May 22, 2017
Volume 5-Issue 10
WHA Physician Leaders Council Discusses PDMP, AHCA
Council provides feedback on WHA members’ integrated physician enterprise needs
The WHA Physician Leaders Council met May 11 and discussed a range of topics impacting physicians and physician practice within WHA’s member hospitals and health systems, including:
Latest developments on the American Health Care Act (AHCA), including WHA policy priorities and advocacy strategies;
Prescription Drug Monitoring Program (PDMP) functionality and efforts to expedite interoperability of PDMP data with EHRs;
A continued dialogue on how WHA can best support its members’ integrated physician enterprise now and in the future;
Building on the WHA Physician Engagement and Retention Toolkit, identifying additional resources to help physician leaders and organizations engage and retain their physicians;
WHA budget advocacy to expand graduate medical education (GME) program funding; and,
Rulemaking on standards for level III and IV trauma facilities.
WHA President/CEO Eric Borgerding and Jenny Boese, WHA vice president, federal affairs and advocacy, provided a report to the Council on the latest developments related to the AHCA in both Washington, DC and Madison, including WHA policy priorities and advocacy strategies. WHA along with hospital and health system leaders were in Washington, DC May 9 and met with both of Wisconsin’s U.S. senators. The key message of those meetings was the need to make key improvements to the AHCA in the Senate to protect Wisconsin’s coverage gains.
For more information about the AHCA and WHA’s discussions with Wisconsin’s U.S. senators, see www.wha.org/pubarchive/valued_voice/WHA-Newsletter-5-12-2017.htm#1.
PDMP Functionality and Interoperability
Matthew Stanford, WHA general council, provided the Council with an update on ongoing discussions with state officials regarding the Prescription Drug Monitoring Program (PDMP), including efforts to expedite interoperability of the PDMP data with electronic health records (EHRs), clarify requirements and address delegation issues.
Stanford discussed the WHA letter signed by WHA Physician Leaders Council Chair Steve Kulick, MD, requesting additional clarity regarding physician discipline related to the PDMP mandate, and the subsequent resolution by the Controlled Substances Board that provided additional clarity regarding that Board’s intent to use discretion in making referrals to licensing boards for non-compliance with the mandate (see www.wha.org/pubarchive/valued_voice/WHA-Newsletter-3-17-2017.htm#6).
Stanford also shared joint efforts by WHA and the Wisconsin Medical Society to clarify the ability of physicians to satisfy the PDMP review mandate by delegating the review to another individual as permitted by existing principles of medical delegation, as well as other clarifying language intended to create additional options for EHR connections to the PDMP data. (See story on the joint memo submitted by WHA and the Wisconsin Medical Society to the Controlled Substances Board and the Board’s action below.) Additionally, during the meeting, the Joint Finance Committee unanimously approved a recommendation to amend the state budget bill to include that clarifying change in statute regarding medical delegation (see www.wha.org/pubarchive/valued_voice/WHA-Newsletter-5-12-2017.htm#4).
Council members continued to talk about the benefits of having access to the PDMP database, but also raised concerns about the length of time the web-based PDMP can take to use as well as the utility and effectiveness of some of the alerts provided by the PDMP. For example, one member said for an average child psychiatrist seeing 25 patients per day, the total time that it takes to access the web-based PDMP adds up to around an hour of extra time in the physician’s work day. Others noted that especially for physicians in a multi-specialty clinic setting, some of the ePDMP alerts were not useful or created false positives. By moving to a flexible approach to interoperability with EHRs that focuses on the sharing of data and enabling providers to choose what analytics are most relevant to their practice, some of these concerns could be addressed.
Council members also expressed interest in learning more about newly available PDMP functionality for medical coordinators and supervisors. WHA staff said it would work with the Department of Safety and Professional Services (DSPS) to organize a WHA webinar for physician leaders that can better introduce and explain the new PDMP functionality.
WHA activities supporting members’ integrated physician enterprise
The Council continued a dialogue from its last meeting on how WHA can best support its members’ integrated physician enterprise now and in the future. The Council is a key component of WHA’s efforts to continuously define and identify how best WHA can meet members’ needs in support of members’ integrated physician enterprise.
"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 WHA Chief Medical Officer Chuck Shabino, MD. "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."
Physician retention and engagement
Building upon the 2016 WHA Physician Engagement and Retention Toolkit, the Council discussed the need for additional education or resources to help physician leaders and their organizations further engage and retain their physicians. Staff presented and sought feedback on potential options WHA could develop and provide to help physician leaders and their organizations regarding engagement and retention. In the coming weeks, look for additional announcements from WHA on new engagement and retention resources for physician leaders.
Legislative and regulatory update
WHA staff provided an overview of several additional current WHA legislative and regulatory advocacy efforts impacting physicians and physician practice within WHA’s member hospitals and health systems.
One of WHA’s budget advocacy efforts is to increase Wisconsin’s investment in the state’s GME matching grant program to help expand access to GME programs in Wisconsin.
"Wisconsin’s aging physician workforce and aging patient population is creating challenges for the state’s health care delivery system. Data shows Wisconsin needs between 2,000 and 4,000 additional physicians by 2035," said Shabino. "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."
Andrew Brenton, WHA assistant general counsel, provided an update to the Council on developing rulemaking that would impact level III and IV trauma centers, and in particular sought input from the Council regarding draft proposed standards that would place specific responsibilities on physicians. Brenton told the Council WHA staff has been working with the Department of Health Services (DHS) since DHS first proposed the development of a new rule in 2016 and that the rule has several more steps to go, including a public hearing, before the rule is finalized. Brenton said WHA will keep the Council informed as the rule further progresses.
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WHA Launches Physician Quality Academy
Physicians and providers from hospitals and health systems across the state attended the first session of the WHA Physician Quality Academy May 10. The Academy is designed to provide knowledge about quality improvement tools and principles to increase the likelihood that a physician will be more successful in and comfortable with his/her quality leadership role. The first session focused on designing and conducting quality improvement projects, engaging physician colleagues in quality improvement and measurement, physician profiles and the role of physician leaders in quality work.
"WHA is a recognized leader among hospital associations nationwide in offering our members the support and training necessary to successfully implement quality improvement projects in their organizations," according to WHA President/CEO Eric Borgerding. "The WHA Physician Quality Academy is a new resource that will assist our hospitals and health systems engage their physicians and help them lead quality improvement efforts within their health care organizations."
The format for the Academy combines didactic learning, exercises and generous time for discussion. "The academy participants were highly engaged throughout the day with discussion about how to apply the quality concepts being presented," said Kelly Court, WHA chief quality officer. "I was very impressed with the willingness of everyone to participate and share their experiences and advice with one another. This culture of sharing is very similar to what we see in our quality work with their non-physician counterparts."
Registration is still open for the second cohort of the academy on September 29 and November 3. The full event agenda and online registration are available at www.cvent.com/d/wvq5nm.
The Academy is jointly provided by AXIS Medical Education and WHA. AXIS Medical Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing education for physicians. AXIS Medical Education designates this live activity for a maximum of 10 AMA PRA Category 1 Credit(s)TM.
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WHA Offers Education on Newly Available Expedited Physician Licensure Process
With the Interstate Medical Licensure Compact’s voluntary expedited licensure process recently becoming operational, WHA will offer a 45-minute webinar on how the new Compact process can help physicians more quickly receive a Wisconsin medical license or a license in another state if the physician already holds a medical license in a Compact state.
WHA General Counsel Matthew Stanford will present information on eligibility, which states are participating in the Compact; completing the application process, applicable fees, how to maintain a Compact expedited license and considerations for utilizing the Compact expedited process versus the traditional licensure process.
The webinar, scheduled May 23 from 12:00-12:45 pm, is being offered via a partnership between WHA and the Wisconsin Medical Group Management Association (WMGMA). There is no fee to participate in this webinar, but pre-registration is required. Registration is now open at: www.cvent.com/d/z5qq0r.
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WHA, WMS Make Joint Proposal on PDMP Rule to Facilitate EHR Interoperability
On May 12, the Controlled Substances Board (CSB) held a hearing and took votes on CSB 4, a rule governing Wisconsin’s Prescription Drug Monitoring Program (PDMP).
During that meeting, the Board voted to make a change to the rule language so it would be consistent with amended statutory language recommended the day before by the Joint Finance Committee that would align PDMP review requirements with accepted practices of agency and medical delegation (see www.wha.org/pubarchive/valued_voice/WHA-Newsletter-5-12-2017.htm#4). The Board also voted to request the Department of Safety and Professional Services review its agreement with its PDMP vendor to help facilitate the integration of the PDMP with electronic health records (EHRs).
WHA and the Wisconsin Medical Society jointly provided testimony to the Board recommending additional clarification to regulations created by the Board in emergency rule regarding the ePDMP mandate in Wisconsin. These comments focused on facilitating EHR integration and providing regulatory clarity regarding the review mandate to achieve a maximally functioning PDMP system that is carefully tailored to balance and recognize impacts on care delivery efficiency, clinical efficacy and quality of care, and the professional medical judgment of physicians and other prescribers.
"Achieving a maximally functioning PDMP system is particularly important for physicians and their health systems as they are under significant pressure to provide health care in the most efficient and cost-effective manner possible," said Matthew Stanford, WHA general counsel. "Those and other pressures are also contributing to ever-increasing rates of physician burnout, which ultimately impacts access to physician care in Wisconsin. Thus, it is important that regulations and processes are carefully tailored to balance and recognize impacts on care delivery efficiency, clinical efficacy and quality of care, and the professional medical judgment of physicians and other prescribers."
For additional questions about the CSB’s actions as well as the recommendations proposed to the CSB, contact Stanford at firstname.lastname@example.org.
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WHA, Members in DC to Discuss AHCA
Meet with U.S. Senators Johnson, Baldwin
The Wisconsin Hospital Association along with hospital and health system leaders were in Washington, DC May 9 and met with both of Wisconsin’s U.S. Senators. The focus of discussion was the House-passed version of the American Health Care Act (AHCA) and the need to make key improvements in the Senate to protect Wisconsin’s coverage gains.
“With recent House action on the AHCA, we now look to the Senate to correct the inadequacies of the House-passed bill,” said WHA President/CEO Eric Borgerding. “Bringing stability to the insurance market, ensuring coverage for hundreds of thousands of older, sicker or poorer Wisconsinites and recognizing the unique Wisconsin Model for coverage expansion all need to be addressed before moving forward.”
Sen. Ron Johnson, part of the group of Republican senators put together by Senate Majority Leader Mitch McConnell to discuss Senate changes to the AHCA, indicated Congress should focus initially on stabilizing the insurance market and repairing the damage done by ObamaCare.
“Congress must ensure that coverage is available and affordable to Wisconsinites, and we agree with Senator Johnson that a good first step is to stabilize the insurance market. One way to begin doing so is by funding the cost-sharing reductions that have been available on the federal exchange,” said Borgerding, referring to a provision that is currently in limbo due to a Republican lawsuit and which continues to roil the insurance market. “As deliberations move forward in the Senate, WHA will continue to work with Senator Johnson and provide him with the data, modeling and information he needs.”
WHA and hospital leaders also met with U.S. Sen. Tammy Baldwin during their time on Capitol Hill. Baldwin indicated the health care system needs “constant tending” and that the House and the Senate should always be looking at ways to constructively improve the system. However, she indicated if the Senate chooses to move forward with the AHCA as passed by the House, this is a non-starter.
With respect to the AHCA, Baldwin highlighted not only do these changes impact people and their health care, but impact communities, the economy and jobs.
“We appreciated the opportunity to talk with Senator Baldwin and hear her strong support for Wisconsin’s health care delivery system,” said Borgerding. “We look forward to working with her on this and other important health care issues.”
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Fee Schedule Again Proposed for Worker’s Compensation
On May 9, the manager’s representatives to the Worker’s Compensation Advisory Committee again put the idea of a government-established fee schedule on the table for discussion, as they did in 2013 and in 2015. The previous proposals have been strongly opposed by WHA, the Wisconsin Medical Society, the Wisconsin Chiropractic Association, the Wisconsin Physical Therapy Association and others in the health care provider community, and will again see similar opposition.
The Council is comprised of five representatives of labor and five representatives of management, and offers a chance for labor and management to come to agreement on policy changes they would like to see in the Worker’s Compensation program. Typically, labor and management come to agreement and the agreed-to proposal is often adopted by the Legislature. The notable exception was in 2013-14, when the proposal included government-established reimbursement rates for providers. At that time, the bill failed to make it out of committee in the Legislature.
At the May 9 meeting, both management and labor representatives identified policies they would like to see in a bill that would eventually make its way to the Legislature. In addition to setting provider reimbursement at 150 percent of Medicare rates, management representatives also proposed allowing employers to direct care, meaning employers would be allowed to specify a list of health care providers who are authorized to provide care for injured workers. Currently, injured workers can choose their care provider. Manager’s representatives also propose establishing treatment guidelines for care that would have to be followed unless a pre-authorization from the insurer was obtained.
Labor representatives also put forth their proposals, none of which included a fee schedule, directed care or treatment guidelines. Labor representatives are interested in helping to address the use of opioids and have asked the health care community for its assistance.
WHA and other health care groups are very concerned about the management proposals. Over the past several years, the health care community has worked to emphasize to the Council and legislators that a fee schedule puts at risk the excellent outcomes produced by one of the best worker’s compensation systems in the country.
Joanne Alig, WHA senior vice president, policy and research and WHA liaison to the Council noted, “The data shows that injured workers in Wisconsin return to work faster than other states, have access to high-quality care, and are happy with that care. The data simply doesn’t support the case for these proposals,” she said.
Alig pointed to information provided to the Council earlier this year. Staff from the Worker’s Compensation Research Institute presented data showing that Wisconsin has a relatively low percentage of workers who lose more than seven days of work after injury, has low litigation, steady utilization, the lowest number of injured workers reporting “big problems” getting medical services and the lowest percentage of injured workers who are “very dissatisfied” with overall care. With respect to medical prices, in 2014-2015, medical prices for non-hospital services grew just 1.8 percent.
In addition, the Council recently heard from Bernie Rosauer, president of the Wisconsin Compensation Rating Bureau (WCRB)—the independent agency that establishes rates charged by insurance companies for worker’s compensation insurance coverage in Wisconsin—who discussed the positive attributes of Wisconsin’s worker’s compensation system. In a presentation provided to the Council, Rosauer reminded the Council that worker’s compensation insurance rates decreased by -3.19 percent in 2016 for all job classifications in aggregate, but decreased even more for manufacturing at -5.00 percent. Rosauer noted Wisconsin has “got a good thing going” with its worker’s compensation system, and other states are aware of Wisconsin’s well-functioning system.
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Wisconsin Ranked Top State for Nurses; Among Top Ten States for Senior Health
For those of us who live here, we know Wisconsin is a great state to live, work and play. But it is always nice to have an outside group confirm what we know to be true.
This week, Wisconsin came out on top in a WalletHub ranking of the best and worst states for nurses. The ranking was based on pay, the quality of the nursing schools, the number of elderly expected to be in the state in 2030, number of job openings, the number of health care facilities and work hours, to name just a few. See their methodology.
In a recent panel discussion in Milwaukee, WHA Board Chair Catherine Jacobson voiced her concerns about workforce shortages, including nurses. She said the aging of the population in Wisconsin is significant for what it will mean for the health care delivery system and workforce needs.
While health care professional shortages loom, another ranking indicates Wisconsin providers are paying special attention to ensure older adults receive the care they need.
United Health Foundation’s America Health Rankings Senior Report ranked Wisconsin tenth in the nation for senior health care, up three spots from the last report in 2013.
Key findings in Wisconsin were:
On clinical care measures, Wisconsin was the 7th best state overall, rating 5th in the nation in diabetes management, 4th on health screenings, and 9th on hospital deaths of Medicare decedents aged 65 years and over. Since 2013, hospital deaths decreased 30 percent from 25 percent to 17.5 percent.
Food insecurity among seniors was low, while volunteerism was high at 7th best in the nation.
The report noted that in the past three years in Wisconsin, the geriatrician shortfall increased 19 percent, from 52.9 percent to 63.2 percent.
“While all states struggle to recruit physicians who specialize in caring for older adults, Wisconsin’s population is aging at a faster rate than many other states,” according to WHA President/CEO Eric Borgerding. “This report confirms that we must continue to focus on creating more opportunities in our state to educate and retain geriatricians, psychiatrists and other specialists in high-demand areas of medicine.”
That is why WHA is a strong supporter of a package of workforce, quality improvement and population health legislation known as the Rural Wisconsin Initiative (RWI). The legislative package provides matching grant funding for the training of advanced practice clinicians and allied health professionals in rural Wisconsin hospitals, state support for the expansion of quality improvement work provided by WHA and a one-time matching grant program to provide seed money for the development of medical wellness facilities and programs in rural Wisconsin. Read more here.
“The Rural Wisconsin Initiative bolsters our state’s health care infrastructure by ensuring we have a workforce in place to care for our residents by creating in-state opportunities for health care professionals to complete their education and training,” Borgerding said. “We are very proud of the fact that health care is an economic development asset in our state. We want to do everything we can to ensure we have the workforce necessary to deliver high-quality, high-value care in all of our communities.”
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