October 16, 2015
Volume 59, Issue 41

Medicaid Program Director Moore Tells WHA Board: Medicaid is a "Resource and Investment"
"CMS understands that Wisconsin is an innovative leader…able to move projects forward."

Wisconsin Medicaid Director Kevin Moore arguably has one of the most challenging jobs in state government. But his work is easier than it is in other states that are slashing Medicaid payments to providers and cutting program funding.

Speaking at the WHA Board meeting October 15 in Madison, Moore said he is pleased that the Governor and State Legislature have made a commitment to ensure Wisconsin’s most vulnerable citizens have access to health care, dental services and food. Moore said he is pleased that funding the Wisconsin Medicaid program has been a priority for state legislators. Moore noted that Gov. Scott Walker funded and made the Disproportionate Share Hospital Program (DSH) permanent.

"We have worked to educate legislators about the Medicaid program," Moore said. "At the end of day, this (Medicaid) is a resource and an investment we need because one in five Wisconsin residents are on Medicaid."

Moore has an "open door" policy and values hospital, health system and WHA’s engagement with and feedback to his department. He said the state’s Medicaid program staff have a good relationship with the Centers for Medicare and Medicaid Services (CMS), as well.

"I value the positive relationship we have with CMS," Moore said. "They understand that Wisconsin is an innovative leader in its ability to move projects forward."

As planning begins for the next state budget, Moore said they will look closely at acuity, which drives cost. He expects acuity may decrease in some parts of the program, but increase in others. When people first connect with coverage, it is expected that acuity will be high as they may seek care in ERs for previously untreated conditions. But, as they have access to appropriate, coordinated care and their disease is more closely managed, their use of medical resources should moderate.

"We think as they get care over a period of time, costs will be lower on the acute side and higher on the pharmaceutical side as they move into maintenance," according to Moore. "We are going into open enrollment, so there will be some volatility there."

Moore said enrollment for childless adults has remained steady while the number of children in the program has decreased by about 10,000. One of the reasons for this may be that parents are picking up family coverage in the exchange or through their employers.

Moore described a new pilot program funded in the state budget that will enhance dental provider rates in four Wisconsin counties, a move he believes will also increase access to dental services for those who are now seeking care for these issues in hospital emergency departments. He also hopes that this program will serve as a model on how to connect children and pregnant women to a medical home sooner.

On a final note, Moore expressed his appreciation to WHA members for their preparation related to the transition from ICD-9 to ICD-10. Moore said their first two weeks of experience processing claims has been trouble-free. "I can tell you, other states have not been so lucky," he added.

Nominating Committee Presents Roster of Nominations

The Board accepted the Nominating Committee’s recommendations for WHA Board appointments (see story below). Catherine Jacobson, president/CEO, Froedtert Health, will serve as WHA 2016 chair-elect (see story below).

Borgerding Presents Goals Update

WHA President/CEO Eric Borgerding presented an update on several of WHA’s 2015 Goals, noting progress has been excellent on nearly all of the 14 goals approved by WHA’s Board earlier in the year.

The goal to promote Wisconsin’s high-quality, high-value health care as an economic development asset and release of two studies this year is on track. A new efficiency study released October 13 by UW-Whitewater (see story below) shows that Wisconsin is the third most efficient state for health care in the nation. A number of media outlets picked up the news release, while hospitals and health systems posted the good news on their social media channels.

Borgerding said WHA has been working on a number of operational priorities in 2015, including the consideration of changes to the WHA bylaws to enable a couple of process changes in policy development and budgeting.

Kelly Court, WHA chief quality officer, provided a brief update on the WHA "Clinical Performance Improvement" goal, and confirmed WHA’s commitment to continue to support the CMS goals of 20 percent reduction in readmissions and 40 percent reduction in hospital-acquired harm in 2016. Court said hospitals are being actively recruited to join the WHA hospital engagement network to continue this work.

State Advocacy: Licensure Compact, Behavioral Health Package, Move Forward

Kyle O’Brien, senior vice president government relations, provided the Board with an extensive update on key legislative priorities for WHA and expectations for the rest of the Legislature’s fall session. O’Brien said the Legislature has been very busy over the past few weeks, counting down to the final day of the fall floor period in early November.

Legislation to add Wisconsin to the growing list of states that are adopting the Interstate Medical Licensure Compact led off the discussion. O’Brien said the bill, which has now garnered 77 co-sponsors, received a 95-1 bipartisan vote in the state Assembly in September. This strong, bipartisan support was strengthened by WHA’s 2015 Advocacy Day when more than 650 people met with legislators on behalf of their local hospital to support this bill. O’Brien reported that WHA has very recently been working with Sen. Leah Vukmir (R-Wauwatosa), chair of the Health and Human Services Committee, and her staff to move this bill in the Senate.

As part of the most recent biennial budget, WHA’s government relations team worked to find $1 million for two behavioral health Medicaid pilot programs and a proposal to implement a mental health bed tracking system in Wisconsin. State Rep. Mary Czaja (R-Irma) spoke at the August WHA Public Policy Council meeting about her intentions to author legislation implementing these pilot programs with Sen. Vukmir. O’Brien provided an update to the Board on this legislation, which was recently introduced and quickly voted on by the Senate Committee on Health and Human Services. The bill is scheduled to reach the Senate floor October 20 with subsequent action in the State Assembly’s Mental Health Reform Committee.

O’Brien also reported the Joint Finance Committee passed, with a unanimous vote, a bill to require additional oversight of decisions made by the Group Insurance Board impacting state employee health insurance. Decisions impacting the state employee health insurance program can have significant fiscal impacts on the state budget and could also cause disruption in Wisconsin’s health insurance market, according to O’Brien.

WHA has also been working with Rep. John Nygren (R-Marinette) and Attorney General Brad Schimel on their respective opioid abuse prevention initiatives. O’Brien provided an overview of Nygren’s HOPE 2.0 (Heroin, Opiate, Prevention and Education) package of legislation and told Board members that WHA’s government relations team has been in regular communication with Nygren and his staff about potential amendments to the bills.

O’Brien also provided updates on recent activity related to workers compensation and legislation prohibiting employers from implementing mandatory influenza vaccination policies.

Federal Advocacy Report: Fiscal Cliff, 340B Program

In a federal and regulatory update, Jenny Boese, WHA vice president, federal affairs & advocacy, highlighted the Health Resources & Services Administration’s (HRSA) recent proposed 340B guidance and discussed areas of concern WHA will highlight in its forthcoming comment letter to HRSA. She also provided insight into upcoming fiscal cliffs Congress must address this fall, pending legislation and several proposed rules pending at the Centers for Medicare & Medicaid Services.

Council Reports

WHA Advocacy Committee: Chair Ed Harding, president/CEO, Bay Area Medical Center, reported on the status of the Wisconsin Hospital State Hospital PAC and Conduit campaign.

RPB 5: WHA AHA Delegate Sandy Anderson, regional vice president, Ministry Health Care’s northern region and president of the northern region hospitals, reported on key issues discussed at the AHA Regional Policy Board held October 1.

Workforce Development: Efforts to increase the diversity of Wisconsin’s workforce were discussed at the July 30 meeting. Kyle O’Brien reviewed the recently-enacted biennial state budget, which included key WHA priorities. O’Brien also previewed activity expected in the fall legislative session.

Public Policy:
The August 20 meeting was held in a Senate committee room at the State Capitol. Rep. Mary Czaja (R-Irma) presented to the group and reiterated her strong support for funding the DSH program and making it permanent. WHA’s government relations team provided a brief overview of the enacted state budget while Borgerding briefed the Council on a workers compensation proposal being offered by Wisconsin Manufacturers and Commerce.

Finance and Payment: Mike Reilly, executive director of the Wisconsin Health and Educational Facilities Authority (WHEFA), presented an overview of WHEFA at the August 19 meeting, while Jenny Boese, WHA vice president, federal affairs & advocacy, updated the Council on key federal issues.

Physician Leaders Council: WHA’s Physician Leaders Council met September 16 and discussed a wide range of issues from progress on passage of the Interstate Medical Licensure Compact Bill in Wisconsin, to efforts to address prescription painkiller abuse to the creation of a new WHA task force on telemedicine.

Medical and Professional Affairs: Two groups of health care providers are proposing an expansion of their scope of practice in Wisconsin. The Council was briefed on these proposals by WHA Vice President, Workforce and Clinical Affairs, Steven Rush at their September 17 meeting.

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Jacobson to Serve as WHA 2016 Chair-Elect
Wallace will chair Association in 2016

Catherine Jacobson, president/CEO of Froedtert Health, has been selected by the Wisconsin Hospital Association Nominating Committee to serve as WHA chair-elect in 2016 and chair in 2017. A member of the WHA Board since 2013, Jacobson was a member of the WHA Graduate Medical Education (GME) Task Force, as well.

Jacobson joined Froedtert Health in 2010 as executive vice president of finance and strategy, chief financial officer and chief strategy officer. She was promoted to president in 2011, and assumed the CEO role in 2012. Prior to joining Froedtert Health, Jacobson spent 22 years at Rush University Medical Center in Chicago in various leadership roles.

Jacobson served as the voluntary national chair of the Healthcare Financial Management Association (HFMA) during the 2009-10 term. A member of HFMA since 1989, she served on the national Board of Directors from 2004-10 and the Principles & Practices Board from 1995-2001 (chair, 2000-01).

Jacobson currently serves on the American Hospital Association’s Section for Metropolitan Hospitals Governing Council, a three-year term ending in 2017.

Current board appointments include Mercy Health of Cincinnati (formerly Catholic Health Partners); VHA-UHC Alliance; Wisconsin Hospital Association; United Way of Greater Milwaukee; The Milwaukee Health Care Partnership (chair); Integrated Health Network of Wisconsin (chair); Blood Center of Wisconsin; United Hospital System, Kenosha, Wis.; the Milwaukee Regional Medical Center; the Greater Milwaukee Committee and Metropolitan Milwaukee Association of Commerce. She also serves on the UW-Milwaukee College of Health Sciences Dean’s Advisory Board.

Jacobson is a member of the Healthcare Financial Management Association, the American College of Healthcare Executives, the Healthcare Institute and the Healthcare Executives Study Society. She is also a member of the Chicago Network—an organization for women executives, and TEMPO and Professional Dimensions—two Milwaukee-based women’s leadership organizations.

Jacobson is a Certified Public Accountant. She received her Bachelor of Science degree in accounting from Bradley University, Peoria, Ill.

Wallace to Chair Association in 2016

Mike Wallace, president/CEO of Fort HealthCare, Fort Atkinson, will chair the Association in 2016.

Prior to joining Fort HealthCare in 2006, Wallace served at Trinity Regional Health System, located in Rock Island, Illinois and Bettendorf, Iowa. Previously, he was the chief executive officer at Lucas County Hospital in Chariton, Iowa. He also held similar positions while employed with HealthSouth Corporation, serving as chief executive officer of two hospitals in Phoenix, Arizona.

Wallace is a graduate of the University of Pittsburgh, where he received a master of health administration degree. He received his bachelor’s degree from DePauw University, Greencastle, Indiana. Wallace has achieved Fellow status with the American College of Healthcare Executives (ACHE) and is Board certified in health care management. He is a two-time winner of the ACHE Regents Award-Early Career Healthcare Executive and is a past winner of the Iowa Hospital Association Young Executive Achievement Award.

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Guest Column: WHA Quality Improvement Team Supports Members’ Goals
By Kelly Court, WHA Chief Quality Officer

October 18-24 is National Healthcare Quality Week. I’ve often thought that as health care professionals we are "celebration impaired." When we achieve a success, we quickly move on to the next set of strategic improvement goals, knowing that our work is never done as we seek even higher levels of quality. This constant focus on the future and the drive to excellence in patient care have earned Wisconsin a national reputation as a high quality state. The focus on delivering the best care possible is driven by visionary leaders and implemented by a dedicated health care team. However, an organization also needs capacity and skills related to measuring and improving the daily care process to execute the vision.

WHA’s quality strategy is also focused on the future. Our goal is to provide you with tools and resources that build your quality capacity and skills. Over the past 10 months, WHA has worked with 74 hospitals to decrease readmissions, patient falls, sepsis mortality, Clostridium difficile infections and improve how we engage patients and families in their care. As we close out the year, we are recommitting to the CMS goals of a 20 percent reduction in readmissions and 40 percent reduction in harm. This work started in 2012, with 98 percent of the acute care hospitals in Wisconsin participating in a hospital engagement network. The WHA goal is for equally strong participation over the next 12 months with either WHA or another network as we drive the Wisconsin rates for these events even lower.

WHA is working hard to help hospitals increase their capacity to improve care by getting frontline staff more engaged in and more knowledgeable about quality improvement. Transforming Care at the Bedside (TCAB) helps hospital nurses learn these important skills and focuses energy on changes in the daily work of nurses. Nursing units that commit to TCAB not only improve quality and safety, they also report measurable improvements in efficiency and teamwork. The third cohort of TCAB is completing their work this month, bringing the total number of hospitals that have committed to this project to 52. As the third cohort completes their work, the fourth cohort that consists of 14 new nursing units, launches into their 18-month project.

Becoming the new quality department leader can be challenging. These are jobs that have many diverse responsibilities and little access to any formal training. WHA’s partnership with the Rural Wisconsin Health Cooperative provides formal training and support through the Wisconsin Quality Residency program. The first class of 35 residents will graduate in January and the second class will start in March. The program supports new quality leaders and is developing future leaders who may be part of a succession plan.

During National Health Care Quality Week, let’s take a collective deep breath and celebrate what we have accomplished together. Be sure to thank your quality department team who work so hard every day to support your quality measures and projects. Acknowledge the contributions that physicians, nurses and staff make to improve their work processes. And I thank each of you for creating an environment in Wisconsin that is collaborative and focused on building the health care system of tomorrow that delivers even higher quality care.

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WHA Board Approves Nominating Committee Recommendations

The Nominating Committee presented their recommendations to the WHA Board October 15. The Board voted and approved the Nominating Committee’s recommendations. The following individuals will serve on the WHA Board effective January 1, 2016.

Joan Coffman
(1st term)
President/CEO, HSHS St. Joseph’s Hospital, Chippewa Falls

Gerard Colman
(1st term)
Chief Operating Officer, Aurora Health Care, Milwaukee

Paula Hafeman
(1st term)
Divisional Chief Nursing Officer, HSHS St. Mary’s Hospital Medical Center & HSHS St. Vincent Hospital, Green Bay

Mark Herzog
(2nd term)
President/CEO, Holy Family Memorial, Inc., Manitowoc

Monica Hilt
(1st term)
President/Region VP, St. Elizabeth Hospital, Appleton

Steve Little
(2nd term)
President/CEO, Agnesian HealthCare, Fond du Lac

Charisse Oland
(1st term)
CEO, Rusk County Memorial Hospital, Ladysmith

Peggy Troy
(1st term)
President/CEO, Children’s Hospital and Health System, Inc.,

Chris Woleske
(filling unexpired term)
CEO, Bellin Health Oconto Hospital, Oconto

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Wisconsin Third-Best State for Health Care Efficiency
High-quality care boosts efficiency, patient satisfaction, better outcomes

A new study by the University of Wisconsin-Whitewater found Wisconsin’s health care system is the third-most efficient in the country. That is good news for consumers and employers, according to the Wisconsin Hospital Association.

"Wisconsin hospitals and health systems are making steady progress to improve patient safety, decrease readmissions, and improve the quality of care," according to WHA President/CEO Eric Borgerding. "We know that quality improvement also has an impact on efficiency and cost. Our goal is to increase the value of health care, and we are on the right path."

The study by Russell Kashian, professor of economics at UW-Whitewater, found that Wisconsin uses its health care delivery system resources more efficiently than all but two states—Hawaii, which was first, and Iowa. Minnesota was the fourth-most efficient state.

Supported by the Wisconsin Hospital Association, the study was designed to provide employers a better perspective on whether their investments in employee health care are providing a good return on the dollars spent compared to other states.

Kashian used financial and human resource data along with patient satisfaction scores and studies that measured patients’ access to care over a five-year period (2008-2012).

Efficiency is important in all industries because it influences cost, according to Kashian. As efficiency increases, costs decrease. Health care costs are a significant concern for consumers, but for employers, cost is especially relevant.

"Since employers pay a portion of employee health premiums, improvements in how efficiently resources are used in health care help moderate or reduce costs," Kashian said. "High-quality care translates into good health outcomes that ensure employees return to work and to their normal activities faster. That reduces costs associated with absenteeism and creates a positive work environment."

To develop an acceptable comparison mechanism, Kashian and his research team created an index of outputs that were common to all 50 states. The outputs compared how well states were doing on measures related to quality of care, patients’ satisfaction with the care they received and health outcomes. It also took health insurance coverage rates and life expectancy for patients being treated for chronic diseases.

State Technical Efficiency Rank 2008-2012

  1. Hawaii
  2. Iowa
  3. Wisconsin
  4. Minnesota
  5. Massachusetts
  6. Maine
  7. Utah
  8. District of Columbia
  9. Nebraska
  10. Michigan
For more information, see:

If you have questions, contact Mary Kay Grasmick, WHA, at 608-274-1820 or mgrasmick@wha.org.

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Court Rules Against Use of Orphan Drugs in 340B

On October 14, the U.S. District Court for the District of Columbia issued a decision in favor of the Pharmaceutical Research and Manufacturers of America (PhRMA) related to the use of orphan drugs under the 340B program. At issue is whether certain 340B covered entities—critical access hospitals, sole-community providers, rural referral centers and free-standing cancer centers—can purchase or-phan drugs at 340B discounts if the drugs are used for treatments other than the primary orphan drug designation. The issue of orphan drugs discounts under the 340B program has been the subject of a previous lawsuit by PhRMA and an interpretive rule by HHS. This week’s court action vacates that HHS interpretive rule.

"We are very disappointed by this decision and the impact it could have on Wisconsin’s rural hospitals and the vulnerable patients they serve," said WHA President/CEO Eric Borgerding. "Unfortunately, the result of this decision is to place even greater financial pressures on our hospitals and patients."

The American Hospital Association filed an amicus curie in February in support of HHS and the use of orphan drugs under the 340B program. HHS could appeal this decision, but has not commented since the ruling was issued.

"At a time when acquisition costs for even the most basic drugs used in hospital settings are skyrocketing for little or no apparent reason, the regulatory and legal attacks on 340B are doubly concerning," Borgerding said.

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Bipartisan Behavioral Health Legislation Heard in Senate Committee
Rep. Kolste: Bill promotes thinking "outside the current delivery system in mental health"

Legislation authorizing over $2 million in investments to improve outcomes for individuals with mental illness in Wisconsin’s Medicaid program moved through a Senate Committee October 13. Senate Bill 293, authored by a bipartisan group of four state lawmakers, would provide funding to test alternate payment models in the state Medicaid program that encourages mental health care coordination within an integrated health system and promotes psychiatric consultations between providers.

At a hearing before the Senate Health and Human Services Committee, lead authors Rep. Mary Czaja (R-Irma) and Rep. Deb Kolste (D-Janesville) testified in favor of the legislation. Czaja said the bill is a "three-part initiative that seeks to better coordinate mental health services and to improve outcomes for Wisconsin Medicaid patients who are suffering from mental illness."

"This subgroup of mental health patients have higher costs and poorer outcomes than other patients partly because of co-morbidities," Kolste said. "This bill is simply testing a pilot program to see if there is a system that will work better for the delivery of mental health to these patients and include their medical well-being."

Committee Chair Leah Vukmir (R-Wauwatosa), the lead Senate author of the bill, said she was encouraged by the broad, bipartisan support that the bill received and thanked her Democratic colleague, Sen. Janet Bewley (D-Ashland), for joining her as a co-author of the legislation.

WHA General Counsel Matthew Stanford testified at the Committee hearing alongside Sue Janty, RN, director of behavioral services at Meriter-UnityPoint Health.

"We have seen an ever-increasing amount of research that shows individuals with significant mental illness utilize higher levels of medical, non-behavioral, health care than do individuals without significant mental illness," said Stanford. "Our members are eager to try out new care delivery models for individuals with mental illness, but payment models need to support those care delivery models."

Janty spoke to UnityPoint Health’s experience in Moline, Illinois where the health system targeted 388 individuals with severe mental illness and provided additional care coordination services for those patients. The Illinois project showed a 49 percent reduction in emergency room utilization by the target population, a 54 percent reduction in psychiatric admissions and a savings of $8 million to the Illinois Medicaid program.

Janty believes that a similar model could help address utilization of emergency department services at Meriter, where a disproportionate number of super-utilizers in the emergency room are on the state Medicaid program.

"What’s interesting at Meriter is in the first six months of 2015, there were 30 people who used the emergency services department 305 times, so that’s about 10 visits in a six-month period," said Janty. She continued by saying that "two-thirds of those individuals we are seeing, utilizing the Meriter ER as a clinic, are on Medicaid."

Senate Bill 293 was heard and recommended for adoption with a unanimous, bipartisan vote from the Senate Health and Human Services Committee October 13. The legislation will be in front of the full Senate October 20 and will likely receive action in the Assembly Committee on Mental Health Reform shortly thereafter. Senate Bill 293 has 70 legislative co-sponsors.

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Wisconsin Health Leaders Offer Re-Designed ACO Payment Model

Two Wisconsin health care leaders, David Krueger, MD, executive director, Bellin-ThedaCare Healthcare Partners and John Toussaint, MD, president, ThedaCare Center for Healthcare Value, were challenged by the Centers for Medicare and Medicaid Services (CMS) to develop a better way to reimburse Accountable Care Organizations (ACOs). The authors proposed a global risk-adjusted payment system they described in an October 5, 2015 Health Affairs blog post. Here are a few selected excerpts from that post:

Read the full blog post here: http://healthaffairs.org/blog/2015/10/05/creating-the-next-generation-the-payment-model-we-need-from-medicare

With permission:
David Krueger and John Toussaint, Creating The Next Generation: The Payment Model We Need From Medicare Health Affairs Blog, October 5, 2015, http://healthaffairs.org/blog/2015/10/05/creating-the-next-generation-the-payment-model-we-need-from-medicare/, Copyright ©2010 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.

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Courtroom Advocacy: WHA Advocates for Medmal Cap at Court of Appeals

On October 15, the Wisconsin Hospital Association along with the Wisconsin Medical Society and American Medical Association, filed a joint amicus brief with the Wisconsin Court of Appeals supporting the constitutionality of Wisconsin’s $750,000 medical malpractice non-economic damage cap enacted in 2006.

In Ascaris Mayo v. IFPCF, the District I Court of Appeals is hearing arguments on whether the cap can be unconstitutional "as applied" to a particular plaintiff but constitutional for other plaintiffs, as well as whether the cap is constitutional overall. In 2005, the Wisconsin Supreme Court held in the Ferdon case that Wisconsin’s previous $350,000 non-economic damage cap was unconstitutionally low, but also held that a higher cap could be constitutional.

"Wisconsin’s unique, balanced medical malpractice system that includes a cap on non-economic damages is a key policy that has helped Wisconsin retain and attract high quality physicians to Wisconsin communities," said WHA President/CEO Eric Borgerding. "Without a sufficient supply of physicians in communities throughout the state, Wisconsin’s high rankings in health care quality and access would not be achievable."

Tom Pyper, an attorney with Whyte Hirschboeck Dudek, who wrote the brief on behalf of WHA and the Wisconsin Medical Society, explained, "Just as a state’s general litigation environment is an important factor in the decisions businesses make when deciding where to locate, a state’s medical liability environment affects physician decisions to practice in a particular state. Accordingly, Wisconsin’s medical liability system affects its ability to compete with other states to attract and maintain sufficient numbers of physicians to continue to provide high-quality, cost-effective health care for Wisconsin residents."

The brief notes a Northwestern University study showing the impact on physician location decisions following the loss of Illinois’ non-economic damage cap in 2010. "Half of all graduating medical residents or fellows trained in Illinois leave the state to practice medicine elsewhere, in large part due to the medical liability environment in Illinois."

Attracting and retaining high-quality physicians to Wisconsin communities impacts not just the health of communities, but also has an impact on economic development in Wisconsin. Just this week UW-Whitewater released a study connecting health care quality and access to a state’s ability to attract and retain business.

"Access to high-quality local care also impacts employers’ decisions to locate or maintain jobs in Wisconsin," wrote Pyper in the WHA and Society brief. "’Because Wisconsin provides some of the best health care in the nation, companies located here or that choose to locate within the state will provide their employees with exceptional health care at competitive rates, enjoy lower-than-average premium increases and improve productivity and job satisfaction—leading to a strong competitive advantage for Wisconsin’s employees and employers.’"

The brief also emphasizes that the non-economic damage cap is a part of a larger balanced system that includes the unique Injured Patients and Families Compensation Fund. Unlike plaintiffs in other personal injury cases whose medical bills, lost wages and other economic losses may exceed the defendant’s assets and insurance coverage and thus be unrecoverable, Wisconsin’s mandatory Injured Patients and Families Compensation Fund provides unlimited loss coverage ensuring that medical malpractice plaintiffs are compensated for all of their medical bills, lost wages and other economic losses.

"The [Injured Patients and Families Compensation] Fund places malpractice award recipients in a better position than other injured parties—recipients are guaranteed recovery from the Fund," wrote Pyper. "[O]ther injured parties are not guaranteed recovery, left instead to hope that a tortfeasor has sufficient insurance coverage."

Finally, the brief argues that the Legislature is in a better position to make these far-reaching policy decisions than the courts.

"The trial court’s ‘as applied’ challenge is actually a facial challenge," wrote Pyper in the brief. "[B]y questioning whether an individual award from the Fund will threaten the overall policies supporting the cap, the trial court usurped the role of the Legislature to make policy decisions on an aggregate basis for the good of all residents rather than on an as applied basis for the good of the current plaintiff."

The case will be decided by the Court of Appeals in the coming months. Following that decision, the parties will have an opportunity for the Wisconsin Supreme Court to review the decision.

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Assembly, Senate Health Committees Hear HOPE Legislation
Rep. Nygren, physicians testify on second round of opiate abuse prevention bills

Legislation intended to impact the overuse and abuse of opioid medication received public hearings in the Senate and Assembly, respectively, on October 13 and 14. Rep. John Nygren (R-Marinette), who was the catalyst behind this public policy discussion last legislative session, has recently introduced his second round of HOPE (Heroin, Opiate, Prevention and Education) legislation.

"The goal of these bills is to stop the abuse of prescription drug medications before it begins," said Nygren in testimony before the Assembly Health Committee. Nygren’s package of legislation includes four bills—two impact the current operation of the state’s Prescription Drug Monitoring Program (PDMP) and the other two establish government registration and certification requirements for pain clinics and methadone clinics operating in this state. One of the bills, as originally authored, would mandate that the PDMP must be checked prior to prescribing any monitored drug.

WHA has been working with Nygren and his staff over the past several weeks to accommodate for concerns raised by hospital and physician members. Nygren met with WHA’s Physician Leaders Council in June and heard directly from chief medical officers and other physician leaders about the importance of interoperability between the PDMP and hospital electronic health records systems. WHA provided written testimony to the Senate and Assembly Health Committees, indicating the importance of ensuring that the PDMP is a functional system that efficiently and effectively pushes information to prescribers.

In written testimony, WHA provided a list of recommendations from a 2013 report to Congress that would "increase utilization among providers and strengthen PDMPs through the use of health information technology." These recommendations include ensuring that PDMP data is incorporated directly into provider workflow via health information technology, requiring the state PDMP to implement a single sign-on capability that would allow PDMP access through a provider’s EHR, and finally, generating alerts directly to prescribers of suspected patients who would be considered doctor shoppers.

"It’s typically been my preference to work with the interested parties to get to a position where we can all come together and be supportive of this effort," said Nygren. He continued by saying, "Prior to the executive session, you will see some proposed changes to address some of the concerns that have been brought forward."

"We purposefully did not put penalties into these bills," said Nygren. "The medical community has been an ally with us and partner in addressing these issues. We don’t want to make this punitive, we want to give them the tools to treat patients…However, if someone is flaunting the law of the land, if this becomes law, there are opportunities with the Medical Examining Board, the Controlled Substance Board and the Pharmacy Examining Board for issues to be addressed."

Jerry Halverson, MD, president of the Wisconsin Medical Society, testified in front of the Committee for information only. Halverson discussed recent conversations that he has had with physician members of the Wisconsin Medical Society who express frustration with the current operation of the PDMP.

"What I am hearing as I talk to my colleagues, I hear quite a bit about the poor user interface, how difficult the technology is to use and how this is just one more mandate that we have to do," said Halverson. "But, I’m here to tell you that it’s an important piece for us to do, and that is certainly what I’m going to be bringing to my membership."

Halverson continued by saying, "Make no mistake about it, you are probably going to hear from physicians in your district that are going to say ‘this is going to add more time to my day and I already have a lot that I have to do.’ We are going to work to try to educate them on why this is an important piece and it’s worth the time."

Timothy Westlake, MD, on behalf of the Medical Examining Board and the Controlled Substance Board, testified in favor of the legislation. "I have had a lot of concerns about a universal mandate to check the PDMP before I prescribe. The idea of the government telling physicians how to practice and when to do something really runs against the grain for me."

"If you told me two years ago that I would be speaking at a Committee hearing in support of a PDMP mandate, I would have told you that you were nuts. I’ve come to see that this is one of the best things that we can do, in the right way," said Dr. Westlake.

The legislation has been passed out of the Senate Committee on Health and Human Services without changes, but amendments are expected to be voted on by the Assembly Health Committee October 21. WHA continues to work with Rep. Nygren, his fellow lawmakers and his staff to provide input on these amendments. WHA believes it is important to ensure that if PDMP use is mandated, improvements are first made to the existing PDMP technology and the system’s functionality is tested and working efficiently.

To see a copy of WHA’s written testimony to the Senate Committee on Health and Human Services, see www.wha.org/pdf/SB268-10-13-15.pdf.

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Bailet Named to Federal Advisory Committee on Physician Payment Models

On October 9, Aurora Health Care Medical Group President Jeffrey Bailet, MD, was named to the U.S. Department of Health and Human Services’ (HHS) Physician-Focused Payment Model Technical Advisory Committee. In this role, Bailet along with other committee members will provide insight and advice to HHS as it considers new physician payment models under Medicare.

This HHS advisory committee was created under the Medicare Access & CHIP Reauthorization Act (MACRA), which eliminated the Sustainable Growth Rate for physicians and replaced it with a new Merit-Based Incentive Payment System (MIPs) along with provisions encouraging transitions to new Advanced Payment Models (APMs). The Technical Advisory Committee will assist HHS as it looks at these new APMs.

Bailet is an otolaryngologist and the president of the Aurora Health Care Medical Group, a multi-specialty medical group consisting of 1,700 physicians and 800 advanced practice clinicians staffing more than 150 clinics and 15 hospitals across eastern Wisconsin and northern Illinois.

Read more about Bailet and the other members of the Technical Advisory Committee at: www.gao.gov/press/appointments_hhs_advisory_committee_physician_payment_methods.htm.

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