February 24, Wisconsin Health News

The Wisconsin Department of Justice has reached an agreement with Adapt Pharma to offer an anti-overdose nasal spray at a discounted rate when bought in bulk by police, first responders and state or local government agencies.

Narcan Nasal Spray can reverse some of the effects of an opioid or heroin overdose. Under the agreement, approved entities that purchase the nasal spray in quantities of greater than 48 units can receive a 40 percent discount. 

That reduces the price from $125 to $75 for two 4mg doses. The rate is set until Feb. 15, 2018. 

Schimel earlier in February renewed an agreement with Amphastar Pharmaceuticals that established a rebate program for each of its naloxone syringe purchased by public entities in Wisconsin through Feb. 1, 2018.

Join Wisconsin Health News for a Newsmaker Event with Department of Health Services Secretary Linda Seemeyer, who will outline Gov. Scott Walker's 2017-19 budget and discuss department priorities.

The event is being held March 21st from 11:30 am to 1:00 pm at the Madison Club, 5 E. Wilson St, Madison WI 53703.  Register now.

February 20, Wisconsin Health News

More than 12,000 doctors and other prescribers have registered for the state's Enhanced Prescription Drug Monitoring Program, Department of Safety and Professional Services staff told the Medical Examining Board last week.

That's about a third of the total number of expected eventual participants, said Andrea Magermans, PDMP analyst. More than 5,000 delegate users, which act on behalf of prescribers, have signed up too, she told board members last Wednesday.

The registration process is different than under the older program, which has posed a challenge, she said.

"There have been some customer service type of issues," she said. "We've been addressing them as they've come up."

Magermans noted that getting used to the new format has posed a challenge for users as well. But once they're used to it, "it seems to be going well," she said. They've received positive feedback about the changes.

Effective April 1, those prescribing controlled substances will have to review a patient's records before writing a prescription. Prescribers will also have to update the PDMP by end of the next business day after dispensing a controlled substance in most cases.

Magermans said they hope to create a new category in the PDMP for medical directors by April 1, which will allow those overseeing prescribers to review their prescribing methods. By the start of April, DSPS also plans to add a component to the program so prescribers can review their own prescribing history. 

DSPS is also in talks with health systems, including Aurora Health Care, Gundersen Health System, Marshfield Clinic Health System, ProHealthcare and UW Health, about pilot projects allowing health systems to integrate their electronic health records with the ePDMP, she said.  

At least one pilot organization will be working on it prior to April 1, but Magermans didn't know how far they would be in the process.  

Gov. Scott Walker's 2017-'19 state budget, released earlier this month, recommends $1 million to fund five positions "for the continued improvement" of the PDMP. Dr. Tim Westlake, vice chair of the Medical Examining Board, said the new positions should help with the rollout.

But he said that a concern they should have is whether the board has the resources to prosecute the cases, in case there's a spike.

"We want to make sure we have enough investigative resources to be able to prosecute the cases," he said. "If we get an extra 20, 30 or 50 opioid prescribing cases that can bog the whole system down."

February 15, Wisconsin Health News 

Group Insurance Board members sent a letter last week to lawmakers, revealing more information on the process they used when deciding to self-fund and regionalize the health plan for state employees. 

Their plan, approved last week, would shift the state away from a fully insured model, which involves 18 companies, to a model with six vendors. They estimate the move could save more than $60 million in the 2017-'19 state budget from reduced administrative and insurer risk fees as well as improved discounts. Department of Employee Trust Funds spokesman Mark Lamkins did not provide a further breakdown of the savings. 

Any self-insurance contract is subject to approval by the Legislature's Joint Finance Committee.

The board selected Compcare Health Services Insurance Corp. to offer a statewide option as well as a regional option. The other companies serving regions would be Dean Health Plan, HealthPartners Administrators, Network Health Administrative Services, Security Administrative Services and Quartz, which is affiliated with Unity Health Insurance and Gundersen Health Plan. 

In a letter sent Friday to JFC co-chairs, GIB Chair Mike Farrell and board member Stacey Rolston, who is a deputy administrator in the Division of Personnel Management at the Department of Administration, wrote that those participating in the state employee health plan will have greater access to providers than are currently available to most members under a proposed move to self-insurance because CompCare has a broader network. 

They also wrote that providers that are part of Group Health Cooperative of South Central Wisconsin, which did not respond to an RFP on administering the program, will be included via other third party administrators. In addition, Physicians Plus, which responded to the RFP but wasn't selected as a vendor, is exploring a partnership with Unity and Gundersen, according to the letter. 

According to GIB, nine companies responded to the RFP. That also included Mayo Clinic Health Solutions, the self-insurance business unit of Health Traditions Health Plan, which wasn't chosen. WEA Trust also participated in the process and did not receive an offer.  

GIB noted that many of the plans with minimal participant enrollment in the program chose not to respond, including Arise, Group Health Cooperative - Eau Claire, MercyCare Health Plans and Medical Associates. 

But Patrick Cranley, MercyCare chief operating officer, said GIB's characterization was "a little bit disingenuous." 

"We could not respond to the RFP because the RFP required that respondents be able to serve an entire region defined by the RFP," Cranley said. He called it "a conscious decision to limit the number" of plans participating in the state program. 

Cranley called the board's decision an "unfortunate choice" for the wider market as it eliminates a number of high quality community health plans from participation in the health plan.

"I think it does long-term damage to the competitive insurance market in the state of Wisconsin," he said. "You're essentially perhaps even crippling some of the plans that are smaller plans that provide important competition in the markets in which they participate."

Cranley said MercyCare serves 1,400 members in Jefferson, Rock and Walworth Counties through the state plan. That's out of 48,000 total members for his plan.

"I would prefer to continue to serve these folks and let them have access to our health plan," he added. 

ETF often pursues an "aggressive education campaign" to ensure participants understand their choices under the program, according to the letter. The communication strategy for 2018 "will be unprecedented," Farrell and Rolston wrote.

The board plans to finish contract negotiations by the end of March.

Read the letter.

Increasing prescription drug costs have caught the attention of the President and the public. What's behind the rapid rise and how far are lawmakers willing to go?

Would allowing Medicare to negotiate with drugmakers make an impact? What about cutting taxes and regulations? And would lower prices mean less innovation?  

Learn more at a Wisconsin Health News Panel Event March 7 at the Madison Club.  Panelists include: Holly Campbell, Senior Director of Public Affairs, PhRMA; Dr. Mark Huth, CEO, Group Health Cooperative of South Central Wisconsin; Andy Pulvermacher, Specialty Services Supervisor, UW Health; and Paul Rosowski, Senior Director, Industry Relations and Contracting, Navitus Health Solutions.

Learn more and register (link). 

February 8, Wisconsin Hospital Association

As you know, physicians are often assigned a role with a hospital or health system’s quality department or committee or asked to lead a quality improvement project.

The Wisconsin Hospital Association (WHA) has developed an important resource for physicians and advance practice providers who have an assigned role related to quality measurement and improvement within a WHA member hospital or health system. The WHA Physician Quality Academy will provide physicians the opportunity to increase their knowledge of quality improvement tools and principles; therefore, increasing the likelihood that a physician will be more successful in and comfortable with this leadership role.

The Academy offers two non-consecutive days of in-person training and access to supporting resources both between and after the live sessions: May 10 and July 21, 2017 at the Glacier Canyon Lodge at The Wilderness Resort, Wisconsin Dells; OR September 29 and November 3, 2017 at the Glacier Canyon Lodge at The Wilderness Resort, Wisconsin Dells.

As part of the Academy, participants will learn to:

• design and conduct quality improvement projects utilizing proven improvement models;
• interpret data correctly;
• facilitate physician colleague engagement in quality improvement and measurement ;and,
• discuss quality requirements, medical staff functions and their link to quality improvement.

The Academy is offered twice in 2017 (dates below), allowing physicians associated with a WHA member hospital/health system to choose the cohort that works best for his/her schedule. Attendance will be limited to the first 100 registrants per cohort, so if interested, register today at http://www.cvent.com/d/wvq5nm. Download brochure (link). 

February 8, Wisconsin Health News

The Group Insurance Board voted 10 to 1 to self-fund and regionalize the health plan for state and local employees at a meeting Wednesday. They estimate the move would save more than $60 million over the 2017-2019 biennium.

An additional $30 million in fees under the federal health reform law could be avoided by moving to a self-funded regionalized model. GIB gave the Department of Employee Trust Funds the power to enter into contract negotiations to move to a self-funded health plan effective Jan. 1, 2018.  

Compcare Health Services Insurance Corp., run by Anthem Blue Cross and Blue Shield in Wisconsin, will serve as the third party administrator for a statewide option.

Security Administrative Services will serve the northern region of the state. Compcare and Network Health Administrative Services will serve the eastern part of the state.

Dean Health Plan and Quartz will cover the southern part of the state. HealthPartners Administrators Inc. will cover the western region.

The contracts will be for three years. They are subject to Joint Finance Committee approval.

ACEP has launched its #ILookLikeAnERDoc Campaign on the organization's Facebook and Twitter channels to promote the importance diversity and inclusion. Learn and share why diversity matters to emergency physicians.

Advocacy is the Cure for the Political Frustrations of 2016
By Bobby Redwood, MD, WACEP President

You don't need me to tell you; 2016 was kind of a rough year. We lost Bowie, Prince, and Princess Leia. Zika cast its shadow over our vacations, while authoritarian regimes thrived, the E.U. frayed, and democracy stumbled. The political tension in America and in Wisconsin reached a fever pitch throughout one of history's most negative presidential campaigns ever and then, on November 9th, republican and democratic physicians alike were left exhausted and confused, wondering what will happen to our patients and our profession under the Trump administration.

Well, we at WACEP implore you: don't despair! Here are some of the (solvable) challenges that we, as emergency physicians, can expect in the upcoming year.

• The Affordable Care Act will likely go away. Will it just be a name change (it was basically RomneyCare after all)? Will the individual mandate be undone leaving a glut of 234,000 uninsured patients in its wake? Will Medicaid really be transformed into a block grant system as many have foreseen? 
• The opiate epidemic will continue to challenge our state and our state's physician workforce. Will the new ePDMP provide the accountability and real-time information that we were promised it would? Will the new medical examining board CME help get all providers on the same page in terms of best practices for opiate prescriptions? Will WACEP's opiate prescribing guidelines have the reach and influence that we are hoping they will have?
• Mental health services will evolve...for the better? Suicide is at a 30-year high and fewer than half of the 800,000 Wisconsinites who need mental health treatment actually get professional help. A consensus bill, the Mental Health Reform Act of 2016 (S. 2680), passed the Senate HELP committee in March 2016 and will likely come to vote in the Senate this year. If passed, will it deliver the community crisis response systems and increased access to acute psychiatric hospital care that were anticipated? Will the Wisconsin psychiatric bed database come to fruition? Will psychiatric transfers from Wisconsin EDs become easier to facilitate?

Engagement is the way forward. Emergency physicians are problem solvers, and whether your motivated by compassion for your patients, consideration for your physician-group, or simple self-preservation; we at WACEP need you to step forward and engage with your colleagues, so that we can solidify our message, amplify our voice, and help solve the challenges ahead together. Need a roadmap for getting engaged in emergency medicine advocacy? Here are the next steps:

1. Register for the March 28th WACEP Spring Symposium. Get the 4-1-1 on emergency medicine advocacy from national ACEP president Rebecca Parker. REGISTER HERE.
   
2. Sign up for the March 29th Doctor Day event at the Capitol. Feel the comradery of your profession as hundreds of physicians swarm the state capitol. REGISTER HERE.
   
3. Attend the March WACEP listening tour in Merrill, WI. Let us know how WACEP can better serve your needs. REGISTER HERE.
   
4. Donate to the WACEP PAC. Since its inception, the WACEP PAC has given emergency physicians unprecedented access to state lawmakers. As our PAC grows, so does our collective voice. DONATE HERE.
   
5. Reach out to your legislators. There is no better cure for political frustration than connecting directly with your lawmakers and making your voice heard.
   

There is no doubt that the healthcare landscape will be changing in 2017 and we have the power to shape the future of our practices and our specialty. By showing up, by putting our money where our mouth is, by connecting with our peers and our political leaders; emergency physicians can use the same strength and tenacity that we exude in our clinical work to shape the future of emergency medicine in Wisconsin.  

Thank you to each and every emergency physician in Wisconsin for your dedication to your patients, colleagues, and profession. Whether you are excited about the Trump shake-up or sense a bad moon rising, now, more than ever, we need physician engagement in local and national advocacy.

The Wisconsin Department of Safety and Professional Services (DSPS) launched the new Wisconsin Enhanced Prescription Drug Monitoring Program (ePDMP) on January 17, replacing the former program.

2015 Act 266 requires physicians and other prescribers to review patient information from the ePDMP before issuing a prescription for any controlled substance beginning April 1, 2017. (More information, including exceptions to the requirement to consult the PDMP, in this nonpartisan Legislative Council memo.)

Be ready with the following information in order to register for the ePDMP, and note that prior login credentials no longer work.

• Last name.
• Last four digits of your social security number.
• License number.
• License type (profession).
• Specialty or primary area of practice.
• DEA number.

 The ePDMP supports current browsers and two previous versions, except it only supports the current and previous version of Internet Explorer. If you experience issues, DSPS suggests that you update your browser.

Once the registration process is complete, users can begin looking up patients and managing delegates. The multistate search function will be available to both prescribers and their delegates as soon as their accounts are established. Training materials, including brief tutorial videos and information about creating and maintaining delegates are available at pdmp.wi.gov.

If you have questions or experience problems with the registration process, contact pdmp@wisconsin.gov.