Physician Edition

11-01-2017


November 1, 2017

Volume 5-Issue 20


Webinar on ePDMP Medical Coordinator Access, Nov. 7

On November 7, WHA will host a complimentary WHA Member Forum that will provide information about the Wisconsin Enhanced Prescription Drug Monitoring Program’s (ePDMP) new “medical coordinator” functionality that enables certain individuals within health care organizations to view prescribing metrics reports and audit trails. In general, individuals with medical oversight and quality assessment and improvement roles at health care organizations may have access to the ePDMP’s medical coordinator functionality.

Andrea Magermans, managing director of the Prescription Drug Monitoring Program at the Wisconsin Department of Safety and Professional Services, will present information during the webinar on the role of the medical coordinator in the Wisconsin ePDMP, how to register as a medical coordinator in the Wisconsin ePDMP and how to access ePDMP prescribing metrics reports specific to a medical coordinator’s prescribers.

Audiences that may be interested in this webinar include chief medical officers, other physician leaders with prescriber oversight roles and quality managers.

To register for this webinar, go to: www.cvent.com/d/9tql1b.

Top of page

Rogers, Beloit Memorial Join WHA in Testifying on Emergency Detention Bill

WHA-led bipartisan bill addresses provider liability, EMTALA concerns

The Assembly Mental Health Committee received testimony from WHA and WHA members on October 24 in support of Assembly Bill 538. This bipartisan, WHA-led bill reconciles Wisconsin’s emergency detention law with federal EMTALA (Emergency Medical Treatment and Active Labor Act) requirements for appropriate transfers of patients and provides additional liability clarity for health care providers treating patients during a mental health crisis.

Reps. John Jagler (R-Watertown) and Eric Genrich (D-Green Bay) and Sens. Rob Cowles (R- Green Bay) and Janis Ringhand (D-Evansville) are the lead authors of the bill, which has 29 cosponsors from both sides of the aisle.

Jerry Halverson, MD, chief medical officer at Rogers Behavioral Health, and Sharon Cox, chief nursing officer at Beloit Health System, joined Matthew Stanford, WHA general counsel, in testimony in support of the legislation. 

“This bill provides better clarity in statute so 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,” explained Stanford. “The bill further clarifies that a health care provider may fulfill a duty to warn by contacting law enforcement or the county crisis agency.”

Halverson told the committee that under current law, “Chapter 51 puts our providers who are taking care of some of our most ill psychiatric patients in a double bind. It does not give the medical experts the ability to place an emergency detention, but also does not clearly absolve them from liability when the county/legal official decides to decline to place a patient on an emergency detention.”

“AB 538 addresses this liability concern that has long caused consternation at Rogers at all levels of care, other psychiatric facilities and other emergency rooms across the state,” said Halverson. Stanford also explained how the bill addresses the current misalignment between federal EMTALA requirements and Wisconsin’s emergency detention law.

“This legislation is a product of nearly three years of conversations between the Wisconsin Hospital Association (WHA) and the Wisconsin Counties Association (WCA) to find a compromise policy that helps remedy a regulatory conflict between Wisconsin law and federal law,” said Stanford. “This legislation does not change the process to initiate an emergency detention, but necessarily and correctly leans on the medical judgment of health care professionals in hospital emergency departments to ensure a patient transfer is medically appropriate.”

Cox shared a story with the Committee of an example where lack of alignment between Wisconsin’s emergency detention law and the federal EMTALA law resulted in a federal CMS citation for her hospital.  Cox said they appealed the federal citation arguing that Wisconsin’s emergency detention law gives no authority to emergency departments to initiate or direct placement for emergency detention. CMS denied the appeal, and their response was that Wisconsin needed to change its law to enable hospitals to comply with EMTALA, said Cox.

The Wisconsin Counties Association also provided testimony sharing their work on and comfort with the bill.

“There was significant back and forth between WHA, WCA, representatives from the county corporation counsel association, and county human services departments to develop language that ensures the best interests of an individual in crisis are met, while also ensuring the valuable role each entity plays in the process is respected,” said Sarah Diedrick-Kasdorf, deputy director of government affairs for the WCA. “After several years of meetings, conference calls, etc., Assembly Bill 538 was introduced that WCA believes protects the county role in the emergency detention process, while ensuring our partners are in compliance with federal law.”

Kristen Freier, MD, department chair of behavioral health medicine at Gundersen Health System, also spoke in favor of the bill to the Committee.

“This legislation better aligns statutes with integrated health care and clinical-based recommendations for treatment,” said Freier. “We are pleased to support this legislation for improved processes and clinical protocols for the safety of our patients and communities.”

WHA is working with Assembly Mental Health Committee Chair Paul Tittl (R-Manitowoc) and the bill’s authors to schedule a Committee vote on AB 538 that will advance the bill for a vote by the full Assembly before the end of the year.

Top of page

WHA Comments on CMS’ Proposed Changes to Bundled Payments

On October 16, WHA submitted comments to the federal Center for Medicare and Medicaid Services (CMS) on a proposed rule issued by CMS in August, in which CMS signaled its intent to implement flexibilities within value-based payment programs. WHA expressed support for the partial conversion of mandatory bundled payment models into voluntary programs, as voluntary participation in program innovation is always preferable to a mandate. However, WHA also noted how value-based payment programs have spurred innovation in our state

In late 2015, hospitals in both the Madison and Milwaukee Metropolitan Statistical Areas (MSAs) were selected to be mandatory participants in CMS’s Comprehensive Care for Joint Replacements (CJR) bundled payment program. Wisconsin’s high-performing health systems have generally embraced the challenges presented by the mandatory CJR bundle, and many are experiencing positive results from years 1 and 2 of the CJR.

In the proposed rule, CMS announced plans to prospectively make participation voluntary for all hospitals in approximately half of the geographic areas in the CJR model, including hospitals in Wisconsin. The rule also proposes several technical refinements and clarifications for certain CJR model payment, reconciliation, and quality provisions, and a change to the criteria for the Affiliated Practitioner List to broaden the CJR Advanced Alternative Payment Model (APM) track to additional eligible clinicians. Additionally, the rule proposes to cancel the Episode Payment Models (EPMs) and the Cardiac Rehabilitation (CR) incentive payment model, established by the Center for Medicare and Medicaid Innovation (Innovation Center). These were scheduled for implementation in 2018.

If the changes in the proposed rule are finalized, hospitals in Wisconsin that are currently participating in CJR will be able to make a choice about continuing to participate. Many of these hospitals will continue to do so because they have already made invested time, infrastructure and resources with very positive results for improved care coordination and overall quality. This includes markedly improved coordination of care both within the organizations and with outside entities such as post-acute care providers.

With a new direction evident at CMS, what’s next for bundled payments?  Bundled Payments for Care Improvement (BPCI), another CMS program which will expire in 2018, has been successful and will likely be followed soon by a new, voluntary bundled payment program, BPCI-Advanced. CMS expects a high amount of interest in BPCI-Advanced because it will qualify as an APM, which exempts participating physicians from potential payment reductions they could face under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

CMS has also issued a Request for Information (RFI) for feedback on a new CMS direction to promote patient-centered care and to test market-driven reforms that “empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, reduce costs, and improve outcomes.”

WHA will submit feedback to this RFI by November 20. For further information, contact Laura Rose, WHA vice president, policy development, at lrose@wha.org.

Top of page

WHA Continues to Make Progress on 2017 Goals as New Projects, Issues Arise

Board discusses worker’s comp fee schedule, state legislative agenda, health reform

When WHA launched their newly redesigned pricing website, WiPricePoint.org October 10, it included changes recommended by the Board earlier in the summer and incorporated feedback from consumers.

“We released PricePoint with some great changes, as suggested by the Board, consumers and our own staff,” WHA President/CEO Eric Borgerding told the WHA Board at their October 23 meeting. “PricePoint has evolved to an increasingly consumer-facing resource that helps them ask the right questions and connects them to the answers, including facilitating communication with their insurance provider.”

Borgerding said PricePoint and WHA’s quality public reporting site, WiCheckPoint.org, have helped keep Wisconsin at the forefront of health care transparency.

WHA has been promoting the recent accolades and rankings. Wisconsin’s health care delivery system and its hospitals have been recognized as the best in the country based on quality by the federal Agency for Health Care Quality (AHRQ) and Wisconsin’s critical access hospitals were the best in their class for quality improvement and public reporting. WHA purchased newspaper ads , radio ads and digital ads to promote the fact that Wisconsin’s health care is the best in the country. Elected officials are also picking up on the message, including Gov. Scott Walker who consistently touts Wisconsin’s high-quality care as an asset.

Borgerding said more than 50 legislators and their staff attended a recent WHA-sponsored briefing at the state capitol. The briefing focused on the value Wisconsin’s high-quality care has for not only the health of the state’s residents, but also to the health of our communities. The work of several WHA members related to care coordination was also showcased at the briefing. Rep. Joe Sanfelippo presented the welcome at that event.

WHA’s 2017 Workforce Report will be released later in October. Borgerding said the report garners a lot of media attention, but more importantly, it serves as WHA’s primary guidebook to its workforce agenda.

“We comment a lot about what we are seeing in the health care workforce in the report, which also serves as our primary agenda-setting tool,” Borgerding said. 

The workforce report from prior years drove the team-based care regulatory reform package. Most recently, WHA has been working on legislation that will update Medicaid regulations related to co-signatures required for orders made by other providers. The workforce report was also used to document the importance of passing the enhanced Nurse Licensure Compact and supporting the Rural Wisconsin Initiative that can be used to fund clinical training for advanced practice clinicians and allied health professionals.

Borgerding said WHA staff, with help from members, are making excellent progress in meeting the 2017 goals. As is the case with nearly every other year, some of the goals will carry over into 2018 because of how the legislative session is scheduled, but also because many are perennial issues.

Another issue that is new to the goals document but not novel to WHA members is working on issues related to dental access for people with special needs. Behavioral health issues are also evolving, and that workgroup will begin meeting again soon.

Immediately following the President’s report, WHA COO Brian Potter presented the WHA 2018 budget, which the Board approved, with no dues increase.

Borgerding announced that Debbie Rickelman, former vice president of the WHA Information Center, passed away October 12. She is greatly missed by staff and members alike. A memorium to Debbie can be found below.

Borgerding said Kelly Court, WHA chief quality officer, is retiring soon (see story at www.wha.org/wha-newsletter-10-6-2017.aspx#s6), and he introduced her successor, Beth Dibbert, to the Board. 

WHA joins coalition to oppose medical fee schedule in worker’s comp program
The push to enact government price controls for medical care delivered to injured workers is facing strong opposition from a coalition armed with the facts. And the facts do not support the allegations that are being used to support the latest effort to reduce provider rates in the worker’s compensation program, according to WHA Senior Vice President Kyle O’Brien.

O’Brien said a coalition comprised of WHA, along with the Wisconsin Chiropractic Association, Wisconsin Medical Society and the Wisconsin Physical Therapy Association, have joined publicly to highlight the fact that effective October 1, Wisconsin employers experienced a significant reduction in worker’s compensation premiums for the following year, all without implementing a government fee schedule for health care services.

“Worker’s comp is an asset in Wisconsin for job creation, not a liability,” according to O’Brien. “Workers injured on the job in Wisconsin receive some of the highest quality care in the nation. Because of that, they use fewer medical services, are more satisfied with their care, initiate fewer litigated claims and return to work faster than every other state in the nation. Wisconsin’s health care providers are delivering value to our work comp program.”

The State Budget and Fall Session
In his report, O’Brien said Gov. Scott Walker signed into law Wisconsin’s 2017-19 biennial state budget September 21, 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.

Wisconsin’s Medicaid DSH program was increased by over $60 million, taking Wisconsin’s total Medicaid DSH program up to $134 million over the two-year budget. In addition, the Joint Finance Committee (JFC) recognized rural hospitals who do not qualify for DSH because of a federal law criteria that 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.

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 the 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. 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.

WHA activities supporting members’ integrated physician enterprise
The Board discussed and approved an assessment of how WHA can best support its members’ integrated physician and clinic enterprise now and in the future. The assessment was a culmination of work by the WHA Physician Leaders Council and the Board at its July planning session.

“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. “This assessment does not represent a new space for WHA, but the assessment brings WHA’s integrated physician and clinic-focused efforts and initiatives into a single summary and guiding document.”

Mark Thompson, MD, chief medical officer, physician integration, SSM Health–Wisconsin Region and at-large physician leader WHA Board member, praised the assessment. “We need leaders, physicians and CEOs to work to support our physicians,” said Thompson.  “The right people are in this room to support that work.”

Federal Update: Repeal and Replace
Joanne Alig, WHA senior vice president, policy and research, reviewed the latest developments on federal efforts around health care reform. Alig emphasized WHA’s top priorities continue to be sustaining coverage and market stabilization. Alig said WHA supported the provisions in the Graham/Cassidy/Heller/Johnson bill in late September that recognized Wisconsin’s partial expansion, and by various estimates would have provided added funding to Wisconsin for health care. She noted, though, some concerns about the bill, including sustainability of Medicaid funding and overall HHS authority versus state flexibility. 

Alig also provided an overview of the Murray-Alexander efforts this week, which would fund the cost sharing reduction subsidies for another two years, among other provisions to help stabilize the market in the short term. She noted the exchange open enrollment period starts November 1 and ends December 15 for benefits for the 2018 calendar year. As reported in The Valued Voice last week (www.wha.org/wha-newsletter-10-13-2017.aspx#s2), premiums overall are higher, in part to make up for the anticipated loss of the CSRs, and there are fewer insurers in the exchanges in 2018. Alig also noted some challenges with enrollment this year, including a shorter enrollment period, system outages for maintenance and lack of federal outreach. As some in Congress are seeking stability through legislative proposals, Alig said WHA encourages the Walker administration and the state Legislature to seek ways to improve and stabilize the markets at the state level as necessary. 

WHA State PAC & Conduit Report
WHA Advocacy Committee Chair Mike Wallace, president/CEO, Fort HealthCare, informed the Board that during the first three quarters of the year, fundraising for the Wisconsin Hospitals State PAC & Conduit is at 83 percent of its 2017 goal of raising $312,500. The campaign hit the $258,000 mark this week with contributions from 270 individuals. (See full article below.)

Top of page

WI Hospitals State PAC/Conduit: $50K In 50 Days?

Fundraising campaign hits $260,000

The 2017 Wisconsin Hospitals State PAC & Conduit campaign hit the $260,000 mark this week with contributions from 274 individuals. This puts the campaign at 83 percent of goal. In addition, the fundraising campaign has raised $20,000 since launching its “$50,000 in 50 days” initiative. You can make an impact today by contributing at www.whconduit.com.

A few other interesting statistics on the 2017 fundraising campaign are:

  • The average contribution to date is $949/person
  • The campaign is raising, on average, $6,050/week
  • There are 41 first-time contributors
  • There are 6 contributors at the “Leaders Circle” Level of $5,000 and above
  • There are 19 contributors at the “Platinum Club” Level of $3,000-$4,999
  • There are 52 contributors at the “Gold Club” Level of $1,500-$2,999

If you missed the full list of contributors in the October 20 edition of The Valued Voice, take a look at www.wha.org/wha-newsletter-10-20-2017.aspx#s3.

There are still over two months left to go in the calendar year to raise the remaining $50,000 needed to reach goal. Join your peers across the state by making your contribution today at www.whconduit.com or by calling WHA’s Jenny Boese at 608-268-1816 or Nora Statsick at 608-239-4535.

Top of page

WHA Board Approves Nominating Committee Recommendations

The Nominating Committee presented their recommendations to the WHA Board October 19. The Board voted and approved the Nominating Committee’s recommendations. The following individuals will serve on the WHA Board of Directors effective January 1, 2018.


Top of page

WHA Quality Forum Launches with Patient Safety Tools and Concepts

Hospital quality and risk management staff recently attended the first session of the 2017-2018 WHA Quality Forum to learn about patient safety tools and concepts. Alex Hunt, quality improvement specialist for AboutHealth, and Kelly Court, WHA chief quality officer, served as faculty for the day.

Attendees learned a variety of practical patient safety tools including root cause analysis, apparent cause analysis and failure modes and effects analysis. The forum is designed to allow people to learn new things from the faculty and each other and then practice what they learned using a variety of scenarios.

“The forum provides a unique and affordable opportunity for WHA to share basic quality and patient safety education,” according to Court. “All attendees left the session feeling confident they would be able to use the information in their daily work.”

The forum series, which will cover additional topics such as medical staff quality, survey readiness, external quality requirements and basic quality improvement, will continue into 2018. WHA members can find a full brochure and link to registration for future sessions at www.wha.org/seminars.aspx. For questions about the content of these education events, contact Beth Dibbert at bdibbert@wha.org.