November 23, Wisconsin Health News

Wisconsin hospitals spent $1.7 billion in 2015 to support programs and services that had a positive impact in the communities they serve, according to a new report produced by the Wisconsin Hospital Association.

That includes more than $1 billion they lost caring for patients in the Medicaid program. They also lost $1.6 billion on Medicare.

Hospitals reported spending $65 million on activities and programs aimed at improving community health.  They spent $177 million on graduate medical education for physicians and nearly $12 million on education and clinical experiences for nurses.

The 14 hospitals that operate nursing homes reported losses totaling nearly $13 million, a slight decrease from 2014.

Charity care was also down, from $278 million in 2014 to $176 million last year. That’s despite a 21 percent increase in the number of patient visits that qualified for free care, from 1.3 million to 1.6 million.

“The fact that there were more cases, and the cost decreased, may reflect the fact that more services are provided in the less costly outpatient setting than in the hospital, which is consistent with what we are seeing with all patient care,” according to Brian Potter, a senior vice president at WHA.

Potter also said that while more people have gained coverage, many patients still struggle to meet their co-pays and deductibles. “That continues to be a real concern for hospitals,” he said.

Read more.

The Medical Examining Board approved a revised version of a rule defining telemedicine Wednesday. It now heads to Gov. Scott Walker’s office and then the state Legislature for approval.

 

The board has spent the last year drafting the rule, scrapping its original proposal after healthcare providers raised concerns. The final rule clarifies that a physician-patient relationship can be established through telemedicine and provides guidelines on equipment and technology as well as internet diagnosis and treatment.

 

“The two different versions of the telemedicine rule are pretty stark,” said Mark Grapentine, senior vice president of government relations at the Wisconsin Medical Society. “One was super-detailed and lengthy, the other one is much more flexible and probably useable by the board itself.”

 

The Alliance of Health Insurers also backed the rule.

 

“Telehealth is a means to improve upon the high-quality healthcare system we already enjoy, particularly by improving patient access, regardless of distance and mobility,” Executive Director R.J. Pirlot wrote in testimony.

 

Claudia Tucker, vice preisdent of government affairs for Texas-based TelaDoc, said they’re pleased that the board accepted their recommendations to address HIPAA concerns and said they also support the latest version of the rules.

 

But some testimony questioned whether the rule could be construed to prohibit other healthcare professionals from providing care through telehealth.

 

Linda Roethle, vice president of regional business development at Bellin Health, said that more than just physicians and physician assistants should be covered under the rule, including nurse practitioners, clinical psychologists and clinical social workers.

 

“Please do not create any additional barriers for patients,” she wrote in her testimony.

 

Tine Hansen-Turton, executive director of the Convenient Care Association, recommended language stipulating that nurse practioners can practice telehealth. The association represents clinics located inside retail locations like grocery stores and pharmacies.

 

“Wisconsin’s retail clinics are primarily staffed by nurse practitioners,” Hansen-Turton wrote. There are 35 retail clinics in the state, according to her testimony.

 

Dr. Kenneth Simons, board chair, said the board can’t create rules for professions it doesn’t oversee.

 

Read the rule.

Heathcare organizations called on Gov. Scott Walker’s administration and lawmakers to consider the impact that self-funding the health plan for state and local employees could have on Wisconsin’s healthcare market.

Fourteen groups, including the Wisconsin Counties Association, Wisconsin Hospital Association and the Wisconsin Medical Society, sent a memo to lawmakers Monday cautioning that the “potential repercussions” of self-insuring “could be far-reaching” and “significant” for the state’s taxpayers and economy.

The Department of Employee Trust Funds has issued a request for proposals to self-insure the health plan for state and local employees. In such an arrangement, the state would take on the risk for the roughly 250,000 state and local employees, as well as their families, currently covered under the program.

The proposal could reduce the number of HMOs serving the program. It could also save the state up to $42 million, according to one report. A different report said the move could save $20 million or cost the state up to $100 million. Walker has said any savings would go to education.

The 14 organizations called on the state’s Group Insurance Board, members of the Joint Finance Committee and Walker to “fairly compare” the results of the RFP to the current system, evaluate “possible significant risks to state taxpayers” and assess whether self-funding protects the competitive strength of the state’s health insurance market.

“The State Group Health Program has been remarkably successful in using choice and competition to control costs, improve quality and maintain financial stability and value for taxpayers,” they wrote. “Any alternative the state considers should be held to this high standard.”

Walker spokesman Tom Evenson wrote in an email that the governor appreciated the input and will take it in consideration.

“In the end, we will move forward with a plan that is best for Wisconsin,” he said.

The Group Insurance Board is next scheduled to meet Nov. 30.

Read the memo.

 

The day after the election saw the highest number of people signing up for health insurance through Healthcare.gov since the beginning of the month, as consumers show an intense interest in buying plans on the individual market both nationwide and in Wisconsin.

More than 100,000 people signed up for coverage last Wednesday, White House Press Secretary Josh Earnest told reporters last week. He called the sign-ups an “indication of the intense demand” for the coverage offered under the law.

Caroline Gomez-Tom, program manager for the Milwaukee Enrollment Network and navigator program manager at Covering Wisconsin, saw a similar spike in interest and enrollment last Wednesday.

Gomez-Tom said they’ve noticed that those calling and booking appointments have raised questions about the future of the Affordable Care Act, given the calls for repealing and replacing the law from President-elect Donald Trump and congressional Republicans.

Gomez-Tom said naviagators have assured consumers they’ll still be able to enroll in 2017 plans.

She added there’s strong interest in renewing policies. In previous years, they’ve “kind of had to shake the trees” to make sure people who need to renew coverage come back for help, Gomez-Tom said.

“People want to get in, and they want to get in early enough before Dec. 15, so they’re not dealing with a rush,” she said. “Because of that, we’re dealing with a rush, which is good.”

Consumers during the last few weeks have sometimes had to spend up to 30 minutes at wait pages, which pop up when a high number of users are on the website. Gomez-Tom said they didn’t see those wait pages last year until the final day people could buy or renew insurance for a policy that began at the start of the year.

She attributes the interest to “consumer savviness” as enrollees and others are beginning to understand how the market works.

“People are coming to us rather than us having to do that significant amount of outreach to get them into our offices,” Gomez-Tom said.

Joy Tapper, executive director of the Milwaukee Health Care Partnership, said despite questions about the future of the law, there are affordable plans that will remain in place in 2017.

She added that people with pre-existing conditions can still get insurance, that subsidies are available for consumers and that tax penalties will likely remain in effect for next year.

“Any change will be complex and take time,” she said.

Donna Friedsam, health policy programs director at the University of Wisconsin Population Health Institute as well as principal investigator and director of Covering Wisconsin, said there’ll likely be a transition period no matter what type of policy is purused.

She added that the election hasn’t had any impact on what’s currently in the marketplace, regardless of future changes.

“Whether it’s Obamacare or Trumpcare, the navigators and the assistors are there to make sure consumers understand what’s available to them and can use it effectively,” she said. “I don’t see that mission going away.”

 

Doctors who prescribe controlled substances will have to complete training relating to the Medical Examining Board’s opioid guidelines under a rule that went into effect Thursday.

The Department of Safety and Professional Services signed off on the emergency rule last week. It requires doctors renewing their licenses to complete two hours of training on the guidelines out of their 30 hours of binniel mandatory continuing medical education.

 

Read the rule.

Wisconsin Health News

The percentage of Wisconsin physicians receiving information electronically from other providers was the highest in the nation in 2015, according to a recently released survey.

 

About 65.5 percent of Wisconsin physicians received information electronically from other providers, according to a Centers for Disease Control and Prevention report from October. The percentage was statistically significantly greater than the national average of 38.3 percent.

 

About 54.1 percent of Wisconsin physicians searched electronically for information from other providers, again significantly greater than the national average of 34 percent. It was the third highest in the nation, behind Oregon and Washington.

 

Wisconsin was also higher than the national average when it came to electronically integrating patient health information with outside providers as well as sending patient health information electronically. But those percentages were not statistically significantly different from the national average, according to the report.

 

“I don’t think Wisconsin’s success is surprising,” said Dr. Seth Foldy, a Medical College of Wisconsin professor of family and community medicine. “Wisconsin has led the nation for some years in the installation of electronic health records in doctor practices and hospitals.”

 

Foldy, who also serves as medical director of My Choice Family Care and was co-founder of Wisconsin Health Information Exchange, attributed Wisconsin’s lead to the large number of group practices and hospital networks in the state, as well as electronic health record vendors like GE, Epic and Marshfield Clinic. There’s also other businesses that are collecting, storing and exchanging electronic information, he said.

 

The large group practices have led to a large base of installed electronic health records, which means that in general the state has some of the highest number of doctors using EHR in the nation, he said.

 

Another factor explaining Wisconsin’s high numbers could be public health registries like the Wisconsin Immunization Registry, which doctors frequently use to check records. And a final factor could be the state’s prevalence of health information exchanges, which help exchange electronic health information, Foldy said.

 

Joe Kachelski, CEO of the Wisconsin Statewide Health Information Network, said Wisconsin’s always been a leader in EHR implementation and use.

 

“There’s a lot of data that we are moving,” he said of WISHIN. “I would think we’re part of what’s being measured in this study.”

 

Rick Abrams, Wisconsin Medical Society CEO, said the high percentages show the state’s healthcare system is highly integrated.

 

“The upper Midwest is really unique, but unique in a very good way,” he said. “Our physicians absolutely recognize the upside of the use of electronic health records, especially interoperable health records.”

 

While EHRs can enhance quality, healthcare technology is still in its infancy, Abrams said. Doctors say the systems cut into their time with patients, and Abrams called for more collaboration between stakeholders to “flatten out the bumps in the road that we see in the use of technology and the negative impact” it has on care delivery.

 

Read the report.

With more changes likely in store for healthcare, what will be done to address the state and nation’s growing physician and provider shortage?

How will primary care be delivered in the future? 

In what areas does it make sense to expand the scope of practice? Where does it not?

 

A panel of experts will tackle these questions and more during a Wisconsin Health News Panel Dec. 6 in Madison at the Madison Club.

 

 Register now.

Panelists:

• Dr. Dave Clemens, President-Elect, Wisconsin Dental Association
• Gina Dennik-Champion, Executive Director, Wisconsin Nurses Association
• Eric Elliot, President-Elect, Wisconsin Academy of Physician Assistants
• Linda Jorgenson, Former President, Wisconsin Dental Hygienists Association
• George Quinn, Executive Director, Wisconsin Council on Medical Education and Workforce
• Steve Rush, Vice President, Workforce and Clinical Practice, Wisconsin Hospital Association
• Dr. Ken Schellhase, President-Elect, Wisconsin Academy of Family Physicians

Wisconsin Health News Editor Tim Stumm will moderate.

When: Tuesday, Dec. 6, noon to 1 p.m. (registration and networking starts at 11:30 a.m.).

Where: Madison Club, 5 E Wilson St, Madison, WI 53703

 

The federal health reform law faces an uncertain future after Republican Donald Trump’s stunning upset to become the next president of the United States, and Wisconsin Republican Senator Ron Johnson’s victory, helping Republicans maintain control of the U.S. Senate. Trump, who carried Wisconsin, has called for repealing and replacing the law, allowing for the sale of health insurance across state borders and allowing families to deduct their health insurance premium payments from their taxes. He’s also called for more price transparency from healthcare providers, block granting Medicaid to states and removing barriers for drug manufacturers. Johnson, who defeated former Sen. Russ Feingold, called the law “a disaster,” at a debate in October. “The fact of the matter is thousands of Wisconsinites lost the health plans they could afford,” Johnson said.

Wisconsin Health News

Larry Schroeder will retire as CEO of Sauk Prairie Healthcare in January, according to a Monday statement.

Schroeder joined Sauk Prairie Healthcare in 1998 as chief operations officer and became CEO in April 2008. During his tenure, the health system built two new clinics, developed a new hospital and expanded surgeon and physician practices.

Sauk Prairie Healthcare will partner with an executive recruitment firm to conduct a nationwide search to replace Schroeder. Carol May, former chief financial officer, will serve as CEO in the interim.