The chair of the state’s Medical Examining Board said last week that he expects doctors should be able to obtain a license under the interstate licensure compact in January.
“We want to be issuing the first licenses by Jan. 1,” said Dr. Kenneth Simons, who called it a conservative timeline. Simons serves as one of the state’s commissioners for the group developing the compact.
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The Department of Health Services is requesting an increase of $452 million in general purpose revenue for Medicaid in its 2017-’19 biennial budget request to the Department of Administration.
Secretary Linda Seemeyer wrote in the request sent Thursday to DOA that the department’s budget request that the increase in Medicaid funding is based on projected enrollment, costs per enrollee and other factors.
“While still a significant amount of funding, this increase is small by historical standards,” Seemeyer wrote, noting that the last three biennial budgets increased state spending in the program by $650 million, $685 million and $1.6 billion respectively.
Seemeyer also noted they expect the program to be below budget in the current biennium, with more than $260 million GPR expected to lapse into the state’s general fund at the end of fiscal year 2017. That lapse is separate from the department’s request for an increase.
“These slowing Medicaid growth rates reflect the success of Governor Walker’s entitlement reforms, efforts to improve health outcomes through better care coordination and initiatives to identify and eliminate waste, fraud and abuse,” she wrote. “They also result from improved oversight of managed care contracts and reforms enacted by the governor and Legislature.”
Karen Timberlake, director of the University of Wisconsin Population Health Institute, is joining Michael Best Strategies as a senior advisor, according to a Wednesday statement.
Timberlake has served as director of the institute since 2011. She previously served as the Department of Health Services’ secretary.
She starts Oct. 10, according to Kanoe Riedel, a spokeswoman for Michael Best & Friedrich, the law firm affiliated with Michael Best Strategies.
But is healthcare something that can really be shopped for like other industries? What factors are patients most interested in when making decisions? How are payers and providers responding? What will it mean for healthcare costs?
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APPLETON – The federal government has released ratings of hospitals nationwide, but Wisconsin health care leaders say the numbers don’t necessarily add up.
The new Center for Medicare and Medicaid Services (CMS) ratings by the federal Department of Health and Human Services evaluate 64 quality measures up to five stars. Those measures address everything from patient satisfaction and mortality rates for common ailments that land patients in hospitals to infection rates for different types of procedures.
But are these measures helpful to consumers and patients in the Fox Valley? Buyer beware, hospital and physician groups say.
“I do think this is a good first step, but there are some real flaws,” said Donn Dexter, chief medical officer of the Wisconsin Medical Society, a physician advocacy group. “The playing field is null and equal, and the measurements aren’t always applied equally to all hospitals.”
In the Fox Valley, almost all of the hospitals received three-star or four-star ratings. St. Elizabeth Hospital in Appleton, Aurora Medical Center and Mercy Medical Center in Oshkosh, were four-star hospitals in the southern part of the Fox Valley. In the Green Bay area, Bellin Memorial Hospital and Aurora Baycare Medical Center also had four stars.
All seven medical centers affiliated with Appleton-based ThedaCare received three-star ratings. The seven medical centers are in Appleton, Berlin, Neenah, New London, Shawano, Waupaca and Wild Rose.
ThedaCare is supportive of ratings like these being publicly available, said CEO Dean Gruner in a statement to USA TODAY NETWORK-Wisconsin, citing other rankings from Wisconsin Collaborative for Healthcare Quality and the Wisconsin Health Information Organization.
“The CMS star rating is new and we will learn as we go,” he said. “We always use feedback to help us further improve the great work of our team members.”
Dexter said it’s important to be wary of the rankings though, depending on whether the information is from patients’ opinions or the medical center has a smaller number of patients.
“If your patient comes in and wants narcotics for pain, and you don’t give them narcotics because while it’s easy, it’s not appropriate and because you want to prevent them from being addicted, you can get a very adverse rating (for patient satisfaction),” Dexter said. “Even though, you did the right thing.”
Robert Batt, a University of Wisconsin-Madison business professor, said he liked how CMS included reporting from patients.
“Surveys tend to have people with extreme opinions, but even at that, it’s real data of real patients who were there and who can say something,” he said.
Hospitals could also have higher infection rates according to the CMS data after certain surgeries or ailments, for example, but only because they had one patient who received that surgery and subsequently got an infection, Dexter said.
A smaller rural hospital, often referred to as critical access hospitals, will also likely rank lower than a large hospital with research capabilities, like UW Health in Madison or Froedert in Milwaukee, he said.
“It’s just not the same thing and we have to understand that,” Dexter said. “Interpreting these rankings with a little skill takes time.”
Patients with chronic illnesses or conditions should not just evaluate the general measures, but look at specific measures for their condition, said Patrick Falvey, chief transformation officer at Aurora Health Care.
If a patient has heart issues, they should dive deeply into measures related to cardiovascular health, for example, Falvey said. But, if hospitals perform well overall on the general measures, hospitals likely have a “solid foundation” of medical practice.
Beyond individual hospitals, Wisconsin as a whole has higher rated hospitals than its counterparts nationwide. All but three hospitals statewide scored at least three stars or higher.
Officials with the Wisconsin Hospital Association said the group is happy that Wisconsin scored well on the ratings. Dexter had similar sentiments, saying Wisconsin is in a much better place overall compared to other states.
“However, we are concerned that the large number of different hospital ratings that exist and the complexity of how these ratings are calculated can cause confusion for health care consumers,” said Kelly Court, Wisconsin Hospital Association’s chief quality officer, in a statement to USA TODAY NETWORK-Wisconsin. “Hospitals are working hard to improve the quality of the most important services they provide, which may or may not be reflected in this new rating.”
Northeast Wisconsin CMS hospital ratings
Madeleine Behr: 920-996-7226, or mbehr@postcrescent.com; on Twitter @madeleinebehr
Read article here.
The announcement comes after intense pressure from industry stakeholders and policymakers to ease implementation of theMedicare Access and CHIP Reauthorization Act, which is set to start Jan. 1, 2017. Two months ago, CMS Acting Administrator Andy Slavitt said the agency was considering delaying the start date.
Next year, eligible physicians and other clinicians will be given four options to comply with new payment schemes such as the Merit-based Incentive Payment System (MIPS) or an alternative payment model such as accountable care organizations.
Under MIPS, physician payments will be based on a compilation of quality measures and the use of electronic health records. About 90% of physicians are expected to pursue MIPS because a qualifying APM requires a hefty amount of risk.
In the first option offered Thursday, any data reported will allow providers to avoid a negative payment adjustment. The goal is to ease providers into broader participation in the following two years.
The second option allows providers to submit data for a reduced number of days. This means their first performance period could begin later than Jan. 1 and that practice could still qualify for a small payment if it submits data on how the practice is using technology and how it’s improving.
The third option is for practices that are ready to go in 2017.
“We’ve seen physician practices of all sizes successfully submit a full year’s quality data, and expect many will be ready to do so,” Slavitt said.
For months now, medical groups, including the American Medical Association, the American Academy of Family Physicians and the Medical Group Management Association, have campaigned toward the same end.
The AMA Thursday expressed relief that CMS listened to physicians’ concerns.
“The actions that the Administration announced today will help give physicians a fair shot in the first year of MACRA implementation. This is the flexibility that physicians were seeking all along,” Dr. Andrew Gurman, president of the AMA said in a statement.
“We’re making the consequences of not being ready more modest as these models start up,” Slavitt said in a call with Modern Healthcare.
Lawmakers had shown great concern for small and rural practices, which have said MACRA could force them to join hospitals or larger practices because of the paperwork and payment changes required.
Slavitt said the CMS is concerned about the potential conflicts and will address them in the final rule expected to drop in November.
“Some of the things that are on the table, (that) we’re considering include alternative start dates, looking at whether shorter periods could be used, and finding other ways for physicians to get experience with the program before the impact of it really hits them,” he said during a Congressional hearing in July.
Congressman Michael C. Burgess, a Republican doctor from Texas and chair of the House Energy and Commerce Subcommittee on Commerce, Manufacturing, and Trade said he was pleased CMS had heard his calls and the calls of his colleagues.
“Today’s announcement from CMS regarding the agency’s dedication to flexibility in the implementation of MACRA is proof of the benefits of keeping Congress involved in policy implementation,” Burgess said in a statement.
Slavitt said he hopes the flexibility his agency is offering providers will allow them to focus on patient care.
“The bulls-eye for us isn’t what will happen with this program in 2017, it’s about what will lead to the best patient care in the long term,” he said.
Chet Speed, vice president of public policy for the American Medical Group Association said his trade group remains concerned that the strict requirements to be an advanced APM will limit participation in that option and will hinder the goal of transitioning from volume to value.
As patients take on an increasing share of their healthcare costs, they are becoming more engaged consumers. The shift is likely to transform how healthcare is delivered and how providers and payers communicate with their members.
But is healthcare something that can really be shopped for like other industries? What factors are patients most interested in when making decisions? How are payers and providers responding? What will it mean for healthcare costs?
Learn more at a Wisconsin Health News Panel Event, Tuesday, Oct. 4 at the Milwaukee Athletic Club.
Panelists:
The Wisconsin Medical Examining Board (MEB) approved best practice guidelines for opioid prescribing at its monthly meeting in Madison in July. This action is a result of Wisconsin State Assembly Rep. John Nygren’s HOPE legislative package; 2015 Act 269 granted the MEB authority to post the guidelines, which are inspired by those already in place from the Centers for Disease Control and Prevention and the state’s Worker’s Compensation program.
While the guidelines are not mandatory practice parameters, they are expected to assist physicians with making more informed decisions about their prescribing practices. Click here to view the guidelines.
The MEB is expected to finalize these requirements at its meeting later this month.
