emergency, but many high utilizers are individuals who go to the ED when they really should be seeing their general practitioner.

The Milwaukee Health Care Partnership analyzed this trend and found that 47 percent of ED visits were for non-emergent issues. Many of these patients either don’t know how to access health care more appropriately or simply can’t, for a wide variety of reasons. In many cases, it can be as simple as the patient either not knowing that they should be going to their primary care physician for these issues or not being able to get to their doctor during business hours. Other challenges these patients face often relate to basic socio-economic factors like unemployment, family obligations, and access to housing or transportation. If emergency departments had the resources and incentives to follow up with these patients and help them resolve their issues, we could solve the problem of overutilization by actually addressing the underlying causes, and that’s exactly where care coordination comes in.

We’ve seen impressive results from care coordination programs here in Wisconsin. Aurora’s pilot program saw a 44 percent reduction in ED visits after six months, and a staggering 77 percent reduction after 12 months. Ascension St. Joseph’s program reduced ED visits by 5,000 encounters. Through simple, but impactful, assistance like scheduling and maintaining primary care appointments, providing transportation, or arranging child care, these patients are able to get the care that they really need. These promising results are why AB 871 attempts to implement a larger Medicaid pilot program for care coordination statewide in order to see how well these results scale. By providing hospitals and health care systems with financial incentives to follow-up with high utilization patients, Wisconsin can realize massive cost savings while, simultaneously, improving the quality of care that this vulnerable population of patients receives.

Representative Joe Sanfelippo (R-New Berlin) is Chairman of the Assembly Committee on Health and a lead author of Assembly Bill 871.

Top of page (2/23/18)

 

WHA Expertise in Workforce Highlighted in EBHPP Panel

Teams, technology and provider pathways were highlighted by a panel of workforce experts, including Ann Zenk, WHA vice president, workforce and clinical practice, in a legislative briefing sponsored by UW Population Health Institute’s Evidence-Based Health Policy Project (EBHPP).

During the panel, “Right Providers in the Right Places: What Policies Support Adequate Health Workforce in Wisconsin,” Zenk shared data, themes and recommendations from WHA’s 2017 annual workforce report. Zenk noted, “Health care is an important public infrastructure, like roads and schools, and it’s critical that key stakeholders, like all of us, and like policymakers, support the changes necessary to address rapidly evolving workforce needs.”

Panelists linked common themes important to policymakers to the data used to identify these themes and trends, and to legislative and regulatory action taken as a result to ensure an adequate health care workforce. Patricia Pittman, PhD, co-director, George Washington University Health Workforce Institute noted, “States take the lead over the federal government in addressing workforce, and sound decision-making is needed at a state level.” Pittman stressed the importance of collecting and sharing workforce data, a sentiment echoed by Susan Zahner, DRPH, associate dean for faculty affairs, UW-Madison School of Nursing. Zahner said, “We must maintain and enhance databases so we can know that the changes we are making are making a difference.”

Building on the theme of physician shortages and team-based care introduced by Richelle Andrae, program analyst, Wisconsin Council on Medical Education and Workforce (WCMEW), Zenk provided examples of recent legislation supporting teams, top of scope practice and rapidly evolving technology. Zenk said, “Regulations and policy don’t always keep pace, so when care models change, or technology allows better and more accessible care, policymakers need to make sure statutes guiding practice and payment also evolve.”

Pittman had the final word on the panel with, “We’ve heard a lot about physician and clinician shortages, but it’s important to remember the importance of teams with adequate support,” noting, “Career pathways are essential to bring in entry-level workers to support physicians and other providers.”

Program materials will be posted on the EBHPP’s program page. You can contact Zenk at azenk@wha.org or 608-274-1820 if you have questions about the program.

Top of page (2/23/18)
 

Hoelter Joins WHA Government Relations Team

WHA has another addition to its public policy and government relations team. Jon Hoelter has joined WHA as its new director of federal and state relations effective February 26.

“Jon has over a decade of experience crafting and implementing health care policy in both Washington, D.C. and Madison, Wisconsin,” said WHA President/CEO Eric Borgerding. “He has a deep interest in health care, knows the issues and the policymaking process, and will immediately help expand our presence and impact at both the federal and state levels. The WHA team is excited to welcome him aboard.”

“I’m excited to be joining such a great organization focused on making Wisconsin a national leader in providing high-quality, accessible and affordable health care,” Hoelter said. “I’m looking forward to being part of the team that promotes these priorities for Wisconsin’s hospitals at the state and federal levels.”

Hoelter comes to WHA from the Wisconsin Department of Health Services (DHS), where he has served as DHS legislative advisor since July 2015. In addition to his policy and legislative responsibilities at DHS, Hoelter served as the DHS Secretary’s designee for the Child Abuse, Neglect, and Prevention Board; Criminal Justice Coordinating Council; Early Childhood Advisory Council; and Office of Children’s Mental Health - Collective Impact.

Before joining DHS, Hoelter served as the senior policy advisor to Gov. Scott Walker, advising the Governor on issues related to Public Instruction (DPI), Health Services (DHS), Children and Families (DCF), and Office of Commissioner of Insurance (OCI). Hoelter chaired the Governor’s Read to Lead Development Council and led the National Governors Association Health Workforce Policy Academy for Wisconsin. 

Prior to joining Walker’s staff in 2013, Hoelter served nearly three years in the Washington, D.C. office of Wisconsin Congressman Sean Duffy. Hoelter became senior legislative assistant, specializing in health care issues and staffing Congressman Duffy on the House Committee on the Budget. Prior to going to Washington, Hoelter served four years as a research assistant in the office of state Rep. Mary Williams.

Hoelter has a Bachelor’s Degree in political science and sociology from the University of Wisconsin-Madison.

Hoelter is the latest addition to WHA’s policy and advocacy team. On February 12, WHA announced the hiring of Lisa Ellinger, vice president, public policy, and Kari Hofer, vice president, advocacy.

“Jon, Kari and Lisa add even more depth to WHA’s highly talented team, and will help us continue extending our reach and growing our agenda,” said Borgerding. “The impact our members have in their communities across the state goes far beyond the walls of their hospitals. WHA goes where its members are, and we will continue expanding our capabilities to craft and consistently deliver relevant, proactive policy agendas in synch with our members, focusing on the continuum of care.”

Top of page (3/2/18)

 

Understanding New APC Grant Training Opportunities Focus of WHA Webinar

The Wisconsin Department of Health Services is in the process of developing a Request for Applications (RFA) for new advanced practice clinician training grants. The release of the RFA is tentatively scheduled for mid-March. To assist members in better understanding the new grant opportunities and the application process, WHA is hosting a complimentary webinar March 19, which you can register for at www.whareg4.org/RWIGrantWebinar.

The new grant program, proposed by the Rural Wisconsin Initiative and included in the state’s 2017-2019 biennium budget, is designed to increase the number of physician assistants and advanced practice registered nurses practicing in Wisconsin’s rural communities by supporting new training sites in rural hospitals and clinics. As currently envisioned, the grants will encourage partnerships among small rural hospitals and clinics, education providers and health systems. Hospitals and clinics in communities with populations of less than 20,000 will receive priority for funding. Year one funding is designed for developing the infrastructure to facilitate quality training. The grants are capped at $50,000 per applicant per year and require a dollar for dollar match.

The webinar is scheduled for Monday, March 19 from 10:30 – 11:30 am. There is no cost to participate in this webinar, but pre-registration is required. To register for this webinar, visit www.whareg4.org/RWIGrantWebinar.

For questions about the grant opportunities, contact Ann Zenk at azenk@wha.org. For registration questions, contact Kayla Chatterton at kchatterton@wha.org or call 608-274-1820.

Top of page (3/2/18)
 

 

WHA Announces Virtual Journal Club for Clinicians

Focus on antimicrobial stewardship

Judicious use of antimicrobials is key to preventing hospital-acquired infections and curbing the epidemic of multi-drug resistant organisms; however, the best available evidence can sometimes be buried in 20+ pages of clinical guidelines. As a clinician, it can be difficult to know the best way to stay current on the dos and don’ts of antimicrobial stewardship. In an effort to assist, WHA is excited to announce a four-part virtual Journal Club on antimicrobial stewardship topics for clinicians.

The series will include the following sessions, with content appropriate for physicians, advanced practice providers, nurses and quality professionals:

  • When to Test and When to Treat…A Deep Dive on Asymptomatic Bacteriuria

            April 12, 12-1 pm CST

  • Evidence-based Strategies to Avoid Prescribing Unnecessary Antibiotics

            June 11, 12-1 pm CST

  • Evidence-based Strategies to Prescribe Antibiotics More Effectively

            August 13, 12-1 pm CST

  • Pre-op Urinalysis Before Orthopedic Surgery…What is the Current Evidence

            October 15, 12-1 pm CST

The series will be hosted by Robert Redwood, MD, MPH. Dr. Redwood is WHA’s physician improvement advisor, works full time as an emergency and preventive medicine physician at Divine Savior Hospital in Portage and is chair of the hospital’s antimicrobial stewardship committee.

The virtual Journal Club series will utilize Zoom technology, allowing participants to see each other and converse, as well see the presenter and his material. Those participating in the live sessions have the ability to earn continuing education credit. The sessions will also be recorded and available for future viewing. To register for individual sessions or the full series, visit www.whareg4.org/WebJournalClub. There is no cost to participate in the Journal Club, but pre-registration is required.

Mark your calendars and feel free to spread the word. For questions about content, email Beth Dibbert at bdibbert@wha.org. For registration questions, contact Kayla Chatterton at kchatterton@wha.org or call 608-274-1820.