Physician Edition

03-15-2017


March 15, 2017

Volume 5-Issue 5


U.S. House Republicans Release ACA Repeal and Replacement Draft

An initial draft of the much-awaited replacement legislation for the Affordable Care Act (ACA) was released March 6 including anticipated proposals to change the insurance markets and fundamentally change how Medicaid is financed. The bill, named the American Health Care Act, was being marked up this week by two separate House committees.

The bill has been receiving much scrutiny and is seeing opposition among both conservative and democratic groups. As reported by the Associated Press, Wisconsin Gov. Scott Walker, who is currently chair of the Republican Governor’s Association, believes “more work needs to be done” on the bill.

At issue for Medicaid is how states are funded now and into the future, given that some states chose to expand their programs under the ACA’s Medicaid expansion rules and received higher federal funding for doing so. Wisconsin instead chose a “partial expansion” approach, adding about 130,000 childless adults to its program, without receiving enhanced federal funding. Wisconsin is one of 19 states that did not take the expansion as defined by the ACA and the previous Administration. If parity between non-expansion and expansion states is not addressed, funding inequities could be locked in for future years.

The legislation would change Medicaid funding to a per capita allotment, but allow expansion states to continue to receive their enhanced federal funding through 2020. Non-expansion states, like Wisconsin, would receive a portion of a new “safety net funding pool” based on their share of the population with income below 138 percent FPL.

As reported in Wisconsin Health News, WHA President/CEO Eric Borgerding noted that even though the bill makes a few steps toward addressing funding inequity, Wisconsin would still end up with “the short end of the stick.” WHA estimates that under the bill, Wisconsin could be eligible for about $70 million in the new safety net funding pool. However, if Wisconsin’s partial expansion is counted on par with expansion states, Wisconsin would be getting about $250 million.

The legislation would make several other changes to the insurance markets, such as removing the individual and employer mandates for coverage, changing how insurance companies could set premium rates based on age and changing the current income-based tax credits for purchasing coverage to new credits based primarily on age. Borgerding noted these new age-based credits could negatively impact a state like Wisconsin that relied heavily on the income-based credits to help low-income individuals buy coverage in the private market.

The U.S. House Ways and Means Committee advanced its portion of the bill, and the U.S. House Energy & Commerce Committee approved its bill March 9. Both bills will now move to the House Budget Committee where they will be merged. Republican leadership reportedly hopes to move the merged bill to House floor in the next few weeks.

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WHA Physician Leaders Council Requests Additional MEB Clarity on PDMP Compliance

Council also discusses 2017 goals, ACA repeal and replace, and state budget

WHA Physician Leaders Council meeting March 2, 2017In a WHA letter to the Medical Examining Board (MEB) sent March 9, the WHA Physician Leaders Council asked the MEB to consider providing via MEB resolution additional clarity to physicians regarding the MEB’s intent regarding physician discipline and the upcoming Prescription Drug Monitoring Program (PDMP) prescriber mandate. The letter, signed by the chair of the WHA Physician Leaders Council, Steve Kulick, MD, CMO ProHealth Care, was the result of discussions at the March 2 WHA Physician Leaders Council meeting. A copy of the letter can be found here: www.wha.org/pdf/WHALettertoMEB3-9-17.pdf.

“Physicians greatly appreciate the information contained in the PDMP and have significant interest in utilizing the PDMP to enable physicians to make more informed decisions,” wrote Kulick. “However, the Council has also been concerned that a well-intentioned mandate for use of a PDMP system has the potential to introduce additional, unintended regulatory complexity for physicians, particularly if the PDMP system is not optimally designed to be integrated into existing physician practice patterns and EHR resources.”

“It is clear that physicians across the state have many questions regarding multiple technical compliance questions regarding the new PDMP mandate and how the Medical Examining Board will be approaching physician discipline related to the April 1 mandate,” wrote Kulick. “By articulating a clear and common sense approach that aligns with the intent of the PDMP prescriber mandate, the Medical Examining Board can help physicians focus on the benefits of the PDMP and remove technical compliance concerns of physicians intending to make good faith use of the PDMP tool.”

The letter was one outcome of a detailed discussion by the WHA Physician Leaders Council at its March 2 meeting of a growing list of PDMP implementation concerns being identified by physicians and physician leaders in health systems across Wisconsin. Discussions were consistent with the concerns discussed at a WHA-organized February 28 meeting of multiple health systems with the Department of Safety and Professional Services (DSPS) including:

The critical importance for DSPS to expedite the implementation of an interoperable/integrated EHR solution for accessing the PDMP database.
The lack of progress by the PDMP vendor to have a widely available interoperable/integrated EHR solution before April 1.
Multiple, ongoing functionality problems with the new web-based PDMP.
Timeliness of response to questions and multiple organizations asking the same questions.
Staff also reported that following the February 28 meeting, DSPS indicated they would be taking additional steps recommended by WHA to help advance a successful full implementation of the PDMP including:
Create a PDMP user group to help formally inform DSPS and its vendor as they continue to implement the new PDMP.
Add new FAQs and resources to the PDMP website to address questions and concerns that are brought to DSPS’s attention, including information about how the MEB will interpret compliance requirements.
Add to the PDMP website a list of “known issues” that DSPS is working on, what the solution will be and the timeline for the solution.
WHA also offered to DSPS to help host or promote any additional educational webinars DSPS is planning regarding PDMP usage and implementation before April 1.

“The burden of regulatory complexity, intended or not, on physicians is a significant concern to physicians and their hospitals and health systems,” said WHA Chief Medical Officer Chuck Shabino, MD. Regulatory complexity adds to physician frustrations and professional dissatisfaction as even well intentioned regulations such as the PDMP mandate can erode trust in physicians’ professional judgement and negatively impact their ability to meet the public’s expectations to provide efficient, high-quality patient care. When regulations are added, government has an obligation to make sure that it is taking all steps possible to minimize the burden of those regulations. ”

2017 Physician Leaders Council Plans and Goals
As has been the case in prior years’ WHA goals, WHA’s 2017 goals includes a section addressing physician engagement in the integrated health care enterprise. At its March 2 meeting, the Council discussed WHA’s past and present integrated physician engagement and advocacy efforts, and potential topics and efforts the Council would like to focus on in 2017.

“As WHA’s members’ focus has evolved beyond the traditional ‘walls’ of the hospital to a presence as local and regional integrated health systems, WHA’s focus has similarly evolved,” said Shabino. “The physician component of our members’ enterprise is significantly larger, and WHA has been evolving to respond to those changes by enhancing WHA activities to incorporate, from the system prospective, physician issues, opportunities and initiatives.”

Legislative and Regulatory Input
Matthew Stanford, WHA general counsel, provided an overview of the Governor’s proposed state budget and other WHA advocacy efforts to the Council. As part of that overview, staff asked the Council for input on three policy items: A state budget proposal to permit licensing boards such as the Medical Examining Board to impose fines on licensees, the pros and cons of gathering workforce data as part of physician license renewal, and potential federal Stark/Anti-kickback reform.

The Council was particularly concerned with the state budget proposal that would authorize licensing boards to impose fines on licensees. The Council said the licensing boards already have broad authority to take a wide range of actions against licensees, each of which can impose significant financial costs on licensees. Council members did not see how imposing forfeitures would improve patient safety and would instead add another layer of regulatory subjectivity on physicians.

ACA Repeal and Replace
Joanne Alig, WHA senior vice president, policy and research, shared with the Council the latest developments related to the ACA. Her presentation discussed WHA’s policy priorities and advocacy strategies both in Washington, D.C. and Madison.

Alig said WHA has been fully engaged in the federal reform issue, making several trips to Washington to meet with Wisconsin’s congressional delegation. WHA staff has also delivered several letters and white papers to the congressional and state delegation along with state agency leaders to keep them fully informed on the impact reforms would have on their constituents. In addition, WHA Board Chair Cathy Jacobson recently appointed a subcommittee on health care reform to help WHA proactively engage and react to health care reforms as Congress and the President move toward repealing and replacing the ACA.

The next meeting of the WHA Physician Leaders Council is May 11.

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Wisconsin Hospitals Slash Readmission Rates, Penalties through Partnerships with Hospital Association, Multiple States


Wisconsin’s average penalty for 2017 will be 0.33 percent, which ranks the state at 17th when compared to other states
By: Jeff Lagasse, Associate Editor, Healthcare Finance News

The following article appeared in Healthcare Finance News, March 3, 2017 online edition.

Hospitals in Wisconsin have reduced their readmission rates, and the penalties applied to them by the Centers for Medicare and Medicaid Services, largely through local partnerships, according to a report from the Wisconsin Hospital Association.

Wisconsin hospitals began working with the WHA in 2012 in CMS’ Partnership for Patients Hospital Engagement Networks, and readmission rates began to decline appreciably, along with a host of other performance improvements.

The third phase of Partnership for Patients, the Hospital Improvement Innovation Network, was launched in September 2016; WHA’s participation in the HIIN over the next three years will be in partnership with the Michigan Health and Hospital Association and the Illinois Hospital Association as the Great Lakes Partners for Patients Network.

The partnership will allow the three states to pool their resources to offer education, training, data management and clinical expertise to all participating hospitals. The 79 Wisconsin hospitals enrolled in the HIIN are working with WHA to achieve an additional 20 percent reduction in harm and 12 percent reduction in preventable readmissions.

Leveraging these partnerships, Wisconsin hospitals have made headway in those readmissions by improving internal care processes, and by partnering with community agencies that help to care for patients once they leave the hospital.

Wisconsin’s average penalty for 2017 will be 0.33 percent, which ranks the state at 17th when compared to other states. Twenty-six percent of Wisconsin hospitals received no penalty, and no hospital will be penalized more than 1.51 percent.

When it came to the Value-Based Purchasing Program, 85 percent of eligible hospitals in the state received an incentive bonus, with the average bonus at about 0.7 percent. No hospital will be receiving a payment penalty over 0.65 percent.

The state’s hospitals have also made headway in the Hospital Acquired Condition (HAC) Penalty program. The number of Wisconsin hospitals receiving the HAC penalty has decreased each year;
16 percent of eligible hospitals will receive the penalty in fiscal year 2017.

Used with permission of Healthcare Finance News Copyright© 2017. All rights reserved.
 

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Register Now for the 2017 WHA Physician Quality Academy

May 10 and July 21, 2017
Glacier Canyon Lodge at The Wilderness Resort, Wisconsin Dells

** OR **

September 29 and November 3, 2017
Glacier Canyon Lodge at The Wilderness Resort, Wisconsin Dells

For more information and to register, visit: www.cvent.com/d/wvq5nm

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WHA Post-Acute Care Work Group Refines Focus, Develops Guiding Principles

WHA Post-Acute Care Work Group 3/3/2017Hospitals continue to increase their focus on post-acute care as they assume greater responsibility for patient outcomes following discharge from the hospital. The goal of WHA’s recently formed Post-Acute Care Work Group is to develop policy initiatives that improve the ability of hospitals and health systems to provide or locate post-acute care for their patients.

The Work Group held its second meeting March 3 at the WHA offices in Madison and began framing principles that will guide the development of its policy recommendations. The Work Group decided to focus its efforts on post-acute care provided during the first 90 days following a patient’s discharge from an acute care hospital. This focus is due, in part, to the impact of federal payment policies, including readmission penalties and bundled payments.

Additional guiding principles developed by the Work Group at the meeting recognize the increasing need for hospitals and post-acute providers to closely collaborate to improve patient outcomes after a hospitalization. The Work Group also recognized the challenges facing hospitals when planning for post-acute care for specific patient populations, including pediatric patients, patients with the most complex medical needs, patients who have dementia and mental health challenges and patients at the end of life. Shortages of direct care workers in post-acute settings, burdensome regulatory requirements, and reimbursement policies will also be addressed by the Work Group as it develops its policy recommendations. Finally, the Work Group will examine ways to improve access to high-quality, timely post-acute care.

The Work Group reviewed provisions in Gov. Scott Walker’s budget bill that affect post-acute care. Some of the significant items that may have an impact on post-acute care are rate increases targeted to the nursing home and personal care direct care workforce; elimination of the waiting lists for the Children’s Long-Term Support Program; increased funding for the Wisconsin Rural Physician Residency Assistance Program; and funding for the Board on Aging and Long-Term Care to provide ombudsman services to participants in the Include, Respect, I Self-Direct (IRIS) program.

WHA will continue to monitor these and other budget items, as well as advocate for provisions advantageous to our membership.
 

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Gov. Scott Walker Confirmed As WHA Advocacy Day 2017 Luncheon Keynote

Make sure your hospital teams are registered!

Gov. Scott WalkerGov. Scott Walker is confirmed as the luncheon keynote speaker at WHA’s Advocacy Day 2017, April 19 at the Monona Terrace in Madison. You won’t want to miss this event, perfectly timed to fall during legislative action on the state budget. Assemble and register your hospital groups now at: www.cvent.com/d/svqylc.

“WHA is pleased to, once again, have Governor Walker as the luncheon keynote speaker at Advocacy Day,” said WHA President/CEO Eric Borgerding. “From the release of his proposed state budget to working with other governors and national leaders on potential changes to the Affordable Care Act, we know our attendees will want to be at Advocacy Day to hear from him.”

The morning keynote is Amy Walter who is known as one of the best political journalists covering Washington, D.C., having worked for multiple news outlets. Walter has built a reputation as an accurate, objective and insightful political analyst. The morning sessions will include the always-popular state legislative leader panel discussion.

Register for Advocacy Day with a legislative visit in the afternoon. WHA strongly believes the afternoon legislative meetings are the most important part of the day. With the state budget process in full swing, this is your opportunity to make the voice of hospitals heard on priority issues liked Medicaid, behavioral health and workforce funding. To prepare attendees for their meetings, WHA schedules all meetings and provides an issues briefing at Advocacy Day. Additionally, WHA will host an optional pre-event webinar on these legislative visits April 11 at 9:00 a.m.

Make sure you and your teams are registered before March 17 to be entered into our early bird drawing. Register today at: www.cvent.com/d/svqylc. For Advocacy Day questions, contact Jenny Boese at 608-268-1816 or jboese@wha.org. For registration questions, contact Kayla Chatterton at kchatterton@wha.org or 608-274-1820.

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Bipartisan, WHA-Supported Legislation will Expand Use of Dental Hygienists


Several Wisconsin legislators, including Sens. Sheila Harsdorf and Tim Carpenter and Reps. Kathy Bernier, Joe Sanfelippo and Evan Goyke, are poised to introduce a bill that will change current law to expand access to preventive oral health care through dental hygienists. The Wisconsin Hospital Association (WHA) has joined a coalition of hospitals, health systems, dental hygienists, physicians and dentists in supporting this bill, which will fully leverage the skills and services of dental hygienists to enable them to provide care directly, without dentist supervision, in additional care settings including hospitals, medical clinics and nursing homes. This proposal is both a policy recommendation of WHA’s Medicaid Policy Workgroup and one of WHA’s priority agenda items for 2017.

Wisconsin’s Medicaid program has struggled to provide access to essential oral health care for adults and children enrolled in the program. According to the Wisconsin Medicaid program’s most recent access plan from December 2016, data shows the fee-for-service Medicaid population utilizes dental services at a low rate—with only 43 percent of children and 34 percent of adults utilizing dental services.

Safety net providers—including hospitals and low-income clinics—are helping to fill this access gap. WHA Information Center data from 2015 shows that over 33,000 emergency room visits were attributable to preventable dental conditions.

Expanding access to preventive oral health care could help to prevent avoidable hospital emergency department visits. By expanding practice settings for dental hygienists, passage of this legislation will further the important public health goal of expanding access to preventive oral health care for all Wisconsin residents.

The bill is being circulated for co-sponsorship through March 10, and the WHA government relations team expects the Legislature to take quick action on the bill yet this spring.

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