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  • August 21, 2017 4:09 PM | Sally Winkelman (Administrator)

    Bobby Redwood, MD, MPH
    President, Wisconsin ACEP

    Out of network billing (OONB) is a concept that is understandably difficult for our patients to grasp. The usual story goes like this: an insured patient presents to an emergency department during a period of vulnerability and need, they receive high quality emergency care, but then receive a bill six weeks later stating that their hospital fees are covered by insurance, but their physician services are not. From a patient perspective, that looks like the hospital is charging a couple hundred dollars, while the emergency physician is charging a couple thousand…what gives?!

    As physicians, the problem seems pretty simple…the insurer is refusing to pay. In other words, the patient’s emergency physician did the work and the insurance company, in an effort to increase revenues for their shareholders, has created an unreasonably narrow network of providers in order to cut costs (and stick the patient with the bill for physician services). The patient has done nothing wrong here. They bought insurance and had an emergency. It is quite reasonable to be angry that the insurance they spent their hard-earned money on is not paying for the services it was supposed to cover.

    Of course, as physicians, we have an intimate knowledge of the health care bureaucracy and the unscrupulous maneuvers that insurers turn to in order to avoid payment are nothing new to us. The problem is that physicians and physician staffing companies have been receiving the lion’s share of the blame for a phenomenon that we have very little (if any) control over. The New York Times has reported extensively on OONB. They routinely call it “surprise billing” and have quoted health policy experts calling the practice everything from, “a bait-and-switch” to “financial roulette” to “the health equivalent of a carjacking.” The Times is one of my most trusted news sources, but on this issue, they really miss the mark.

    In an article titled, Surprise! Insurance Paid the E.R. but Not the Doctor, the Times authors state that; “These doctors negotiate separate deals with insurance companies for payment. If the doctor and the insurance company never strike a deal, the visit is billed at much higher out-of-network rates”. There is a partial truth here, some independently owned physician groups are placed in the difficult position of having to contract with as many insurance companies as possible to mitigate the effect of the insurance companies’ cruel insistence on not covering all aspects of emergency care. Still, it is disingenuous to paint problem in such a way that places physicians as equal partners in this inhumane withholding of emergency care coverage. For those physician groups that do need to negotiate their rates in order to be considered “in-network”, the rates that payers offer are often far below fair market value. Personally, as a contracted employee of an independently owned hospital, I am not out there negotiating which unfairly narrow networks will cover my labor—I clock in, I see patients, I clock out.

    Another Times article titled, The Company Behind Many Surprise Emergency Room Bills tries to pin the blame on the national physician staffing company EmCare. Citing a single study that has been widely criticized for flawed methodology, the authors portray EmCare as an evil corporation that swooped in to a rural emergency department, increasing the cost of an average level 5 visit from $467 to $1,649. This sounds concerning of course, but the readers are not told that patients are now being seen by emergency specialists. Has the quality of care improved? Is the hospital able to handle more complex pathophysiology in-house with specialists in the emergency department? Were they even able to staff the facility appropriately prior to the EmCare contract? We do not know, because the article does not say, but I suspect there is a lot more to the story than EmCare running up the tab.

    There is a practical solution to the OONB problem of course. Four states have adopted the Minimum Benefit Standard, which essentially mandates that insurers cannot pay providers less than 80% of usual professional service charges. These charges are based on a geographically comparable database of usual and customary clinician charges and the database is maintained by an independent non-profit organization. In other words, these states let a third party decide what fair compensation is and then compensate their providers fairly without putting the patient in the crosshairs of our unnecessarily complicated insurance landscape. An in-network discount is reasonable, but patients should not be financially punished for having a medical emergency.

    At present, we at WACEP have thankfully not heard many OONB horror stories in our state, but we are keeping our ears to the ground and have put together a task force to explore the issue. Has your group been a victim of unfair OONB practices? Are your patients complaining about billing practices that are out of your control? We’d like to hear from our membership on this important issue.

    For more information, check out ACEP’s website on fair coverage and the cited NY Times articles below:

  • August 16, 2017 1:45 PM | Sally Winkelman (Administrator)

    Join Wisconsin Health News for a discussion on Innovation... one of the biggest buzzwords in healthcare.

    Tuesday, Sept. 5, 2017; 11:30 am - 1:00 pm
    The Wisconsin Club, 900 West Wisconsin Avenue, Milwaukee, WI 53233 

    • How are providers and insurers embracing, and advancing, new technologies? What hurdles stand in their way?
    • Which advancements will have the most impact on patient health?

    Panelists include:

    • Mike Anderes - chief innovation and digital officer for Froedtert Health and the president of Inception Health, a company formed by Froedtert & the Medical College of Wisconsin to accelerate the adoption of digital health, identify and partner with innovative companies and increase the innovation capacity of the network. 
    • Ilya Avdeev - professor of mechanical engineering at the University of Wisconsin-Milwaukee. He's the principal investigator and co-director of the National Science Foundation I-Corps Site of Southeastern Wisconsin - a partnership of UWM, Marquette, Medical College of Wisconsin, Concordia and Milwaukee School of Engineering.
    • Craig Hankins - vice president of digital products at UnitedHealthcare. He oversees the strategy and delivery of mobile solutions. His responsibilities include developing new and innovative mobile technologies that serve an array of healthcare stakeholders, including consumers, care providers and employers.
    • Mike Lappin - chief administrative officer of Aurora Health Care. He is responsible for overseeing compliance, government relations, human resources, information services, internal audit, legal services, real estate and facilities management, as well as affiliations, acquisitions, joint ventures and other transactions.
  • July 26, 2017 12:22 PM | Sally Winkelman (Administrator)

    On September 20, the Wisconsin Hospital Association is sponsoring the “WHA Emergency Preparedness Conference: Ready to Respond” at the Sheraton Hotel in Madison. Conference details and registration are available online.

    This important, one-day conference will feature national experts who will share communication and preparedness lessons learned from real world events and focus on current threats facing health care organizations, including workplace and community violence and highly infectious diseases. Attendees will have the opportunity to collect strategies to enhance their current emergency management programs, practice them through interactive exercises, and integrate those preparedness and communication strategies into daily operations.

    Vincent Covello, PhD, will keynote the conference and offer a deep-dive session in the afternoon specifically for public information officers and health care public relations professionals.

    Covello is a nationally and internationally recognized trainer, researcher, consultant and expert in crisis, conflict, change and risk communications. Over the past 25 years, he has held numerous positions in academia and government. Covello was a senior scientist at the White House Council on Environmental Quality in Washington, D.C., a study director at the National Research Council/National Academy of Sciences and the director of the risk assessment program at the National Science Foundation. Covello has authored or edited more than 25 books and published over 75 articles on risk assessment, management and communication.

    Covello will share principles, strategies and practical tools for communicating effectively in a high stress situation.

    Chris Sonne and William Castellano, both of HSS EM Solutions, will share best practices and lessons learned from live active shooter scenarios, as well as direct tabletop exercises and a practical, scenario-based training exercise, during a special afternoon session focused on planning and preparing for an active shooter.

    Additional sessions include a look at infectious disease outbreaks and what hospitals can do to better prepare; as well as the role of governmental agencies, including the Department of Health Services and the Department of Public Health during an emergency.

    This conference has been designed for hospital emergency preparedness directors, emergency department directors and physicians, infection prevention staff, department directors, public relations professionals and public information officers. 

  • July 26, 2017 11:55 AM | Sally Winkelman (Administrator)

    September 14-16, 2017: WISAM Conference
    Advancing the Art and Science of Addiction Prevention and Treatment in Wisconsin
    Pyle Center, Madison, WI

    This two day conference on addiction prevention and treatment is open to all providers across disciplines.

    A post-conference workshop on Saturday, September 16 will provide training for clinicians in the use of buprenorphine and naltrexone for the office-based management of substance use disorders. Attendees will also have the opportunity on Saturday to participate in an Opioid Prescribing Guidelines session that meets the Wisconsin Medical Examining Board’s mandatory education requirement.

    View conference agenda . Learn more and register.

  • July 19, 2017 12:12 PM | Sally Winkelman (Administrator)

    Bobby Redwood, MD, MPH

    Wisconsin emergency physicians should be leery of the U.S. Senate’s latest version of The Better Care Reconciliation Act (BCRA). Stripping away the loaded messaging from the special interest groups and the political baggage that haunts the Affordable Care Act (ACA), what the Senate has proposed is a bill that will deliver a triple blow to emergency medicine in Wisconsin. Stated simply, passing the BCRA will have a negative impact on our patients, our profession, and our physician workforce.

    Painful Cuts for Patients: With the BCRA, our patients are definitely being forced to take their medicine (and there is no spoonful of sugar to help it all go down). Tax credits for out-of-pocket expenses will be phased out by 2019, insurers can charge older patients up to five times as much as younger patients, and annual/lifetime limits on individual coverage are coming back. Furthermore, patients will again have the option to buy what Kaiser Health News calls “junk insurance” (low cost, minimal coverage plans that were eliminated under the ACA). Oh, and guess what, the BCRA eliminates the individual mandate, so all those invincible young patients coming in with mental health crises, overdoses, and traumatic injuries will no longer be obligated to have insurance, but EMTALA will still require emergency physicians to provide their uncompensated care. The congressional budget office sums up this can of worms quite nicely, estimating that the BCRA will eliminate insurance coverage for more than 20 million people over the next decade and Wisconsin’s hit would be 394,100 newly uninsured patients.

    Painful Cuts for Emergency Department Revenue: Since Wisconsin has a thriving, diverse payer mix; the best course for our state would be to reform the ACA, rather than repeal it, so that even more Wisconsinites can have access to private insurance plans. Wisconsin is already worst in the nation in terms of Medicaid reimbursement*, compensating emergency physicians just $37.77 for a level 5 visit (compared to Medicare’s $169.14 for a level 5 visit). The changes proposed by the BCRA will distribute federal Medicaid funds to the states based on a capped, per-capita or block grant basis. Our state government has already shown us how much they value our work…what will happen to emergency department and emergency physician compensation under the (presumed) cuts of a block grant system?

    Painful New Realities for Practicing Emergency Physicians: For the 99% of us who are not policy wonks, how will the BCRA affect our daily workflow in the emergency department? For starters, an greater underinsured population will equate to more challenges securing inpatient psychiatric beds, so expect those mental health boarding times to increase. Blocking federal payments to Planned Parenthood will decrease young women’s access to contraception, HPV vaccines, cervical cancer screening, and prenatal care; so expect more pelvic exams, more abnormal findings on pelvic exams, and more pregnancy complications. Some of those patients who were briefly insured under the ACA, but have since lost coverage, will be turning to the ED to manage their recently discovered chronic health conditions and lets not forget the return of lifetime limits on individual coverage. “I’m sorry Mrs. Smith, you reached your coverage limit with your last cardiac stent, how about this DNR paperwork instead?” If the BCRA passes, I sincerely hope you compensation is not tied to patient satisfaction, because we are going to be seeing a lot of unhappy individuals under this substandard attempt at health insurance reform.

    National ACEP has already weighed in, warning that “the BCRA would allow insurance companies to offer skimpy plans that offer no essential benefits coverage to consumers” and that “the consequences for emergency patients could be devastating.” I agree and would add that the consequences for Wisconsin will be particularly jarring for our state’s patients, profession, and physician workforce. Tammy Baldwin is a vocal opponent of the BCRA, but Ron Johnson is still on the fence.

    Tell Ron Johnson to vote "NO" on the BCRA:

    *WACEP is working hard to improve this dismal statistic.

  • July 19, 2017 12:11 PM | Sally Winkelman (Administrator)

    By: Lisa Maurer, MD, WACEP Treasurer/Secretary

    Earlier this month, the Wisconsin Court of Appeals decision in Mayo v Wisconsin Injured Patients and Families Compensation Fund (IPFCF) made changes to the liability system in our state that will affect every practicing physician by removing the cap on noneconomic damages altogether. The trial court for this case initially found that although the cap on noneconomic damages was constitutional, the plaintiff in this case was an exception and was awarded $16.5 million in non-economic damages. This ruling by the Court of Appeals goes one step further, arguing that any cap on noneconomic damages is unconstitutional, and removing it completely. 

    Wisconsin has adjusted this noneconomic cap several times over the last decade or so. Prior to 2005, Wisconsin had a $350,000 cap on economic damages. In 2005, a decision in Ferdon v. IPFCF struck down the $350,000, stating that it violates the equal protection rights of severely injured patients. The cap of $750,000 that was in place until just this month was adopted in 2006 on the basis that a cap would protect the IPFCF and patient’s access to care, with the limit of $750,000 based on other states’ experiences. In contrast, Wisconsin has not had a limit on economic damages. For clarification, whereas noneconomic damages corresponds to any pain and suffering the plaintiff may have undergone, economic damages corresponds to actual expenses or lost wages. 

    The IPFCF is expected to file an appeal with the Wisconsin Supreme Court, but has not done so at this point, and advocates on either side of the issue are watching closely. Patient advocates worry that a cap such that was in place limits the injured patients’ ability to be made whole. Most recently, the Court of Appeals argued that in a situation that we had where a cap was in place, but individuals were made to be exceptions to that cap, creates two classes of plaintiffs: one that is fully compensated and one that is not. Proponents for a cap on noneconomic damages, such as the Wisconsin Medical Society, argue that reasonable caps are what maintains a strong IPFCF, ensuring that Wisconsin patients have the ability to recover unlimited economic damages. They also have concerns that a lack of cap incentivizes attorneys to file groundless claims. 

    Unlike the Wisconsin Medical Society, WACEP does not have a policy compendium to dictate an official position on topics such as this. Let us know what you think the Wisconsin Supreme Court should decide if this case is brought to them. Send us an email, post to our Facebook page or tweet us.

  • July 14, 2017 10:23 AM | Sally Winkelman (Administrator)

    July 14, Wisconsin Health News 

    UnitedHealthcare raised concerns about Gov. Scott Walker's administration's proposal to terminate Medicaid benefits for six months for childless adults that don't complete certain requirements under its proposed waiver.

    The Department of Health Services is seeking federal approval on a waiver to drug screen childless adults. Under the proposal, DHS would also be allowed to impose premiums on that population and cap eligibility for the program for those not working or in work training programs at four years. 

    If a member hits that cap or doesn't pay premiums, they'd be ineligible for Medicaid for six months. The state provides ways for members to regain their benefits sooner if they complete certain requirements. A federal public comment period on the waiver ends Saturday. 

    UnitedHealthcare Community Plan of Wisconsin, which serves 166,000 Medicaid members in Wisconsin, warned that limiting benefits for a six-month period could "negatively impact continuity of care" for childless adults, "driving up overall healthcare costs for the population."   

    Interruptions in Medicaid coverage can lead to greater emergency department use, they warned, as well as increases in hospitalizations for conditions that can be managed through other means.

    "While Wisconsin's coverage suspension is limited to six months, research has shown that even short-term losses of coverage can have significant impact," said Ellen Sexton, UnitedHealthcare Community Plan of Wisconsin CEO.

    The insurer recommended that Wisconsin use a tiered benefit system, like Indiana pursued. Medicaid recipients in Indiana that meet specific requirements have access to a full benefits package while those that don't lose access and receive a "skinnier" package of benefits. The state could also consider a hardship exemption for members that can't meet all the requirements to maintain coverage.

    A spokesman for UnitedHealthcare declined to comment on the testimony or whether the organization still has the same concerns about the proposal. The insurer has other recommendations in the letter, relating to its role under the provision and the proposed healthy behavior incentives. 

    In its revised waiver application submitted to the federal government, DHS noted that exemptions to their proposal mean a small percentage of members would be affected. DHS notes that it'll consider including community service and actively seeking work as qualified activities.

    "As the federal comment period closes on the 15th and the negotiations with CMS progress, we look forward to working with our partners to implement this substantial entitlement reform and continue our success in eliminating the coverage gap in Wisconsin while helping our childless adult members transition from government dependence to independence," DHS spokeswoman Jennifer Miller wrote in an email.

  • July 12, 2017 10:42 AM | Sally Winkelman (Administrator)

    July 10, Wisconsin Health News 

    Milwaukee-based Infinity Healthcare has been acquired by Envision Physician Services, part of Colorado-based Envision Healthcare Corporation.  

    Infinity Healthcare currently staffs 25 emergency medicine sites, 10 urgent care centers and other programs for health systems in Wisconsin and Illinois, including Ascension and Hospital Sisters Health System. 

    It has more than 340 physicians and other providers who deliver emergency and hospitalist medicine as well as anesthesia and radiology services. 

    "The opportunity to align with Envision Physician Services is an exciting next chapter for us," Dr. Glenn Aldinger, co-founder and CEO of Infinity, said in a statement last week. 

    Envision provides services at more than 1,600 clinical departments in 45 states and Washington D.C. It also owns and operates 264 surgery centers and one surgical hospital.

  • July 10, 2017 10:55 AM | Sally Winkelman (Administrator)

    July 6, Wisconsin Health News

    An appeals court struck down a state law Wednesday capping the amount of money that injured patients can receive for some malpractice claims. 

    The 1st District Court of Appeals ruled that a state law capping awards for noneconomic damages at $750,000 was unconstitutional. Noneconomic damages are intended to compensate for pain and suffering. 

    Judge Joan Kessler, who penned the majority opinion, wrote that the law imposes "an unfair and illogical burden only on catastrophically injured patients, thus denying them the equal protection of the laws." 

    The case involves Ascaris Mayo, who lost her limbs after she wasn't notified she had an infection after visiting a Milwaukee-area emergency room in May 2011. Mayo and her husband sued, and a jury awarded them $16.5 million for noneconomic damages.  

    The state's Injured Patients and Families Compensation Fund, which is funded by hospitals and doctors and covers large medical malpractice claims, moved to reduce that amount to the $750,000 limit. The Mayos challenged that. 

    Hospitals and doctors in the state were concerned about the Wednesday's ruling. Wisconsin Hospital Association CEO Eric Borgerding expects the state's Supreme Court to review the decision. 

    "We believe the court will uphold the well-supported and bipartisan public policy balance set by the Legislature to help ensure accessible healthcare in Wisconsin," he said in a statement.

    A spokeswoman for the Office of Commissioner of Insurance, which provides administrative staff to the 13-member board, didn't respond to a request for comment on whether the state would appeal the decision.

    Dr. Noel Deep, Wisconsin Medical Society president, said the decision"endangers the long-term solvency of the Injured Patients and Families Compensation Fund and its ability to adequately compensate patients." He warned that it could incentivize "attorneys to file questionable cases in hopes of astronomical jury awards seen in other states without caps."

    Dan Rottier, an attorney for the Mayos, called the society's claim regarding fund's solvency "ridiculous." The fund reported a net position of $879 million as of June 2016, according to an annual report.

    Rottier said that pursuing such cases are difficult because "they're extremely expensive...these cases are not taken lightly.

    Rottier said the court's decision has "implications for a few cases every year where there's horrendous's those cases where the inequity is the most severe." He noted that applying a cap in this case would have reduced the jury award by more than 95 percent.

    "I would call it 5 percent justice instead of 100 percent justice," he said.

  • June 29, 2017 12:02 PM | Sally Winkelman (Administrator)

    June 15, Wisconsin Health News 

    The Senate approved the final two proposals that are part of a special legislative session on opioids that Gov. Scott Walker called in January. 

    All 11 proposals that are part of that session have now passed the Legislature and await Walker's signature to become law.  

    The bills were based on recommendations from an interim report released in January by the Governor's Task Force on Opioid Abuse, which was chaired by Lt. Gov. Rebecca Kleefisch and Rep. John Nygren, R-Marinette. 

    "We have a lot of work left to do on a massive epidemic that's sweeping our state," said Ashland Democratic Sen. Janet Bewley, who served on the task force as well. "We are learning that it's even bigger and more profound than we ever thought." 

    The Senate approved a proposal Tuesday that would provide limited legal immunity to overdose victims. Sen. Steve Nass, R-Whitewater, was the sole no vote.  

    The chamber also approved a bill allowing for families and others to involuntarily commit a person with drug dependence. 

    The Senate also voted down along party lines a Democratic amendment to the latter proposal requesting the attorney general to consider filing a lawsuit against opioid manufacturers. A few states, like Ohio, have filed lawsuits against drugmakers.  

    Senate Majority Leader Scott Fitzgerald, R-Juneau, predicted that a class action lawsuit against drugmakers "is coming. It's just a matter of time...and I'm sure we'll be part of that at some point." He moved to reject the proposal as he didn't want it tied with the bill.  

    See a list of the special session bills.