July 29, 2016
Volume 60, Issue 30


ETF Issues RFP for Self-Funding
Timeline for submission moved up

On July 22, the state Department of Employee Trust Funds (ETF) issued the final version of its request for proposals (RFP) for self-funding the state employee group health insurance program, with responses now due September 9, 11 days sooner than the draft timelines issued previously by ETF. State officials have consistently described the request for proposals process as a way to obtain the data and information needed to determine if self-funding is feasible for Wisconsin. 

“An RFP serves a certain purpose, and only a partial purpose when it comes to a decision with such broad ranging ramifications as self funding and the risk it inherently transfers to the state," said WHA President/CEO Eric Borgerding. "We encourage the Governor and the Legislature to take a much deeper dive into self-funding, well beyond the limited and uncertain information an RFP can yield to ensure a fair comparison of self-funding to the current model that is serving Wisconsin well. It is incumbent upon policymakers to obtain a fuller picture of the risks to the state and impact on the health insurance market. These are significant issues that an RFP will not address.” 

There were few other changes to the final RFP compared to a draft that was issued in June (see July 1 Valued Voice article at www.wha.org/pubarchive/valued_voice/WHA-Newsletter-7-1-2016.htm#5). The RFP includes four regions with the southeast and northeast being combined for one eastern region. Potential vendors can bid on statewide/nationwide and/or individual regions. The final RFP noted that cost will be 40 percent of the overall scoring, and proposers will be required to submit their current price information. 

In moving from the current fully insured model to many fewer plans or even a statewide/national plan where the state is now at risk for medical costs, ETF’s proposal would include enhancements to auditing and utilization review functions, putting significantly more administrative burden on hospitals. While softened a bit in the final RFP—the threshold for triggering an audit increased from $100,000 to $200,000—it is similar to the RAC audits in place for Medicare, which have been heavily criticized for inaccuracies and inappropriate denials. In fact, CMS has paused certain reviews due to such concerns. 

The contract term would be for five years, with two options for two-year renewals, putting the total possible contract term through December 31, 2026. This means the state will be bound to a five-year contract arrangement that one consultant, hired by the state, noted could end up costing state taxpayers an additional $100 million a year. 

The state’s Group Insurance Board is scheduled to meet November 15 to discuss the proposals. The state Legislature’s Joint Committee on Finance will have final approval over any contract approved by the Group Insurance Board. 

The proposal can be found on the state’s vendornet website at: 

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Wisconsin Work Comp Premium Rates Lowest Among Neighboring States
But Injury Rates Among the Highest in the Country

The Wisconsin Department of Workforce Development (DWD) announced July 26 that rates determining worker’s compensation premiums for employers will drop 3.19 percent effective October 1, 2016. Gov. Scott Walker said the announcement is “good news for employers” and is another indication that Wisconsin is a “great place to work and do business.” According to DWD’s press release announcing the 2016 rate adjustment, the average annual net worker’s compensation premium change for employers since 2006 has been only 0.14 percent.

WHA President/CEO Eric Borgerding commended the work of Wisconsin’s health care providers in getting injured workers back on the job more quickly than nearly every other state in the nation, helping to lower the cost of worker’s compensation claims in Wisconsin by reducing an injured worker’s time on disability.

“It’s abundantly clear that when an injured worker comes to a Wisconsin hospital, they are getting some of the best care in the country,” said Borgerding. “What’s also clear is Wisconsin still has work to do when it comes to reducing workplace injuries and reducing the demand for health care services related to those injuries.”

According to the U.S Bureau of Labor Statistics, in 2014 Wisconsin’s overall incidence rate of nonfatal occupational injuries and illnesses was among the worst in the U.S. Wisconsin’s overall incidence rate for private-sector employers was at 3.9 cases per 100 equivalent full-time workers in 2014, compared to 3.2 nationally. Wisconsin tied with three other states for the seventh worst rate in the country.

”The health care component of Wisconsin’s worker’s compensation program has a very strong record of performance, with fast return-to-work rates, low utilization of health care services, high levels of patient satisfaction and overall cost per claim that is among the lowest nationwide, all of which helps lead to positive premium trends for employers and better care for those injured on the job in Wisconsin,” said Borgerding.

2014 Worker's Compensation Midwest Rate Comparison

Actual Cost Per $100 of Payroll (Source: https://dwd.wisconsin.gov/wc/insurance/2014_comp_rates.htm)











Each year, the Wisconsin Compensation Rating Bureau (WCRB) establishes premium rates for the state’s worker’s compensation insurance carriers. These rates are developed into premiums, based on claims experience and adjustments for industry sectors. 

According to the most recent data on DWD’s website (2014), Wisconsin’s worker’s compensation rates are the lowest in the Midwest.

“The commitment of Wisconsin hospitals and health systems to our state’s workforce goes beyond providing exceptional care to those injured on the job and helping them return to work and productivity,” Borgerding said. “Our members are working with local employers across the state to design safety and health management programs and partnering to improve overall employee health. Despite the data, despite these partnerships, some in Madison continue pushing controversial Worker’s Compensation policies that increasingly appear to be solutions looking for a problem.”

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WHA Provides Medicare PPS Rule Summaries and Hospital-Specific Analysis on Medicare Reimbursement 

In addition to the nice weather that summer brings, it is also the season for CMS to release their Medicare proposed and final prospective payment system rules for hospital-based services ranging from inpatient and outpatient, to home health, psychiatric, rehab and SNF services. 

WHA has excellent online resources at WHA.org to help members understand these important Medicare payment rules, by providing detailed rule summaries and hospital-specific analysis on the financial impact of the changing rules. 

All completed PPS rule summaries can be found on the WHA website at www.wha.org/medicare.aspx. Once there, see the left hand side of the webpage for the PPS topic of interest to you.

The hospital-specific fiscal analysis of the Medicare PPS payment rules are posted on the WHA member portal at http://members.wha.org.


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Register Today for Hospital Foundation Workshop, August 16

Hospital foundation directors, their board members and hospital executives are encouraged to attend “Prescription for Success: A Workshop for Hospital Foundations” August 16 in Wisconsin Dells. 

This year’s workshop will be led by Lori L. Jacobwith, nationally-known communication and fundraising strategist. Jacobwith, who is back by popular demand, will lead two interactive sessions, sharing tools and techniques to deepen donor engagement and increase support from Foundation Board members. 

With the partnership and support of the Wisconsin Office of Rural Health (WORH), the Wisconsin Hospital Association (WHA) and the Rural Wisconsin Health Cooperative (RWHC), this annual workshop is available at a minimal cost to hospital and hospital foundation staff. This year’s workshop is also approved for 5.0 continuing education credits by CFRE International.

The Hospital Foundation Workshop will be held Tuesday, August 16, at Glacier Canyon Lodge at The Wilderness Resort in Wisconsin Dells. A full workshop brochure is in this week’s packet. Online registration is available at http://events.SignUp4.net/Foundation16.

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Save the Date: November 10-11, 2016
Interprofessional Collaborations: Advancing Wisconsin’s Healthcare and Education

Madison Marriott West

Sponsored by The Wisconsin Council on Medical Education and Workforce (WCMEW) and the Wisconsin Area Health Education Council (AHEC)

Conference Objectives
• Engage with colleagues practicing in health care and education interested innterprofessional education (IPE) and interprofessional clinical practice (IPCP).
• Develop and build on knowledge and skills across the spectrum of IPE and IPCP program development.
• Learn the current state of IPE and IPCP, theory-based best practices, and lessons learned in the field.
• Advance and sustain IPE and IPCP to facilitate effective and patient-centered health care education and practice.

Open to Wisconsin’s health care community. Registration link and call for proposals: www.ahec.wisc.edu

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New Zika Presentation Added to WHA Online Resources 

David O’Connor, Ph.D., professor, Department of Pathology and Laboratory Medicine at UW-Madison, is working with researchers internationally to study and to develop a response to the Zika virus. A presentation in Madison at Wednesday Nite @ the Lab by O’Connor was filmed July 6, 2016 and posted to the UW-Madison Biotechnology Center website: http://www.biotech.wisc.edu/webcams?lecture=20160706_1900 This presentation would be of interest to clinicians, educators and the general public. 

CDC held a media briefing on Zika July 29. The transcript is available here: www.cdc.gov/media.

To help our members respond to requests for information from their clinical staff and patients, WHA has dedicated a page to Zika in its emergency preparedness resources at WHA.org. 

WHA will continue to monitor the media and post links on the resource page to outside news sources that we believe will be helpful in keeping our members informed on this emerging public health issue.

Direct questions related to Zika to Steven Rush, WHA vice president, workforce and clinical practice, at srush@wha.org or 608-274-1820.

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