Latest News 

  • January 06, 2017 4:36 PM | Sally Winkelman (Administrator)

    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.

  • December 19, 2016 11:31 AM | Sally Winkelman (Administrator)

    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 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.
    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, 2016 10:04 AM | Sally Winkelman (Administrator)

    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, 2016 8:32 AM | Sally Winkelman (Administrator)

    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.

  • December 14, 2016 12:37 PM | Sally Winkelman (Administrator)

    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.

  • December 14, 2016 10:09 AM | Sally Winkelman (Administrator)

    December 14, Wisconsin Health  News

    The Group Insurance Board delayed a decision Tuesday on changes to the health plan for state employees, including whether to shift to a regional or self-insurance model. 

    Chair Michael Farrell said the board has directed Department of Employee Trust Funds staff and Segal Consulting to gather more information and data about the proposals. The board will reconvene in January.  

    "There is much complexity and volumes of information that relate to our consideration," he said. "We're not taking these decisions lightly." 

    During closed session Tuesday, members weighed seven scenarios offered by ETF staff, according to a memo.  

    One proposal could continue the current fully insured model with minimal changes. That model would have up to 16 different vendors participating.  

    Other scenarios under consideration would have between six and 11 participating vendors. Those proposals could be fully insured, self-insured or a hybrid. Some of them would divide the state into regions.  

    A seventh proposal, which is not recommended by ETF or Segal, would have one or two vendors under a self-insured model.  

    The board has been considering self-insurance off and on for five years according to the memo. It's also considering other changes like three-year contracts with health plans.  

    Phil Dougherty, spokesman for the Wisconsin Association of Health Plans, said his members "recognize that more can be done in the current competitive model to achieve the state's financial and quality goals." 

    "Moving to Segal's regionalization strategy would create the risk of reducing competition and choice, eliminating high quality healthcare networks and separating plan participants from their doctors and medical homes," Dougherty said in a statement. "The right answer for the state is to use the current competitive structure and Wisconsin health plans to build on what works." 

    Read a summary memo on the proposals and discussion.

  • December 14, 2016 8:54 AM | Sally Winkelman (Administrator)

    The Wisconsin Medical Society is offering “Wisconsin Medical Examining Board Opioid Prescribing Guidelines,” a two-hour webinar available on-demand. The course satisfies the new MEB mandate requiring physicians with a DEA number to complete two continuing medical education (CME) credits on its Opioid Prescribing Guidelines during the current CME cycle, as well as another two credits during the next cycle.

    Presented by Society member Michael McNett, MD, the webinar provides a comprehensive review of the guidelines. I completed it myself last week and thought it was not only outstanding, but a good reminder of the excellent work the Society does every day to meet its members’ needs. Click here to register or for more information.

  • December 12, 2016 12:54 PM | Sally Winkelman (Administrator)

    Major changes are likely in store for the country's healthcare system. Obamacare, Medicaid and Medicare could all be in for overhauls.

    How far will lawmakers go? Will people with pre-existing conditions get to keep their coverage? What about the 22 million Americans, and 200,000 Wisconsinites, who have gained health insurance? How would the industry react to a transition period? Are they ready to start over?  Learn more at a Wisconsin Health News Panel Event Jan. 12 at the Madison Club.  Panelists include: 

    • Eric Borgerding, CEO, Wisconsin Hospital Association 
    • Coreen Dicus-Johnson, CEO, Network Health Plan
    • Donna Friedsam, Health Policy Programs Director, University of Wisconsin Population Health Institute
    • Mike Wallace, CEO, Fort HealthCare
    Register now.
  • December 08, 2016 12:34 PM | Sally Winkelman (Administrator)

    Wisconsin Health News

    Rep. Joe Sanfelippo, R-New Berlin, will continue to chair the Assembly Committee on Health next session, according to a Wednesday statement.   Rep. Samantha Kerkman, R-Salem, will serve as vice chair of the committee.

    Assembly Speaker Robin Vos, R-Burlington, also reappointed Rep. Paul Tittl, R-Manitowoc, to serve as chair of the Assembly Committee on Mental Health. Rep. John Jagler, R-Watertown, will vice chair the committee.  Rep. Tom Weatherston, R - Caledonia, will chair the Assembly Committee on Aging and Long-Term Care. Rep. Warren Petryk, R-Eleva, will vice chair that committee.  Rep. Kevin Petersen, R-Waupaca, was tapped to chair the Assembly Committee on Insurance and Rep. Cindi Duchow, R-Delafield, was picked for vice chair.

    Vos also announced new committees for next session, including one focused on science and technology and one on regulatory licensing reform.

    See more committee leadership appointments.

  • December 01, 2016 4:50 PM | Sally Winkelman (Administrator)

    Wisconsin Health News

    Group Insurance Board members questioned the amount of savings the state receives under its current health insurance model and called for increased access to data as they discussed a possible move Wednesday to self-insurance. 

    Michael Heifetz, state Medicaid director, said the board needs better access to data to make sure they're providing the best care at the best price to employees who "have more skin in the game - a phrase I hate but gets used all the time - than they ever had before.” 

    "We need data to know if we are getting the best deal and to know if we are getting the best quality," he said. "For us not to have that control and to rely on the vendors puts us at a disadvantage." 

    The board selected Truven Health Analytics to serve as its data warehouse vendor at the meeting. But Heifetz noted that if the board doesn't have "any actual good data to shove into that data warehouse, it's not going to help us very much." 

    "Folks can analyze the self-insured vs. fully insured model, but if we don't have data, whatever decision we make is not well-founded," he said. "Politics at the national level have changed. Great. Maybe the Affordable Care Act goes away, maybe it doesn't. This board's mission hasn't changed and we still have to ensure high quality at a reasonable price for our members. And again, it takes data to do that."  

    He questioned the $283 million in cost reductions over the last nine years under the current model, described in a memo prepared by the Department of Employee Trust Funds. The reductions were determined by the difference between the preliminary and final bids by health plans.  

    "Without the right data, I don't know if those initial bids are great numbers or not, or if it's 'Let's see what the state will give us or not,'" said Heifetz, a former lobbyist for SSM Health Care of Wisconsin. "I've been on the other side of this to some degree and that number keeps being thrown at us as if it's sacrosanct and absolute. And I simply don't accept that premise."  

    He said it's "pretty self-serving" for someone to provide a number, then lower it and "tell us how much they saved," he said. "We don't know if we really saved that much."  

    Heifetz added that "a piece of me would love" to have the discussion on self-insurance held in open session, rather than the closed session the board held Wednesday afternoon.  

    "There are folks who will criticize us for being in closed session even though it's all proprietary things that they probably wouldn't want aired in the public arena," Heifetz said. "I have mixed emotions about going into closed session to discuss these things. I am a member of the public, I'm a taxpayer and I'm a member who gets benefits for my family through this process." 

    Phil Dougherty, senior executive officer for the Wisconsin Association of Health Plans, noted that health plans' rates for the State Group Health Program match the healthcare risk they cover. 

    "Driven by the market competition structure of the program, annual premium increases for the program over the past nine years averaged 3.7 percent, significantly below the national trend," he wrote in an email. 

    The state's decision to contract with Truven will provide data to ensure it gets competitive rates from health plans serving the program, he added.  

    J.P. Wieske, deputy insurance commissioner, noted that the average costs of the plans sold on the state's individual exchange are cheaper than those sold though the employers' exchange.  

    "Some of these carriers in Milwaukee and Dane County are carriers in the exchange as well," he said. "And the fact that their rates have been lower in the exchange than the employee plan is really surprising given the risks. I don't believe the population inside the exchange, especially with the problems that they have, especially with how (the Department of Health and Human Services) has administered it, the health of that individual market is probably worse than the state employee population, which is stable, large and consistent."  

    Herschel Day, a professor at the University of Wisconsin-Eau Claire, said that part of the problem could be that members are insulated from the carriers. He noted that they pay the same amount for plans in the highest tier regardless of how plans charge and called for more transparency.  

    "Folks can see what the actual premiums charged are, but given that there's no impact within Tier 1 for the member, I think in some sense we're insulating them from that difference," he said. "That could feed into the higher rates."