April 27, Wisconsin Health News

Doctors and acupuncturists oppose a bill that would allow chiropractors to perform physical examinations for student athletes and practice "chiropractic acupuncture" and "chiropractic dry needling" if they receive additional training.

The bill received a public hearing Wednesday before the Assembly Committee on Health.

Under the proposal, schools that require a pupil to have a physical examination to participate in sports and other activities will have to accept a physical examination completed by a chiropractor the same way it accepts those completed by doctors. The chiropractor would have to hold a certificate in health or physical examinations.

The same requirement would apply to the state's technical colleges or a two-year campus within the University of Wisconsin System that require physical examinations for students to participate in sports.

"With some additional training, doctors of chiropractic could provide a high quality exam," Mark Cassellius, a chiropractor practicing in Onalaska, told lawmakers.

Dr. Tosha Wetterneck, past president of the Wisconsin Medical Society, opposes the bill.

The physical examination isn't just focused on the athletics, but on at-risk behaviors, immunizations and other factors that might impact sports participation, she said. That requires extensive training.

"This is rocket science," she said. "This is difficult."

The bill would also allow chiropractors to practice "chiropractic acupuncture" if they complete at least 200 hours of instruction and the acupuncture examination administered by the National Board of Chiropractic Examiners.

The bill would also allow chiropractors to practice "chiropractic dry needling," which involves puncturing the skin with needles to treat "neuromusculoskeletal pain and performance," if they complete 50 hours of postgraduate study.

Shawano-based chiropractor Brian Grieves said the bill could help address the opioid epidemic by increasing access to alternatives pain treatments.

"We have very limited, proven, effective non-drug options to offer people for pain," he said. "Being able to augment that by offering chiropractic acupuncture would greatly expand that access."

Elissa Gonda, chair of the legislative committee for The Wisconsin Society of Certified Acupuncturists, opposes the bill.

"Acupuncture is a serious and rigorous profession," she said. "It's not a method or technique that can be employed on an occasional basis by another healthcare practitioner." 

Steve Conway, executive director of the Chiropractic Society of Wisconsin, said they're generally supportive of the bill but they're still vetting it. 

April 27, Wisconsin Health News

Wisconsin will receive $7.6 million from the federal government to combat opioid addiction, the Department of Health and Human Services announced Thursday night.

HHS is providing $485 million to all 50 states, the District of Columbia and six U.S. territories. The funding, made available under the 21st Century Cures Act, will go toward prevention, treatment and recovery services.

States were awarded funding based on rates of overdose deaths and unmet need for treatment. Florida received the most money at $27.2 million, while five territories received $250,000 each.

Gov. Scott Walker directed the Department of Health Services to seek the funding in an early January executive order. DHS can re-apply for additional funding next year. 

April 25, Wisconsin Health News

The Senate Committee on Education approved two bills Monday that are part of a special session ordered by Gov. Scott Walker to tackle the opioid epidemic.

A bill that would provide $50,000 to help establish a recovery charter school, which would serve 15 high school students in recovery from substance use disorder, passed out of committee 6-1. Sen. Steve Nass, R-Whitewater, voted against it. 

An additional proposal providing $200,000 a year to expand the use of a substance abuse screening by the Department of Public Instruction passed 7-0. The Assembly has already approved both measures.

April 24, Wisconsin Health News

The Medical Examining Board approved permanent rules last week that govern the practice of telemedicine and mandate continuing medical education requirements for doctors on opioid prescribing.

The rules are expected to go into effect June 1, Department of Safety and Professional Services staff told board members.

The final telemedicine rule clarifies that a physician-patient relationship can be established through telemedicine and provides guidelines on the use of telemedicine.

The other rule requires doctors renewing their licenses to complete two hours of training on guidelines written by the board that relate to opioid prescribing. Doctors have to complete 30 hours of continuing medical education every two years.

April 18, Wisconsin Health News

Gov. Scott Walker has signed into law a bill ending state penalties for those who possess cannabidiol without psychoactive effect if they have written certification from a doctor.

The bill also directs the state's Controlled Substances Board to reschedule CBD oil, which is derived from marijuana and sometimes used to treat seizures in children, within 30 days following a change at the federal level. The bill passed the Senate 31-1, and the Assembly 98-0.

The bill builds on a 2014 law that aimed to make the drug available with a prescription in the state. But supporters said that providers weren't able to prescribe the drug, which is still illegal to obtain under federal regulations. 

While Republicans may have walked away from the American Health Care Act, the healthcare debate is certain to continue. Will the Trump Administration fight to keep the Affordable Care Act afloat? Or will it use its power to hasten the law’s demise? Will lawmakers move left or right to forge a new deal?

In the meantime, Gov. Scott Walker is pushing ahead with Medicaid reforms that likely would not have been approved a year ago.  What does it mean for the program? 

National and regional healthcare experts will tackle these questions and more at the 2017 Wisconsin Health News Conference, July 19 at the Monona Terrace in Madison.  Registration is now open (link).

April 14, WHA Valued Voice

With the Interstate Medical Licensure Compact’s voluntary expedited licensure process becoming operational this month, WHA will be offering a 45-minute webinar on how the new Compact process can help physicians more quickly receive a Wisconsin medical license or a license in another state if the physician already holds a medical license in a Compact state. WHA General Counsel Matthew Stanford will present information on eligibility, which states are participating in the Compact, completing the application process, fees, how to maintain a Compact expedited license and considerations for utilizing the Compact expedited process versus the traditional licensure process.

The webinar, scheduled Tuesday, May 23 from 12:00-12:45 pm, is being offered through a partnership between WHA and the Wisconsin Medical Group Management Association (WMGMA). There is no fee to participate in this webinar, but pre-registration is required. Registration is now open at: www.cvent.com/d/z5qq0r.

Wisconsin joined the Interstate Medical Licensure Compact through the enactment of legislation in December 2015, which was a key legislative priority for WHA. To apply for a medical license through the Interstate Medical Licensure Compact expedited process, individuals should visit https://imlcc.org.

Effective April 1, 2017, Wisconsin Act 266 requires all Wisconsin-licensed physicians and other prescribers to review a patient’s records from Wisconsin’s Enhanced Prescription Drug Monitoring Program (ePDMP) before issuing a prescription order for a monitored prescription drug.

To help members and their health care teams assess options for compliance with this new requirement, the Wisconsin Medical Society has prepared Wisconsin ePDMP: Frequently Asked Questions. Click here to download the PDF.

Part of the Wisconsin legislature’s Heroin, Opioid Prevention and Education (HOPE) Agenda, the requirement pertains to each prescription order for a controlled substance unless one of the following exceptions applies:

1.       The patient is receiving hospice care.

2.       The prescription is for a three-day or less supply with no refills.

3.       The drug is lawfully administered to the patient.

4.       Due to an emergency, it is not possible to review the ePDMP before issuing the prescription.

5.       The practitioner is unable to review the ePDMP data because either the ePDMP or the means to access it are not operational.

Monitored prescription drugs include most Schedule II, III, IV or V controlled substances (as well as any other substance identified by the Controlled Substances Board as having a substantial potential for abuse).

Prescribers subject to this requirement must register with the ePDMP to access the system. Click here to register if you have not done so already.

April 12, Wisconsin Health News

A compact that aims to expedite the process for doctors obtaining medical licenses in multiple states launched in Wisconsin last week.

So far 18 states have passed legislation to join the Interstate Medical Licensure Compact, which aims to make it easier and faster for doctors to get a license in other participating states.  

Illinois, Iowa and Minnesota have entered the agreement. Other states, including Michigan have bills pending in their legislatures that would allow them to join.

The compact began accepting and processing applications from qualified physicians on April 6, according to a statement from the commission overseeing it. 

Mark Grapentine, senior vice president of government relations at the Wisconsin Medical Society, said there are still details to work out before the compact process is functional among all participating states. But Iowa and Wisconsin are ready to go, he said.

"It will greatly help physicians and patients who may cross the Mississippi River to either give or receive care," he wrote in an email.

Dr. Donn Dexter, vice chief medical officer at Mayo Clinic Health System northwest Wisconsin, said the compact will help attract doctors to the state, particularly in underserved areas. 

It will also support educational efforts by making it easier to get a license in Wisconsin, allowing doctors in neighboring states to "come over and work and train in our community and hopefully stay," he said. 

Brian Vamstad, government relations manager for Gundersen Health System, called the launch a "great step." The compact will help with telemedicine efforts, he said. 

"It really will help us and others to meet the needs of communities," he said. 

So far, doctors with licenses who are either living, employed or have 25 percent of their business in Wisconsin can apply through the compact to practice in any of the other participating states, according to the Interstate Medical Licensure Compact Commission. 

Eleven states, including Minnesota, aren't comfortable serving as states of principal licensure, meaning doctors solely licensed by those states and either residing or practicing there can't use the compact until policymakers approve technical fixes. 

Diane Shepard, secretary for the commission, said Minnesota is close to approving its technical fix.

April 4, Treatment Advocacy Center, Research Weekly

Mental health conditions increase the likelihood that adults who visit hospital emergency departments (ED) will become frequent utilizers, according to a new analysis of ED use by high-need, high-cost patients who repeatedly use healthcare services.

In 2014, ED super utilizers made up no more than 6% of ED patients by age or payer category but generated  up to 26% of all ED visits in 13 states, according to a statistical brief published by the Agency for Healthcare Research and Quality (AHRQ). 

Mental health symptoms increased the likelihood a patient would be a super utilizer.* 

The Role of Mental Health in ED Super Utilization

The authors of "Characteristics of emergency department visits for super-utilizers by payer, 2014" maintain that identifying the characteristics of ED super utilizers is essential to addressing their high use of the ED services. 

"Over the last several years, health care stakeholders have paid increasing attention to issues specific to high-need, high-cost patients who constitute a very small percentage of the population but account for a disproportionally high amount of health care utilization," H. Joanna Jiang and colleagues say. "These patients, dubbed super-utilizers, represent a broad spectrum of demographic and clinical characteristics and socioeconomic conditions. 

"Programs designed to improve care for super-utilizers need to be tailored to the specific needs of the different subgroups of these patients. As part of this effort, it is important to examine differences in utilization patterns among different types of super-utilizers, in comparison to national benchmarks." 

For the statistical brief, AHRQ examined 2014 ED data from 13 geographically dispersed states that are home to about 28% of the US population. They compared ED use patterns by payer: Medicare for recipients 65 years and older, Medicare for recipients 1 to 64 years old, Medicaid, private insurance. 

Findings 

Among the findings: 

• Mental health ED visits were more common for super-utilizers than for other patients regardless of payer. Among super utilizers insured by Medicaid, for example, 7% of ED visits were for mental health complaints, double the rate for individuals who were not making high use of the ED. Super utilizers insured by Medicare, regardless of age, and by private insurers also were more likely than other patients to visit the ED with mental illness symptoms. 
   
• Super utilizers as defined by AHRQ made an average of four to five more ED visits per year than other patients. The 6.1% of Medicare patients 1-64 years old who were super utilizers, for example, made 26.2% of all ED visits. Similar patterns were seen for older Medicare, privately insured and Medicaid patients. 
    
• Super utilizers accounted for an outsized proportion of ED costs. For example, while only about 4% of ED users insured by Medicaid were super utilizers, these patients accounted for nearly 20% of total ED charges to Medicaid.  
    
• Among the payer groups, Medicare and Medicaid patients 1-64 years old were the most likely to be super utilizers. Approximately one in 10 patients in this age group were super utilizers. In contrast, approximately one in 20 patients who were privately insured or 65 years old and insured by Medicare were classified as super utilizers. 

The most common reasons for super utilizers visiting the ED were medical (e.g., chest pain, superficial injury, abdominal pain and other physical conditions). Patients with three or more chronic conditions were more prevalent among the super-utilizer population than among other ED visitors.

The role of mental illness on super utilization in America's EDs is one of several issues the Treatment Advocacy Center examines in its upcoming study, A Crisis in Search of Data: The Revolving Door of Serious Mental Illness in Super Utilization, scheduled for release April 18.

*AHRQ defines ED super utilizers as private patients age 1-64 years who make four or more ED visits in a year or Medicaid/Medicare patients who make six or more visits.