September 18 2015
Volume 59, Issue 37
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Physician Licensure Compact Legislation Moves Forward
Assembly Health Committee members vote 11-0 to recommend passage
A bipartisan group of legislators on the state Assembly’s Health Committee voted unanimously in favor of Assembly Bill 253 (AB 253) September 15 during a meeting held in the Wisconsin State Capitol. AB 253 adopts the Interstate Medical Licensure Compact, which will create an alternative, voluntary, expedited process for qualified physicians licensed in other states to receive a Wisconsin medical license.
The Compact was crafted under direction from the Federation of State Medical Boards with input from providers, including Wisconsin hospitals and health systems, to offer a state-based solution to interstate physician licensure. Wisconsin’s version of the legislation ensures that the provisions and costs of the Compact only affect those physicians that choose to be licensed through the Compact. Under the bill, Wisconsin’s Medical Examining Board continues to maintain its authority to regulate the practice of medicine for those licensed through the Compact.
“Physician workforce and medical education training issues continue to be a top advocacy priority of the Wisconsin Hospital Association,” said WHA President/CEO Eric Borgerding. “On behalf of our members, we thank Rep. Joe Sanfelippo and all the members of the Assembly Health Committee for moving this important bill forward.”
Speaking in favor of the legislation, Health Committee Vice-Chair and Rep. Mike Rohrkaste (R-Neenah) said, “Access is critical for our health care needs long term. Access, because of a lack of providers in particular fields, is a problem. I see that this legislation will help in the long run.”
The legislation has received broad support from Republicans and Democrats in the Senate and Assembly. The bill has 75 co-sponsors with 18 Senators and 57 Representatives, more than it takes to pass the bill in either house.
“This will absolutely be a benefit,” said Health Committee Ranking Member and Rep. Debra Kolste (D-Janesville). She continued by saying the Compact legislation “will certainly make it easier for physicians to be granted licenses to go across state lines to practice medicine. I truly support this.”
Lawmakers also see the Compact as an important piece of public policy to create additional access for mental health services in Wisconsin. The chairman of the Assembly Mental Health Committee, Rep. Paul Tittl (R-Manitowoc), said “We have a shortage of over 270 psychiatrists that could be hired here in the State of Wisconsin” and said that he believes the Interstate Medical Licensure Compact could help address this workforce need.
In mid-August, WHA General Counsel Matthew Stanford and Burnett Medical Center CEO Gordy Lewis testified before the Assembly Health Committee in favor of Assembly Bill 253. Rep. Nancy VanderMeer (R-Tomah) is the lead author of Assembly Bill 253 and Sen. Sheila Harsdorf (R-River Falls) is the lead author of its companion bill, Senate Bill 196.
The WHA government relations team expects AB 253 to receive a vote by the full Wisconsin State Assembly on September 24. The bill will then be referred to the Senate for further action in that chamber.
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Nygren Circulates Bill Requiring Oversight of State Employee Health Plan
Legislation would require Joint Finance Committee review before implementing changes
State Rep. John Nygren (R-Marinette) announced on September 16 his intent to introduce legislation that would require review and approval by the Joint Finance Committee to any changes made to the state employee health insurance program. Currently the Group Insurance Board (GIB), a board made up primarily of gubernatorial appointees, believes it has unilateral authority to change the design of the state employee health insurance program, which provides insurance coverage for over 250,000 Wisconsin public employees and their families.
Nygren spoke to the WHA Board of Directors in February 2015 and raised his concerns about the potential impact to the marketplace that comes with wholesale changes to state employee health insurance. At the time, the GIB had already commissioned two reports and was in the process of commissioning a third study to look at the costs and benefits of moving Wisconsin’s current fully-insured state employee health program to a self-insured model.
The first two reports showed significant concerns about moving to a self-funded model. The studies noted this change could disrupt existing payer/provider relationships, including negotiated discounts, and the ability to manage care for patients, which is critical to lowering overall costs. The studies also noted the disruption for patients and their potential need to change providers. Overall, one of the studies showed that these considerations could result in a potential additional cost to the system of up to $100 million.
In Nygren’s memo to his colleagues asking them to sponsor the legislation, he said the “GIB should be required to work together with the Legislature to find reasonable solutions before pursuing their own policies that could have a destabilizing effect on the state budget.”
WHA supports the legislation and believes it is important for lawmakers, who are ultimately responsible for any fiscal impact of decisions made by the GIB, to have a voice in this process.
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WHA Physician Leaders Discuss Prescription Painkiller Campaign and Policy
Council concerned with mandating clinician use of useful, but technically flawed PDMP
WHA’s Physician Leaders Council met September 16 and discussed a wide range of issues ranging 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.
The Council led off with a timely discussion of Attorney General Brad Schimel’s “Dose of Reality” campaign released September 17. WHA staff shared that the direction of the Attorney General’s campaign is to focus on raising public awareness of prescription painkiller abuse by educating the public on appropriate uses of prescription painkillers and the dangers of their misuse. The need for a public awareness campaign on this issue was a key message that WHA shared with Attorney General Brad Schimel this spring and was a need identified by the Council to combat opioid abuse at its June meeting.
WHA staff also discussed WHA’s work to convene stakeholders to collaborate on messaging for health care providers as part of the “Dose of Reality” campaign. (For more information about the “Dose of Reality” campaign, see article above.)
The Council also discussed Rep. John Nygren’s announcement on September 8 that he would pursue four new bills as part of his Heroin, Opiate Prevention and Education (HOPE) agenda.
Consistent with the Council’s discussions at its April and June meetings, the Council viewed the current Prescription Drug Monitoring Program (PDMP) as an important clinical asset, but that it is significantly flawed from a technical and clinical workflow perspective resulting in slow-downs in care.
As discussed at its previous meetings, including the Council’s meeting with Rep. Nygren in June, Council members expressed concerns about mandating via legislation that clinicians utilize the PDMP and instead believed that greater clinical utilization could be achieved by focusing on modernizing the PDMP technical infrastructure and enabling it to be integrated into physicians’ and clinicians’ electronic health records.
The Council also preliminarily reviewed one of Rep. Nygren’s proposed bills that would create new regulations and certification requirements for pain clinics. WHA indicated it would proactively work with Rep. Nygren to discuss various questions and issues raised regarding the new HOPE bills.
Staff provided the Council with an update on WHA’s regulatory-focused webinar series on advance practice clinician hospitalists. A key take away from that series is that the regulatory complexities regarding usage of advance practice clinicians can be significant and extend beyond a simple focus on advance practice clinician scope of practice. Staff also discussed the status of proposed regulatory and legislative proposals to change scope of practice language for advance practice nurse prescribers.
Staff provided background on WHA’s sepsis initiative to the Council and sought feedback on how best to present the materials and resources within hospitals.
Building from discussions the Council had in 2014, WHA will form a Telemedicine Task Force later this year, and the Council heard a draft outline of plans for that task force.
Staff also provided the Council with information and received feedback on several other issues, including the status of Wisconsin’s Interstate Physician Licensure Compact legislation, community paramedics legislation, potential rulemaking on trauma system designation, potential legislation regarding transitional care facilities for post-hospital discharge care, and chiropractor scope of practice.
The next meeting of the Physician Leaders Council will be December 2.
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WHA Council Hears Proposals for Expanded Scopes of Practice
Two groups of health care providers are proposing an expansion of their scope of practice in Wisconsin. The WHA Council on Medical and Professional Affairs was briefed on proposals by WHA Vice President, Workforce and Clinical Affairs, Steven Rush.
The first proposal would allow emergency medical services (EMS) personnel such as emergency medical technicians (EMT) and paramedics to expand their scope of practice for in-home visits. Patients who would be targeted for these visits include frequent users of emergency medical services, those who have recently been discharged from a hospital or patients with a chronic medical condition. The proposal calls for additional training, supervision by an ambulance service director and limits those eligible to EMTs or paramedics who are employed by an ambulance service provider. The types of services these certified EMS personnel could potentially provide may include medical assessments, wound care, medication reconciliation and collection of blood samples. The proposal calls for Medicaid reimbursement for the new in-home visits. The Council discussed differences between this proposal and similar programs that are being coordinated by members of WHA.
The Council was also briefed on a white paper prepared by the Wisconsin Chiropractic Association. The paper calls for a new certification, termed Primary Spine Care Physician (PSCP), for chiropractors. Chiropractors seeking the certification would complete a two-year master’s program. Once certified, a PSCP could diagnose causes of spinal pain and deliver treatments that include manual therapies, prescription of medications and percutaneous invasive therapies. WHA staff is continuing to seek information and member input on both of the above proposals. In summarizing the discussion Rush said, “It is clear there are legitimate patient care issues involved in these proposals. It remains unclear however if the solution to the problem is the expansion of these two roles. WHA will continue to seek input from members on these two emerging health care issues.”
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WCMEW to Host Team-Based Care Summit November 12
Building upon Wisconsin’s work on health care redesign and advancing team-based care, the Wisconsin Council on Medical Education and Workforce (WCMEW) will host a one-day event of interdisciplinary education and discussion that will serve to strengthen existing teams, catalyze new team development, bridge care silos and spark new ideas. “Team-Based Care Summit 2015: Transforming Concepts into Reality” will be held November 12 in the Fox Valley.
The Summit will begin with an opening keynote session presented by Peter Knox, executive vice president of Bellin Health and senior fellow at the Institute for Healthcare Improvement, focused on ways to engage organizational leadership in team implementation and build the business case for teams. A plenary session will examine payer perspectives on team-based care and will feature Dr. Greg Long, chief medical officer for ThedaCare and Terry Bolz, chief executive officer of Unity Health Plan.
Breakout sessions will focus on using metrics as a guide for team-based care; provide a how-to guide to managing workflows, protocols and team member roles; ways to leverage learners in existing or developing teams; and measuring the outcomes of a team’s impact. In addition, poster presentations highlighting more than examples of successful team-based care initiatives from throughout the state will be on display.
Registration is now open for this event. For information, including the day’s agenda, visit: http://events.SignUp4.net/15TBC1112 or review the conference brochure included in this week’s packet. Registration questions can be directed to Jenna Hanson at firstname.lastname@example.org or at 608-274-1820.
The Wisconsin Council on Medical Education and Workforce (WCMEW) is a multi-stakeholder organization whose purpose is to facilitate strategies to assure an adequate supply of health care providers to meet the needs of Wisconsin citizens today and into the future. In addition to the Wisconsin Hospital Association, stakeholders include the Wisconsin Medical Society, the Medical College of Wisconsin, Pharmacy Society of Wisconsin, Rural Wisconsin Health Cooperative, UW School of Medicine and Public Health, Wisconsin Academy of Family Physicians, Wisconsin Academy of Physician Assistants, and the Wisconsin Nurses Association.
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Register for the WHIO 2015 Learning Forum & 10th Anniversary Celebration
The Wisconsin Health Information Organization (WHIO) celebrates the 10th anniversary of its founding at WHIO’s 2015 Learning Forum: Spotlight on Big Data, October 13 at the Crowne Plaza Hotel, Madison.
The day-long conference will offer a multi-faceted look at the power and possibilities of Big Data to help transform health care in Wisconsin. The keynote address is Socio-Economic Variables in Risk Adjustment, by Dan Dunn, PhD, former senior vice president for business solutions at OptumInsight and principal in Optum’s health care consulting practice.
Other topics include:
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WHA Foundation’s 2015 Global Vision Award Honors Two Community Initiatives
On September 18, the WHA Foundation announced the recipients of the 2015 Global Vision Community Partnership Award, including the “Fit Families Rock” program, nominated by St. Mary’s Janesville Hospital; and the “Lakeshore Community Health Center,” co-nominated by Aurora Medical Center-Manitowoc County, Two Rivers and Holy Family Memorial in Manitowoc.
“Fit Families Rock” (FFR) is a comprehensive program aimed at Rock County families of overweight children ages 8 to 12 years old, who are in the 85th percentile of their age-appropriate body mass index. The program was designed to foster weight loss and teach healthy living habits to the children and at least one of their parents or guardians. Over an 11-week period, participants learn healthy eating habits and work to increase exercise in their daily routine. Participants meet twice a week, once to focus on exercise as a large group, and once in separate children and adult groups for educational classes. Participants also keep a food log with weekly review and feedback from a registered dietician. Measurable outcomes show decreases in screen time and fast food consumption, as well as increased fruit and vegetable consumption, decreased BMI and average weight loss of four pounds. FFR is a partnership between St. Mary’s Janesville Hospital, Dean Clinic, UW Extension, YMCA of Northern Rock County and the University of Wisconsin-Whitewater. It was developed after the community health needs assessment, conducted by the hospital in 2011, revealed one in four children in Rock County is obese or overweight and as a result of harmful lifestyle choices, Rock County ranked 67 out of 72 Wisconsin counties in poor health behaviors and quality of life.
The “Lakeshore Community Health Center” (LCHC) was born as a result of a collaborative community partnership focused on addressing adequate access to health care. That partnership includes Aurora Medical Center Manitowoc County/Aurora Health Care, Holy Family Memorial, Northeastern Wisconsin Area Health Education Center, Manitowoc County Health Department and United Way of Manitowoc County. LCHC provides comprehensive medical, dental and behavioral health services, with a mission to improve the health of the community by providing quality patient-centered, family-based health care, health promotion and support services free from cultural, linguistic and economic barriers. Since the opening of LCHC, 56 percent of patients who were previously uninsured now have access to primary medical care. Also, 45 percent of patients with chronic disease are now accessing medical care to help them manage the disease. Since 2012, emergency department visits by Medicaid patients in Manitowoc County have decreased 18 percent.
The WHA Foundation’s Global Vision Community Partnership Award is a competitive grant award created in 1995 to recognize the efforts of WHA members in meeting the documented health needs in their communities through creativity, innovation, partnership, and collaboration. To date, the Award has honored 40 innovative programs in communities throughout Wisconsin.
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24th Annual $2,500 Rural Health Prize - June 1, 2016 Deadline
The Hermes Monato, Jr. Prize of $2,500 is awarded annually for the best rural health paper. It is open to all students of the University of Wisconsin (any campus) as well as those who will be recent graduates at the time of submission.
Students are encouraged to write on a rural health topic for a regular class and then submit a copy to the Rural Wisconsin Health Cooperative as an entry by June 1.
Previous award winners as well as judging criteria and submission information are available at www.rwhc.com/Awards/AnnualMonatoEssay.aspx.
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