Wisconsin's population is aging and healthcare care costs for the elderly and those needing long-term care are growing along with it. Gov. Walker's budget increases Medicaid reimbursement for nursing homes and provides more money for direct care workers. Is it enough to address workforce shortages? And what's next for Family Care? After puling back its plans to overhaul the program, the administration is pushing forward with a statewide expansion. Will they incorporate other proposed program changes? 

Learn more at a Wisconsin Health News Panel Event May 2 in Madison. Panelists:

• Lynn Breedlove, Co-Chair, Wisconsin Long Term Care Coalition
• Curtis Cunningham, Assistant Administrator of Long-Term Care Benefits and Programs, Department of Health Services
• Tim Garrity, Chief Innovation Officer, Community Link
• John Vander Meer, Executive Director, Wisconsin Health Care Association

Register Online

March at Wisconsin ACEP: In Like a Lion, Out Like a Tiger
By Bobby Redwood, MD

We are over the moon here at Wisconsin ACEP (WACEP). The last month has really showcased the positive impact that Wisconsin emergency physicians can create when we work together and show up in force. To put it succinctly, March was a time of Influence, Education, and Accolades for Wisconsin emergency medicine.

Influence. Our month started off with an important milestone: the WACEP PAC reached an historic high and 100% of the WACEP board (as well as many general members) donated to the cause. The strength of our PAC gives emergency physicians unprecedented access to representatives in the state and national legislature at a time when the future of our healthcare safety net is more uncertain than ever. With the collapse of the American Health Care Act, our elected officials are scrambling to come up with strategies to provide broad access to care and also maintain a high level of quality care. WACEP will continue to advocate for increased Medicaid reimbursement for emergency physicians (we are 50th in the nation after all, in terms of Medicaid reimbursement for level 3, 4, and 5 emergency visits). Our thriving PAC is how we are able to build relationships, gain access to key meetings, and ensure that emergency medicine always has a seat at the table. Are you feeling me on this? Be a catalyst for change and contribute to the WACEP PAC at http://www.wisconsinacep.org/PAC

Education. On March 28th, emergency physicians from across the state felt the love of their colleagues and the pride of their specialty at the WACEP 2017 Spring Symposium. We pounded out our 2016 LLSA articles, we learned cutting edge emergency ultrasound techniques, and we celebrated the role of women in emergency medicine while also strategizing against the harmful gender stereotypes that unfortunately continue to plague our physician workforce. Dr. Steve Hargarten gave a provocative and inspiring keynote address on the epidemic of firearm violence in Wisconsin; local EM celebrities Tim Westlake, Brian Sharp, and Julie Doniere educated our membership on the new mandatory opioid prescribing guidelines issued by the state medical examining board; and then educational speed dating ensued with breakout sessions on hot topics in emergency medicine that ranged from contract negotiations to fluid resuscitation in the septic CHF patient. It was a fabulous example of scholarly fellowship in Wisconsin emergency medicine and we cannot wait to reveal what we have planned for the 2018 Spring Symposium.

Accolades. WACEP was honored to have our signature issue highlighted as a one of three priority issues at the 2017 Doctor Day at the Capitol on March 29th. More than 470 physicians from all specialties flooded the halls of the capitol and, in the spirit of unity and collective impact, advocated face-to-face with our legislators for increased Medicaid reimbursements for EMTALA related care. With passion and conviction, physicians across the board presented legislators with the graphic pasted below, a striking reminder that Wisconsin Medicaid reimbursement rates pale in comparison to our neighbors in the Midwest. 

But the accolades don't end there. While presenting at the WACEP Spring Symposium, Dr. Rebecca Parker (president of national ACEP) revealed that she has just been named by Modern Healthcare as one of the top 50 Most Influential Physician Executives and Leaders of 2017. We at WACEP are incredibly proud of Dr. Parker (who has visited Wisconsin twice in the past year!) and are asking all WACEP members to vote for Dr. Parker to be THE most influential physician executive and leader by casting your vote at https://www.surveymonkey.com/r/XFVWR78

I remember learning in grade school that March comes in like a lion and goes out like a lamb. Let's be real, this is Wisconsin; March comes in like a lion and goes out like a tiger. The wind is howling, the rain is nipping fiercely at our noses, and we at Wisconsin ACEP are loving every minute of it!

Doctor Day 2017 Recap
By Lisa Maurer, MD

WACEP has been a long-time proud sponsor of Doctor Day, where physicians of all specialties come to Madison to discuss issues important to our practice and our patients.  

At this week's event, which drew nearly 500 physicians from across the state, Medicaid physician reimbursement--and specifically emergency physician reimbursement--was, without a doubt, the issue that garnered the most energy at the Capitol.

What I did expect, was that our specialty would be well represented. We had 24 emergency physicians at the event, telling our story of how we are stuck in our practices between a federal mandate and state fee schedule, losing money on each encounter with Medicaid enrollees.  

What I didn't expect was the overwhelming support from our colleagues in other specialties. We didn't even have to be the ones to speak up! 

• Primary care physicians were the ones to ask legislators, "If the ED's lose their ability to attract quality EM docs, who will be the front lines for the opioid epidemic?"  
• Psychiatrists challenged the legislators, "How can we expect EM groups to stay afloat when they lose money every time we have to send them our patients with psychiatric emergencies?"  
• Our physician partners working as CMOs of Wisconsin insurance companies were there at our sides saying, "Payors in Wisconsin have a responsibility to support the safety net of our health care system."  

The legislators of Wisconsin heard loud and clear that patients AND physicians of many specialties depend on us! WACEP looks forward to using this momentum to find a solution for our state. Be sure to thank your colleagues around your community this week for the huge impact they had on our behalf.

Wisconsin physicians are now required to follow an additional procedure before prescribing Schedule II, III, IV, and V controlled substances, or any other drug identified by the board by rule as having a substantial potential for abuse.

Beginning on April 1, 2017, under Wisconsin Statute 961.385, Wisconsin practitioners must review a patient's records in the Wisconsin Prescription Drug Monitoring Program before the practitioner issues a prescription order for the patient.

This requirement does not apply under the following circumstances:\

• The patient is receiving hospice care.
• The prescription is for a dosage that is intended to last 3 days or less and is not refillable.
• The monitored prescription drug is lawfully administered to the patient.
• Because of an emergency, it is not possible for the practitioner to review patient records before issuance of the prescription.
• The practitioner cannot review records because the program is not operational or due to some other technological failure (if the practitioner reports the failure to the board).

More information regarding Wisconsin's Prescription Drug Monitoring program can be found online at https://pdmp.wi.gov/

ACEP President On the Ballot for Most Influential Physician Executives and Leaders 

Voting Open Through April 28: Cast Your Ballot

ACEP President Becky Parker has been nominated to be on the ballot for the 50 Most Influential Physician Executives and Leaders as recognized by Modern Healthcaremagazine.

Becky has already made the cut for the top 150 people most nominated to be put on this ballot, which in itself is a tremendous accomplishment considering how many influential physician executives and leaders there are and that were no doubt nominated.

The voting is open now for who will be the Top 50 recognized by this widely read publication. Cast your vote for Becky today! 

Only one vote per device is allowed, but you may vote from your computer, your phone, your tablet, etc. Your vote will help Becky be recognized for her outstanding leadership, and this honor would be a great credit to Becky, ACEP, and our specialty.

March 20, Wisconsin Health  News

Professional groups oppose a move by Gov. Scott Walker to eliminate state boards that regulate optometrists, radiographers and podiatrists as well as consolidate advisory councils and boards that oversee healthcare professions.

Walker's 2017-19 budget would end the Radiography Examining Board, the Podiatry Affiliated Credentialing Board and the Optometry Examining Board and transfer their functions, rules and pending matters to the Medical Examining Board.

The budget would also create a Medical Assistants Council, consolidating advisory councils on physician assistants and others. And it establishes a Medical Therapy Examining Board, ending boards overseeing physical therapists and others.

"Currently, taxpayer dollars are going to provide administrative services to each of the boards that are proposed to be consolidated," Alicia Bork, Department of Safety and Professional Services spokeswoman, wrote in an email. "Merging these functions...will allow efficiencies that cannot be found when separate silos exist."

The combined actions, along with other changes at DSPS, would cut state spending by $50,800 in program revenue over the next two fiscal years, according to the Legislature Fiscal Bureau. There were 1,172 optometrists, 424 podiatrists and 6,994 radiographers with active licenses in Wisconsin as of July 2016. 

Peter Theo, executive vice president of the Wisconsin Optometric Association, said his members have "serious concerns" about the proposal as turning regulatory control over to another profession may hurt their ability to diagnose and treat eye diseases.

"Optometrists are primary eye care providers whose regulatory independence is critical to maintaining the high standard of care needed to ensure the safe and competent practice of optometry," he said. 

The Wisconsin Podiatric Medical Association raised concerns about not having representation on the Medical Examining Board. 

"The Medical Examining Board cannot be expected to keep up with the advances in all of the professions that they are looking to be charged with," Dr. Bob Sage, the association's president, said in a statement. "It is unrealistic."

Sandy Helinski, legislative committee chairperson for the Wisconsin Society of Radiologic Technologists, said the elimination of the Radiography Examining Board, established in 2010, would be an "indisputable step backward in the health of Wisconsin's patients." 

"Anything that could possibly dilute the effectiveness of what we've been able to accomplish in these last seven years is of great concern to us," she said.

Connie Kittleson, president of the Wisconsin Physical Therapy Association, opposes eliminating of the Physical Therapy Examining Board and the creation of a Medical Therapy Examining Board.

She noted other states have tried consolidation in the past and have returned to independent boards.

"The data out there shows it doesn't make things more efficient, it doesn't save money," she said. "But more importantly, it wouldn't be worth the risk to public safety to have people who do not have expertise or training in a particular field regulating professionals of another field."

Reid Bowers, Wisconsin Academy of Physician Assistants' advocacy committee chair, raised concerns about the proposed Medical Assistants Council, saying it "would severely limit the ability of PAs to shape how they are regulated by the Medical Examining Board." 

At a Medical Examining Board meeting last week, Chair Dr. Kenneth Simons said the budget would put them "in charge of things we have no expertise" in. Others raised similar concerns. 

Tom Ryan, the board's executive director, said that the boards put under the authority of the Medical Examining Board meet three to four times a year. Doctors on the board could do "curbside consults," he said.

"I don't think it's as formidable a challenge as you would think," he said.

Mark Grapentine, senior vice president of government relations for the Wisconsin Medical Society, said the Medical Examining Board has to investigate complaints against physicians and regulate the profession.

"If adding these non-medical professions to their duties takes away from that responsibility or makes fulfilling that duty less efficient, it's difficult to divine the upsides to the proposal," he said in a statement.  

Buoyed by the promise of better care and lower costs, health organizations are increasingly flocking to care coordination models. But they are not always easy to organize in today’s disjointed healthcare system and current payment structures often don’t reward the effort. Also, coordination among different programs is lacking.

A panel of experts will share their experiences from the field. Find out what’s working, what’s not and what they see as the future of care coordination. Panelists:

·    Joy Tapper, Executive Director, Milwaukee Health Care Partnership
·    Tom Lutzow, CEO, Independent Care Health Plan
·    Jane Pirsig-Anderson, Director, Aurora Health Care Family Service

The event is Tuesday, April 4 from 11:30am – 1pm at the Wisconsin Club in Milwaukee (900 West Wisconsin Avenue). Register now.

Leaders of the Wisconsin Chapter of the American College of Emergency Physicians were invited to join the Wisconsin Medical Society and a small group of key health care stakeholders last week in Madison to begin to address myriad issues related to mental and behavioral health.

Representatives from the Psychiatric Association and the Wisconsin Academy of Family Physicians were also part of the discussion. The group’s goal is to find ways for physicians to influence and improve three key areas: stigma, access and workforce.

“Through this steering committee, we hope to reduce the stigma around mental/behavioral health both within the medical community and in the public at-large; expanding the workforce available to treat and deal with mental health issues; and increasing access for mental/behavioral health treatment particularly in rural, urban, and other health shortage areas,” said Molli Rolli, MD, chair of the Wisconsin Medical Society’s Board of Directors.

The group plans to engage other stakeholders in the coming months and plans to develop a comprehensive strategy to achieve these goals.

March 10, Wisconsin Health News

Two Assembly committees approved five bills that target the state's opioid addiction Thursday. The bills are part of the special session ordered by Gov. Scott Walker to fight the epidemic. 

Most of the bills made it out of committee on bipartisan, unanimous votes. But a proposal providing $420,000 over the next two fiscal years to hire four investigators at the Department of Justice targeting drug trafficking passed 9-3.

Reps. Jesse Kremer, R-Kewaskum; Fred Kessler, D-Milwaukee; and Rep. David Crowley, D-Milwaukee, voted against passage.

"This means of course we're going to send up more people into prison," Kessler told members of the Assembly Committee on Criminal Justice and Public Safety. "Because now we're going to investigate more, find more and prosecute more. You have to take that into consideration."

Other special session bills that made it out of committee, including the Assembly Committee on Education:

• A bill allowing school district personnel to administer naloxone, an anti-overdose drug. Lawmakers also backed an amendment from Rep. Jill Billings, D-La Crosse, extending the bill to residence hall directors at colleges and universities.
• A bill that would continue providing $2 million annually s to fund more treatment and diversion programs in the state and provide $150,000 annually to expand the program and $261,000 annually for a pilot program for expanded efforts. Lawmakers voted down an amendment 8-4 on party-lines from Rep. Evan Goyke, D-Milwaukee, that would have added more funding to the bill.
• A bill that would allow the University of Wisconsin System to establish a charter recovery high school for up to 15 students with substance abuse disorders. Lawmakers backed two amendments.
• A bill that would provide funding to expand a substance abuse disorder screening tool used in public schools. Lawmakers amended the bill to provide $400,000 over the next two years, bringing the amount in line with the governor's budget.

March 10, Wisconsin Health News

The Senate Committee on Revenue, Financial Institutions and Rural Issues approved a bill Thursday that would increase funding for rural broadband and add healthcare criteria the Public Service Commission should consider when awarding money.