August 18, 2017

Volume 61-Issue 33

CBO Says Not Funding CSRs Will Increase Federal Deficit by $194 Million;

In a new report released August 15, the federal Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) say that a policy of not funding cost sharing reductions (CSRs) would result in market uncertainty and higher federal outlays for premium tax credits. The report analyzes the effect of a hypothetical announcement by the end of August that the CSRs would not be funded beginning January 1, 2018.

CSRs are center stage in the question of overall market stability for the exchange marketplace and the overall individual market. The Trump Administration has been announcing on a month-to-month basis whether it will continue funding cost sharing reduction payments for each month of the 2017 benefit year, with the latest report on August 16 that the payments will continue through August. 

About 125,000 people with income between 100 and 250 percent of the federal poverty level (FPL) in Wisconsin enrolled in exchange coverage currently qualify for these subsidies. The effect of defunding the cost sharing subsidies, however, does not fall only on these individuals. Rather, because insurers would still be required to pay for the cost sharing subsidies without federal funding, insurers have signaled they will either have to raise premiums or choose to exit the market. Thus, the immediate impact of the federal government withholding funding for CSRs is on the overall stability of the market which could jeopardize coverage for all exchange enrollees. This, in turn, has a broader impact on overall coverage expansion in Wisconsin.

In a statement released last week and ahead of the CBO report, WHA President/CEO Eric Borgerding raised serious concerns about the impact loss of the CSRs could have on coverage in Wisconsin. “Wisconsin’s uninsured rate has dropped 38 percent since 2013, and the insurance exchange has been an integral part of that reduction,” Borgerding said. “Wisconsin has much at stake in what comes next out of Washington, and something must come next. Inaction is not an option, nor is intentionally allowing failure of insurance markets an acceptable strategy or outcome.” 

The latest CBO report says that insurers would likely raise premiums by an average of 20 percent if the CSRs are not funded, and the federal government will bear $194 million in increased costs as a result. The report attributes the increase to two factors: first, the amount of premium subsidies paid by the federal government will be higher, and second, more people will receive the subsidies. 

Why will premium subsidies be higher? 
Most state insurance regulators are asking insurers to load the cost increase for the CSRs onto the premium for the silver level plan in the exchange. The silver level plan is key to the amount of premium tax credit a person receives. The amount paid by the enrollee is generally set by the parameters of the Affordable Care Act (ACA) and depends on the person’s income. When the premiums for the second lowest cost silver plan go up, the amount of premium tax credit goes up, while the amount paid by the enrollee generally stays the same. 

To help illustrate this, for a person with income just under $30,000 (equal to 250 percent FPL), the ACA sets the maximum amount the person will have to pay for the silver plan at 8.2 percent of their income, or $2,460 per year. If the premium for the second lowest cost silver plan in their area is, say, $3,500 per year, the tax credit is $840 ($3,500-2,460). If instead the premium for the second lowest cost silver plan in their area rises by 20 percent to $4,200, the tax credit goes up to $1,540. 

The CBO says for most people eligible for the CSRs with income up to 200 percent FPL, the higher premium cost and thus higher premium subsidies paid by the federal government will generally offset the CSR payments the federal government otherwise would have made. However, for people at higher income levels, also subject to the premium increases, the increases in premium tax credits will exceed the CSR payments. 

Why will more people be eligible for premium tax credits?
The CBO estimates that more people with income between 200 and 400 percent FPL will enroll in coverage in the exchange marketplace if CSRs are not funded and premiums for the silver plans increase. This is because as the tax credit increases, people at higher incomes will be able to buy plans for lower net premiums or even buy gold level plans with lower deductibles at the same price as they pay now for silver plans that have higher deductibles. 

In the example above, the tax credit of $1,540 can be used to buy any plan on the exchange. Gold level plans generally have higher premiums but lower deductibles and lower copayments. As premiums in the silver plan increase, those premiums come closer to the premium for the gold level plan and, CBO projects, may even exceed the premium for the gold plan. If a person looking to buy coverage now receives a higher tax credit and can purchase a gold level plan for the same premium as they now pay for the silver plan, this is more attractive and may incent more people to buy coverage in the exchange. CBO estimates that more people would purchase plans in the exchange than would have otherwise and fewer people would purchase employment-based health insurance. 

Effects on market stability
CBO also assumes more insurers will not participate in the exchange in the first few years of the policy, as a result of substantial uncertainty about the effects of the policy. As a result, CBO estimates that five percent of the population will live in areas that would have no insurers in the individual market in 2018. A recent analysis by WHA showed that, given all announcements to date about changes in insurer participation in the Wisconsin markets, Menominee County would have no insurer participating in the exchange in 2018, and 10 counties would have a choice of only one insurer. (See previous Valued Voice article).

WHA continues to focus on ways to sustain coverage and maintain stability in our health care markets. “The CBO’s findings only serve to confirm WHA’s concerns and reinforce the need for Congress and the President to act,” Borgerding said.


Top of page (8/18/17)

CMS Proposed Rule Significantly Alters Bundled Payment Programs 

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

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

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

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

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

Top of page (8/18/17)

WI Hospitals State PAC & Conduit Surpasses $200,000
See full contributor list

The Wisconsin Hospitals State PAC & Conduit 2017 fundraising campaign surpassed the $200,000 mark with contributions from 219 individuals. A total of $207,000 has been contributed to date with an average of $6,272 contributed per week. On average, individuals contributed $945 each.

“The 2017 fundraising campaign is two-thirds of the way to its aggressive goal of raising over $312,000 this year,” said WHA President/CEO Eric Borgerding. “I would personally like to thank everyone for their support during this non-election, but still very important fundraising year. To the 219 individuals listed here, your participation is recognized and valued.”

See the full contributor list below. If your name did not make the list, make sure you contribute today to be included on the next contributor list. Contribute online at www.whconduit.com or by calling WHA’s Jenny Boese at 608-268-1816 or Nora Statsick at 608-239-4535.

Contributors ranging from $1 to $499
Bagnall, Andrew HSHS - St. Nicholas Hospital
Breen, Melissa Marshfield Clinic
Byrne, Frank SSM - St. Mary's Hospital
Cahoy, Jim WHA Information Center
Carr, Alistair WHA Information Center
Clark, Julie HSHS - St. Joseph's Hospital
Cliffe, Elizabeth Ascension Wisconsin
Collins, Sherry Wisconsin Hospital Association
Competente, Brian WHA Information Center
Danner, Forrest Aspirus Clinics
Dettman, Amy Bellin Hospital
Dresang, Andrew Froedtert Health
Drone, Kim Wisconsin Hospital Association
Dux, Larry Froedtert & MCW Community Memorial Hospital campus
Fielding, Laura Holy Family Memorial, Inc.
Foley, Kathy Kelsey Aspirus
Garibaldi, Isabelle Watertown Regional Medical Center
Groskreutz, Kevin HSHS - St. Joseph's Hospital
Halida, Cheryl HSHS - St. Joseph's Hospital
Hart, William Columbia St. Mary's Hospital - Milwaukee
Hieb, Laura Bellin Hospital
Helgeson, Jason HSHS - Eastern Wisconsin Division
Hendrix, Jamie Columbus Community Hospital
Hill, Juliet HSHS - Sacred Heart Hospital
Kempen, Jacob Aspirus Wausau Hospital
Kingston, Mary Beth Aurora Health Care
Klay, Chris HSHS - St. Joseph's Hospital
Kluth, Doreen HSHS - St. Vincent Hospital
Koebke, Troy Bellin Hospital
Luehring, Sally HSHS - St. Vincent Hospital
Lux, Teresa Froedtert & MCW Community Memorial Hospital campus
Lynch, Sue Mayo Clinic Health System - Franciscan Healthcare
Manley, Paula Prevea Health/Hospital Sisters Health System
Margan, Rob Wisconsin Hospital Association
Markgraf, Janelle Aspirus Langlade Hospital
Maurer, Mary Holy Family Memorial, Inc.
McNally, Maureen Froedtert & The Medical College of Wisconsin
McCawley, Thomas Beloit Health System
McMeans, Scott Aurora BayCare Medical Center - Green Bay
Meicher, John SSM - St. Mary's Hospital
Miller, Thomas Children's Hospital of Wisconsin
Mirasola, Tony WHA Information Center
Nagle, Dan WHA Information Center
Nevers, Rick Aspirus Medford Hospital & Clinics, Inc.
Nicklaus, Todd Aspirus, Inc.
O'Brien, Colleen Bellin Health System
O'Keefe, James Mile Bluff Medical Center
Page, Alison Western Wisconsin Health
Peck, Lori Aspirus, Inc.
Peiffer, Susan HSHS - Sacred Heart Hospital
Pempek, Kalynn Aspirus, Inc.
Peterson, Douglas Chippewa Valley Hospital
Pinske, Heather SSM - St. Mary's Hospital
Prunty, Brian Aspirus
Quackenboss, Tatum HSHS - St. Vincent Hospital
Riddle, Roberta Rusk County Memorial Hospital
Risley-Gray, Ruth Aspirus, Inc.
Rislov, Amy Aurora Health Care
Roethle, Linda Bellin Hospital
Roundy, Ann Columbus Community Hospital
Rude, Nels The Kammer Group
Schaetzl, Ron SSM - St. Clare Hospital & Health Services
Selle, Ginger SSM - St. Clare Hospital & Health Services
Sheehan, Heather Hayward Area Memorial Hospital and Nursing Home
Smith, Robert Aspirus Wausau Hospital
Strasser, Kathy Aspirus, Inc.
Statsick, Nora Wisconsin Hospital Association
Statz, Darrell Rural Wisconsin Health Cooperative
Staudenmayer, Suzanne WHA Information Center
Stelzer, Jason SSM - St. Clare Hospital & Health Services
Tandberg, Ann HSHS - St. Joseph's Hospital
Tapper, Joy Milwaukee Health Care Partnership
Thompson, Mark Aurora Health Care
Tincher, Pat Aspirus Langlade Hospital
Trinkner, Steve WHA Information Center
VanStraten, Randy Bellin Hospital
Walker, Troy SSM - St. Clare Hospital & Health Services
Werkheiser, Cindy Monroe Clinic
Westbrook, Diane River Falls Area Hospital
Wetenkamp, Vicki Holy Family Memorial, Inc.
Wymelenberg, Tracy Aurora Health Care
Wysocki, Scott SSM - St. Clare Hospital & Health Services

Contributors ranging from $500 to $999
Bayer, Tom HSHS - St. Vincent Hospital
Brenny, Terrence Stoughton Hospital Association
Carlson, Peter Aurora Psychiatric Hospital
Curran-Meuli, Jane Holy Family Memorial, Inc.
DeGroot, Dan HSHS - St. Clare Memorial Hospital
Dexter, Donn Mayo Clinic Health System - Eau Claire
Elfner, Christopher Bellin Health System
Elkins, Kelly Ascension Columbia St. Mary's
Francaviglia, Stephen Aurora Health Care
Geboy, Scott Hall, Render, Killian, Heath & Lyman
Gille, Larry HSHS - St. Vincent Hospital
Graf, John Watertown Regional Medical Center
Hartberg, David Gundersen - Boscobel Area Hospital and Clinics
Heaney, Dwight Fort HealthCare
Herzog, Sarah Wheaton Franciscan Healthcare
Jensema, Christine HSHS - Eastern Wisconsin Division
Johnas, Lora HSHS - Sacred Heart Hospital
Just, Lisa Aurora Memorial Hospital of Burlington
Keddington, Richard Watertown Regional Medical Center
Kersten, Juliet Children's Hospital of Wisconsin
Kneiser, Patti Froedtert & The Medical College of Wisconsin
Larson, Margaret Affinity Health - Mercy Medical Center
Logemann, Cari Aspirus, Inc.
Miller, Brent Marshfield Clinic
Nelson, James Fort HealthCare
O'Brien, Colleen Bellin Health System
Quinn, George Wisconsin Hospital Association
Richardson, Todd Aspirus
Rocole, Theresa Wheaton Franciscan Healthcare
Roesler, Bruce The Richland Hospital
Rohrbach, Dan Southwest Health Center
Rutkowski, Jennifer Grant Regional Health Center
Schnedler, Lisa Upland Hills Health
Sczygelski, Sidney Aspirus, Inc.
Shabino, Charles Wisconsin Hospital Association
Sprecher, Lon  
Strasser, Kathy Aspirus, Inc.
Stuart, Philip Tomah Memorial Hospital
Van Meeteren, Bob Reedsburg Area Medical Center

Contributors ranging from $1,000 to $1,499
Anderson, Andy Aurora Health Care
Brenton, Andrew Wisconsin Hospital Association
Cadieux, Marc Children's Hospital of Wisconsin
Dietsche, James Bellin Hospital
Ericson, Allen Froedtert & MCW St. Joseph's Hospital Campus
Geraghty, Tricia Children's Hospital of Wisconsin
Gunn, Veronica Children's Hospital of Wisconsin
Gustafson, Andy & Sara SSM Health
Hafeman, Paula HSHS - Eastern Wisconsin Division
Jacobson, Terry St. Mary's Hospital of Superior
Jelle, Laura SSM - St. Clare Hospital & Health Services
Kulick, Dr. Steven ProHealth Care, Inc.
Miller, Kimberly Beaver Dam Community Hospitals
Nelson, David HSHS - Sacred Heart Hospital
Nelson, Meg Children's Hospital of Wisconsin
Newson, Reggie Ascension Wisconsin
Norell, Brett Holy Family Memorial, Inc.
Oland, Charisse Rusk County Memorial Hospital
Pollard, Dennis Froedtert Health
Punzenberger, Lindsay Children's Hospital of Wisconsin
Reardon, Brian Hospital Sisters Health System
Reding, Dr. Douglas Ascension Wisconsin
Robertstad, John ProHealth Care - Oconomowoc Memorial Hospital
Roller, Rachel Aurora Health Care
Schafer, Michael Spooner Health System
Ter Horst, Thomas SSM Health
Tyre, Scott Capitol Navigators, Inc
Voelker, Dr. Thomas Aspirus Riverview Hospital & Clinics
Wolf, Edward Marshfield Clinic

Contributors ranging from $1,500 to $1,999 - Gold Club
Anderson, Sandy Ministry Health Care
Bakkum, Kyle Vernon Memorial Healthcare
Bloch, Jodi Children's Hospital of Wisconsin
Brussow, Julie Security Health Plan
Clapp, Nicole Grant Regional Health Center
Coffman, Joan HSHS - St. Joseph's Hospital
Colman, Gerard Aurora Health Care
Court, Kelly Wisconsin Hospital Association
Doeringsfeld, Jean WHA Information Center
Frank, Jennifer Wisconsin Hospital Association
Grasmick, Mary Kay Wisconsin Hospital Association
Gullingsrud, Tim Hayward Area Memorial Hospital and Nursing Home
Harding, Edward Aurora - Bay Area Medical Center
Heywood, Matthew Aspirus, Inc.
Hilt, Monica Affinity Health - St. Elizabeth Hospital
Hogan, Denis Bellin Health System
Kluesner, Kevin Ascension Wisconsin
Levin, Jeremy Rural Wisconsin Health Cooperative
Lewis, Gordon Burnett Medical Center
Lindberg, Steve Mayo Clinic Health System - Red Cedar
McKevett, Timothy Beloit Health System
Rose, Laura Wisconsin Hospital Association
Russell, John Columbus Community Hospital
Sanders, Michael Monroe Clinic
Sexton, William Crossing Rivers Health Medical Center
Sheehan, John UW Health - The American Center
Teigen, Seth Ascension Wisconsin
Turney, Dr. Sue Marshfield Clinic Health System
White-Jacobs, Mary Beth Black River Memorial Hospital
Woleske, Chris Bellin Hospital
Zenk, Ann Wisconsin Hospital Association

Contributors ranging from $2,000 to $2,999 - Gold Club
Hanson, Gail Aurora Health Care
Hanus, Andrew Aurora Health Care
Herzog, Mark Holy Family Memorial, Inc.
Kachelski, Joe Wisconsin Statewide Health Information Network
Leitch, Laura Wisconsin Hospital Association
Natzke, Ryan Marshfield Clinic
Norbin Killoran, Carrie Aurora Health Care
Pandl, Therese HSHS - St. Clare Memorial Hospital
Potts, Dennis Aurora St. Luke's Medical Center
Schulze, Connie UW Health
Stanford, Matthew Wisconsin Hospital Association

Contributors ranging from $3,000 to $4,999 - Platinum Club

Alig, Joanne Wisconsin Hospital Association
Andersen, Travis Columbia St. Mary's, Inc.
Boatwright, Damond SSM Health
Boese, Jennifer Wisconsin Hospital Association
Duncan, Robert Children's Hospital of Wisconsin
Jacobson, Catherine Froedtert & The Medical College of Wisconsin
Kammer, Peter The Kammer Group
Kerwin, George Bellin Hospital
Little, Steven Agnesian HealthCare
Mettner, Michelle Children's Hospital of Wisconsin
Meyer, Daniel Aurora BayCare Medical Center - Green Bay
Normington, Jeremy Affinity Health - Mercy Medical Center
O'Brien, Kyle & Laura Wisconsin Hospital Association
Potter, Brian Wisconsin Hospital Association
Sherry, Bernie Ascension Wisconsin
Standridge, Debra Ascension Wisconsin
Starmann-Harrison, Mary Hospital Sisters Health System
Wallace, Michael Fort HealthCare

Contributors ranging from $5,000 to $9,999 - Leaders Circle
Borgerding, Eric & Dana Wisconsin Hospital Association
Brenton, Stephen Wisconsin Hospital Association
Size, Tim Rural Wisconsin Health Cooperative
Troy, Peggy & Ron Children's Hospital of Wisconsin
Turkal, Nick Aurora Health Care


Top of page (8/18/17)

Active Shooter, Cyber Threats, Infectious Disease Outbreaks: Be Ready to Respond

WHA brings international experts to Madison for Emergency Preparedness Conference 

Wisconsin hospitals must be prepared to respond to a number of challenges, including infectious diseases, active shooters and cyber threats, to name just a few. These very real situations can happen anywhere and at any time. 

On September 20, WHA is sponsoring the “WHA Emergency Preparedness Conference: Ready to Respond.” This one-day conference will feature Vincent Covello, PhD, a nationally and internationally recognized trainer, researcher, consultant and expert in crisis, conflict, change and risk communications. Covello will keynote the conference and offer a deep-dive session in the afternoon specifically for public information officers and health care public relations professionals. Peter Shult, PhD, associate director of the Wisconsin State Laboratory of Hygiene, will brief the audience on infectious disease outbreaks in the past, present and those that are anticipated in the future. Shult will also share best practices and describe ways hospitals can be better prepared for these events.

Chris Sonne and William Castellano, both of HSS EM Solutions, will share best practices and lessons learned from live active shooter scenarios, as well as direct tabletop exercises and a practical, scenario-based training exercise, during a special afternoon session focused on preparing for an active shooter.

The role of state government during an emergency involves a series of steps that are not always well understood by outsiders. Stephanie Smiley, director of the bureau of communicable diseases at the Wisconsin Department of Health Services, will explain the process the state follows to officially declare an emergency and what triggers the declaration that would impact hospitals. 

Hospitals are encouraged to take advantage of this in-state training opportunity designed for hospital emergency preparedness directors, emergency department directors and physicians, infection prevention staff, department directors, public relations professionals and public information officers.

This conference is September 20 at the Sheraton Hotel in Madison. The registration fee is $225 per person. The agenda and registration are available at www.cvent.com/d/b5qw08.

Top of page (8/18/17)

HSHS St. Clare Hosts U.S. Rep. Gallagher for Health Care Roundtable

Over a dozen leaders from HSHS St. Clare Hospital in Oconto Falls and the Wisconsin Hospital Association participated in a roundtable discussion with freshman legislator, U.S. Rep. Mike Gallagher, hosted at St. Clare Hospital.

“The opportunity for our leaders to spend quality time discussing the health care we deliver in Oconto Falls was important,” said HSHS St. Clare Chief Administrative Officer Dan DeGroot. “Federal policy decisions on health reform, Medicare and Medicaid have complex impacts on our hospital and community, and those impacts need to be raised with our elected officials. We appreciate Rep. Gallagher listening, learning and offering to help.” 

Topics discussed included the aftermath of failed efforts to repeal and replace the Affordable Care Act (ACA) and next steps Congress should take to stabilize the ACA federal exchange. The group told Gallagher that market instability is impacting the northeastern part of the state, citing research done by the Wisconsin Hospital Association on reduced coverage options on the exchange in 2018. Multiple insurers have indicated they are exiting the exchange market in Wisconsin, with many of Gallagher’s counties impacted by these announcements. As of today, only one insurer option will remain on the exchange in 2018 for Marinette, Oconto, Brown, Kewanee and Door Counties and no insurer options will be available in Menomonie County. (See WHA coverage maps.) 

Among other issues discussed, David Lally spoke of the importance of telehealth and how this could be utilized in rural communities if Medicare policies were more flexible and allowed for its reimbursement. HSHS Eastern Chief Nursing Officer Paula Hafeman highlighted the importance of Wisconsin’s medical liability system and the value of the “340 B” drug discount program. 

Top of page (8/18/17)

DSPS Webinar to Provide Update, Receive Feedback on ePDMP 

The Department of Safety and Professional Services ePDMP (Prescription Drug Monitoring Program) staff will be holding a webinar Thursday, August 24 from 2-3:30 p.m. to share the latest iteration of reports as well as the public-facing statistics dashboard of ePDMP metrics. Department staff will be soliciting feedback from stakeholders and users at that time. If you would like to attend this call, contact Matthew Stanford, WHA general counsel, at mstanford@wha.org for webinar information. 

Top of page (8/18/17)

Fast Facts from the WHA Information Center: Protect Your Children’s Eyes During the Eclipse—and Always!

August is Children’s Eye Health and Safety Month

With a total eclipse of the sun occurring Monday, August 21, NASA recommends that people who plan to view the eclipse should check the safety authenticity of viewing glasses to ensure they meet basic proper safety viewing standards. Children could be at risk, so take care to ensure they are aware of the danger of looking directly at the solar eclipse. 

While the solar eclipse is raising awareness of potential eye injuries, eye injuries can happen anytime. The WHA Information Center reported that from April 2016 - March 2017, Wisconsin hospital emergency rooms treated 1,913 children for eye-related injuries and saw 539 more in urgent care settings. 

As children grow, be vigilant about eye health. The earlier problems are identified, the sooner they can be addressed. Below are four tips for healthy eyes and vision:

  • Get regular childhood vision screenings
  • Know and share your family eye health history
  • Watch for signals of eye problems
  • Wear protective eyewear when playing sports
Data provided by the WHA Information Center (WHAIC). WHAIC is 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.