April 10, 2015
Volume 59, Issue 14
Top of page (4/10/15)
WHA Physician Leaders Council Tackles Physician Satisfaction and Alignment
Opioid abuse strategies, physician licensure streamlining, other key items discussed
WHA’s Physician Leaders Council met April 8 and discussed physician satisfaction, efforts to address opioid abuse, efforts to streamline the medical licensure application process, as well as a number of other WHA advocacy efforts relating to physician practice.
Physician professional satisfaction in a time of transformation
“Physician satisfaction with the profession is not only a major determinant of physician retention,” said Charles Shabino MD, WHA chief medical officer, “but also a critical component of successful alignment of physician and organizational goals.”
With that organizational focus and interest in physician satisfaction, the Council spent half of its meeting focusing on the current state of physician professional satisfaction in Wisconsin.
Donn Dexter MD, chief medical officer of the Wisconsin Medical Society, presented the preliminary findings of the Medical Society’s recent Physician Professional Satisfaction Survey. The survey was designed to measure the current state of Wisconsin physician’s professional satisfaction as well as identify both satisfiers and dis-satisfiers. Dexter indicated that the Medical Society is continuing to analyze the results and expects to release a final analysis by mid-year.
Given the topic’s interest to physician leaders, Shabino indicated the Council will continue to focus on this topic in future meetings.
Efforts to address opioid and heroin abuse
The Council discussed the increase in heroin and opioid abuse in Wisconsin, and policy and practice efforts to combat the problem. New and ongoing provider efforts to prevent “doctor shopping” for prescription pain medications were discussed, though federal confidentiality provisions as well as technological barriers were noted as challenges.
The creation of the Prescription Drug Monitoring Program (PDMP) has been an important tool to make doctor shopping more difficult, according to the Council. But, members expressed frustration that the PDMP tool has not been as technically reliable as providers expect and is “clunky” from a usability perspective.
The Council believes future updates to the PDMP should focus on those improvements and ensure that its functionality better integrates into existing practice workflow. Members were particularly concerned about adding “clerical” requirements to physicians related to the PDMP that could be better met by other less expensive members of the care team.
Streamlining the medical licensure application process
Multiple efforts are underway to streamline the medical licensure application process in Wisconsin. Each of these efforts cut red tape by eliminating redundant paperwork for physicians seeking a Wisconsin license and for the Medical Examining Board that processes those license applications. More importantly, streamlining the licensure process improves access by reducing the amount of time for a physician to get a license to practice in a Wisconsin community.
The Council received an update on an effort to enact the Interstate Physician Licensure Compact in Wisconsin, which would permit physicians in Wisconsin and other states that enact the Compact to utilize an expedited process to receive a license to practice in any compact state. A coalition of WHA, the Wisconsin Medical Society, and provider organizations is working with Rep. Nancy VanderMeer (R-Tomah) to champion this legislation.
The Council also reviewed and expressed its support for internal efforts underway within the Department of Safety and Professional Services (DSPS) to speed the licensure process for physicians, including eliminating certain application requirements for physicians with no prior discipline or malpractice history. Additionally, DSPS has also begun using a uniform application for medical licensure used by 23 other states, which will further reduce paperwork requirements for many physicians seeking to practice in Wisconsin.
The next meeting of the Physician Leaders Council will be June 11, following the WHA Board meeting.
Top of page (4/10/15)
New Legislator Profile: Rep. Nancy VanderMeer (R-Tomah)
VanderMeer: Strong Medical Facilities Attract Economic Development
Wisconsin Worker’s Comp Program is a “national model”
As a former member of the Tomah Memorial Hospital Board, Rep. Nancy VanderMeer is well aware of the complexities and challenges of meeting the health care needs of those living in rural areas. She also knows how important access to high-quality, high-value health care is to the community’s economic vitality.
“I always felt that one of the reasons to participate on my local hospital board was because if you have a strong medical institution and strong health care in your community, it will be more likely you can attract new business and industry into the area,” VanderMeer said in an interview with WHA Valued Voice Editor Mary Kay Grasmick. “And a strong, vibrant economy is important.”
That understanding of rural health care is one of the reasons VanderMeer is working very hard to facilitate the introduction and adoption of a bill that would enact a physician licensure compact in Wisconsin. She believes this will allow the credentialing process to keep pace with advances in areas of interstate health care delivery, like telemedicine.
The physician licensure compact was proposed by the Federation of State Medical Boards as a way to expedite the licensure of physicians who practice in multiple states, while also maintaining state authority to regulate the practice of medicine. Wisconsin has over 10,000 physicians who are licensed in multiple states. WHA is, along with a coalition of health systems and other provider groups, leading the effort to pass legislation that would implement this voluntary expedited licensure process in Wisconsin.
“The physician licensure compact is important because it is an opportunity to advance technology, which has evolved over the last several years to be able to take care of patients in more remote locations,” VanderMeer said. “Having physicians available to make a complex diagnosis remotely when the expertise is not available locally will serve a lot of patients, improve the quality of care they receive and ensure they are diagnosed more quickly, which will lead to a healthier outcome for those patients.”
VanderMeer, who was elected to the Wisconsin State Assembly in 2014, is also aware of the important role that a strong Worker’s Compensation program can have in attracting, and keeping, employers. When asked about the proposed changes to the Worker’s Compensation program, she referenced Wisconsin’s reputation.
“We need to look at keeping the Worker’s Compensation system the way it is because Wisconsin is a national model for worker’s comp right now,” according to VanderMeer. “I think we need to be well informed on the current status of our program because we have very good outcomes, employees return to work quicker, and our costs are usually lower compared to other states.”
Top of page (4/10/15)
Payment Reform Requires Creating New Models for Care and Reimbursement
Wisconsin seen as progressive state—thanks to forward-thinking health care leaders
Experts at a panel discussion agreed the tipping point for payment reform in health care to move from volume to value can be reached, and Wisconsin health care is on the right track to reaching it. As a state with a national reputation for high-quality, high-value health care, Wisconsin is in a favorable position to take up value-based purchasing models and thrive as new models are adopted.
Three Wisconsin health care leaders joined Wisconsin Health News Editor Tim Stumm in a panel discussion April 7 at the Madison Club focused on payment reform. Presenters included Dave Krueger, MD, executive director, Bellin-ThedaCare Healthcare Partners; John Foley, RVP, Provider Solutions at Anthem Blue Cross and Blue Shield; and Karen Timberlake, director, University of Wisconsin Population Health Institute.
Krueger said the Bellin-ThedaCare Pioneer accountable care organization (ACO) experience taught them that the way the program is built is critical. Questions about how to account for patients who receive care outside of the ACO, and how to measure success—both financial and clinical quality—must be addressed.
“You can be the highest quality and lowest cost in the Pioneer program, and still end up owing the Centers for Medicare and Medicaid money,” Krueger said. “It was a problem with how the Pioneer program was built. We do see differences in the new model.”
The new program Krueger referred to is based in the Center for Medicare and Medicaid Innovation (CMMI), which supports testing innovative payment initiatives. The new model has changes that Krueger said they wanted to see, including financial incentives for Medicare patients if they obtain care from providers within the ACO. It also encourages providers, such as hospitals and nursing homes, to work together. It basically gives the ACO the ability to let the providers decide, within given parameters, how to produce the best care.
Timberlake, who is co-leading a state innovation model (SIM) grant project funded by CMS in Wisconsin, said the Statewide Value Committee, of which WHA is a founding member, has been tackling the questions surrounding payment reform, quality and population health.
“Our starting point is with people, “said Timberlake. “We need to ask ourselves, who are the people we are worried about, what are their health care needs, and what does better practice look like for them? Then we need to align payment with that care and scale it for the state.”
Foley agreed that it starts with patient-centered care, building trust among providers and insurers, and then designing the payment system around that.
“We have a long way to go to educate consumers on what their responsibility is and how they will benefit from care coordinators and health educators,” Foley said. “The focus will be on patients with chronic diseases, but all patients need a better understanding of their health care.”
There is not a road map to success in the new health care environment. But there are signs that Wisconsin may be on the right track.
“In the end, we are unique in Wisconsin and we have to figure out how we can do this. We have to experiment,” according to Krueger. “We could be world leaders if we set up our payment system based on value.”
Foley agreed. “When I come together with my peers, they ask what we are doing in Wisconsin because we are seen as progressive,” Foley said. “We are very progressive. It is a credit to the organizations in this room.”
Top of page (4/10/15)
Calling all CEOs! Complete the WHA Member Survey Today
As a reminder, one executive at each member hospital and health system has been invited to complete the WHA membership survey. If you received that invitation, please complete the survey by April 24.
Full member participation in the survey is critical to the success of this effort. This is your opportunity to rate WHA’s effectiveness and value. Please take full advantage of it and provide your feedback today. If you have any questions about the member survey, contact Jennifer Frank at email@example.com or 608-274-1820.
Top of page (4/10/15)
ICD-10 Physician Specialty Reference Guides Posted to WICD10.org
WHA, WHIMA partner to help Wisconsin physicians transition to ICD-10
The ICD-10 implementation deadline is October 1, 2015. WHA, in collaboration with the Wisconsin Health Information Management Association (WHIMA) has made 17 specialty-specific documentation reference guides available to help physicians transition from ICD-9 to ICD-10. These reference guides, developed by an ICD-10 coding expert, have been used by practicing physicians and were found to be functional and effective. The reference guides are available free-of-charge at www.wicd10.org/Education/PhysiciansandProviders.aspx
As WHA Chief Medical Officer Chuck Shabino, MD, explains (see https://youtu.be/Ya9FJ9I7ulI), physicians should consider the following steps for ICD-10 code conversion:
• Identify top diagnoses for your practice. Focus attention not only on your specialty but also identify chronic/preexisting conditions that you see within your patient population. (Diabetes/Hypertension).
• Review your documentation with the reference guides to identify any gaps.
• Review code assignment workflow—convert your software lists or charge ticket from ICD-9 to ICD-10.
• Maintain the documentation reference guide for ongoing use to ensure proper reimbursement and better quality metrics reported to programs such as PQRS and Medicare Advantage.
WHA and WHIMA encourages physicians to take advantage of the resources available at www.WICD10.org. If you have questions, contact Debbie Rickelman, WHA Information Center vice president, at firstname.lastname@example.org or 608-274-1820.
Top of page (4/10/15)
Wisconsin Board of Nursing Considers Change to the Nurse Licensure Compact
The Wisconsin Board of Nursing (BON) discussed endorsement of the new Nurse Licensure Compact (NLC) at its April 9, 2015 meeting. The new NLC, which is significantly different from the compact currently in place for Wisconsin nurses, is a joint effort from the National Council of State Boards of Nursing (NCSBN) and the National Nurse Licensure Compact Administrators (NLCA) to modernize the compact and to better reflect the health care environment of today. NCSBN has detailed information available on their website regarding the NLC (https://www.ncsbn.org/compacts.htm).
Currently, Wisconsin is one of 24 states that belong to the NLC. Six of these states have already introduced legislation to adopt the new model language and the Wisconsin BON is considering support and future endorsement of the new compact, which would require a legislative repeal of current statute and a replacement with the new model language.
The BON is reaching out to the Wisconsin Hospital Association (WHA) as a source of information and input regarding the impact a new NLC might have on the nurses and their employers in the state. Specifically, the BON is asking if adoption of the new NLC would have a negative impact on Wisconsin hospitals and health care employers. Additionally, what impact would it have if Wisconsin withdrew entirely from the present compact agreement?
At the meeting, Steve Rush, WHA vice president of workforce and clinical practice, commented that participation in the compact, both in its current form as well as the proposed new NLC, does impact WHA member hospitals since many of these hospitals employ nurses who live across state lines or who are working as a temporary contracted employee as a travel nurse. Rush said he will continue to work with the BON to provide information regarding the proposed changes to the compact.
The BON has scheduled a public hearing on the nurse compact at their July 9 board meeting at 9 a.m. in Madison. WHA will provide information at this hearing and encourages WHA member hospitals to either provide comments in person or to speak with Rush prior to the meeting. Contact Rush at email@example.com or 608-274-1820.
Top of page (4/10/15)
Free ICD-10 Training for Small Practice Physicians and Managers, May 6
WHA has teamed up with the Wisconsin Medical Group Managers Association (WMGMA), the statewide ICD-10 partnership (WICD-10) and CMS to offer free ICD-10 training to physicians and practice managers. “Road to 10: A Small Physician Practice’s Route to ICD-10” will be offered May 6 in Green Bay, in conjunction with the WMGMA Annual Conference. You do not need to attend the WMGMA conference in order to attend the “Road to 10” training.
Designed for physicians and practice managers, this free educational session will offer background and strategies on ICD-10 implementation so small physician practices will understand the business imperative around implementing ICD-10. The presentation will include discussion of the basics, differences, and benefits of ICD-10 and will explore common codes, primers for clinical documentation, and clinical scenarios all broken out by specialty. In addition, attendees will have the opportunity to create a customized action plan, personalized by specialty and practice details.
Register today at http://wmgma.site-ym.com/events/event_details.asp?id=596393&group.
Top of page (4/10/15)
WHA Advocacy Day Tops 900
Still two weeks left before premier event
Registrations hit 900 this week, and there are still two weeks left before WHA’s Advocacy Day event on April 28. Make sure you’ve registered so you can join hospital colleagues from across the state at this premier event, http://events.signup4.net/15AdvocacyDay0428.
Advocacy Day will break all records this year with attendees hearing from our always popular bipartisan legislative panel. Confirmed panelists include: Sen. Sheila Harsdorf (R-River Falls), Sen. Jen Shilling (D-La Crosse), Rep. Joe Sanfelippo (R-West Allis) and Rep. Peter Barca (D-Kenosha).
Attendees will hear from morning keynote Tucker Carlson, nationally-known veteran journalist and political commentator, who will share an insider’s view on Washington, D.C. Governor Scott Walker will keynote the luncheon.
With the record-breaking crowd, WHA expects close to 600 attendees to then take what they’ve learned and head the two blocks to the State Capitol to meet with legislators or their staffs. With Advocacy Day falling during legislative action on the biennial state budget bill, hospital advocates will be able to speak up about important budget issues, such as Medicaid funding. Optional pre-event webinars are also available for those going on legislative visits.
Advocacy Day will take place April 28 in Madison at the Monona Terrace Convention Center. Register today at: http://events.signup4.net/15AdvocacyDay0428.
For Advocacy Day questions, contact Jenny Boese at 608-268-1816 or firstname.lastname@example.org. For registration questions, contact Jenna Hanson at email@example.com or 608-274-1820.
Top of page (4/10/15)
Reedsburg Area Medical Center ER Staff Respond to Gunman Situation
Courses in health care worker self-defense proved extremely valuable
The staff at the Reedsburg Area Medical Center (RAMC) thwarted the efforts of a gun-wielding man who burst into the ER in an attempt to steal narcotics on March 29.
RAMC President/CEO Bob Van Meeteren, said the armed man approached the ER registration desk clerk, who then alerted an ER nurse before the man entered the ER area. The man pointed his weapon at multiple employees before finally exiting the hospital when he may have heard on a scanner that the local police were responding to a call for help at the hospital.
“Our ER nurse went to every one of our treatment rooms and alerted the staff to keep the patients and family in the rooms, pull the curtains and call 9-1-1. She took it upon herself to secure the patients and her co-workers at the same time staff was pulling the silent alarms,” according to Van Meeteren. “We were extremely pleased that it only took our local police about one minute to reach the hospital.”
Van Meeteren said the gunman walked around in the ER, pointing his weapon at many employees, but the staff all stayed very calm and focused on keeping the man from becoming more agitated.
“Hospital staff are trained to help people, so their first thoughts were that of protecting their patients and trying to help this man without him hurting anyone,” Van Meeteren said.
RAMC staff had recently trained with a paramedic who works with the local ambulance service and teaches self-defense courses for health care workers. Van Meeteren said he plans to have many more staff take that course.
“First and foremost, I have to give credit to my staff. You can drill for everything, but we did have some heroes working in our ER that night,” he said. “Health care workers in general are patient care givers and they think the best of everyone. They don’t judge. But in this situation, they knew they needed to protect their patients and themselves from this intruder.”
Van Meeteren encourages hospital administrators to review the location of their security cameras and silent alarms and to have local police officers tour the hospital on a regular basis to ensure they are familiar with the facility’s layout. Following the incident, an employee assistance advisor counseled the employees, which proved valuable in their own personal recovery from the event.
“We hope this never happens again, but we are going to prepare for it and learn from this experience,” Van Meeteren said. “I am extremely proud of my staff and our local police department. They did a fabulous job in their response, too.”
Top of page (4/10/15)