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Physician Edition

09-06-2017


September 6, 2017

Volume 5-Issue 16


Wisconsin Health Care Best in the Nation

Wisconsin ranks #1 among all states based on quality

For the second time in a month, Wisconsin health care receives top honors

Wisconsin is the top state in the nation for health care with the highest overall health care quality score among all 50 states, according to the federal Agency for Healthcare Research and Quality (AHRQ). The ranking is based on Wisconsin’s performance across more than 130 statistical measures that AHRQ uses to evaluate health care performance.

Wisconsin is first in the nation, followed closely by Massachusetts and Pennsylvania. The top ten performing states are all located in either the Northeast or Midwest. Wisconsin ranked third highest in the nation last year and has only been out of the top three twice in the past decade.

“The AHRQ rankings are a national validation of what we know here; Wisconsin’s local and regional health systems are delivering some of the best care in the country,” according to Wisconsin Hospital Association President/CEO Eric Borgerding. “Across all care settings, in rural and urban communities, we are maintaining consistently high performance, while striving to set even higher standards of care. It is that combination of performance and commitment to be better that makes Wisconsin a perennial leader.”

The AHRQ top ranking is based on the overall quality of care in the state. It arrives on the heels of Wisconsin’s Critical Access Hospitals (CAHs) being singled out in July 2017 as the best in the nation by the federal Health Resources and Services Administration (HRSA) for outstanding quality performance. That ranking was based on participation in and achievement on the Medicare Beneficiary Quality Improvement Project (MBQIP). (See WHA’s press release.) Wisconsin CAHS achieved the highest reporting rates and levels of improvement in the country over the past year. CAHs are hospitals with fewer than 25 beds that provide essential services in rural areas. There are 58 CAHs in Wisconsin. 

“We know as we improve quality, we reduce health care costs and patient outcomes are better,” Borgerding said. “That helps ensure that Wisconsin will continue to be known for high-quality, high-value care, which is an economic development asset in every part of the state.”

Wisconsin has shown consistently high performance since AHRQ started the state rankings in 2006. This year, the state’s strongest performance was in acute and chronic care, and patient safety. The best scores in Wisconsin based on the setting where the care was provided were in the hospital, medical clinic and by home health and hospice providers.

The quality of health care varies widely across the nation, according to AHRQ. That is why, according to Kelly Court, WHA chief quality officer, Wisconsin’s performance is impressive because health care providers here are focused on delivering high quality care across all settings.

“The consistency from year to year is important,” says Court. “This demonstrates that health care is coordinated across settings and delivered as an entire system statewide. It also demonstrates that Wisconsin providers continue to evolve as health care changes, but they never lose their focus on improving important aspects of patient care.” 

The AHRQ quality measures are compared to achievable benchmarks, which are derived from the top-performing states. AHRQ measures health care quality in three different contexts: by types of care (such as preventive, acute, or chronic care), by settings of care (such as hospitals, nursing homes, home health or hospice), and care by clinical area (such as care for patients with cancer or respiratory diseases). They also report measures by race and ethnicity.

While Wisconsin shows strong overall performance in most areas of care, there is still work to be done related to health care equity, including care for both high and low income populations and ethnic minorities. When measures are segmented by race and ethnicity, the performance is average.

“WHA members are aligning their quality improvement goals to address health care equity issues as they work with community partners to develop programs and policies that will have a positive impact on population health,” Court said.

Access the full AHRQ report here: https://nhqrnet.ahrq.gov/inhqrdr/state/select

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WCMEW Workforce Summit Features President-elect, AAFP

Michael Munger, MD, president-elect of the American Academy of Family Physicians (AAFP), will keynote Wisconsin’s statewide health workforce summit September 27, which is sponsored by the Wisconsin Council on Medical Education and Workforce (WCMEW). WCMEW is a collaboration of stakeholders across Wisconsin, including the Wisconsin Hospital Association, Wisconsin Medical Society, Medical College of Wisconsin and UW-Madison School of Medicine and Public Health, among others.

Munger will provide opening remarks to hospital leadership, clinicians, and community partners—laying the groundwork for in-depth discussion of public policy, transformation of care delivery, and health workforce data presented throughout the day. He will highlight trends and challenges facing health care professionals nationwide. He will also present best practices identified by the AAFP, emphasizing the role of health care leadership at all levels and across sectors to strategically plan for the needs of tomorrow’s health care workforce. He will present time-sensitive solutions to transforming care delivery and lay the groundwork for conversations around clinician training, community partnerships and present data on projected shortages.

While in Wisconsin, Munger will also tour educational institutions and health care facilities. He is a practicing physician in Leawood, Kansas, where he serves as vice president of medical affairs for primary care at Saint Luke’s Medical Group in the Kansas City area. He also serves on the Employed Physician Enterprise Board of Directors. Munger had a critical role in the group’s process to secure recognition as a Patient-Centered Medical Home, Level 3, based on 2011 outcome, access and patient satisfaction metrics. 

Visit www.wcmew.org/wp-content/uploads/2017/08/2017wcmew9-27.pdf for more event information, or register at www.cvent.com/d/85qxys. If you have questions, contact WCMEW Executive Director George Quinn, at qguinn@wcmew.org.

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CMS Proposed Rule Significantly Alters Bundled Payment Programs

On August 16, the Centers for Medicare and Medicaid Services (CMS) issued a notice of proposed rulemaking that would cancel two mandatory payment models and significantly scale back a third. Currently slated to begin in January 2018, the two mandatory payment models proposed to be eliminated are the Cardiac Rehabilitation (CR) incentive payment model and the Episode Payment Models. The Episode Payment Models include the acute myocardial infarction (AMI), coronary artery bypass graft (CABG), and surgical hip/femur fracture treatment episodes of care (SHFFT). 

The currently mandatory Comprehensive Care for Joint Replacement (CJR) model will create optional, rather than mandatory, participation for several of the currently participating hospitals. The CJR model was implemented in April 2016. It is proposed that up to half of the currently participating hospitals will no longer be required to participate. 

Under the proposed rule, the CJR model would continue on a mandatory basis in approximately half of the selected geographic areas (that is, 34 of the 67 selected geographic areas), with an exception for low-volume and rural hospitals, and continue on a voluntary basis in the other areas (that is, 33 of the 67 selected geographic areas). The Madison MSA (Columbia, Dane, Green, and Iowa counties) and Milwaukee-Waukesha-West Allis MSA (Milwaukee, Waukesha, Ozaukee, and Washington counties) will now be optional CJR participants.

CMS is proposing a one-time participation election period for hospitals located in the voluntary participation MSAs. The voluntary participation election period is proposed to begin January 1, 2018 and end January 31, 2018. This same voluntary election period will also apply to low-volume and rural hospitals in the mandatory participation MSAs.

Comments on the proposed rule are due to CMS October 17, and WHA will prepare comments on the proposed rule for submittal to CMS. For further information on the proposed rule, contact Laura Rose, WHA vice president for policy development, at lrose@wha.org.

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Help Physicians Improve Quality at the WHA Physician Quality Academy

Physicians are often assigned a role with a hospital or health system’s quality department or committee or even asked to lead a quality improvement project. Knowledge about quality improvement tools and principles can increase the likelihood a physician will be more engaged in, successful in and comfortable with his/her leadership role.

You can provide your physicians the training and resources needed by encouraging them to attend the WHA Physician Quality Academy this fall. The WHA Physician Quality Academy offers two non-consecutive days of in-person training, co-led by physicians and quality professionals and geared toward all levels of physician quality engagement, from the general workforce, to medical director, physician champion, or director of quality. Participants will learn to design and conduct quality improvement projects utilizing proven improvement models; interpret data correctly; facilitate physician colleague engagement in quality improvement and measurement; and, discuss quality requirements, medical staff functions and their link to quality improvement.

“Attending the Quality Academy was an enlightening experience. (The Academy) helped me develop a broader framework of systems thinking in health care and the importance of critically defining metrics involved,” said Paul Bekx, MD, chief of staff and medical director of quality and regulation for Monroe Clinic and participant in the 2017 spring cohort of the Physician Quality Academy.

The fall cohort of the Academy will be offered September 29 and November 3 at Glacier Canyon Lodge at The Wilderness Resort in Wisconsin Dells. The 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. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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WCAC Again Seeks Government Fee Schedule for Medical Services

“An outdated solution looking for a problem”

At the end of two days of meetings August 23, the Workers Compensation Advisory Council (WCAC), which includes five representatives of organized labor and five representatives of management, voted to support a fee schedule to reimburse hospitals, doctors and other practitioners who provide health care services to injured workers through the Worker’s Compensation program.

WHA President/CEO Eric Borgerding emphasized the Wisconsin system is considered one of the best in the nation. “We have the top ranked health care in the country (see www.wha.org/whanr8-22-17-wihealthcareno1.aspx). Workers injured on the job in Wisconsin get some of the best care, have some of the best outcomes, satisfaction and return to work rates, and lowest service utilization in the country. And Wisconsin workers comp premiums continue to plummet. Yet here we are, once again, talking about fee schedules and price setting; outdated solutions looking for a problem. It’s really time to move on.”

In 2014, health care provider groups defeated a proposal put forth by the WCAC that would have the government set provider fees in the worker’s compensation program. It was the first time in the history of the Council that its proposal was not adopted by the Legislature.

When reviewing what will be introduced in the Legislature this biennium as the Worker’s Compensation bill, the Council gave no fiscal impact of the proposal, but described it as “approximating the average price of group health in Wisconsin.” The details of how this will be determined are unclear, but the Department of Workforce Development (DWD) would be required to develop the fee schedule using available data and a survey of self-insured employers, all of which would be considered proprietary and none of which would be subject to open records requests. The fee schedule could be adjusted by medical inflation each year, but once set would only be reset every 10 years. The fee schedule, under their proposal, would be implemented in 2019.

Given the excellent system, Borgerding questioned the wisdom of the Council’s decision. “If the Council gets its way, a government agency will establish how much doctors, hospitals, and other practitioners who take care of injured workers are paid for their services. That’s government rate setting. When has government rate setting improved quality or efficiency? When has it reduced costs?”

Additional policies, including proposals to reduce the use of opioids are also part of the agreed to package, which can be found here: www.wha.org/data/sites/1/pdf/WCAC2017FinalProposals.pdf.

The DWD is beginning the process of obtaining a legislative bill draft containing the proposals. The Legislature generally considers and votes on the WCAC’s bill during its spring floor session. WHA and the other provider organizations are calling on members of the Legislature and the Walker Administration to reject the Council’s plan and protect Wisconsin’s excellent worker’s compensation system.

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Six Health Plans to Leave State Employee Health Care Program

This week the Department of Employee Trust Funds (ETF) announced six health plans have chosen to exit the state employee health care program, leaving 10 plans to offer coverage to state and local government employees in 2018.

The news comes in a year of uncertainty over the state employee plan as the Group Insurance Board voted to move the program from a fully insured program to a self-insured program, with far fewer health plan choices. That proposal was rejected by the Joint Finance Committee in June (see previous Valued Voice article). The Group Insurance Board is expected to meet August 30 to finalize rates and offerings for the program for 2018.

In its announcement ETF does not indicate why the plans have chosen to exit the market, but notes the decisions will affect about 53,000 enrollees. The health plans that have elected not to participate in the program in 2018 are:

  • Anthem Blue Preferred Northeast, which serves Northeast Wisconsin with 4,300 enrollees
  • Arise Health Plan, which serves Northeast Wisconsin with 1,700 enrollees
  • Health Tradition Health Plan, which serves Western Wisconsin with 4,600 enrollees
  • Humana, which serves Eastern and Western Wisconsin, and including Humana’s Medicare Advantage offering, with 18,100 enrollees. 
  • UnitedHealthcare of Wisconsin, which serves Eastern Wisconsin with 14,000 members
  • WPS, which serves all of Wisconsin with 10,600 members

Pending approval by the Group Insurance Board, the health plans available in 2018 will be: 

  • Dean Health Insurance and Dean Health Insurance-Prevea360
  • Group Health Cooperative of Eau Claire
  • Group Health Cooperative of South Central Wisconsin
  • HealthPartners Health Plan
  • Medical Associates Health Plans
  • MercyCare Health Plans
  • Network Health
  • Security Health Plan – Central and Valley
  • Quartz – Community and UW Health (formerly Gundersen, Physicians Plus and Unity)
  • WEA Trust – East, Northwest Chippewa Valley and Mayo Clinic Health System

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Patient Safety Tools/Concepts the Focus of First WHA Quality Forum Session

WHA is offering a one-day session October 17 focused on patient safety tools and concepts to launch the new WHA Quality Forum. The Quality Forum is a series of day-long education events that will address high-priority topics for hospital quality leaders and others involved in quality improvement in Wisconsin hospitals and health systems.

“Patient Safety Tools and Concepts” will have an emphasis on the deviation management process, and include a discussion on a variety of practical tools including FMEA, RCA2, ACA and risk-based decision making and data management. Kelly Court, WHA chief quality officer, and Alex Hunt, quality assurance manager, Community Blood Center, Appleton, will present. Hunt is well known in Wisconsin quality leadership circles and has served as director of patient safety for Hospital Sisters Health System and was the quality director for the ThedaCare system.

Hospital quality leaders, patient safety officers, risk managers, as well as staff and unit leaders will benefit most from this first session.

A brochure highlighting all six sessions currently planned for the WHA Quality Forum is included in this week’s packet. The series includes topics such as medical staff quality, survey readiness, meeting external reporting requirements and more, and presenters for each will share topic expertise and best practice applications.

Registration is open online at www.cvent.com/d/f5qhb9. Registration at each session will be limited, so those interested should register as soon as possible. For registration questions, contact Kayla Chatterton at kchatterton@wha.org. Contact Beth Dibbert at bdibbert@wha.org for questions about the content of these education events.

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