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Physician Edition

11-15-2017


November 15, 2017

Volume 5-Issue 21


Annual WHA Physician Leadership Development Conference, March 9-10, 2018

Early bird discount available; register today

Registration is now open for WHA’s 13th annual Physician Leadership Development Conference, scheduled March 9-10, 2018 at The American Club in Kohler. 

The full conference brochure is included in this week’s packet. Online registration is available at www.wha.org or directly at www.cvent.com/d/ktql9j. Discounted registration is available to those registering by January 15, 2018.

This year’s conference will include a full-day session with presenter Allison Linney called “A Leader’s Guide to Resolving Conflict.” This session will focus on the skills needed to make conflict productive, make attendees aware of their own conflict styles, and allow them to practice conflict management and effective communication skills. In addition, a half-day session called “Putting High Reliability Organizing (HRO) to Work,” led by Craig Clapper, will focus on the physician leader’s role in shaping performance culture, discussing the principles of high reliability organizing, and demonstrating various skills physician leaders can use to shape culture. Continuing medical education credits are available again this year.

Both Linney and Clapper are nationally-recognized faculty from the American Association for Physician Leadership (AAPL), formerly the American College of Physician Executives, and both will discuss important and practical leadership skills that help physician leaders move beyond their clinical training and take a new approach to managerial decision making and problem solving.

For questions about the annual Physician Leadership Development Conference, contact Jennifer Frank at jfrank@wha.org or 608-274-1820.

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WI Health News Panel: Wisconsin Worker’s Comp Works Now Without a Fee Schedule

The facts and data show the Wisconsin Worker’s Compensation program is working well. That’s the message from the Wisconsin Hospital Association (WHA) and the Wisconsin Medical Society during a panel discussion moderated by Wisconsin Health News Editor Tim Stumm, November 7 in Madison.

Joanne Alig, WHA senior vice president, policy & research, joined Mark Grapentine, senior vice president of government relations, Wisconsin Medical Society; Charles Burhan, assistant vice president and senior public affairs officer, Liberty Mutual; and Chris Reader, director, health and human resources policy, WMC, to discuss the latest proposal to implement a medical fee schedule in Wisconsin. 

In his introductory comments, Reader noted one reason Wisconsin should want a fee schedule is that 44 other states have found that as a policy solution to rising medical costs.

But Alig questioned that logic. “Just because 44 other states have a fee schedule, why should we?”  She noted that premiums have been coming down in Wisconsin—8.46 percent starting October 1, on top of 3.19 percent the year before—resulting in about $220 million in savings to employers over the past two years. Grapentine added that in October when the rates took effect, it was the health care sector that was touting what a great benefit that was to Wisconsin business.

Alig also took issue with the basic premise that medical costs in Wisconsin are higher than other states. She noted the Worker’s Compensation Research Institute (WCRI) adjusts their data, automatically resulting in Wisconsin’s costs looking higher compared to the other 18 states it includes in its study. Alig pointed out that WCRI has at least four different numbers on how Wisconsin compares to other states on medical costs per claim, all depending on how the data is displayed. Rather, relying on data from the National Council of Compensation Insurance (NCCI) and looking at the last three years’ of data, Alig said Wisconsin is below the national average. 

The fee schedule, as proposed by the Worker’s Compensation Advisory Council, would take rates negotiated between health insurers in the group market and providers, and apply those rates to the worker’s compensation program. Burhan noted that “most employers cannot negotiate in worker’s compensation.” Burhan went on to say they believe they need the state to help them negotiate. 

Alig and Grapentine both explained that the worker’s comp program is looking for the same discounts that group health receives; however, the proponents of a fee schedule take no interest in doing the hard work to reduce the “worker’s comp industrial complex” that operates behind the scenes and adds costs to the system. They both noted there is a give and take in negotiations. Alig pointed out that group health insurers negotiate lower prices with providers based on factors such as prompt payment. 

“In the worker’s comp program, only 8 percent of the claims are paid within 30 days. In group health, over 70 percent of the claims are paid in 30 days,” Alig said. “No other business would wait 12 to 18 months to get paid.”

They also pointed out the loss ratio in worker’s comp is 62 percent. “That means 38 percent or about $760 million is going to insurers’ administrative costs and profit,” Alig said. Grapentine added that it would be “fair to have transparency in that area.”

Grapentine also emphasized that injured employees have rapid access to care and treatment, they return to work three weeks faster than the national average, they receive the highest quality of care and the program’s medical costs are at the national average. 

According to Reader, however, health care shouldn’t take any credit for the great return to work statistics.

“No doubt we have excellent care,” he said. “But that’s not why workers get back to work faster.”

WHA and WMS took issue with that sentiment. Grapentine described a recent op-ed that highlights the difference in opinion. “Management said that it’s laughable that health care would have anything to do with getting people back on the job. That’s the difference between where health care is, taking care of patients and concentrating on patients, which is every chiropractor and PT and physician and hospitals’ number one job.” 

“We are just really proud of health care overall, when it comes to taking care of people, and we don’t think we need to take a sledgehammer to the system,” Grapentine said. 

Alig said if a fee schedule goes into effect, injured patients will still get high-quality care. “We are number one in the country, and it’s what we do in Wisconsin,” she said. “But, if a fee schedule goes into effect, we won’t have done the hard work of getting at the underlying costs of the system.”

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Hospitals Find Experienced Nursing, Entry-Level Positions Difficult to Fill

WHA report says team-based care will help address workforce gaps, while innovation, technology change how care is delivered

Hospitals and health systems are not immune to the workforce struggles all employers are facing as the number of available workers continues to decline and baby boomers retire. That leaves positions that require experienced professionals difficult to fill in hospital intensive care units, operating rooms and highly specialized care units, such as oncology and surgery.

“Employers will need strategies, such as flexible or shorter shifts, less physical work and ‘as needed’ positions to keep the boomers, with all their experience, working a few years longer,” according to Ann Zenk, Wisconsin Hospital Association (WHA) vice president, workforce and clinical practice.

A new WHA report indicates that with the number of people over age 65 living in Wisconsin expected to double by 2030, the health care workforce will need to grow more than 30 percent to meet the demand for care. That growth is dependent on health care organizations successfully competing for entry-level applicants.

Unlike many other employers, hospitals offer a career pathway for most entry-level professions. For example, a certified nursing assistant can advance to registered nurse and then pursue an advanced degree and become a nurse practitioner. Hospitals list advanced practice nurses as one of their most sought after and difficult positions to recruit (see infographic).

“It is critical that we have a pipeline of advanced practice nurses, respiratory therapists, surgical technicians and physical therapists. These positions are among the hardest to replace,” Zenk said.

The good news is that millennials are showing increased interest in health care professions.

“As a generation, millennials want to make a difference. They value teamwork and they form strong bonds with their employers, all values that are embodied in health care,” according to Zenk. “Not only are they eager to serve patients, they also want to be actively involved in their workplace and bring new ideas that will help shape the future of health care.”

Technology, innovation are changing care delivery, creating new roles
Health care leaders recognize that new models of care must leverage health care professionals’ time, while ensuring patients receive the care they need, when they need it, as close to home as possible.

Advanced in-home technology is being used to monitor patients with chronic conditions so they do not need to travel to the clinic or hospital. Patients can be remotely monitored by nurses, physicians or therapists who can facilitate self-care, or direct patients to the appropriate care setting if their health cannot be managed in the home.

Telemedicine has brought the expertise of specialists located anywhere in the country to the bedside and exam room to diagnose, monitor and treat patients. According to the WHA survey, over 75 percent of Wisconsin hospitals have implemented some form of telemedicine. Physician specialists are often difficult to recruit, but through telemedicine, their expertise can be available to hospitals and clinics in rural areas of the state.

Innovation in how care is delivered expands access to medical services as teams of health care professionals share the responsibility for patient care. These care teams can be comprised of, for instance, a physician, physical therapist, dietician, social worker, pharmacist and nursing assistant. Together, they apply their specific skillsets to meet the needs of the patient.

The Future Is Now: WHA Workforce Recommendations
Wisconsin is consistently ranked as having the highest quality of health care in the nation. That standard of care is only possible if there is a highly skilled, adequate workforce. Key recommendations WHA makes in the 2017 report to help ensure the demand for health care can be met today and into the future: 

  • Nursing schools at all levels should collaborate with one other and with key stakeholders to ensure that faculty supply is aligned to demand for nurses in the workforce.
  • Educators should continue to create innovative solutions, such as online, accelerated and early entry programs, to support a nursing career pathway to advanced degrees for clinical practice, education and informatics.
  • State government has a critical role in growing the workforce locally by supporting grant programs that help hospitals and their partners develop training programs that offer opportunities for advancement for entry-level positions.
  • Policymakers and state agencies must understand and seek to reduce the impact of burdensome regulation and documentation requirements that do not improve patient care and may hinder access; a clinician’s workday is a finite resource.
  • Reimbursement to hospitals and health systems should recognize the investment of time and technology that is required to perform care coordination, especially for rural and safety net providers who care for vulnerable patient populations who require complex care.
  • Policymakers must continue to support broadband expansion with priority to rural and remote areas of the state. This will ensure that access to health care will be backed by evolving technology.

“Technology and innovation in the hands of highly qualified health care professionals will ensure Wisconsin will continue to deliver the highest quality of care in the nation,” according to WHA President/CEO Eric Borgerding. “To do this, the health care workforce must keep pace with the demand for medical services in a rapidly changing, increasingly complex environment. Together, with our partners in the Legislature, education, and state government, we can achieve the goal of providing even better care, higher value and healthier people in Wisconsin.”

The Wisconsin Health Care Workforce Report is an annual publication of the Wisconsin Hospital Association.

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CMS Releases Final 2018 Physician Payment Rule

Rule includes policy changes affecting hospital outpatient departments, PQRS measures, telehealth services

The Centers for Medicare & Medicaid Services (CMS) issued its final rule for the physician fee schedule (PFS) for calendar year 2018. In addition to increasing physician payment rates for 2018 by an estimated 0.41 percent compared to 2017, the final rule makes a number of important policy changes, including in the areas of hospital outpatient departments in the context of Section 603 of the Bipartisan Budget Act of 2015, required measures under the Physician Quality Reporting System, payable telehealth services and the value modifier program.

Hospital outpatient departments

Unfortunately, CMS continued to make changes to its policy implementing Section 603 of the Bipartisan Budget Act of 2015, which impacts various provider-based, off-campus hospital outpatient departments (HOPDs). Under the statute and subsequent regulations, CMS finalized in its rules that services furnished in impacted HOPDs were no longer able to bill under the outpatient prospective payment system (OPPS), but under the physician fee schedule at 50 percent of its previous OPPS rate. The good news is that in its 2018 PFS rule, the agency did not finalize its proposal to cut payments even further—to 25 percent of the OPPS rate—for non-excepted services in 2018. However, the bad news is that CMS did finalize an additional cut for these services, taking reimbursement down from the current 50 percent of the OPPS rate to 40 percent of those rates.

WHA continues to believe the analysis CMS used to formulate this most recent payment cut is deficient. Further, WHA believes the way CMS operationalized Section 603 in 2017 is overly restrictive and negatively impacts hospitals and health systems from locating services where those services are needed. This is especially problematic for rural areas.

Reduction in PQRS measure burden

While data submission for the CY 2018 Physician Quality Reporting System (PQRS) has passed, CMS will retroactively lower the number of required measures from nine to six to more closely align the program with the new Merit-based Incentive Payment System that will affect payment starting in CY 2019. WHA expressed its support for this provision in a September 11, 2017 comment letter to CMS.

Other positive policy changes

In the final rule, CMS adds two new services to the list of telehealth services that are payable under Medicare: psychotherapy for crisis and counseling visits to determine low-dose computed tomography. In addition, CMS finalizes a policy to pay for the following services that are billed to Medicare as add-ons to codes already on the telehealth list:

  • Interactive complexity;
  • Administration of patient-focused health risk assessment instrument;
  • Administration of caregiver-focused health risk assessment instrument for the benefit of the patient; and,
  • Comprehensive assessment of and care planning for patients requiring chronic care management services.

CMS also lowers the maximum negative payment adjustment under the CY 2018 value modifier (VM) program from 4.0 percent to 1.0 percent for individual clinicians and groups of under 10 clinicians, and to 2.0 percent for groups of 10 or more clinicians. In addition, only those clinicians and groups failing to report data would experience a negative VM adjustment. WHA also expressed support for changes that reduced these penalties as providers transition to the new Quality Payment Program. Finally, the final rule delays until January 1, 2020, the appropriate use criteria program for advanced diagnostic imaging services.

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Tom Still Column:  Why health care can attract business, workers

By: Tom Still, Wisconsin Technology Council

This column appeared in the Wisconsin State Journal November 3, 2017.

Every few years someone in state government laments, “We need a better brand for Wisconsin!” Cabinet secretaries scurry about, agency communications directors scratch their heads over possible slogans and marketing campaigns go largely unfunded.

Here’s an idea: Let’s talk about Wisconsin’s tangible business assets without making it all about tourism and cheese (as much as Badger state loyalists value both).

One such asset is quality health care, a commodity largely taken for granted inside Wisconsin and largely unknown to people and companies who may be thinking of moving or expanding here.

Much like an educated workforce, reliable public utilities and affordable business costs for land and talent are worth bragging about, so is quality health care. That’s the conclusion of a report issued this month by the Wisconsin Technology Council.

“Taking the pulse: How quality health care builds a better bottom line” examined leading indicators of health-care quality, based on public and private data. It also compared quality rankings to costs. Key findings were:

Wisconsin is consistently one of the top states for quality health care, as measured by 200 metrics compiled by the federal Agency for Healthcare Research and Quality. It ranked No. 1 in the nation in 2017. In the seven-state region surrounding or within a day’s drive of Wisconsin, only two other states (Iowa and Minnesota) ranked in the top quartile. Wisconsin has ranked no lower than 7th nationally since 2006.

Wisconsin ranked just $3 above the national median ($4,666 versus $4,663) in the average employer share of single premium health insurance in 2015. That placed the state in the second-lowest cost quartile among the 50 states. Wisconsin was $800 above the national median ($13,187 versus $12,387) in the average employer share of family premium health insurance for the same year, still outside the most expensive quartile.

Wisconsin health insurance premiums are growing slower than other states in the seven-state region and the nation, especially since 2010. For single coverage, the cost increase has averaged 2.2 percent per year versus 3.8 percent nationally. Wisconsin ranked second best in the nation in this category. For family coverage, the cost increase has averaged 4 percent versus 4.5 percent nationally. Wisconsin is tied for 10th nationally in controlling the growth in family coverage premiums since 2010.

Wisconsin also ranks favorably in national and regional comparisons of deaths that could have been avoided by proper health care, Medicare 30-day hospital readmissions, hospital length of stays, mean inpatient charges, the percentage of the total population covered by health insurance and use of electronic health records. All are rankings that speak to quality while controlling costs.

The logjam over Obamacare in Washington. D.C., has upended the health insurance market as companies and workers come to grips with rising costs. That confusion is playing out this fall in Wisconsin and elsewhere as group health plan enrollments come due for employers and employees alike.

One potential asset for Wisconsin is that it’s not a captive health insurance market. The report revealed that Wisconsin is one of only two states (New York is the other) in which the three largest insurers control less than 60 percent of the market. Other states in the seven-state region showed “top three” insurance market shares ranging from 67 to 97 percent. The U.S. median is 90 percent. More choice may lead to more competition over time, even if Obamacare is dismantled.

Employers have a right to complain about health care costs, but they aren’t powerless to control the rate of increase or the outcomes.

As the report noted, individual companies, groups of companies or institutions have found ways to work with health systems. This is often accomplished through on-site clinics, incentive programs and prevention strategies that engage employees. Results include lower rates of absenteeism and people showing up sick; avoiding procedure costs through preventive care; and lower costs of care due to better physical fitness and health habits.

Examples cited in this report include Colony Brands and Monroe Clinic; Ashley Furniture and Gundersen Health System; Hoffmaster and Thedacare; Organic Valley and Vernon Memorial Healthcare; Northeast Wisconsin Technical College and Bellin Health; a collection of companies working with Columbus Community Hospital; and a mix of Chippewa Valley institutions working with Mayo Clinic.

Quality health care is not only nice to have; it’s an asset in the state-to-state race to attract and retain companies and workers. Let’s market one of the things Wisconsin does best.

Find at: http://wisconsintechnologycouncil.com/2017/inside-wis-measuring-quality-why-health-care-can-attract-business-workers.

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Assembly, Senate Wrap Up Fall Floor Session

WHA-led team-based care, behavioral health priorities move forward

Wisconsin’s Assembly and Senate wrapped up their work for this fall legislative session by approving two key WHA legislative priorities, including legislation to reform Wisconsin’s emergency detention law and legislation clarifying the ability for advanced practice clinicians and other providers to order services for Medicaid enrollees. The Legislature can come back in 2018 for three general business floorperiods in January, February and March before they adjourn the entire 2017-2018 biennial legislative session.

On the evening of November 7, the Senate unanimously approved Assembly Bill 529, legislation that clarifies a section of Wisconsin state law referencing the ability for providers to order services for Medicaid patients. The bill, which was drafted by the Wisconsin Department of Health Services (DHS) and is supported by WHA, provides better clarification to health care providers that Wisconsin’s Medicaid program recognizes orders made by physicians and non-physician providers alike. WHA led a coalition memo and testified in support of the bill at both the Senate and Assembly hearings. Months ago, WHA met with DHS to begin discussing solutions to address the concerns being addressed by this legislation.

The bill does not change any provider’s scope of practice and maintains the already recognized Medicaid policy acknowledging valid orders made within a provider’s scope of practice under statutes, rules and regulations governing the provider’s practice.

Prior to being approved by the Senate, Assembly Bill 529 passed through the state Assembly November 2. The bill will now be sent to Gov. Scott Walker for his signature—which is expected to occur in the coming weeks.

In addition, the Assembly unanimously approved Assembly Bill 538, a WHA-led bill reconciling Wisconsin’s emergency detention law with federal EMTALA (Emergency Medical Treatment and Active Labor Act) requirements for appropriate transfers of patients and providing additional liability clarity for health care providers treating patients during a mental health crisis. The bill has been in development for several years in conjunction with WHA, the Wisconsin Counties Association and in consultation with law enforcement organizations.

Assembly Bill 538 was led by a bipartisan group of four lawmakers: Reps. John Jagler (R-Watertown) and Eric Genrich (D-Green Bay) and Sens. Rob Cowles (R- Green Bay) and Janis Ringhand (D-Evansville). The bill passed unanimously out of the full Assembly November 9.

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WI Hospitals State PAC/Conduit Campaign

Fundraising campaign tops $261,000

The 2017 Wisconsin Hospitals State PAC & Conduit campaign topped the $261,000 mark this week with contributions from 277 individuals. This puts the campaign at 84 percent of goal. There are only eight weeks left to make your contribution for 2017! Make an impact by contributing today.

Make sure your name is on the next full list of 2017 Wisconsin Hospitals State PAC & Conduit contributors, which will run soon. Contribute today at www.whconduit.com or by calling WHA’s Jenny Boese at 608-268-1816 or Nora Statsick at 608-239-4535.

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WHA’s Special Needs Dental Patients Work Group Begins its Work


WHA’s engagement in access to oral health care is one example of WHA’s work beyond the hospital walls.  As part of its oral health care agenda, WHA recently formed a Special Needs Dental Patients Work Group, which held its first meeting October 31. The goal of the work group is to develop a proposal to address the severe lack of dental care in Wisconsin for patients with special needs.

Dental patients with special needs are individuals with physical, medical, developmental or cognitive conditions resulting in substantial functional limitations which require treatment modifications in order to provide them with comprehensive oral health care services. Treatment modifications may include providing dental care in a hospital setting under general anesthesia, and many Wisconsin hospitals are currently providing surgical suite access to dentists to treat patients with special needs.

Members of the work group are:

  • Mark Hamilton, Vice President, UW Hospital and Clinics and Executive Director of Wisconsin Dialysis, Madison
  • Steve Francaviglia, President, Greater Milwaukee South Market, Aurora Health Care
  • Donna Gliniecki, Social Worker, Marshfield Clinic, Wausau
  • Ron Bullen, Director of Surgical Services, Oconomowoc Memorial Hospital/ProHealth Care, Waukesha
  • Chris Brabant, Executive Director Surgical Services, HSHS St. Mary’s Hospital Medical Center, Green Bay
  • Sandra Brekke, Senior Consultant Population Health, Gundersen Health System, La Crosse
  • Lori Barbeau, DDS, Medical Director, Children’s Hospital of Wisconsin Dental Center, Milwaukee
  • Pamela Fraser, Director, Dental Services, Children’s Hospital of Wisconsin, Milwaukee

The work group identified barriers to adequate and consistent access to necessary dental treatment for these patients. The barriers include poor Medicaid reimbursement for dental procedures, a lack of training opportunities in Wisconsin for hospital-based dentistry, a need for care coordination, an insufficient comfort level among dentists working with complex special needs dental patients, a shortage of dentists with higher level sedation permits, and a shortage of sufficiently equipped dental suites in hospitals.

The work group will meet again before the end of the year to review information on patients with special needs and identify policies that could address the barriers to care identified at its first meeting.

For more information on the Special Needs Dental Patients Work Group, contact Laura Rose, WHA vice president, policy development, at lrose@wha.org.

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Be Involved: Join a WHA Council or Committee

WHA is currently soliciting appointment requests from WHA members to participate in WHA councils and subcommittees. Now is your opportunity to participate on the councils that are at the forefront of identifying key policy issues for the membership and making recommendations on positions to the WHA Board.

The following councils and committee are seeking member participation: 

  • Advocacy Committee
  • Council on Finance and Payment
  • Council on Public Policy
  • Council on Rural Health
  • Council on Workforce Development
  • WHA Physician Leadership Council

Additional information including council responsibilities and current member information is located at www.wha.org/Data/Sites/1/aboutwha/WHAcouncilResponsibilities10-17-17.pdf. To be considered for a council or committee, sign up online at www.surveymonkey.com/r/TDYR9KK. Direct questions to Sherry Collins at scollins@wha.org or 608-274-1820.

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Quality Payment Program Final Rule Issued November 2

Last week, the Centers for Medicare and Medicaid Services (CMS) released the final rule for year two of the Quality Payment Program (QPP; also known as MACRA). This rule, which is of great importance to WHA members and their covered providers, will go into effect January 1, 2018. In the final rule, CMS heeded many of the comments submitted by WHA and other commenters that continues the incremental, flexible implementation of QPP called for by hospitals, health systems and the employed and contracted physicians with whom they partner to deliver care.

Highlights of the final rule include the following:

  • Raised the low volume threshold in 2018 for required participation in the Merit-Based Incentive Program (MIPS) to $90,000 and over in Medicare Part B allowed charges and 200 or more Part B beneficiaries (up from $30,000 in Part B charges and 100 beneficiaries in 2017). CMS anticipates that this increase in the low-volume threshold will exclude 134,000 more clinicians than would have been excluded under the previous low-volume threshold, which means that many more clinicians no longer must demonstrate meaningful use of EHR technology in order to avoid Medicare penalties.
    • Adjusted the weights to the 2018 MIPS final score as follows:
        • Cost: 10 percent (increased from 0 percent in 2017)
        • Quality: 50 percent (decreased from 60 percent in 2017)
        • Improvement activities: 15 percent (same as 2017)
        • Advancing care information: 25 percent (same as 2017)
           
    • Changed the method and timing of removing topped-out measures. Topped-out measures are those measures that the whole country is scoring at or very close to the highest possible score (usually 100 percent). They get removed because there is no further opportunity to improve care around that measure. Under the final rule, topped-out measures will be removed and scored on a four-year phasing out timeline. Topped out measures with measure benchmarks that have been topped out for at least two consecutive years will earn up to 7 points.
       
    • Added virtual groups as a way to participate in MIPS for 2018. Virtual groups may be made up of solo practitioners and groups of 10 or fewer eligible clinicians who come together virtually to participate in MIPS for a one-year performance period.
       
    • Added a complex patient bonus where clinicians can earn up to 5 bonus points for the treatment of complex patients.
       
    • Added a small practice bonus, which will add 5 points to any MIPS-eligible clinician or small group who is in a small practice (defined as 15 or fewer eligible clinicians), as long as the MIPS-eligible clinician or group submits data on at least one performance category in an applicable performance period.
       
    • Extended the 8 percent revenue-based standard under the Alternative Payment Model (APM) Program for two additional years, through performance year 2020. The revenue-based standard is the risk assumed under the APM which is equal to at least a percentage of estimated Parts A and B revenue of the participating APM entities for the performance period.
       
    • Provided an additional year to the phase-in period for the total potential risk for an APM entity under the Medical Home Model standard. The following percentages will apply to the estimated average total Medicare Parts A and B revenues of all providers and suppliers in participating APM entities that will be at risk:
       
        • 2.5 percent for performance year 2018
        • 3 percent for performance year 2019
        • 4 percent for performance year 2020
        • 5 percent for performance years 2021 and after
           
    • Modified the timeframe on which to consider the Medicare fee-for-service payment amounts and patient counts for certain advanced APMs. For advanced APMs that start or end during the performance period (January 1 - August 31 of each year) threshold scores are calculated using dates that the APM entity was able to participate in an advanced APM, as long as they were able to participate for at least 60 continuous days during the applicable QP performance period.
       
    • Added a provision that payers may submit payment arrangements authorized under Medicaid, Medicare Advantage and payment arrangements aligned with a CMS multi-payer model. Payers will also be able to request that CMS make other payer advanced APM determinations before the relevant performance period.

Resources on the QPP are available on the WHA website at www.wha.org/macra.aspx. For additional information on the final rule for year two and other QPP issues, contact Kelly Court, WHA chief quality officer, at kcourt@wha.org, or Laura Rose, WHA vice president, policy development, at lrose@wha.org.

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Wisconsin Tied for 4th in the Nation for Most Top-Rated Health Plans

Provider-owned plans lead the way

Provider-owned health plans serving the commercial market were rated the best in Wisconsin by the National Committee for Quality Assurance (NCQA). NCQA noted Wisconsin is among the states with the highest percentage of high-quality health plans, and it placed Wisconsin in a tie for 4th among the states with the highest number of plans receiving a top rating.

The NCQA ranked more than 1,000 health insurance plans based on clinical quality, member satisfaction and NCQA Accreditation Survey results. The report notes their rating system emphasizes care outcomes and what patients say about their care.

“Wisconsin is fortunate to have choices and competition in our insurance market, unlike other states where one or two big, national insurance companies dominate and dictate the market,” said WHA President/CEO Eric Borgerding. “In a state known for high-quality health care, it is not surprising the highest-rated health plans are provider-owned and based right here in Wisconsin.”

See all NCQA health insurance plan ratings.

Private/Commercial

Type

Rating

Dean Health Plan, Inc.

HMO

4.5

Group Health Cooperative of South Central Wisconsin

HMO

4.5

Gundersen Health Plan

HMO

4.5

HealthPartners Administrators, Inc.

HMO/POS/PPO

4.5

HealthPartners, Inc.

HMO/POS/PPO

4.5

Security Health Plan of Wisconsin, Inc.

HMO/POS

4.5

Unity Health Plans Insurance Corporation

HMO/POS

4.5

 

Medicare

Type

Rating

Group Health Plan, Inc.

HMO

5.0

Gundersen Health Plan, Inc.

HMO

5.0

Medical Associates Clinic Health Plan of Wisconsin dba Medical Associates Health Plans

HMO

5.0

Aetna Life Insurance Company (Wisconsin)

HMO

4.5

Dean Health Plan, Inc.

HMO

4.5

Network Health Insurance Corporation (NHIC)

HMO

4.5

Security Health Plan of Wisconsin, Inc

HMO/POS

4.5

Ratings based on NCQA Health Insurance Ratings 2017 – 2018.

Plans with partial or no data reported did not receive a rating.