The Assembly Committee on Health and the Senate Committee on Health and Human Services for the 2017-18 Session have been set. Committee membership is as follows:

Assembly Committee on Health

• Representative Joe Sanfelippo, R- New Berlin (Chair)
  
• Representative Kathy Bernier, R – Chippewa Falls (Vice-Chair)
  
• Representative James Edming, R – Glen Flora
  
• Representative Ken Skowronski, R - Franklin
  
• Representative Jesse Kremer, R - Kewaskum
  
• Representative Chuck Wichgers, R - Muskego
  
• Representative Dave Murphy, R - Greenville
  
• Representative Andre Jacque, R – De Pere
  
• Representative Deb Kolste, D Janesville
  
• Representative JoCasta Zamarripa, D – Milwaukee
  
• Representative Lisa Subeck, D - Madison
  
• Representative Chris Taylor, D - Madison
  

Senate Committee on Health and Human Services

• Senator Leah Vukmir, R – Brookfield (Chair)
  
• Senator Terry Moulton, R – Chippewa Falls (Vice-Chair)
  
• Senator Devin LeMahieu, R - Oostburg
  
• Senator Jon Erpenbach, D - Middleton
  
• Senator LaTonya Johnson, D - Milwaukee

January 6, Wisconsin Health  News

Gov Scott Walker called for a special session of the Legislature Thursday to consider 11 bills that aim to combat the heroin and opioid epidemic. 

The bills are based on recommendations from a task force that Walker convened last year, chaired by Lt. Gov. Rebecca Kleefisch and Rep. John Nygren, R-Marinette. 

The task force released an interim report Thursday. Even though it hasn't finished its work, the opioid and heroin epidemic are "such a crisis to deal with, we need to start acting now," Walker said.

"We need to tackle this issue head on," Walker told attendees of a Wisconsin Bankers Association event in Madison Thursday. "Not because it's a quality of life, not because it's a public health issue, but because it's a key part of our workforce."

Among the proposals the Legislature will consider are bills that would in the 2017-'19 biennium provide $2 million to support new medically assisted treatment centers, $1 million for consultation services helping medical professionals connect with addiction medicine specialists and $126,000 to the rural hospital graduate training program.

Another bill would provide money to the Department of Justice to fund criminal investigation agents focused on drug trafficking. And another would expand the Screening, Brief Intervention and Referral to Treatment training program offered by the Department of Public Instruction.

"All of us know someone personally affected by a heroin overdose or drug death," Kleefisch said in a statement. "Together, we're going to continue this initiative as we look for new ideas and evaluate the impact of the policies we've adopted the past several years."

An additional proposal would allow school personnel that can administer life-saving drugs like EpiPens to use the anti-overdose drug Naloxone. And two more would require schedule V substances that contain codeine like some cough syrups by dispensed with a prescription and extend limited immunity from prosecution to overdose victims.

Other bills include permitting the University of Wisconsin System to open a recovery school for students who need in-patient care and allowing relatives to commit a drug-addicted family member in the same way as is currently allowed for alcoholism.

Walker's order doesn't include all the recommendations made in the report, such as providing $2 million over the next biennium for Wisconsin hospitals to hire in-house recovery coaches. His spokesman said the bills are in the final stages of draft form and will be released when introduced.

Another order signed by Walker Thursday directs state agencies to pursue a number of different initiatives to curb opioid abuse, including having the Office of the Commissioner of Insurance conduct a survey of opioid addiction treatment coverage for major insurers in Wisconsin. 

"The recommendations included in this report are not the silver bullet," said Nygren, who's authored 17 laws fighting drug abuse though his Heroin, Opioid Prevention and Education Agenda. "I look forward to continuing the fight."  

Wisconsin Hospital Association CEO Eric Borgerding noted that the interim report includes recommendations they suggested, like providing investments in fellowship training for addiction medicine and streamlining regulations for healthcare providers that are trying to expand access to substance abuse treatment.

Wisconsin Medical Society Chief Medical Officer Dr. Donn Dexter called the package of bills "ambitious, which is exactly what dealing with this crisis demands." The Pharmacy Society of Wisconsin said the proposals aim to increase access to treatments and prevent new addictions.

"We're especially excited about the investments to increase the number of providers available and in telemedicine," Bernie Sherry, senior vice president and Ministry market executive for Ascension Wisconsin, said in a statement. "This is a good day for Wisconsin." 

Myranda Tanck, a spokeswoman for Senate Majority Leader Scott Fitzgerald, R-Juneau, said they'll likely maintain their current session calendar for when the full body meets. 

Kit Beyer, a spokeswoman for Assembly Speaker Robin Vos, R-Rochester, said they hope to have the bills ready for committee hearings by the end of the month.

Assembly Democratic Leader Peter Barca, D-Kenosha, said the urgency of the special session is warranted.  

"The opioid epidemic in our state is a very serious issue that requires a very aggressive response," Barca said in a statement. "I hope the committees will collect input from those who know this issue firsthand -from law enforcement, to educators, to medical professionals - as this will help us address this crisis in the most comprehensive manner possible."

Walker also signed an order directing the Department of Health Services to apply for funding available through the 21st Century Cures Act, which was approved by the federal government last year. The act makes $7.6 million per year available for two years to Wisconsin. His order directs the department to apply for the grants by Feb. 17.   

Sen. Tammy Baldwin, D-Wis, said she helped lead the effort in Congress to include $1 billion in the act for the opioid epidemic. 

"The opioid epidemic is not a partisan issue, and a strong partnership between the federal government and our state is essential to an effective response," she said in a statement. "This is a significant step forward for communities fighting the opioid epidemic across Wisconsin."

The Wisconsin Department of Safety and Professional Services (DSPS) plans to launch the new Wisconsin Enhanced Prescription Drug Monitoring Program (ePDMP) on Tuesday, Jan. 17.

2015 Act 266 requires physicians and other prescribers to check 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).

All prescribers will have to register to use the ePDMP—even if they are registered with and use the current system, which is being replaced and will not be available after Jan. 17.

The new ePDMP is designed to promote streamlined workflow integrations and improved data quality using analytics and visualizations to draw user’s attention to the most relevant and possibly concerning data in each report.

Questions about the ePDMP can be directed to pdmp@wisconsin.gov.

More than 50 leaders from health care organizations and systems statewide participated in a Health Care Reform Summit hosted by the Wisconsin Medical Society on Dec. 16. The summit provided stakeholders the opportunity to learn about and discuss pending changes to the Affordable Care Act (ACA) and featured several speakers including Tommy Thompson, former Wisconsin governor and Health and Human Services secretary; Wisconsin Medicaid Director Michael Heifetz; Richard Deem, senior vice president of advocacy for the American Medical Association; and Wisconsin Deputy Commissioner of Insurance J.P. Wieske.

The speakers addressed a number of topics including the likelihood of repeal and replacement of the ACA, the role Medicaid will play in health care reform and the possibility of a transition from an entitlement program to one financed by block and/or per capita grants, and an overview of the health insurance market in Wisconsin.

The Summit also featured a review of various health care reform proposals, including the following:

• A Better Way Health Plan—Speaker Paul Ryan
  
• Empowering Patients First Act—Rep. Tom Price, MD, Health and Human Services Secretary nominee
  
• Patient CARE Act—Sen. Orrin Hatch, Sen. Richard Burr and Rep. Fred Upton
  
• Improving Health and Health Care Plan—American Enterprise Institute
  
• Universal Tax Credit Plan—Avik Roy
  
• Healthy Indiana Plan 2.0—Indiana Family Social Services Administration (Medicaid reform only)
  

Following the presentations, Summit attendees identified several key areas to focus reform efforts that include ensuring those who are currently covered do not lose insurance, maintaining access to affordable and adequate coverage for low-to-moderate income populations, maintaining adequate Medicaid funding, and evaluating opportunities to reduce regulatory burdens.

A subgroup of Summit participants will continue to meet as a steering committee to help direct future advocacy efforts.

For more information, e-mail Chris Rasch, Society vice president of Advocacy and Membership.

January 5, Wisconsin Health News 

The number of Wisconsin residents in accredited rural-focused residency programs jumped 10 percent from the previous year, according to a December report from the Wisconsin Rural Physician Residency Assistance Program. 

There were a total of 87 residents in the programs as of the end of November. That's up from 79 the previous year. 

Between Dec. 1, 2015 and Nov. 30, 2016, WRPRAP awarded seven grants, totaling $528,866. 

Some programs supported by WRPRAP are looking to bring in their first residents this year. The Aurora Lakeland Rural Training Track Family Medicine Program, which hopes to have 12 residents by July 2020, is recruiting its first four residents. 

And the UW Obstetrics & Gynecology Residency Program, the nation's first rural track in the specialty, will match its first resident this year after about 100 applicants competed for the position.  

"We are confident that WRPRAP's funding will continue to champion long-term, viable solutions that address the shortage of physicians in rural Wisconsin communities," the report noted.  

Read more.

When Ascension formally acquired Wheaton Franciscan Healthcare in 2016, it gave the nation's largest nonprofit health system a firm foothold in the state. Ascension Wisconsin, which also includes Ministry Health Care and Columbia St.  Mary's Health System, now boasts 24 hospitals and more than 100 clinics.  

In August, Ascension tapped Columbia St. Mary's CEO Travis Andersen to head its south region and Wheaton executive Debra Standridge to oversee the northern part of the state. At a Wisconsin Health News Newsmaker event on Feb. 7 in Milwaukee, Andersen and Standridge will take part in a wide-ranging discussion on the system's future in the state. Panelists include: 

• Travis Anderson, south region president, Ascension Wisconsin 
  
• Debra Standridge, north region president, Ascension Wisconsin  
  

This luncheon event will be held at the Wisconsin Club, 900 West Wisconsin Avenue, Milwaukee, 53233. Register now.

By Bobby Redwood, MD, MPH, WACEP President, and Lisa Maurer, MD, WACEP Secretary/Treasurer

Across the country, innovative health systems are embarking on a grand experiment and exploring "Alternative Payment Models" (APMs). There are a variety of flavors of APM, but the most commonly mentioned are the Coordinated Care Model and the Patient Centered Medical Home, both of with aim to improve the quality and perhaps efficiency of primary care delivery and thus cut costs on those pesky, wasteful, expensive ED visits*. My question is this: How will APMs affect ED workflows and will EDs be appropriately compensated for their support and contribution to a successful APM?

To be fair, the theory behind the APMs is quite promising. Weinick et al. found that roughly 14–27% of all ED visits could be treated in clinics and urgent-care centers at a lower cost; a potential savings of $4.4 billion per year. By reorganizing primary care, the APMs will hopefully create a new style of health care delivery where continuity, expanded access, coordination, and a team-based approach are used to help patients avoid exacerbations of chronic conditions, treat chronic pain and psychiatric complaints proactively in the home-setting, and gain access to their primary care team for urgent health care needs. If successful, APMs will cut down on ED visits for complaints like chronic pain, depression, medication refills, work excuses, migraine headaches, asthma/COPD/CHF exacerbations, missed dialysis, etc. Who among us would not breathe a sigh of relief to come to work and spend more time treating life-threats and less time plugging holes in the social safety net? 

The evidence supporting APMs continues to grow with over 500 peer reviewed articles on the topic and a generally strong review by the Agency for Healthcare Research and Quality. The main concern that many emergency physicians have with APMs is not the concept itself, but rather the notion that the ED is somehow separate from the Coordinated Care Model or the Patient Centered Medical Home. When I look at policy-makers' flow diagrams for a Coordinated Care Model or read about a Patient Centered Medical Home in the literature, the care coordination seems to magically occur with no emergency department involvement whatsoever. This may sometimes be the case; however, in speaking with my emergency physician colleagues, the consensus is that the ED actually plays an integral role in the success of the APMs. The reality of the situation is that APMs that truly coordinate care work with ED providers to maximize value of any ED visits that do happen, or even work with ED providers in an abbreviated fashion to streamline care and avoid a full ED visit.

Let's walk through a few examples: 

• An after-hours medication refill visit is avoided by a primary care physician calling the emergency physician and asking her to write an InstyMeds prescription that the patient can pick up in the ED lobby without having to actually check in. 10 minutes of emergency physician time spent.
• A patient with CHF presents with a typical exacerbation. After initial evaluation and diuresis, the emergency physician is able to coordinate with the patient’s cardiologist regarding optimizing his medical regimen.  After reviewing the plan with the emergency physician, an emergency coordinator is able to make an urgent follow up appointment with the cardiologist, arrange transportation, and set up a home nurse visit for the next day.  The physician has an extended conversation with the patient regarding disposition options, and ultimately hospitalization is avoided.  20 minutes of emergency physician time spent coordinating care.  30 minutes of care coordinator time spent. 
• An asthmatic patient is having a routine asthma exacerbation due to his nebulizer malfunctioning. As part of a community paramedicine program whose medical director is a hospital-based emergency physician, the patient is evaluated by paramedics. They troubleshoot and repair his nebulizer, and then call the emergency physician to confirm a no-transport. The emergency physician calls the primary care physician to keep him in the loop and coordinate prompt follow-up. 10 minutes of emergency physician time spent. 60 minutes of paramedic time spent.
• The extended family of a dementia patient is home for the holidays and, noting grandpa's gradual physical and mental decline, decide that it is time for him to go to a nursing home. They incorrectly present to the ED, but the ED care coordinator is able to avoid a full evaluation by hosting a conference call with his primary care physician and a social worker to facilitate placement. 60 minutes of emergency coordinator and ED conference room time spent. 

For a real life example, let's look to the literature. Murphy et al. found that a $554 investment per enrollee saved the health system $6091 per extreme ED user and $1285 per frequent ED user, a net savings of $710,474. These results are striking, but they required the ED to invest in a 0.25 full-time equivalent (FTE) medical director for the coordination program, a 1.0 FTE case coordinator, and a 1.0 FTE administrative assistant (hence the $554 per enrollee investment cost). Ultimately, the costs associated with frequent and improper ED use are incurred not only by the patients themselves, but also by other patients, hospitals, emergency physicians, third-party payers, and society in general. Reducing the costs of ED overuse is clearly going to take a team effort and compensation plans for these efforts should not overlook the time, expertise, and facility expenses incurred by the nation's EDs. 

We at Wisconsin ACEP would like to know more about how this issue is impacting our emergency physicians and EDs. 

• Is your health system participating in an APM, how is emergency care coordination being compensated?
• Are you an ED director, what are some of the coordination costs that are not always obvious to CMS or third party payers?
• Do you participate in any healthcare payment reform workgroups or advisory panels, are the ED costs of care coordination being acknowledged in policy making circles?

Email WACEP@badgerbay.co with your questions and comments. If you'd like to learn more, check out this article on Cost-effective ED Care Coordination by our colleagues at Washington ACEP!

*Emergency physicians will immediately recognize the irony here, emergency care represents less than 2 percent of the nation's $2.4 trillion in health care expenditures while covering 136 million people a year and the focus on preventing so-called “non-urgent” emergency department visits distracts policymakers from the real cost savings in reducing hospital admissions and investing in preventive measures.
Sources:
Report: Accounting for the cost of US health care: A new look at why Americans spend more, McKinsey Global Institute, December 2008
Agency for Healthcare Research and Quality. Emergency Room Services-Mean and Median Expenses per Person With Expense and Distribution of Expenses by Source of Payment: United States, 2006. Medical Expenditure Panel Survey Household Component Data. (March 04, 2013)

December 15, WMS Medigram

The Injured Patients and Families Compensation Fund (Fund) Board approved a 30 percent decrease in Fund fees for the 2017-2018 fiscal year on Wednesday. This is the fifth time in as many years that the Board has approved a decrease in Fund fees, and the second consecutive year fees decreased by 30 percent. 

The Board’s decision to decrease fees was based on the recommendation of its actuarial committee, which noted—among other considerations—a better-than-expected return on investments and the release of previously held claims. Fund fees decreased by 30 percent in 2016-2017, 34 percent in 2015-2016, 10 percent for 2014-2015 and 5 percent for 2013-2014. Fee notices reflecting the new decrease will be mailed to physicians and other Fund participants in mid-2017. 

The Fund, which was created by statute in 1975, is a trust that is set up to pay medical negligence claims that exceed physicians’ primary layer of medical liability insurance. In 2011, the state returned $200 million, plus lost earnings and interest to the Fund, following the Wisconsin Medical Society’s successful lawsuit challenging the state’s raid on the Fund in 2007. 

In other business by the Board, the fees for physicians and surgeons insured through the Wisconsin Health Care Liability Insurance Plan (WHCLIP) will not change in 2017-2018, and there was no change in fees for hospital professional liability and hospital liability coverage. 

WHCLIP was created by statute in 1975 as an insurer of last resort to provide the primary level of medical liability insurance to Wisconsin health care providers. WHCLIP is managed by an outside manager with oversight by the Office of the Commissioner of Insurance.

December 15, Wisconsin Health News

Wisconsin ranks as the 20th healthiest state in the nation, up from last year when it was 24th, according to United Health Foundation's 2016 America's Health Ranking Annual Report. 

Wisconsin was one of three states to increase their ranking by four places or more. It ranked behind Minnesota and Iowa, which came in 4th and 17th respectively. But the state received a higher score than Illinois and Michigan, ranked 26th and 34th respectively.

Wisconsin had a high percentage of residents who have graduated from high school, which leads to better health outcomes, according to the report. It also had a lower uninsured rate and prevalence of diabetes compared to other states.

But Wisconsin had the second highest amount of binge drinking in the nation and a high incidence rate of whooping cough. And the state has some of the lowest per capita public health funding in the nation.

"Ranking the states in relativity to one another gives us an opportunity to look at where we can improve," said Dr. Rhonda Randall, chief medical officer of UnitedHealthcare Medicare and Retirement.

In the past five years, drug deaths in Wisconsin have increased 23 percent from 11.4 to 14.0 deaths per 100,000. And in the last year, the number of children living in poverty has increased 13 percent from 16.2 percent to 18.3 percent.

Disparities in health status by education have decreased. Randall noted in the past, Wisconsin has had a greater disparity between the percentage of adults with a high school education reporting good or excllent health compared to those without a degree.

That disparity decreased 20 percent in the past year, from 32.2 percent to 25.8 percent.

"What we're seeing are some very favorable trends and some trends that are concerning us," Randall said. "That kind of puts us at a crossroads with our health in the United States."

She noted that nationwide the number of smokers has decreased and that the rate of uninsured Americans has hit the lowest level in history.

On the other hand, the obesity rate has increased by 157 percent since the first report in the 1990. And the 2016 report shows death rates from heart disease increasing for the first time in the report's 27-year history.

"One year is not enough to make a trend, but it's a very concerning change," she said. 

See Wisconsin's profile.

Building off record attendance at Doctor Day 2016, specialty societies and the Wisconsin Medical Society are expecting to draw another record attendance at the 2017 Doctor Day.  The event is scheduled in Madison on March 29.  Click here  for a list of participating organizations.

This annual advocacy event is timed well for physicians to be able to meet with their legislators and/or staff members, and to have input on the budget and other important health care issues. Participants will hear from Medicaid Director Michael Heifetz of the Wisconsin Department of Health Services and others, then will take part in an issue briefing before heading to the Capitol. Lunch will be provided, and the day will conclude with a reception in downtown Madison. 

Visit the Doctor Day website for more information and to register.