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Physician Edition

12-20-2017


December 20, 2017

Volume 5-Issue 23


WHA Physician Leaders Council Discusses EHR Workload; Psychiatrist Reimbursement Advocacy

The WHA Physician Leaders Council met December 5 and discussed a range of topics impacting physicians and physician practice within WHA’s member hospitals and health systems, including:

  • WHA 2018 advocacy and education re: physician EHR time
  • Medicaid outpatient behavioral health reimbursement
  • APRN Modernization Bill
  • WHA Physician Quality Academy
  • WHA Physician Leadership Development Conference
  • Constitutionality of medical malpractice non-economic damage cap
  • 2018 MACRA/QPP changes

Advocacy and education on EHR-related physician workload

As an outcome of the October Council discussion on the UW family practice study on physician electronic health record (EHR) time burdens, the Council discussed potential WHA advocacy and educational strategies that it could advance in 2018 to address EHR-related physician workload burden. 

“While enabling ‘top-of-license practice’ has traditionally been a concept we talk about for advanced practice clinicians, it is as important if not more important that we ensure physicians are able to practice at their ‘top-of-license,’” said Steve Kulick, MD, chair of the WHA Physician Leaders Council and chief medical officer for ProHealth Care. 

In October, the Council reviewed and discussed the UW Family Practice study, “Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time Motion Observations,” which appeared in the September/October 2017 Annals of Family Medicine. That study quantified the time family practice physicians spent on documentation and interactions with the EHR during and after the work day (see www.wha.org/wha-newsletter-9-15-2017.aspx#s7).

The UW researchers found clinicians spent 5.9 hours of an 11.4-hour workday in the EHR per 1.0 clinical full-time equivalent. The study tracked and measured non-resident UW family practice physician work and interactions with the EHR over a three-year period beginning in 2013. Documentation, order entry, billing and coding, security and other clerical and administrative tasks accounted for 2.6 hours of the workday, and inbox management accounted for an additional 1.4 hours. 

The study also found that 1.4 hours of EHR time occurred outside of 8 a.m. to 6 p.m. clinic hours, and noted that a number of physicians had reduced their clinical FTE to less than full time due to workload.

Continuing to expand WHA’s regulatory relief and reform advocacy to address regulatory burden directly affecting physicians was a key part of WHA’s integrated physician strategic guidance document adopted by the WHA Board in October. 

“Regulatory burden not only personally impacts physicians and contributes to dissatisfaction, but also impacts the efficiency of health care delivery overall,” said Eric Borgerding, WHA president/CEO.  “Addressing that regulatory burden on physicians will be a key focus for WHA as it develops its next five-year strategic plan in 2018.”

WHA advocacy on Medicaid outpatient behavioral health reimbursement for psychiatrists

WHA staff discussed recent WHA advocacy on implementation of the recently announced Medicaid reimbursement increase for outpatient behavioral health services. See November 22 WHA Valued Voice article at www.wha.org/wha-newsletter-11-22-2017.aspx#s5.

In written comments WHA provided to the Department of Health Services (DHS) in November, WHA thanked the Governor and DHS for this important investment of $7 million in state funds to increase Medicaid reimbursement rates for professionals providing outpatient mental health and substance use disorder services.

However, as DHS implements that increase, WHA urged DHS to include evaluation and management (E/M) billing codes for psychiatrists, APNP-psych and psychiatric physician assistants in the list of procedure codes that will receive a reimbursement increase. 

In October, WHA identified a concern that the E/M reimbursement codes utilized by psychiatrists are not located within the section of billing codes traditionally viewed as behavioral health codes. According to feedback provided to WHA by its members, E/M billing codes make up at least 80 percent of psychiatrists’ outpatient visits for Medicaid patients.

WHA also expressed concern about a draft implementation proposal that would pay physicians specializing in psychiatry, APNP-psych, and psychiatric physician assistants at the same rates as other behavioral health providers without prescriptive authority and lesser education and training requirements. Currently, psychiatrists, APNP-psych, and psychiatric physician assistants receive a higher reimbursement than non-prescribing psychotherapists.

APRN Modernization Bill

The Council discussed and provided input on the recently introduced APRN Modernization Bill and WHA’s advocacy to improve the bill. The Council discussed many of the same issues discussed by the WHA Board December 7. (See WHA Board article above.)

Collaboration requirements for certified nurse midwives was one particular area of discussion by the Council. The Council agreed WHA should proactively recommend that the collaboration standard for certified nurse midwives that solely deliver babies in a hospital setting should be changed from a “collaborative agreement” standard to the lower “documented collaborative relationship” standard that currently applies to advanced practice nurse prescribers.

With the additional quality assurance and other regulatory structures in place in a hospital setting, moving from a collaborative agreement standard to the lower documented collaborative relationship standard makes a lot of sense for nurse midwives solely delivering in hospitals, explained one of the Council members who is an OB/GYN physician.

WHA physician education opportunities

WHA shared plans for the 2018 WHA Physician Quality Academy and the 2018 WHA Physician Leadership Development Conference. 

Building on the inaugural 2017 WHA Physician Quality Academy, the two-day training session provides the training and resources for physicians and advanced practice providers who have an assigned role or have been asked to lead a project related to quality measurement and improvement within a WHA member organization. To view the agenda and registration, go to: www.wha.org/Data/Sites/1/education/2018PhysicianQA.pdf.

Chuck Shabino, MD, WHA chief medical officer, also provided an overview of the 2018 WHA Physician Leadership Development Conference scheduled March 9-10 in Kohler. The agenda and registration can be found here: www.wha.org/Data/Sites/1/education/2018PLD.pdf.

Medical malpractice non-economic damage caps

Matthew Stanford, WHA general counsel, briefed the Council on the status of the Ascaris Mayo v. IPFCF case challenging the constitutionality of Wisconsin’s $750,000 non-economic damage cap in medical malpractice cases. Stanford discussed WHA’s strategy regarding the challenge to this important bipartisan public policy, including WHA’s close collaboration with the Wisconsin Medical Society on this issue. For additional information see www.wha.org/wha-newsletter-11-17-2017.aspx#s2.

2018 MACRA/QPP changes

Kelly Court, WHA chief quality officer, and Laura Rose, WHA vice president, policy development, provided an overview of the 2018 Medicare Quality Payment Program (QPP) final rule. They discussed WHA’s advocacy on the proposed rule, and the final participation requirements for 2018 and future years under the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (Advanced APM) pathways created by MACRA. For additional information, see www.wha.org/wha-newsletter-11-10-2017.aspx#s7.

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New, Reappointed Members Join WHA Board 

Two new members will join the WHA Board of Directors as regional representatives, along with one at-large member who is filing an unexpired term, effective January 1, 2018. The new members of the WHA Board are:


These new regional representatives join the following regional representatives who have been reappointed to the WHA Board of Directors:



 

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State Influenza Weekly Reports Available on WHA.org

Influenza activity has been increasing, according to weekly reports provided to WHA by Jonathan Temte, MD, PhD. Temte is a professor of family medicine at the University of Wisconsin School of Medicine and Public Health, and chair of the Wisconsin Council on Immunization Practices. Throughout the influenza season, he shares his weekly updates with WHA. Temte’s updates are posted in the influenza section of WHA’s website at www.wha.org/weekly-influenza-update.aspx.

To date, there have been 210 influenza-related hospitalizations since September 1, 2017 in Wisconsin. 

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WHA Offers 2018 Physician Quality Academy, May 15-16

In an effort to ensure providers have access to the training and resources necessary to successfully lead quality improvement initiatives, WHA is once again offering its WHA Physician Quality Academy in spring 2018. The 2018 Academy is scheduled May 15 and 16 at the WHA Training Center in Fitchburg.

Hospital and health system leaders are encouraged to register their physicians and advanced practice providers who are involved in quality improvement for the Academy. To further enhance the learning, have them attend as part of a dyad, registering a nurse leader or quality improvement leader as well.

Over two consecutive days of training, Academy participants 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.

Registration is now open for the 2018 Academy. The full event agenda and online registration are available at www.cvent.com/d/mtqztx. An event brochure is included in this week’s packet as well.

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Add WHA Advocacy Day to Your 2018 Calendar – March 21 in Madison

Over 1,000 hospital and health system leaders, employees, trustees and volunteers are expected to descend on Madison March 21 for the Wisconsin Hospital Association’s premier Advocacy Day event. Advocacy Day is free to attend, but registration is required.

Register yourself and your team today at: www.whareg4.org/2018AdvocacyDay.

WHA strongly believes the afternoon’s legislative meetings are the most important part of the day, and encourages attendees to register for Advocacy Day with a legislative visit. To prepare attendees for their meetings, WHA schedules all meetings, provides an issues briefing at Advocacy Day and an optional pre-event webinar on legislative visits.

For Advocacy Day questions, contact Jenny Boese at 608-268-1816 or jboese@wha.org. For registration questions, contact Kayla Chatterton at kchatterton@wha.org or 608-274-1820.

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WHA Member Forum Webinar Focuses on New eNLC

On January 16, WHA will offer a WHA member forum webinar entitled “Enhanced Nurse Licensure Compact (eNLC): A Voluntary, Alternative & Expedited Process for Nurse Licensure,” which nurse leaders and human resources leaders will find informative. This complimentary webinar will provide information on eligibility criteria for eNLC multistate licenses, which nurses who currently hold a multistate license will be grandfathered into the eNLC, and which states are members of the eNLC.

Presenters Ann Zenk, vice president of workforce and clinical practice for WHA, and Andrew Brenton, assistant general counsel for WHA, will also provide details about how and when the eNLC will be implemented in Wisconsin.

For more information and to register, visit: www.whareg4.org/eNLCWebinar. For content questions, contact Ann Zenk at 608-274-1820 or azenk@wha.org. For registration questions, contact Kayla Chatterton at kchatterton@wha.org or 608-274-1820.

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WI Hospitals State PAC & Conduit Surpasses Fundraising Goal!

The Wisconsin Hospitals State PAC & Conduit beat its aggressive $312,500 fundraising goal this week with $313,200 in contributions from 335 individuals.

“A huge thank you goes out to all those who understand the importance of the Wisconsin Hospitals State PAC & Conduit and personally contributed in 2017,” said WHA Advocacy Committee Chair Mike Wallace. “Not only did we raise over $300,000 for the second consecutive year, but we surpassed our stretch goal by raising $313,200 and dollars are still coming in!”

On average, over $6,250 was contributed each week to date in 2017, and contributors gave an average of $935 each. The campaign saw 70 new contributors join the effort so far in 2017.

“Thank you, again, to everyone who contributed, including the WHA staff who once again led by example with their generous participation,” said WHA President/CEO Eric Borgerding. “I would like to also thank the 82 contributors who gave at one of the three donor recognition levels, which begin at $1,500. I am grateful for your leadership and your commitment to this important program.”

A final tally of dollars raised and a full list of all 2017 contributors will run in the January 5, 2018 edition of The Valued Voice.

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Early Bird Registration Open: WHA Physician Leadership Development Conference

Register today for WHA’s 13th annual Physician Leadership Development Conference, scheduled March 9-10, 2018 at The American Club in Kohler, and take advantage of the early bird discount.

Information about this year’s conference and online registration can be found directly at www.cvent.com/d/ktql9j. Discounted registration is available to those registering by January 15, 2018.

The conference will include a full-day session with presenter Allison Linney called “A Leader’s Guide to Resolving Conflict,” focusing on the skills needed to resolve conflict productively. 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.

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