Governor Issues Order to Expedite Expansion, Enhance Efficiency of Healthcare Workforce

Governor Evers and Wisconsin Department of Health Services (DHS) Secretary-designee Andrea Palm today exercised their authority under Article V, Section 4 of the Wisconsin Constitution and Sections 323.12(4) and 252.02(6) of the Wisconsin Statutes to simplify healthcare license renewals during the COVID-19 public health emergency and to encourage recently retired professionals with expired licenses to re-enter practice. This full order is available online (link).

The order includes the following policy changes:

  • Interstate Reciprocity: allows any out-of-state health can provider licensed and in good standing to practice in Wisconsin without a Wisconsin credential. The order requires the out-of-state physician to apply for a temporary or permanent Wisconsin license within 10 days of first working at a Wisconsin health care facility; and the health care facility must notify DSPS within 5 days. The order temporarily suspends the visiting physician practice limitations in Med 3.04.
  • Temporary License: Any temporary licensed to an out-of-state provider during the emergency will be valid until 30 days after the conclusion of the emergency.
  • Telemedicine: Allows physicians licensed and in good standing in Wisconsin, another U.S. state or Canada to provide telemedicine services to Wisconsin residents.
  • Physician Assistants: Suspends several current rules regulating the practice of PAs in Wisconsin. This includes: the requirement of PAs to notify the MEB of changes to their supervising physician within 20 days (order changes it to 40 days); the requirement that PAs limit their scope of practice to that of their supervising physician (the order allows them to practice to the extent of their experience, education, training and abilities. It also allows them to delegate tasks to another health provider); the physician to PA ratio of 4:1 (the order allows a physician to oversee up to 8 on-duty PAs at a time, but there is no limit on how many PAs a physician may provide supervision to over time. It also allows a PA to be supervised by multiple physicians while on duty).
  • Nurse Training and Practice:The order suspends many rules related to nursing. This includes suspending a rule that prohibits simulations from being utilized for more than 50% of the time designated for meeting clinical learning requirements. It also suspends the requirement for nurses to submit an official transcript in order to get a temporary license and allows a temporary license to remain valid for up to 6 months. In addition, it suspends the rule requiring license renewal within 5 years.
  • Advanced Practice Nurse Prescribers: Temporarily suspends the requirement that Nurse Prescribers must facilitate collaboration with other health care professionals, at least 1 of whom shall be a physician or dentist.
  • Recently Expired Credentials: Requiresthe state to reach out to individuals with recently lapsed credentials about renewal options. The order also suspends many of the late renewal fees and continuing education requirements for most health professions. The order temporarily suspends MED 14.06(2)(a) to allow a physician whose license lapsed less than 5 years ago to renew without fulfilling the continuing education requirements. It also suspends RAD 5.01 (1) and (2) to allow radiographers or LXMO permit holders who have let their license lapse renew without completing continuing education.
  • Fees: The order also gives DHS the ability to suspend fees or assessments related to health care provider credentialing.

The order is effective immediately and will remain in effect through the duration of the public health emergency.

The full version of the Governor’s press release is available online (link).

Don’t Forget to Take Care of Yourself

Thank you all for your dedication to healthcare and the safety of your communities. We want to remind you to take of yourself as well. Here are some resources. Many are free.

Governor Suspends Evictions and Foreclosures During Public Health Emergency

Governor Evers directed the Wisconsin Department of Health Services (DHS) Secretary-designee Andrea Palm to temporarily order the suspension of evictions and foreclosures amid the COVID-19 public health emergency. The full order is available online (link).

The order prohibits landlords from evicting tenants for any reason unless failure to proceed with the eviction will result in an imminent threat of serious physical harm to another person and mortgagees from commencing civil action to foreclose on real estate for 60 days. Wisconsinites who are able to continue to meet their financial obligations are urged to do so. This order does not in any way relieve a person’s obligation to pay their rent or mortgages.

The full press release is available on the Governor’s website (link).

WHA Leads Health Care Groups’ Call for Public to Limit Virus Spread

WHA Valued Voice, March 26, 2020

WHA led a group of seven leading health organizations asking the public to help slow the spread of COVID-19 in Wisconsin. The call for public awareness of the importance of social distancing and limited public interaction was released soon after Governor Tony Evers announced his “Safer at Home” order on March 23. WHA has been a leading voice in calling for the public and policymakers to help “flatten the curve” of the virus’ impact on hospitalizations. Joining WHA on the press release were organizations representing the state’s physicians, nurses, rural hospitals, low-income clinics and nursing homes: the Wisconsin Medical Society, the Wisconsin Nurses Association, the Wisconsin Primary Health Care Association, LeadingAge Wisconsin, the Rural Wisconsin Health Cooperative and the Wisconsin Health Care Association/Wisconsin Center for Assisted Living.

The group urged citizens to follow the “Safer at Home” directive: “We must do this to keep our health care system from becoming overwhelmed,” the statement said, “and to protect both the public and essential health care workers who are necessary to take care of the critically ill.” The statement recognized that such an order will create difficult ramifications for Wisconsin businesses, their employees and families. “But the continued rise of COVID-19 cases in Wisconsin, now in part due to community spread, necessitates more dramatic action that we believe will help us get through this challenge even faster,” the group said. Governor Evers’ order took effect at 8 a.m. on March 24 and is scheduled to continue through April 24, subject to change by any subsequent order.

National Updates: Congress Refunds, Convocation, Recertification and Board of Governors Exam

Congress Refunds

We are beginning to process Congress registration refunds. Registrants will receive an email with details this week (week of March 23) as well as a confirmation email that the refund has been processed. All refunds will be processed by April 20.

All fees will be returned by the same method of payment used in the original transaction:

  • Credit cards will be refunded directly
  • Refund checks will be mailed to the address on the payment check
  • If you made multiple payments, you may receive multiple refunds

Convocation

Any new Fellow that had planned to walk this year in the 2020 Convocation Ceremony will be invited to participate in the 2021 ceremony. All cap and gown fees for 2020 will be refunded by April 20, in a separate transaction from their Congress registration.

Recertification

  • For those in the 2019 recertification class that received an extension to complete the requirements by March 31, this extension has been continued for the class to complete all requirements and submit recertification application and fee by Dec. 31, 2020.
  • For those who are due to complete their recertification requirements in 2020, ACHE has extended the deadline to complete requirements, submit recertification application, and pay recertification fee until March 31, 2021.

Board of Governors Exam

If any member had planned to take the Board of Governors Exam at Congress 2020, they should have received an email from Julianna Kazragys, FACHE, CAE, credentialing manager, with information on how to schedule their test at a future time.

  • Unfortunately, our testing vendor, Pearson VUE, has temporarily closed all its testing centers. Be sure to visit the following website to stay updated on the latest information on their website: https://home.pearsonvue.com/coronavirus-update
  • If a member has an active exam waiver on file, the waiver will be valid through Dec. 31, 2020
  • All current exam-authorized individuals will have until Dec. 31, 2020 to take and pass the exam without their applications expiring

Governor Announces Stay at Home Order

Governor Evers announced today that he be issuing a “Safer at Home” order effective Tuesday, March 24.  Organizations and individuals providing essential care and services will be allowed to continue travelling to and from work.  This includes healthcare professionals, grocers and family caregivers.  The full details of the order to be announced by the Governor’s office.  Everyone else is asked to not take any unnecessary trips, and to limit travel to essential needs such as getting medications and groceries.

This order is based on the advice and counsel of public health experts, healthcare providers and first responders on the front line of our state’s response to the pandemic.  These unprecedented measures are necessary to reduce rate of spread in COVID-19 cases.  We must do everything we can to keep our healthcare systems from becoming overwhelmed and protect both the public and essential healthcare workers who are taking care of the critically ill.

Business Continuation and Disaster Recovery

Nutanix Americas Healthcare CTO, Cheryl Rodenfels, shares insights from the front lines

One of the best ways that IT executives can keep up in the rapidly changing world of IT is through in-person interactions—to discuss and review use cases with peers, consultants, and vendors. Over the last couple of years, we’ve hosted a series of face-to-face sessions that allow senior IT leaders to interact, engage, and share insights and concerns about relevant topics. Recently, we held sessions on Business Continuation and Disaster Recovery (BCDR). Below is a synthesis of these well-attended sessions by dozens of leading senior IT professionals.

A shift in focus: it’s no longer just a line item for IT

Every organization experiences a disaster recovery incident that impacts their operations. It truly is a matter of “when” not “if.” From a simple application outage to a more complex weather or facility event, no one is immune to service disruptions. What is essential is how prepared they are to support the continuation of business functions when disaster strikes.

For IT leaders, the risk is real—and they are accountable for mitigating risk.

Traditionally, disaster recovery involved duplicating IT infrastructure and software systems in the event of a failure in the primary environment. All of the leaders we’ve listened to have shifted their focus from providing system availability to ensuring business continuation. They commented, “We can buy inexpensive hardware; we have duplicate services available through technology like backup data centers, hosted software, and [the] cloud; but we have to understand the business processes and priorities in order to provide the right solutions.”

Senior IT leaders have become better partners with the organizations they support. They perform research on the many potential threats (technical, environmental, cyber); they understand the negative impact of such events to the business, the customers, the investors, and the community; and they raise awareness of the necessity to create response plans that can be executed quickly and effectively.

According to these leaders, “The investment in business continuation is constant. It’s no longer just an IT line item. It’s an organizational investment in time and planning, developing real-time processes with contingencies, creating multi-step communication strategies, and performing pre-disaster exercises.”

A range of approaches with some common themes

While approaches to BCDR vary by organization type or market segment, there are some broad characteristics that define the two groups of organizations with whom we met:

1. State, Local, and Education (SLED) organizations mentioned being mission-oriented, and keeping the organization running is an expectation of their jobs. Two county CIOs and CISOs discussed the “all-hands-on-deck” approach, activating their plans and testing them against the new challenges introduced in California.

  • “This year was different than other years. The threats were the same with the fires we experience, but the utility company began a series of rolling power outages. While we pay the telecom companies for priority service, that only helped us for a few hours. We had moved several of our systems to the cloud, but there was no internet available to access it. Additionally, our people lost power at home and had no way to access systems.”
  • “We found flaws in our communications plans as employee cell phones lost power and most of our team members no longer have landlines. There were worse traffic issues as the signal lights were out, so even the people we were able to contact had a difficult time getting onsite.”
  • “Everyone is expected to be available, and Public Safety is our number one goal. We will have to revisit several parts of our plan and adjust based on what we experienced.”

2. Private sector CIOs were mixed in their approaches. One described their culture as having a “best efforts” approach to keep operations moving, and others had strong product and operational safety risks associated with power outages.

  • A financial services CIO said, “We knew our systems were up and our processes were running. We only had a few critical people involved in managing the business. Everyone else was told to focus on their families and making sure everyone was safe.”
  • The CIO of a national poultry operation had major concerns and challenges. “We have an extensive investment in backup generators and water supplies to keep the animals healthy. We are able to pause processing if the power situation continues for extended periods of time. But our biggest concerns are trucking and refrigeration for processed chickens. We have USDA standards that must be followed and safe handling procedures. Anything that interrupts that can cause harm to our products and cause danger to consumers. We could lose entire shipments at great financial loss if we do not have appropriate safeguards in place.”
  • The CIO for an extensive shipping operation described the impact of interruptions to their organization: “Our biggest concern is safety. We move tons of goods through daily. There are vessels and trucks coming and going. Everyone needs to know what is happening, where people are, ensure safe and effective loading and unloading, and track activities throughout the property. Corporations pay to have their goods shipped through us. If we cannot guarantee smooth operations, customers will lose trust with us and send their shipments to Canada or Mexico. We rely on continual operation to keep us in business. We have operations centers that run 24/7 to keep disruptions to a minimum.”

3. Common themes emerged, spanning both segments:

  • All senior IT leaders agreed that cyber threats are increasingly seen as a BCDR incident. From small phishing attempts to large ransomware events, each of the organizations have had to create a cyber response plan.
  • Even the most prepared organizations did not anticipate the impact of the rolling power outages.
  • Their communications plans all needed some adjustment. They must align with their business peers to create effective response plans.

Key takeaways for IT leaders

Revisit BCDR plans and focus on improving communication plans and clarifying participant roles during events.

1. Many communication plans are developed in best-case scenarios. Have a Plan B and C ready for when new threats are introduced.

2. Most CIOs were looking into/had already invested in satellite phones for senior executives.

3. Know where your employees and participants live. Distribute responsibilities across your organization’s geography to have a better chance at maintaining operations. (“All of our execs lived in one area of the county. They were responsible for leading the efforts and were least able to.”)

Re-evaluate staffing plans.

1. A command center must be established.

2. Determine primary, secondary, and tertiary assignments to cover each role. You never know who will be available during any particular event.

3. Participants must be flexible and able to perform in any capacity.

Be mindful of all the ways your business is dependent on and integrated with digital technology. For example:

1. Public cloud. In previous business cycles, it may have been enough to have a redundant power source and replicated backup systems in place. Now, what happens to your applications, infrastructure, and/or public cloud when service providers are down? What are your “downtime” procedures?

2. Mobile phones. Batteries have a finite capacity. What alternatives and redundancies do you need and/or have?

3. Electronic BCDR plans. What happens when you can’t access them electronically? Do you have a hard copy?

Business Continuation and Disaster Recovery continues to be a major topic in risk management, and today CIOs are responsible for mitigating both IT and business risks. While IT leaders may have a plan in place, these plans require continuous improvement and updates, given new variables like the recent public power outages and evolving cyber threats. As shown, the investment required is not just for IT services but also for the overall planning, testing, and awareness of the entire organization and its business functions. To paraphrase an old saying, when it comes to BCDR, use more than just an ounce of prevention to mitigate a pound of potential cure. Your business may depend on it.

Author Bio: Cheryl is a seasoned technology executive, having worked extensively across the client, consultant, and solution provider landscape. As CTO for Americas Healthcare at Nutanix, Cheryl’s responsibilities include identifying and developing market opportunities, creating industry-specific training and documentation, enabling sales, and improving technology adoption and solution delivery. You can find her thought leadership across many leading organizations including HIMSS, CHIME, NCHICA, IDG, and Nutanix CXO Focus.

Learn more.

WHN Workforce Briefing

Wisconsin’s aging population is straining the state’s healthcare workforce. Providers are having more difficulty filling slots, while demand for care is set to increase.

How will the state address the coming silver tsunami? A panel of experts will discuss what policies are helping stem the tide, and what more needs to be done at a Wisconsin Health News panel on Tuesday, March 10, in Madison at the Madison Club (5 East Wilson Street).  The event opens at 11:30am with the panel discussion starting at noon).

Panelists:

  • Lisa Pugh, Executive Director, The Arc Wisconsin
  • Patrick Testin, R-Stevens Point
  • Dennis Winters, Chief Economist, Department of Workforce Development
  • Ann Zenk, Vice President of Workforce and Clinical Practice, Wisconsin Hospital Association

Register now (link)

WHN Workforce Briefing

Wisconsin’s aging population is straining the state’s healthcare workforce. Providers are having more difficulty filling slots, while demand for care is set to increase.

How will the state address the coming silver tsunami? A panel of experts will discuss what policies are helping stem the tide, and what more needs to be done at a Wisconsin Health News panel on Tuesday, March 10, in Madison at the Madison Club (5 East Wilson Street).  The event opens at 11:30am with the panel discussion starting at noon).

Panelists:

  • Lisa Pugh, Executive Director, The Arc Wisconsin
  • Patrick Testin, R-Stevens Point
  • Dennis Winters, Chief Economist, Department of Workforce Development
  • Ann Zenk, Vice President of Workforce and Clinical Practice, Wisconsin Hospital Association

Register now (link)