December 15, 2017

Volume 61-Issue 50

Gov. Walker Joins WHA in Support of Tax-Exempt Financing

69 WI health care leaders send letter urging Speaker Ryan to retain PABs
Congressman Gallagher also weighs in

On December 12, Gov. Scott Walker urged U.S. House Speaker Paul Ryan and U.S. Senate Majority Leader Mitch McConnell to retain the tax exemption for private activity bonds (PABs), including for qualified 501(c)(3) hospital bonds. In doing so, Walker joined the Wisconsin Hospital Association (WHA) and 68 other hospital/health system leaders in sending a letter urging the Speaker and conferees to support PABs.

“Currently, state and local governments can utilize private activity bonds to invest in hospital projects that have a public benefit. Non-profit hospitals and health care providers in Wisconsin rely on these private activity bonds to keep infrastructure costs down so that they can focus their valuable resources on patient care and service delivery,” wrote Walker in his letter to Speaker Ryan and Majority Leader McConnell. “I urge you to keep the tax exemption for private activity bonds.”

In a separate letter also sent this week to Speaker Ryan, 69 Wisconsin hospital/system CEOs, WHA and health care leaders urged continuation of PABs and questioned the rationale for their elimination.

“When Congress originally established PABs, hospitals were among those included because of their importance to their local communities and their mission of serving the public good. That is why we are perplexed by the rationale used in the U.S. House Ways & Means Committee summary of this provision, which equates our organizations’ collective purpose—to serve as the health care infrastructure and safety net in the most rural to urban areas of the state—to private business with “similar creditworthiness,” read the WHA, health care leader letter. “We do not see the rationale for nor the wisdom of this policy and, therefore, ask you to retain the tax exemption for PABs, including for qualifying 501(c)(3) hospitals bonds, in the final negotiated package.”

Additionally, U.S. Rep. Mike Gallagher joined 38 House Republicans in sending a letter to Speaker Ryan, Majority Leader McConnell and Chairs Hatch and Brady in support of PABs.

“As Republican members with an interest in infrastructure, we want to express our strong support for maintaining the tax-exempt status for private activity bonds,” the House letter began. “PABs are important financing tools in a wide range of projects from hospitals and schools to airports and local water facilities.”

“Given the administration’s stated priority for increasing investment in infrastructure, we believe the elimination of tax-exempt private activity bonds would be a step in the wrong direction…In fact, it will make infrastructure projects more expensive and limit our ability to effectively leverage the public investment from the federal government.”

WHA’s advocacy on PABs began immediately when the issue arose in early November, including traveling to Washington, D.C., sending and organizing multiple letters, working with the Wisconsin Health & Education Facilities Authority and mobilizing well over 500 grassroots contacts to Wisconsin Delegation members.

“WHA expresses our appreciation to Governor Walker, U.S. Rep. Gallagher, Wisconsin hospital/system leaders and all other legislators who are fighting to protect this important financing tool,” said WHA President/CEO Eric Borgerding.

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WHA Applauds Gov. Walker, Legislature for Supporting Nurse Licensure Compact

At Southwest Health in Platteville December 11, Gov. Scott Walker signed into law Senate Bill 417, legislation to maintain Wisconsin’s participation in the enhanced Nurse Licensure Compact (eNLC) and ensure unnecessary licensure barriers do not prevent nurses from serving patients in Wisconsin communities. This law, 2017 Act 135, will allow 112,000 nurses in Wisconsin the opportunity to keep their interstate license, and it directly impacts over 500 nurses in southwest Wisconsin who depend on this compact license to practice across state borders.

Since 2000, Wisconsin has been part of an interstate nurse licensure agreement, which reduces regulatory burden on nurses looking to practice in Wisconsin from other compact states and also for Wisconsin nurses serving patients in other compact states. In 2015, this nurse licensure compact was updated and quickly adopted by 26 states—initiating the process for states in the current nurse licensure compact, like Wisconsin, to transfer to the enhanced Nurse Licensure Compact. Wisconsin became the 27th state to join the eNLC when this legislation was signed into law.

“An adequately staffed health care workforce is critical to our hospitals and health systems to continue to deliver accessible, efficient and high-quality health care around the clock in their communities,” according to WHA President/CEO Eric Borgerding. “WHA was proud to lead a coalition of health care organizations, including statewide nursing groups, to garner broad, bipartisan support of the eNLC in the Legislature and see this bill signed into law by Governor Walker.”

WHA has worked closely with the Wisconsin Board of Nursing, the Department of Safety and Professional Services and several health care and nursing organizations to enact legislation this year.

“High-quality health care attracts high-quality professionals, and Wisconsin health care is ranked at or near the top by many national measures,” according to Ann Zenk, WHA vice president, workforce and clinical practice. “Sustaining membership in a nurse licensure compact by joining the eNLC will benefit high-quality health care by making it easier for patients to access care by Wisconsin nurses. The enhanced Nurse Licensure Compact helps to remove licensure barriers for nurses successfully recruited to work in Wisconsin’s high-quality health care facilities from other states.”

“Governor Walker, Senator Marklein and Representatives VanderMeer and Tranel have been dedicated to sustaining and improving high-quality health care in Wisconsin—especially for those living in rural communities,” said Borgerding. “WHA has worked closely with these lawmakers this legislative session to provide additional funding to train physicians, advanced practice clinicians and allied health professionals in rural communities as part of the biennial state budget and the Rural Wisconsin Initiative. By signing Senate Bill 417, Governor Walker is taking additional steps to ensure that licensure doesn’t become an unnecessary hurdle for qualified nurses and the employers that depend on a nursing workforce in Wisconsin.”

The eNLC will be effective January 19, 2018. For additional information about the enhanced nurse licensure compact, contact Zenk at azenk@wha.org or 608-274-1820.

WHA summary of new Enhanced Nurse Licensure Compact law now available to members

WHA prepares summaries of new laws passed during the 2017-18 Wisconsin legislative session that could impact Wisconsin’s hospitals and health systems. WHA legal and government relations staff have prepared a summary on eNLC, available in the WHA members only portal. This summary, together with additional summaries that will be prepared over the upcoming months, will help WHA members better understand newly enacted legislation.

The summaries are for WHA members only and will not be generally accessible on our website. Instead, they are posted to the WHA Member Portal, which can be found either at members.wha.org or by clicking on the “WHA Members Only” button on the www.wha.org website. Once in the WHA Member Portal, the summaries can be found in the dropdown menu under the “General” tab. The member portal is a secure location and requires a first-time user to obtain a username and password. If you do not have a member account, go to members.wha.org and click on “Register” to create an account. If you have questions about how to register, contact Tammy Hribar, thribar@wha.org or 608-274-1820.

WHA member forum webinar focuses on new Enhanced Nurse Licensure Compact

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.” See article below or register at www.whareg4.org/eNLCWebinar.

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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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WHA Testifies in Favor of Aligning State Compound Pharmacy Regulations with National Standards

On December 11, the Joint Committee for Review of Administrative Rules (JCRAR) unanimously approved a motion to request the Pharmacy Examining Board (PEB) consider modifications to the Pharmacy Board Chapter 15 (Phar 15), relating to compounding pharmaceuticals. The Committee voted on the motion after hearing testimony from Bob Van Meeteren, CEO, Reedsburg Area Medical Center and Carl Selvick, senior director clinical services, Fort HealthCare, along with Ann Zenk, WHA vice president, workforce and clinical practice, to align Wisconsin’s compounding pharmaceutical regulations with national standards.

At issue is a draft rule from the PEB for pharmacies that compound. A licensed pharmacist compounds a pharmaceutical preparation—a drug—to meet the unique needs of an individual patient when a commercially manufactured drug is not available to meet those needs.

“While we appreciate the PEB’s intention to reconcile the two, the reality is the current Phar 15 draft is not in sync with United States Pharmacopeia’s (USP’s) national compounding standards, and the state’s regulations will not stay in sync because USP standards will be updated in the future and then state regulations will take several years to update—creating two conflicting and diverging standards,” Zenk told the JCRAR members in her testimony.

Van Meeteren also provided testimony. “Aside from the numerous regulations that our pharmacies and pharmacists are required to follow, as a hospital administrator I fear that the Phar 15 regulations may become our next DHS 124 where state rules on compounding drugs become (in the words of a report from the Walker administration) ‘outdated, duplicative and confusing for health care operators,’” Van Meeteren said.  “Requiring the Phar 15 rules to align with USP 797 removes additional time and burden for our pharmacists and removes added and unnecessary cost from the system.”

Selvick, a pharmacist and the director in charge of Fort HealthCare’s pharmacy services, agreed with Zenk and Van Meeteren that aligning state and national standards makes sense.

“Hospital pharmacies rely on the USP as the industry standard to continually ensure safe and effective pharmacy practice.” Selvick noted, “Compounding drugs in our pharmacies is a process that we take very seriously, and I agree 100 percent with what the pharmacy board is aiming for; we just want them to hear that they have not yet reached that aim.”  

WHA, the Rural Wisconsin Health Cooperative and the Pharmacy Society of Wisconsin are among the stakeholders that have shared feedback with the PEB about Phar 15.  Zenk called the JCRAR request for modification “an opportunity to prevent state regulations from becoming stale and confusing for highly regulated hospitals and pharmacies.”

The PEB has until December 26, 2017 to respond to this request for rule modification. For additional information about Phar 15 and USP alignment efforts, contact Ann Zenk at azenk@wha.org or 608-274-1820.

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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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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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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 Joins WPHCA in Asking Congress to Fund Critical Programs

The following op-ed by Stephanie Harrison and Eric Borgerding was submitted to select media outlets December 15.

Critical health programs, all of which have bipartisan support, have been fighting for Congressional attention for months. On September 30, funding for Community Health Centers (CHCs), the National Health Service Corps (NHSC), the Children’s Health Insurance Program (CHIP), along with important Medicare policies like the Medicare Low-Volume Hospital Adjustment (LVA) and the Medicare Dependent Hospital (MDH), all expired. Children, families and those who provide care across Wisconsin rely on these programs to offer affordable services, well-trained doctors and care that is close to home. While we continue to hear from some in Congress that these programs will be funded, the clock continues to tick down. We urge Congress to act now.

Funding for all of these programs is critical for many communities across the state. For example, CHCs in Wisconsin stand to lose $29 million in federal funding without action. That is funding currently used to provide care for families in financial need, including care management and much-needed addiction treatment and recovery services.

In addition, CHCs and other critical providers in high-need areas will be negatively impacted without the NHSC’s loan repayment program. This program helps recruit doctors and dentists and, currently, 150 FTE clinicians, including nearly 50 FTE dentists, utilize this valuable program.

Both of our organizations also strongly support the continuation of the CHIP program, which provides access to health care for Wisconsin children and families. The estimated impact could be as much as $137 million to the State without federal funding. And finally, rural areas will be impacted without LVA and MDH adjustments—two targeted, but important Medicare reimbursement policies that help protect smaller, rural hospitals that see very high or very low Medicare volumes.

During this time of heightened change in the health care sector, ensuring programs like these remain strong is essential to our nation’s and Wisconsin’s health care infrastructure.

Join us in calling on Congress to fund these programs before the end of the year.

Eric Borgerding, President/CEO             Stephanie Harrison, CEO 
Wisconsin Hospital Association              Wisconsin Primary Health Care Association

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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.

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Reducing Workplace Injuries: Mayo Clinic/UW-Eau Claire/Eau Claire Police Department Partner to Curb Back Injuries – Lowering Health Care Costs

Wisconsin hospitals and health systems share a common mission to improve access to care. That is why they are forming partnerships with local employers to develop onsite services, making it easier for employees to meet with a physician, nurse or wellness coach. These partnerships are helping employers hold the line on health care costs, prevent workplace injuries and reduce worker’s compensation costs. All while creating a healthier community and with that, a healthier Wisconsin.

Over the next few weeks, the Wisconsin Hospital Association will share a series of articles that illustrate the innovative and effective programs being created in our state that are keeping employees, and their families, healthier.


Back injuries and injuries tied to overexertion are among the most common workplace maladies. They’re also a leading source of worker’s compensation claims, which costs employers and workers alike in terms of pain, money and productivity.

A partnership between the Mayo Clinic, the University of Wisconsin-Eau Claire and the Eau Claire Police Department could lead to reduced back injuries for officers, research opportunities for the university and its students, and reduced worker’s compensation costs for the clinic and the police department.

At a recent meeting of the WiSys Technology Foundation Board in Eau Claire, the partnership—which has already broadened into other areas, such as research into kidney disease—was described by Chancellor Jim Schmidt, Mayo Regional Executive Jason Craig and a mix of faculty, students and community leaders.

It is one of only two Universal Research Agreements fostered by Mayo in the United States—Arizona State University is the other—and it’s designed to create a “triple bottom line” for the clinic, the university and the larger Eau Claire and northwest Wisconsin communities.

“Partnerships start with relationships,” Schmidt said, and UW-Eau Claire’s relationship with Mayo has reached into many aspects of the university, from its faculty researchers to the undergraduate students who carry it out and into campus projects tied to student and community health.

Craig, who is vice chair of operations for Mayo in northwest Wisconsin, said he expects the partnership to enhance the clinic’s ability to marry research, education and practice. The clinic has five hospitals and 4,000 employees in northwest Wisconsin alone.

“Our product is research,” Craig said, and improving that product helps improve clinical practice.

The police department project involves designing and testing a duty vest to replace duty belts, which carry a variety of equipment used by front-line officers. The weight and positioning of those belts can cause injuries over time. In fact, 16 percent of total worker’s compensation claims nationally are related to lower back pain.

The vest being tested in Eau Claire seeks to redistribute weight without sacrificing the variety and accessibility of equipment used by officers. UW-Eau Claire’s department of kinesiology is leading that effort. Another project involves identifying biomarkers for human polycystic kidney disease, a genetic disorder that can affect people at all stages of life and for which there is no current federally approved cure.

Mayo Clinic has been a leader in trying to uncover treatments and will work with researchers and students in UW-Eau Claire’s biology department. Mayo is also heavily involved in campus plans for the $50 million Sonnentag Center, which will be part sports arena and part student recreation center, as well as a home for the local YMCA. Craig said he expects to see on-site research projects that speed the transfer of research to clinical practice, a timeline that traditionally is measured in decades.

“We hope this can help shorten the time between discovery to transfer,” Craig said.

For Schmidt, another benefit of the Mayo agreement is slashing red tape. Because the legal implications of the agreement have already been worked out, there will be fewer barriers to clear for UW-Eau Claire researchers and students in working with Mayo.

There’s also a tangible benefit for students. Schmidt said UW-Eau Claire wants each student to have at least two “high-impact experiences” outside the classroom before graduating. That may include research, study abroad, internships or community service. The Mayo pact offers possibilities for those kinds of experiences, he said.

Molly Svoboda, a student in UW-Eau Claire’s biology department, said her work on human polycystic kidney disease is already broadening her student experience.

“I’m learning how to network within a scientific community of researchers and clinicians. Where else can I do that?” she said.

This profile appears in the Wisconsin Technology Council’s recent publication, “Taking the Pulse - How Quality Healthcare Builds a Better Bottom Line.” See the Tech Council publication here: http://wisconsintechnologycouncil.com/wp-content/uploads/2017/11/Taking-the-Pulse-Healthcare-Quality-Report.pdf.

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Fast Facts from the WHA Information Center: Be Safe in the Cold!

With the snow starting to fall, many are getting ready to go outside for some winter fun! When you go outside, be careful, bundle up and stay safe.

According to the WHA Information Center, there were 13,276 winter-related emergency room visits to Wisconsin hospitals last winter. In addition to frostbite and exposure to the cold, some of those emergency room visits included:

  • 10,274 falls due to ice and snow
  • 984 visits related to downhill skiing, cross-country skiing, snowboarding, sledding and tubing
  • 117 visits related to ice skating

For more information on how to stay safe and healthy in the winter, visit the CDC website: www.cdc.gov/features/winterweather/index.html.

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.

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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. 

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

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