Physician Edition

04-04-2018


April 4, 2018

Volume 6-Issue 7


School Safety Bill Signed into Law

Includes WHA amendments protecting health care providers acting in good faith

On March 26, Gov. Scott Walker’s School Safety Plan was signed into law as 2017 Act 143, which included key WHA-promoted amendments to a statute-based reporting obligation on health care professionals first proposed by the Governor in mid-March.

WHA raised concerns that the bill as originally drafted was inconsistent with nationally recognized duty-to-warn and emergency detention standards, and left health care providers acting in good faith vulnerable to having their professional judgment second guessed by prosecutors and trial attorneys.

While Act 143 retains a statutory reporting obligation on health care professionals, key WHA changes to the bill included:

  • Amending the reporting obligation consistent with current standards. The original bill language created an additional and vague reporting standard that would have required reporting of any threat of violence in a school even when a health care provider in her professional judgment did not believe an imminent danger existed. WHA was successful in changing the bill’s language to require both a threat and a determination of a serious and imminent danger to school safety, which is consistent with duty-to-warn case law, HIPAA and imminent danger standards under Wisconsin’s emergency detention statute.

Thus, in practice, because the bill as amended better aligns with existing standards, there should be little impact on providers’ existing protocols when a health care provider perceives a serious and imminent danger to others.

  • Including civil and criminal immunities to protect against second-guessing of a professional’s judgment. While the original bill language created immunities when a health care provider made a report to law enforcement, the bill provided no protections to health care providers that in good faith and in their professional judgment determined that a threat was not subject to report. WHA expressed concerns that this left health care providers vulnerable to second guessing by prosecutors and law enforcement.

After highlighting similar statutes in other states, WHA was successful in amending the final bill to include civil and criminal immunity for health care providers who in good faith and in his or her professional judgment conclude that a threat does not pose a serious and imminent threat to the health or safety of a student, school employee or the public.

The incorporation of these changes to the school safety legislation to minimize reporting burdens on health care professionals come on the heels of several WHA-championed mental health emergency reforms signed into law March 7 as 2017 Act 140 (see www.wha.org/wha-newsletter-3-9-2018.aspx#s1). A summary of those reforms is available in the WHA member portal, which can be accessed by clicking on the “WHA Members Only” icon on the www.wha.org website. In addition, a summary of sections 6, 20, and 23 of the School Safety Plan enacted as Act 143 that promulgates the health care professional reporting obligation in statute will be posted to the WHA member portal shortly.

For more information, contact Matthew Stanford, WHA General Counsel, at 608-274-1820 or mstanford@wha.org.

Top of page (3/30/18)

 

The Other March Madness

WHA-championed GME grant programs score results on resident match day

Wisconsin Hospital Association (WHA) and Wisconsin Council on Medical Education and Workforce (WCMEW) reports highlight current and impending physician workforce shortages.

“Wisconsin’s aging physician workforce and aging patient population are creating challenges for the state’s health care delivery system. Data shows Wisconsin needs between 2,000 and 4,000 additional physicians by 2035,” according to Chuck Shabino, MD, WHA chief medical officer and WCMEW board chair. “We know that graduate medical education is a key factor in where physicians end up practicing, and funding GME is a successful model to recruit and retain physicians in Wisconsin.”

Wisconsin has made significant progress expanding medical school class size at both The Medical College of Wisconsin (MCW), which has opened two new campuses, and the University of Wisconsin School of Medicine and Public Health (UWSMPH), which has gradually increased the class size of their program, the Wisconsin Academy of Rural Medicine (WARM), since its inception in 2007.

As Wisconsin medical schools increase enrollment to meet demand, and more medical students march toward physician practice, more residency positions are vital. Match Day, when graduates find out their residency position, is a day that medical school seniors anxiously await. The big day for 2018 grads came March 16. The 2018 Match Day was the largest in National Resident Matching Program history. Nearly 370 graduates from MCW and UWSMPH were among the 37,103 graduates applying for positions nationally. All 370 Wisconsin graduates have been matched to residencies.
 

The percent of Wisconsin graduates entering residencies in primary care increased from 40 percent last year to 42 percent in 2018. This growth in Wisconsin primary residencies is not by chance. It is the result of WHA-championed graduate medical education (GME) grant programs administrated by the Department of Health Services creating new residency opportunities in Wisconsin. Wisconsin is on track to have almost 80 new medical residents by 2021 as a result of the WHA-backed program. The new residency positions have been focused on primary care, and in addition to family practice, internal medicine and pediatrics, include general surgery, psychiatry and rural medicine.

“We’ve struck the right path and it is shaping up to be a successful public-private model,” said WHA President/CEO Eric Borgerding. “Now we need to build on this ‘grow our own’ approach to make sure Wisconsin has enough caregivers for our future.”

Wisconsin graduates matching to Wisconsin residencies also increased from 2106 and 2017. Overall, 26 percent of MCW graduates matched to Wisconsin residencies. That percentage more than doubled, to 53 percent, for graduates of the MCW Green Bay program. Thirty-three percent of UWSMPH graduates will remain in Wisconsin. Over half of the graduates of UWSMPH’s WARM program will be entering residency positions in-state.

Physicians from UWSMPH’s WARM program score big with 89 percent practicing in Wisconsin upon completion of their residency training, validating WHA’s “grow our own” approach.

“We know if a student growing up in Wisconsin attends a Wisconsin medical school and completes a residency here, there is an 86 percent chance a physician who specializes in primary care will practice in Wisconsin,” Shabino said. “We call it the ‘86 percent equation,’ and we have been focusing on each of the components from a public policy perspective. It’s a textbook example of identifying a problem and then working with WHA members and physician leaders, and state agencies and elected officials to craft solutions.”

Top of page (3/30/18)

 

 

Nearly 1,000 Hospital Advocates Attend WHA’s Advocacy Day

Hundreds descend on the Capitol to lobby legislators against worker's comp fee schedules, other key issues

Nearly 1,000 people filled an exhibit hall at Madison’s Monona Terrace March 21 to attend WHA’s 2018 Advocacy Day and hear keynote addresses from Lieutenant Governor Rebecca Kleefisch and Mara Liasson, correspondent for NPR and contributor to Fox News Channel. Over half of the attendees also ventured up to the state capitol in Madison to meet with their state senator and representative on issues impacting Wisconsin’s hospitals, including Medicaid reimbursement and a proposal to implement a government fee schedule in Wisconsin’s worker’s compensation program.

 

Bob Van Meeteren, WHA Board chair and president/CEO of Reedsburg Area Medical Center, welcomed attendees to Advocacy Day. “Every year that I’ve attended Advocacy Day, I am so impressed by the number of people who gather for this event and the passion you all have for your community hospitals, and this year is no different,” said Van Meeteren.

To kick off Advocacy Day, Van Meeteren introduced a video message from Gov. Scott Walker, recorded in advance at the Governor’s residence in Madison. In his remarks, Walker thanked everyone in attendance for contributing to Wisconsin’s achievement as the best state in the country for high-quality health care.

“On behalf of our citizens, I want to say thank you! We are so proud that our health care systems in Wisconsin are ranked number one in the nation for quality. That is so important to individuals and families all over the state, as our health is a top priority. It is also a great recruiting tool for top talent and new employers to the state,” said Walker.

The Governor told the crowd he is “proud to have such a great working relationship with WHA staff and members,” and highlighted several accomplishments achieved by working together.

“We’ve made major investments in Medicaid to keep our systems strong and to care for those in need. We even added more through the Disproportionate Share Hospital (DSH) program,” said Walker, referring to the last budget he signed into law, which increased Wisconsin’s DSH program by $25 million in state funds. The Governor went on to talk about additional investments in the state’s health care workforce, medical education campus expansion, eliminating the waiting period for children’s long-term care services and recent legislation—signed into law at Tomah Memorial Hospital—to create a reinsurance program in Wisconsin to help stabilize the individual health insurance market.

“Together, we will continue to reinforce Wisconsin’s reputation as a national leader in health care. Thank you for your service to your system, your community and to our state.”

Top of page (3/23/18)

Liasson Commends States for Taking the Lead on Public Policy, Despite National Political Polarization

Following American politics today is like riding a roller coaster in the dark—there is no way to know where it’s going to turn next. This dramatic ride is exacerbated by increasing polarization in both our political system and social communities. Those are just a few of the many takeaways left by journalist and political pundit Mara Liasson, political correspondent for National Public Radio (NPR) and regular contributor on the Fox News Channel, when she addressed the crowd at WHA’s Advocacy Day 2018.

Liasson said today’s political polarization is “the biggest and most important dynamic in American politics today,” and that it can be seen most clearly in Congress where conservative Democrats and liberal Republicans used to come together in the center to make deals and move legislation forward. However, today, we have congressional gridlock, which has led to stagnation on a myriad of legislative issues from gun control to immigration to tariffs and, of course, health care.

Because of this, people are turning to their state governments to get things done, particularly when it comes to health care in the wake of failed attempts to repeal the ACA.

“What your health care looks like depends on where you live,” Liasson said. “Blue states are going to have systems more like the ACA, and red states are going to have systems more like pre-ACA.”

Liasson made note of state governments that are innovating and taking the lead, including what has been accomplished here in Wisconsin. “You’ve been able to bring your uninsured rate down, and even if you haven’t expanded Medicaid, you’ve been able to get more people on Medicaid,” she said. “You are using the tools of the ACA to shape the system to your own needs. And that is the trend we’ll see continuing—more and more states taking the lead.”

Despite national polarization, she noted Gov. Scott Walker’s approach to health care saying, “Look at your own Governor. He’s found bipartisan solutions for some of these problems, and I think [it’s] possible.”

When looking ahead to the November elections, Liasson predicts an increased focus on local issues, furthering this look to state governments for progress. While midterm elections are traditionally seen as a referendum on the majority party and incumbent president, no single issue will dominate the national conversation this fall. Rather, the hot issues will depend on where you live and what matters locally, such as gun control in Florida.

Liasson doesn’t see our national polarization going away anytime soon, but does sense a change in engagement. “There is a tremendous upsurge in basic, ordinary, day-to-day citizenship,” with more people paying attention and running for office at all levels of government.

Top of page (3/23/18)


Kleefisch Praises WI Hospitals’ Engagement in Project SEARCH,

 
HOPE Agenda

Lieutenant Governor Rebecca Kleefisch addressed advocates at WHA’s Advocacy Day in Madison March 21. As a cancer survivor who has experienced first hand the world-class health care available in Wisconsin, she applauded the group for their hard work and commitment to their patients.

“When you go through a health care event like that, you don’t forget that you live in a state with the greatest health care around. I am living proof of that.”

Kleefisch acknowledged Wisconsin hospitals’ very active role in Project SEARCH, an initiative giving employment opportunities to individuals with disabilities in all sectors of the economy, as well as the administration’s Heroin, Opiate, Prevention, and Education (HOPE) Agenda.

She referenced Wisconsin’s record unemployment rate saying, “We need everyone engaged in our economy. The members of the Project SEARCH family are given extraordinary opportunities by people like you to get engaged in the economy.” Several Wisconsin hospitals and systems participate in Project SEARCH.

Kleefisch co-chairs the Governor’s Task Force on Opioid Abuse with Rep. John Nygren, and she commended Wisconsin hospitals for their efforts in combatting opioid abuse, leading the nation by example.

“In what we have seen, the medical community and hospitals across Wisconsin in taking a stand against an epidemic, a true crisis, is very impressive. Thank you for your work.”

Top of page (3/23/18)

 

Advocacy Day Legislative Panel Shows Disagreement, Consensus on Key Health Care Issues

Health care policy leaders in the Wisconsin state Legislature participated in a panel during WHA’s 2018 Advocacy Day March 21, disagreeing on the approach states should take to provide Medicaid coverage for low-income Wisconsin residents but agreeing that the state’s worker’s compensation program is working well, showing opposition to a proposal currently languishing in the state Legislature to implement a medical fee schedule.

The panel, moderated by WHA’s President/CEO Eric Borgerding, included a bipartisan group of lawmakers: Sen. Jon Erpenbach (D-Middleton), Rep. Debra Kolste (D-Janesville), Rep. Joe Sanfelippo (R-New Berlin), and Sen. Pat Testin (R-Stevens Point).

Borgerding tied the panel's conversation around the top three issues facing hospital leaders in Wisconsin, including workforce, insurance stability and reimbursement from government payers.

Reinsurance program receives bipartisan support from panel; Medicaid expansion still heavily debated

While the first question from Borgerding was referring to the Governor’s recent reinsurance proposal signed into law to stabilize the individual health insurance market, the panel quickly began to debate Wisconsin’s decision to expand Medicaid coverage only for people living below the poverty line and not to those living between 100 percent and 133 percent of the federal poverty line (FPL).

Sen. Jon Erpenbach, a member of the state’s powerful budget-writing Joint Finance Committee and ranking Democrat on the Senate Health and Human Services Committee, reacted first to the question. “Yes, it’s a good step the Governor took, but it’s essentially the Governor—quoting a colleague of mine – putting out a fire that he started. Nothing will create instability more than the leaders of our state saying ‘Obamacare is going to go—it’s gone—it’s going to go.”

“Certain politicians in Wisconsin have yet to embrace that Obamacare is the law of the land,” said Erpenbach. “Medicaid expansion is still available, despite what the Governor has said and others have said that it is not or won’t be available.”

 

“The instability that we have seen here in Wisconsin is not unique to Wisconsin, so I don’t think it is fair to blame it on the direction that we took. To say that we didn’t do Medicaid expansion in Wisconsin is not correct; we did do a Medicaid expansion, we just chose to fund it differently,” said Assembly Health Committee Chairman, Rep. Joe Sanfelippo. “As a result, the Kaiser Family Foundation reported that Wisconsin is the only state in the country that does not have a gap in coverage even compared to states that did take the federal expansion.”

Sanfelippo continued by comparing Wisconsin’s experience with experiences of Medicaid programs in other states. “Taking the federal expansion is not the golden parachute that some say that it is, because the states that did take it are having as much—or greater—problems in their market than what we are seeing in Wisconsin.”

“Whether you agree with the Affordable Care Act or not, we can all agree on two things. One, the ACA has created a market and insurance rates that are unaffordable and unsustainable for a lot of our families here, and the other thing is that the ACA has provided coverage for a lot of people who did not have it before, so the last thing we want to do is to see that we roll that back,” said Sanfelippo.

Medicaid reimbursement concerns causing lawmakers to “think outside the box”

Wisconsin’s Medicaid reimbursement rates are the second worst in the country, only covering 65 percent of cost, said Borgerding. “Quite honestly, I think that number would be worse, except for the fact that hospitals in Wisconsin are doing a very good job controlling their costs.” Borgerding asked panelists what more can be done to address Medicaid reimbursement for Wisconsin’s hospitals and health care providers.

“This is obviously an issue that we hear quite a bit about—Medicaid reimbursement. We should look at how to increase payment as much as we possibly can within the confines of what we are able to do. A lot of it boils down to needing to think outside the box, do more on the preventive side, because an ounce of prevention is worth a pound of cure,” said Sen. Pat Testin.

Borgerding recognized Sanfelippo’s leadership on looking at new ways to deliver better care for patients in the Medicaid program, including a WHA-supported piece of legislation that Sanfelippo authored to create a care coordination pilot program for Medicaid enrollees, which received strong bipartisan support in the Legislature. Assembly Bill 871 was approved by the Senate March 20 and will now head to the Governor’s desk for his signature.

Borgerding also asked the panel their thoughts on a waiver from the Walker administration that would require Medicaid enrollees to take on additional cost-sharing requirements, including co-pays and premiums.

“You are not alone with your concerns regarding Medicaid reimbursement,” said Democratic Health Committee Ranking Member, Rep. Debra Kolste, “Regarding the waiver, I’m concerned that if we move forward with this even more people will be taken off the Medicaid rolls. When you take people off of Medicaid rolls without changing some of the other dynamics, there are just going to be increases in costs for uncompensated care.”

Lawmakers believe additional federal support for Medicaid should be used to fund health care

Borgerding asked those that supported Medicaid expansion to 133 percent FPL, rather than the Medicaid expansion Wisconsin did to 100 percent FPL, what EXACTLY they would do with any additional funding from the federal government resulting from changing Medicaid eligibility.

Erpenbach said he would “plug some holes” where the Legislature has taken money from to put into Medicaid, but “at the same time, I would plow most of that back into reimbursement.”

 

“Reimbursement rates are important and I would spend a significant amount on reimbursement rates,” said Kolste. “But we can also use this for training to get more people to come back into the health care workforce. I think it is important to use this to increase reimbursement rates.”

But Sanfelippo cautioned attendees on this question, “We are talking about this as if in states that have taken Medicaid expansion it is chocolate and roses and it’s not. They’re having the same problems. In fact, they are having them to a greater extent than what we are having here in Wisconsin.”

“Well maybe Wisconsin should show every other state how it should work and how it can work,” responded Erpenbach to Sanfelippo’s comments. “We should at least try, and the fact that we have not at least tried goes against everything Wisconsin stands for.”

“I think we are. Wisconsin is the only state in the country without a coverage gap—the only state—even when comparing those that took the expansion,” said Sanfelippo. “You can’t say we aren’t leading the way—we are.”

In asking the question, Borgerding noted that many legislators who have supported full expansion in the past have been more interested in using the federal dollars for other state spending, not for Medicaid.

Panel: Worker’s comp program working well right now; panelists express opposition to fee schedule

Borgerding then asked the panel about a proposed medical fee schedule in Wisconsin’s worker’s compensation program, a proposal that has been before the Legislature now two times—never getting enough support to even move out of a Senate or Assembly Committee. The legislation would have government set reimbursement rates rather than having those reimbursement rates negotiated between a health care provider’s and worker’s compensation insurance carrier.

“I haven’t seen anything that leads me to believe that we need a fee schedule,” said Sanfelippo, garnering applause from the Advocacy Day audience.

“I don’t support it,” responded Testin.

“I’m a scientist, I’m driven by data and results. There is nothing currently that says we should change the system; it’s been working. If you change the levers in a system something will go out of whack,” said Kolste.

“We have a national model here in Wisconsin, and there’s absolutely no reason in the world to change it at all – right now or into the foreseeable future,” said Erpenbach. “This is one of those change for the sake of change things that is just way off target.”

Erpenbach continued, recognizing that this year’s fee schedule proposal failed to even have one single legislator put their name as an author or sponsor of the legislation. “There is a reason why legislators are not putting their names on this, and there is a reason why legislators will continue to not put their names on this; we don’t need to make a change at all.”

 

Top of page (3/23/18)