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Physician Edition

03-21-2018


March 21, 2018

Volume 6-Issue 6


Gov. Walker Signs WHA-Championed Emergency Detention Bill

Bill implements recommendations by WHA Behavioral Health Task Force

On March 7, Gov. Scott Walker signed Assembly Bill 538, which enacts recommendations made by WHA’s Behavioral Health Task Force to better define in statute hospitals’ and physicians’ roles in Wisconsin’s mental health emergency detention process. 

Signed into law as 2017 Act 140, the new law addresses liability concerns raised by hospitals and physicians when a health care provider disagrees with a law enforcement officer or county crisis agency determination to not proceed with an emergency detention of a patient. The new law also addresses a regulatory inconsistency between Wisconsin’s emergency detention law and the federal Emergency Medical Treatment and Active Labor Act (EMTALA), and more clearly aligns Wisconsin law and HIPAA regarding disclosures to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

“Wisconsin’s hospitals and emergency departments are often the safety net for patients suffering a psychiatric crisis,” said Eric Borgerding, WHA president/CEO. “This new law takes important steps to ensure patients in need of emergency psychiatric treatment receive the best, most appropriate care.”

“Assembly Bill 538 was crafted through the bipartisan leadership of Representatives John Jagler and Eric Genrich and Senators Rob Cowles and Janis Ringhand from recommendations created by WHA’s Behavioral Health Task Force,” said Borgerding. “WHA has been proud to work with these lawmakers on this important legislation and applauds Governor Walker for signing Assembly Bill 538 into law.”

In summary, Act 140 makes three changes to Wisconsin law:

  • Liability clarification.  Wisconsin is unlike other states that provide health care providers in emergency departments authority to initiate an emergency detention. Instead, in Wisconsin, law enforcement and county crisis agencies have the sole authority to initiate and approve a detention. To address liability concerns and reduce the likelihood of conflicts between medical staff, law enforcement and county crisis staff, the bill provides better clarity in statute that a health care provider’s liability to a patient or other person is limited to the health care provider’s authority under Wisconsin law to seek, but not initiate, an emergency detention. The bill further clarifies that a health care provider may fulfill a duty to warn by contacting law enforcement or the county crisis agency.
     
  • Regulatory protection/emergency department approval of a transfer. The bill removes the possibility that an emergency department could receive an EMTALA citation for an inappropriate transfer due to a transfer decision made by law enforcement or a county without the emergency department’s sign off.  Specifically, consistent with EMTALA, the bill now requires that the emergency department agree that a transfer to another facility is medically appropriate before law enforcement may transport a patient under an emergency detention from the emergency department. 
     
  • Disclosure of health care information. The bill also addresses a 2010 Court of Appeals case that concluded that an individual may be prohibited under Wisconsin law from disclosing information in good faith to a person in order to warn the person about a patient’s substantial probability of serious physical harm to the person. The bill explicitly aligns Wisconsin law with HIPAA law by clarifying that a health care provider may disclose health care information in a good faith effort to prevent or lessen a serious and imminent threat to the health or safety of a person or the public to the extent permitted by HIPAA.

“Wisconsin’s emergency detention process is unique, complex, and impacts multiple stakeholders,” said Matthew Stanford, WHA general counsel. “Guided by recommendations from WHA’s Behavioral Health Task Force and following months of conversations and negotiations with stakeholders like the Wisconsin Counties Association to effectuate those recommendations through this bill, these changes are one more step toward a better functioning emergency detention system across Wisconsin.”

WHA detailed summary of the new Act 140 emergency detention reforms now available to members

WHA prepares summaries of new laws passed during the 2017-18 Wisconsin legislative session that could impact Wisconsin’s hospitals and health systems. WHA legal and government relations staff has prepared a more detailed summary of Act 140, available in the WHA members only portal.

The summaries are for WHA members only and will not be generally accessible on its website. Instead, they are posted to the WHA member portal, which can be found either at http://members.wha.org or by clicking on the “WHA Members Only” Icon on the www.wha.org website. Once in the WHA member portal, the summaries can be found in the dropdown menu under the “Legal Resources” tab. The member portal 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 http://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.

WHA member forum webinar focuses on Act 140 emergency detention reforms

On March 23, from 12 noon – 12:45 p.m., WHA will offer a WHA member forum webinar entitled “New Wisconsin Emergency Detention Law:  Regulatory Reforms Impacting EMTALA, Liability, and Disclosure.”

This webinar is complimentary for WHA hospital and corporate members, but pre-registration is required. To register, visit: www.whareg4.org/WIEmergencyDet. For content questions, contact Matthew Stanford at 608-274-1820 or mstanford@wha.org. For registration questions, Kayla Chatterton at kchatterton@wha.org or 608-274-1820.

Top of page (3/9/18)
 

Fort Healthcare CEO Mike Wallace Reflects on Public Health, Leadership and the role of WHA in Becker’s Interview

Written by Alia Paavola, Becker’s Hospital Review, March 13, 2018

Since joining Fort Atkinson, Wis.-based Fort HealthCare as president and CEO in 2006, Michael Wallace has implemented a vision and executed strategies to improve health outcomes in the community and the state of Wisconsin.

Mr. Wallace’s vision, leadership and dedication helped Jefferson County, where Fort HealthCare is located, move from the 33rd spot out of 72 counties to the 9th spot in 2017 on the University of Wisconsin Population Health Initiative rankings for overall health outcomes.

In addition to his executive leadership role at the health system, Mr. Wallace, an untiring advocate for better health in Wisconsin, served as the chairman of the Wisconsin Hospital Association, is a fellow in the American College of Healthcare Executives and holds a board position at Wisconsin Manufacturers and Commerce.

Here, Mr. Wallace discusses a few key takeaways from his role at the WHA, describes his best colleague and shares his thoughts on the future of rural healthcare.

Note: The following responses were lightly edited for length and clarity.

Question: What is your favorite part about being a CEO in the healthcare industry?

Michael Wallace: I think short and sweet, articulating a vision and making it happen. I enjoy talking about things, organizing people and seeing it come to fruition a few years later. Taking concepts and making them a reality is something I enjoy. An example of a vision that has come to fruition is changing our mission. About eight years ago we changed our mission and vision to improve the health and wellbeing of our community…and our vision was to become the healthiest community in Wisconsin. We organized ourselves in a way and held up our benchmark, and the work that we’ve done has moved us into the top 10 out of the 72 counties when we started out as 33rd. There’s a lot that’s gone into making it happen, but the main thing I enjoyed was keeping that vision and executing it.

Q: What are a few key takeaways from your role at the Wisconsin Hospital Association?

MW: I think an awful lot about the WHA, and a main takeaway is that advocacy works. Testimonials from the field drive the legislative process. Legislators want to hear how a policy will impact operations or how the lack of legislative action would affect players in the healthcare space. I am a firm believer in the process. We are the face of healthcare and if we are not out trying to improve or represent our constituents we will not be represented. 

Another thing is the culture of ‘competitors coming together for the greater good’—players from Milwaukee, Madison and other metropolitan areas are considered competition, but the entire group comes together and spins their hats around to collaborate. A good takeaway from this is just knowing to set aside individual silos and organizational strategies to find the areas of agreement.

Q: If you could change one thing about healthcare overnight, what would it be?

MW: I would increase patient engagement, prevention and self care. People can no longer be passive in healthcare. While [providers] can offer counseling, interventions and other services—the single greatest determinant of a patient’s health is the decision or decisions he or she makes outside of the hospital or doctor’s office.

I think this lack of patient engagement is a challenge in healthcare. We have insulated the patient or consumer too much from the true cost of care and accountability for their overall health outcomes. We can put together outstanding care plans detailing what people should do, and then they leave the ER, or office and the noncompliance of the patient causes the patient to boomerang…they crash, they come back…we rescue and save them again. We are very good at that. But we should be better at the public health approach. So much of what we treat is lifestyle driven illness; we know it’s treatable, manageable and, in many cases, curable but patients need to be engaged. They can’t just wait for the magic pill or intervention. I wish I could change the level of engagement overnight.

Q:  Describe one of your best colleagues. What is it that this person brings that is indispensable to your organization?

MW: The people who have had the most influence on me, both presently and in the past, are leaders with a people-oriented leadership style. Healthcare is a people-oriented business; we take care of people so it takes that type of leadership style. People in those leadership roles need to be visible, available and approachable. You have to have all three. There are many leaders that are visible but not approachable…it’s finding that blend to be in touch with what will make the organization better.

Q: What is one piece of advice you would offer to other CEOs?

MW: I’d say visualize the outcome you want and then go get it. I also like the phrase ‘try hard, fail fast, move on, start over…’ You’re one step closer to a solution if the last one didn’t work. But don’t let perfect get in the way of good. I like to be 8 for 10 rather than 3 for 3…Failure is the byproduct of trying to move an organization forward. If I get 8 of 10 things right, I am going to end up further along, closer to my vision than if I wait to be sure about everything to get that perfect 3 for 3.

Q: Are you optimistic about the future of rural healthcare?

MW: I am very optimistic. I think rural health is critical to the overall success of our healthcare delivery system. Simply stated, as you decrease access to care you increase cost of care. Rural health increases that access and can overall lower that cost. That upper respiratory infection that can be treated with a script of antibiotics…if you decrease access to that care, it becomes full-blown pneumonia, it becomes an ER visit with a $10,000 hospitalization and yeah, we saved the patient, but if they had better access to care or if we preserved rural healthcare, we can mitigate some of those conditions with early detection, prevention and wellness. All roads can’t lead to the big city, certainly some roads need to lead there for tertiary care, but it’s in our interest to preserve and protect the rural healthcare system.

This article was published in Becker’s Hospital Review March 13, 2018. Find at: 
www.beckershospitalreview.com/hospital-management-administration/fort-healthcare-ceo-michael-wallace-on-executing-a-vision-i-like-to-be-8-for-10-rather-than-3-for-3.html

Top of page (3/16/18)

CMS Announces Future Overhaul of Meaningful Use Requirements

Changes to federal payment programs will focus on reducing regulatory burden and increasing EHR interoperability

The Centers for Medicare & Medicaid Services (CMS) intends to implement a “complete overhaul” of federal payment programs that require hospitals and many physicians to demonstrate meaningful use of electronic health record (EHR) technology in order to avoid Medicare penalties. This announcement was made by CMS Administrator Seema Verma March 6 during her remarks at an annual conference hosted by the Healthcare Information & Management Systems Society (HIMSS).

Verma told conference attendees CMS is planning to make changes to the EHR Incentive Programs and to the Advancing Care Information performance category of the Quality Payment Program in order to reduce the time and cost required for providers to comply with these CMS programs and to focus on “increased interoperability and giving patients access to their data across all [CMS] programs.”

CMS’s announcement comes less than a month after enactment of the federal Bipartisan Budget Act of 2018, which removed the statutory requirement that CMS make the meaningful use requirements of the Medicare EHR Incentive Program more stringent over time. (See 2/16/18 Valued Voice article.)

Over the years, WHA has engaged CMS on the meaningful use reporting requirements of the EHR Incentive Programs and Quality Payment Program, expressing support for Congress’s and CMS’s vision of widespread use of interoperable EHRs to support improved clinical care, better coordination of care, and fully informed and engaged patients. As CMS implements changes to the EHR Incentive Programs and Quality Payment Program in 2018 and future years, WHA looks forward to continuing to engage CMS in the development of policies that provide hospitals and physicians with greater flexibility and less regulatory burden.

Also during her remarks at the HIMSS conference, Verma unveiled “MyHealthEData,” a new CMS initiative for EHR interoperability. As explained in a press release issued by CMS March 6, “MyHealthEData will help to break down the barriers that prevent patients from having electronic access and true control of their own health records from the device or application of their choice.” As part of this new initiative, Verma announced a new CMS tool called “Blue Button 2.0.” CMS describes this tool as “a new and secure way for Medicare beneficiaries to access their personal health data in a universal digital format.” According to CMS, more than 100 organizations have agreed to use Blue Button 2.0 to develop applications “that will provide innovative new tools to help [Medicare] patients manage their health.”

For more information, contact Andrew Brenton, WHA assistant general counsel, at abrenton@wha.org or 608-274-1820.

Top of page (3/9/18)

WHA-Backed Rural Training Grant Applications Available Soon

Webinar Informs WHA members on new advanced practice clinician training opportunities

The Department of Health Services is in the process of developing a Request for Applications (RFA) for new advanced practice clinician training grants. The new grant program, spearheaded by WHA, is modeled after the successful WHA-led matching grant GME initiative that has spurred a nearly $22 million investment by state and private sector partners to create more physician residency capacity, especially in rural Wisconsin. WHA President/CEO Eric Borgerding notes, “Applying this same concept to training for advanced practice clinicians and allied health professionals will expose more individuals to rural communities and help address rural workforce shortages.”

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 release of the RFA is tentatively scheduled for mid-March.

WHA will hold an informational webinar about these new grant opportunities and the application process March 19 from 10:30 – 11:30 a.m. 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 content questions, contact Ann Zenk at 608-274-1820 or azenk@wha.org. For registration questions, contact Kayla Chatterton at kchatterton@wha.orgor 608-274-1820.

Top of page (3/9/18)

 

WHA Offers Advanced Practice Clinician Conference

Understand and grow your APC workforce

On September 13, WHA will bring together those interested in examining the challenges and opportunities for integrated care delivery associated with the use of advanced practice clinicians (APCs). “WHA Advanced Practice Clinician Conference: A Comprehensive Look at APC Practice Challenges and Opportunities for Integrated Care Delivery in Wisconsin” will be held at Glacier Canyon Lodge at The Wilderness Resort in Wisconsin Dells. Additional information and online registration are now available at www.cvent.com/d/hgq74q.

The program will provide a comprehensive review of key regulations and payment policies, education and training, scope of practice, and onboarding and retention trends. This one-day conference is designed for hospital and clinic leaders, clinicians in leadership and practice roles, human resources and recruiting specialists and all others who need to understand and navigate nuances, limitations and opportunities to support and maximize the integration of APCs within their organizations.

Registration is open at www.cvent.com/d/hgq74q. Direct content questions to Ann Zenk (azenk@wha.org) or Matthew Stanford (mstanford@wha.org). Registration questions can be directed to Kayla Chatterton at kchatterton@wha.org or call 608-274-1820.

Top of page (3/16/18)

2018 County Health Rankings Data Valuable to CHNA Process

Hospitals and health systems have looked forward to the release of the 2018 County Health Rankings because the data collected and shared in this annual report from the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute is helpful in the community health needs assessment (CHNA) process. The Health Rankings make it clear that good health includes many factors beyond medical care, such as education, jobs, smoking, access to healthy foods, and more.

Wisconsin county-specific information is available here: www.countyhealthrankings.org/explore-health-rankings/reports/state-reports/2018/wisconsin. You can compare counties based on key demographic, social and economic indicators here: www.countyhealthrankings.org/explore-health-rankings#county-select-38.

This year’s rankings show that health gaps persist not only by place, but also among racial and ethnic groups. These gaps are largely the result of differences in opportunities in the places we live.

The 2018 County Health Rankings Key Findings Report highlights social and economic factors that drive health. This year’s data shows:

  • After nearly a decade of improvement, there are early signs that the percentage of babies born at low birthweight may be on the rise (a two percent increase from 2014). In all 50 states, there is a higher percentage of Black low birthweight babies than for other racial groups.
  • Some places and groups of people have fewer social and economic opportunities, which also limits their ability to be healthy. More than 1 out of every 5 youth in the bottom performing counties do not graduate from high school in four years. For American Indian/Alaskan Native, Black, and Hispanic youth, it is 1 out of 4.
  • Residential segregation provides a clear example of the link between race and place. For instance, in smaller metro and large urban counties, Black residents face greater barriers to health and opportunity. Black residents have higher rates of child poverty, low birthweight, and infant mortality, and lower high school graduation rates than White residents.
  • Child poverty rates remain at levels higher than those of the pre-recession era despite declines in recent years. Patterns of recovery vary by both race and place. Child poverty rates have been slow to rebound in rural counties and in those with a greater share of people of color.
  • Teen birth rates have been declining across community types and racial groups for more than a decade. Yet gaps by place and race persist. For example, teens in rural counties have seen the least improvement and continue to have the highest birth rates, nearly twice the rate of teens in suburban counties. American Indian/Alaskan Native, Hispanic, and Black teens have birth rates twice as high as White or Asian teens.

Hospitals, health systems and local health departments can use the rankings to support their work and invite new partners to the table—leaders in education, business, and community development—to take action and put healthy choices within everyone’s reach.

The County Health Rankings & Roadmaps program offers data, tools, and resources in the Roadmaps to Health Action Center so hospitals, community partners, and local health officials can accelerate their health improvement efforts.

Top of page (3/16/18)
 

WHA Foundation Announces Scholarships for Hospital Team Simulation Training

High fidelity clinical simulation provides an environment for a health care team to experience infrequently encountered clinical scenarios, as well as practice and improve team communication. Across Wisconsin, high fidelity simulation labs are available to hospitals; however, cost, scheduling and other logistical issues can be a barrier to participation for some.

Since 2016, the WHA Foundation has provided scholarships to 40 Wisconsin hospitals, allowing them to participate in a variety of simulation training scenarios, including high-risk OB delivery, pediatric trauma, and severe sepsis/septic shock. The feedback from these simulation training experiences were overwhelmingly positive, leading the WHA Foundation to continue this program in 2018.

The WHA Foundation has granted funding to provide another 20 scholarships in 2018, for interdisciplinary teams to participate in clinical simulation training, choosing from stroke, OB or severe sepsis/septic shock scenarios.

Four simulation labs across the state have partnered with the WHA Foundation to offer hospital teams hands-on simulation experiences. This is an excellent opportunity for hospitals who might have limited access to high fidelity simulation.

For complete information on scholarship eligibility and criteria, visit the WHA Foundation webpage.

To apply for a scholarship, visit: www.surveymonkey.com/r/18SimScholarship. The submission deadline is 5:00 pm CST on April 6, with notification by April 13. A maximum of 20 scholarships will be awarded, so hospitals are encouraged to apply as soon as possible. Direct any questions to Jennifer Frank at jfrank@wha.org.