Physician Edition

10-04-2017


October 4, 2017

Volume 5-Issue 18


Governor Walker Signs State Budget into Law with Health Care Investments

Biennial Budget Act Includes Medicaid DSH, GME and Rural Health Care Investments

During a bill signing ceremony at a Neenah elementary school September 21, Gov. Scott Walker signed into law Wisconsin’s 2017-19 biennial state budget, which lays out the state’s $76 billion spending plan through June 30, 2019. The budget bill Walker signed includes nearly all of WHA’s budget priorities this session, including a significant increase in the state’s Medicaid Disproportionate Share Hospital (DSH) program and investments for our state’s rural health care workforce.

“We are pleased the budget that Governor Walker signed today advances several of WHA’s priorities aimed at ensuring Wisconsin’s citizens will continue to have access to some of the highest quality care in the nation,” said WHA President/CEO Eric Borgerding, who attended the bill signing ceremony.

In May, the Joint Finance Committee (JFC) increased Wisconsin’s Medicaid DSH program by over $60 million, taking Wisconsin’s total Medicaid DSH program up to $134 million over the two-year budget. Just three budgets ago, Wisconsin did not have a Medicaid DSH program. In addition, the JFC recognized rural hospitals who do not qualify for DSH because of a federal law criteria which requires the hospital to provide OB services. The JFC provided $1.2 million to support these rural hospitals who treat the same level of Medicaid patients as Medicaid DSH hospitals.

The final budget also includes several WHA priorities to strengthen our state’s physician, advanced practice clinician and allied health professional workforce. The budget bill provides $1.5 million to increase the state’s graduate medical education matching grant program and another $1 million annually for newly created matching grant programs to support hospitals looking to offer new training sites and experiences for advanced practice nurses, physician assistants and allied health professionals.

Wisconsin’s governor has strong partial veto authority to strike specific items from an appropriation bill while enacting the rest of the bill into law. The governor used this power 99 times in this budget and used it to strike one provision WHA lobbied for that created a pilot program for intensive care coordination services provided to Medicaid beneficiaries by hospitals and health systems.

These care coordination services are designed to better manage patients who are high utilizers of hospital emergency department services, which has proven to provide better care for patients and lower overall costs for the Medicaid program. In a letter supporting the provision from Sen. Alberta Darling, Senate co-chair of the JFC, and Assembly Health Committee Chairman Joe Sanfelippo, the two lawmakers stated the provision would “encourage” and “replicate” successful provider-based intensive care coordination programs. The lawmakers stated “hospital-level interventions not only dramatically reduce utilization, but give patients with the highest needs the knowledge and skill to be informed health care consumers.”

Since learning of the veto, WHA has already been in communication with Walker’s senior staff about the need to continue discussing the role hospitals and health systems can and should have in better managing care for patients who are significant utilizers of hospital emergency departments.

“We also look forward to continuing discussions with Governor Walker, DHS Secretary Seemeyer and the Legislature around innovative strategies and partnerships that will deliver better managed and better coordinated care for the state’s most costly Medicaid patients,” said Borgerding in a statement following the budget bill signing ceremony.

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Bipartisan Group of Lawmakers Introduce WHA-led Emergency Detention Reform Bill

Bill helps alleviate physician, provider concerns and frustrations during mental health crisis

A bipartisan group of four Wisconsin lawmakers released legislation September 27 to reconcile Wisconsin’s emergency detention law with federal EMTALA (Emergency Medical Treatment and Active Labor Act) requirements for appropriate transfers of patients and provide additional protections for health care providers treating patients during a mental health crisis.

The bill, circulated as LRB 1983/1 by Reps. John Jagler (R-Watertown) and Eric Genrich (D-Green Bay) and Sens. Rob Cowles (R- Green Bay) and Janis Ringhand (D-Evansville), better aligns Wisconsin law with federal EMTALA duties by explicitly establishing a role in Wisconsin’s emergency detention statute for emergency department staff. Under the bill, law enforcement may not transport an individual in custody of law enforcement from an emergency department until a hospital employee or medical staff have communicated to law enforcement that the transfer of the individual to the detention facility is medically appropriate.

The legislation also provides criminal and civil liability protection for actions taken in good faith by a health care provider to warn of what they believe may be an individual’s dangerousness to himself or others, particularly in situations when the health care provider disagrees with a county or law enforcement decision not to detain an individual. This provision clarifies that a health care provider’s liability to an individual or third party is more clearly limited to the health care provider’s authority to seek, but not impose, an emergency detention on the individual.

Generally, only law enforcement, with the approval of the county mental health crisis agency, may place an individual on an emergency detention without a court order. Wisconsin’s law does not permit health care providers to place an individual on an emergency detention without a court order. Thus, if law enforcement or a county crisis agency drops or will not initiate an emergency detention, a health care provider may not place an individual under an emergency detention, even if the health care provider reasonably believes the person is a danger to his/her self or others.

Finally, 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 clarifies that a health care provider or law enforcement officer may disclose health care information in a good faith attempt to warn others of a patient’s substantial probability of serious physical harm to the person. Federal restrictions on the sharing of patient health information (HIPAA) still apply.

WHA will continue to work with the Wisconsin Counties Association, the state’s law enforcement organizations and individual provider organizations including the Wisconsin Psychiatric Association and Wisconsin Medical Society to marshal support for passage of this legislation.

WHA General Counsel Matthew Stanford testified to these issues in 2013, when the Wisconsin State Assembly Speaker’s Task Force on Mental Health sought input and guidance from WHA during invited testimony to the task force. During this testimony, Stanford testified to requirements of Wisconsin hospitals under EMTALA, how Wisconsin’s emergency detention law conflicts with this obligation and how current state law has created concern among providers if a detention doesn’t occur when the provider believes it is necessary to protect the patient or the public. Several WHA groups have been involved in the development of this legislation, including WHA’s Behavioral Health Task Force and Public Policy Council.

WHA members are encouraged to contact their state elected officials and encourage them to co-sponsor the legislation. Lawmakers can add their name to the bill until the end of the day October 2. If you have additional questions, contact Stanford at mstanford@wha.org or WHA Senior Vice President, Government Relations Kyle O’Brien at kobrien@wha.org.

To see a copy of the legislation and a WHA memo asking lawmakers to support the measure, go to the links below:

www.wha.org/pdf/2017WHA-Request-to-SupportLRB1983-9-27.pdf

www.wha.org/pdf/2017LegislatorCoSponsorMemoLRB1983.pdf

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WisEye Releases Documentary: “Straight Forward: The Truth About Addiction”

Widespread viewing predicted for schools, communities throughout Wisconsin

A new documentary targeting the opioid epidemic in Wisconsin is now available through WisconsinEye, the state’s public affairs cable network, in conjunction with addiction expert Skye Tikkanen and filmmaker Tony Wood.

Straight Forward: The Truth About Addiction features honest, in-depth interviews with young Wisconsinites fighting to recover their lives and futures from addictions that in most cases, involved opioids.

“The message is as raw and disturbing as it is vital and inspiring,” said Jon Henkes, president and CEO, WisconsinEye. “If we can help even one person avoid the trap of addiction, this will have been a successful endeavor.”

Wisconsin is not immune to the growing devastation tied to opioid and heroin addiction. The documentary was produced with the goal of having it shown to every middle and high school student in Wisconsin. Hospitals have identified alcohol and drug addiction as one of the top health needs in their communities. The new documentary could be a tool in drawing members of the community together with health care providers, educators, law enforcement and social service agencies to discuss the problem and take action to prevent and treat addiction. Straight Forward was premiered at Oconomowoc High School September 19 to more than a thousand students, parents, educators and community members.

Anyone interested in showing the documentary and making use of the educational materials should visit www.WisEye.org. The media kit is here: http://bit.ly/2x0063X.

“Straightforward, peer-to-peer messaging has the greatest potential to impact large numbers of our young people, many of whom are at moderate to high risk of addiction,” Henkes said. “We hope this documentary is seen by every young person, and every adult involved with young people.”

Andy Anderson, MD, executive vice president and chief medical officer of Aurora Health Care, provides the introduction to the documentary. “Aurora Health Care is greatly concerned about the devastating effect of opioid addiction in our communities, a growing epidemic which our providers and caregivers see firsthand on a regular basis,” Anderson said. “As such, we’re committed to proactive prevention and treatment efforts across our footprint, and are proud to support this important documentary.”

Straight Forward: The Truth About Addiction features a group of diverse young Wisconsinites from across the state sharing their personal stories of:

  • What happened with their addiction;
  • How they became addicted;
  • What prompted them to get help;
  • What they would say to others; and,
  • The hope and confidence they now have for their futures. 

The documentary also includes stories from parents with an addicted child, and a child who had an addicted parent. The full documentary is 48 minutes in length, with eight topical chapters that can be used or viewed independently. The eight documentary Chapters include: Getting Started, Rock Bottom, Recovery and Advice for a Friend. Curriculum and discussion guides are available.

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WCMEW Conference Focus on Collaboration, Health Care Workforce Issues

WHA: Policy, practice and payment all influence supply and demand

As two famous Pete’s noted—Drucker and Peter Sanderson, MD, medical director, informatics and ambulatory regulation, Ascension Wisconsin in his conference session—“If you want to predict the future, create it.” 

More than 100 health care workforce stakeholders gathered September 27 at the Wisconsin Council on Medical Education and Workforce (WCMEW) conference, “The Future Landscape of Wisconsin’s Health Care Workforce,” to collaborate, compare perspectives and create solutions to Wisconsin’s workforce challenges.

As Ann Zenk, WHA vice president, workforce & clinical practice noted, “Workforce reports from WHA, the Wisconsin Center for Nursing and other tools and resources, such as those created by the Department of Workforce Development (https://jobcenterofwisconsin.com/HealthCare/Default.aspx), inspire us to collaborate, cooperate and act together, to create the workforce needed to sustain Wisconsin’s top-quality health care now and in the future.”

Zenk, along with Bob Van Meeteren, CEO, Reedsburg Area Medical Center (RAMC) and Bruce Palzkill, deputy administrator, Department of Workforce Development (DWD), participated in a panel: “Public Policy that Bolsters the Wisconsin Health Care Workforce,” moderated by Kyle O’Brien, WHA senior vice president, government affairs. The panelists and O’Brien discussed policies and health care trends that impact the health care workforce. 

“Technology is advancing at a rapid pace,” said Zenk. “We have an opportunity to work with technology experts, educators, policymakers, health care leaders and clinicians to build technology, policy and processes that serve the patient and the health care team, rather than a workforce to serve technology.” 

Van Meeteren shared an example of how RAMC is approaching this paradigm through the use of virtual scribes to support providers documenting in electronic health records.

Palzkill said interns are another way to grow a workforce locally. “Of those who complete an internship, 62 percent join the company as an employee,” he said. Palzkill highlighted DWD’s Fast Forward program. 

Building on Palzkill’s point, O’ Brien added, “The Rural Wisconsin Initiative is built on the foundation that physicians who complete a rural residency in Wisconsin stay in Wisconsin to practice in rural areas.”

O’Brien and Van Meeteren both cited engaging with legislators as a key takeaway for attendees. “Workforce is a big issue, and it is a focus of the State Legislature,” O’Brien said, “Now is the time to engage.”

Zenk said, “We all understand health care and the issues we’re facing, and we even have ideas for how to solve them, but what we don’t always know is how to get there.”  She offered attendees a roadmap developed by WHA, noting, “Using WHA’s 3Ps model, Practice, Policy, and Payment, allows health care organizations and their trustees, educational institutions, policymakers, community leaders, and other key stakeholders to assess recommendations and determine priorities, evaluate feasibility and foresee barriers, and choose next steps to translate recommendations into policy, practice and payment changes.”

The 3Ps were referenced by presenters and attendees throughout the day, including by Elizabeth Petty, MD, senior associate dean, academic affairs, University of Wisconsin School of Medicine and Public Health. Petty noted, “When we think about the 3Ps and education and workforce, we should add two more—pipelines and preparation.” 

To learn more about WHA’s 3Ps Model, see www.wha.org/pdf/2017WHA3Ps.pdf or contact Ann Zenk at 608-274-1820 or azenk@wha.org.

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Key to Successful Emergency/Crisis Management is Preparation, Practice

Speakers focus on building EP communications, response infrastructure

Experts in crisis management and emergency response presented along with two state agency representatives at a WHA conference in Madison September 20. WHA President/CEO Eric Borgerding said the recent storms that hit Texas, Florida and Puerto Rico are grim reminders of why emergency preparedness is so critically important.

“Our communities depend on us as the health care safety net in times of distress and disaster,” Borgerding said. “We are gathered here today to learn how to work not just as individuals, but as partners to carry out our responsibility to serve the citizens of Wisconsin.”

State agencies and the governor play significant roles in the state’s response and in deploying critical resources to impacted communities. Stephanie Smiley, director of the Bureau of Communicable Diseases at the Wisconsin Department of Health Services (DHS), described how the incident command center operates at the state level and the state agencies and the processes they work within that are utilized in responding to environmental disasters, food safety, terrorist threats and infectious diseases.

Wisconsin is a “home rule” state, which means local public health departments have the authority to be the lead agency in responding. Smiley said the state does not drive the emergency response unless the locals defer to the state. The State usually just provides guidance and resources to help.

Peter Shult, PhD, associate director of the Wisconsin State Laboratory of Hygiene, provided an overview of the state lab operation and responsibilities, and he acknowledged the critical importance of the network of clinical labs located in Wisconsin’s hospitals to the early identification of a range of diseases, from influenza to anthrax.

“Clinical labs follow a strict rule—use your routine methods, recognize when you might be dealing with something unusual and report that to state lab to rule out if you are working with a high-risk specimen,” Shult said. “We have over 130 clinical labs in the state, and we work with every one of these labs on a first name basis and communicate with them nearly daily.”

Risk communications expert Vincent Covello, PhD, helped attendees understand the importance of preparing in advance for potential crisis situations and developing “message maps” that address the myriad of questions and concerns that can arise during an emergency. He emphasized communicators must keep in mind the fact that when people are stressed or fearful, their ability to process information is compromised, so keeping messages simple is essential.

Conference attendees likewise found value in a breakout session entitled “Active Shooter: Plan and Prepare,” presented by Christopher Sonne and William Castellano from HSS EM Solutions. Sonne and Castellano shared best practices and lessons learned from live active shooter scenarios, which are scenarios in which a person with a gun is harming or threatening to harm hospital staff, patients, or visitors. Participants in this breakout session discussed staff roles and responsibilities, participated in a tabletop exercise and practiced tactics for responding to an active shooter.

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Patient Safety Tools & Concepts Focus of First Quality Forum Session, Oct. 17

On October 17, WHA is offering a one-day session focused on patient safety tools and concepts, including an emphasis on the deviation management process and discussion on a variety of practical tools. Faculty includes Kelly Court, WHA chief quality officer, and Alex Hunt, quality assurance manager, Community Blood Center, Appleton. Hunt is well known in Wisconsin quality leadership circles and has served as director of patient safety for Hospital Sisters Health System (HSHS) and was the quality director for the ThedaCare system.

“Patient Safety Tools and Concepts” launches WHA’s new Quality Forum, 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. 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.

Online registration and information on all six sessions of the WHA Quality Forum can be found 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 sessions.

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Fast Facts from the WHA Information Center: Number of Births to Women Over Age 35 Increases

Data from the WHA Information Center shows while the total number of births in Wisconsin has decreased, over the same time period, the number of women in Wisconsin who are giving birth after the age of 35 has increased.

Nationally, the Centers for Disease Control (CDC) reported women in the early 30s bracket had about 103 births per 100,000 people and the rate for women in their late 20s was 102 per 100,000. On average, the CDC data suggests, women are having their first child at roughly age 28.

Year

Total # Births In Wisconsin

# Births to Women 35 and Older

2014

63,745

6,279

2015

63,654

6,563

2016

63,561

6,840

Data provided by the WHA Information Center (WHAIC). WHAIC s dedicated to collecting, analyzing and disseminating complete, accurate and timely data and reports about charges, utilization, quality and efficiency provided by Wisconsin hospitals, ambulatory surgery centers and other health care providers.