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  • 12/14/2018 1:44 PM | Anonymous

    December 14, 2018, WMS Medigram 

    The Wisconsin Department of Safety and Professional Services (DSPS) has announced there will soon be changes in the license renewal date for credentialed DO physicians. Per 2017 Wisconsin Act 329, the renew-by date for DOs will be aligned with the renew-by date for MDs, meaning DOs must renew their Wisconsin credential by October 31 of odd years.

    The next renewal date for DOs will be October 31, 2019. Since the renew-by date is now sooner than the normal two-year biennium, DSPS will be charging a one-time prorated renewal fee of $118 instead of the normal $141.

    DSPS will be communicating details of this change with DO credential holders via email in the near future.



  • 12/14/2018 1:34 PM | Anonymous

    December 14, 2018, WMS Medigram

    The administrator for the state’s Worker’s Compensation (WC) program signaled support for multiple “agreed-to” bill proposals in the upcoming 2019-2020 state legislative biennium. This allows for one of the bills to contain solely “non-controversial” statute and administrative code updates for the Department of Workforce Development, which oversees the state’s program for work-related injuries. Administrator and former State Sen. Frank Lasee made the comments at the most recent meeting of the Worker’s Compensation Advisory Council (WCAC), held December 11 in Madison.

    Separate bills would be a departure from the norm for the state’s WC policy-making process, which usually sees just one “omnibus” bill each legislative session. The WCAC—which has voting members from Labor and Business entities—meets throughout the biennium to debate potential changes to the state’s worker’s compensation program. The negotiated agreement is then submitted as legislation to the state legislature. The Society is one of the WCAC’s four non-voting health care liaisons who advise Labor and Business on how policy proposals may affect health care’s ability to provide care to patients suffering a workplace-related injury.

    Last session’s omnibus bill included a provision that would have for the first time created a fee schedule for worker’s comp-related care. The Society and other health care groups strongly opposed the legislation as an unnecessary disruption to a WC system viewed as a national leader, providing patients ready access to high-quality care resulting in faster return-to-work and lower costs compared to other states’ systems. That proposal received just one public hearing in the State Senate’s Labor committee and was never introduced in the State Assembly. Administrator Lasee’s suggestion signifies a recognition that future bills containing items health care considers “poison pills” could continue to scuttle any progress in less controversial areas.

    Neither Labor nor Management members of the WCAC signaled agreement with Administrator Lasee’s suggestion—perhaps because Lasee’s position is a gubernatorial appointment and Tony Evers will become Wisconsin’s 46th governor on January 7, 2019.


  • 12/14/2018 1:30 PM | Anonymous
    December 14, 2018, WMS Medigram  

    While the drama of last week’s two-day, overnight extraordinary session approving three lame duck session bills is over, the final fate of those proposals remains unknown.

    The somewhat picayune rules of the legislative timeline could maintain that mystery until after Christmas: once Gov. Scott Walker receives the bills that have passed the legislature, he has six days (excluding any Sunday) to do one of the following:

    • approve the bills in full.
    • veto the bills in full.
    • exercise his line-item veto power over bills that contain any appropriations.
    • allow the bills to become law through inaction.

     
    Legislation that has passed both houses of the legislature does not automatically get sent to the executive branch—the Governor can “call” for the bills to be delivered at any time. If he does not call for the bills by 4:30 p.m. on December 20, they will automatically be sent—at which point the six-day clock begins ticking. That means that December 27 is the latest date to know the fate of the lame duck bills.

    The Society was part of a broad health care coalition opposing Senate Bill 886, the lame duck bill affecting the state’s Medicaid program. After its passage, the Society reached out to the Governor’s office reiterating those concerns, asking him to utilize his veto power to allow state government the maximum opportunity to adapt when providing Medicaid coverage under any federal waiver. Under the approved bill, any desire for the executive branch to modify, suspend or terminate a Medicaid waiver would also require legislative authorization. Gov. Walker earlier this week indicated that some vetoes are possible on one or more lame duck bills.

  • 12/03/2018 11:56 AM | Anonymous

    November’s election results are set to shake up healthcare in Wisconsin. But how far will Democrat Gov.-elect Tony Evers be able to go with a Republican Legislature? What are the chances of campaign promises like expanding Medicaid? And where are there areas for compromise?

    On Dec. 11, we’re assembling some of the state’s best political and healthcare reporters to recap the year’s biggest stories, dissect the potential healthcare impact of the elections and preview the most important stories for 2019.       

    Panelists:

    • Scott Bauer, Associated Press
    • Guy Boulton,  Milwaukee Journal Sentinel
    • Jessie Opoien, Capital Times
    • David Wahlberg, Wisconsin State Journal

    Register Here





  • 11/20/2018 12:17 PM | Anonymous

    November 20, 2018, Wisconsin Medical Society 

    The Wisconsin Medical Society’s House of Delegates (HOD) will convene Sunday, April 7, as part of the Society’s 2019 Annual Meeting at Monona Terrace Community and Convention Center in Madison. Any Society member may submit resolutions for consideration by the HOD to help shape Society policy on important medical issues. The deadline is 4:30 p.m., Friday, Feb. 1, 2019.*

    These guidelines should be followed when drafting resolutions:

    • Select a title that appropriately reflects the action the resolution seeks.
    • Carefully check the resolution for accuracy.
    • The wording of the “Resolved” statement should be able to stand alone as an item to be acted upon by the HOD, because the HOD adopts only the “Resolved” language. The wording in the sections of the resolution that begin with “Whereas” does not appear in the official record of the proceedings of the HOD and will not appear in the Society’s Policy Compendium if the item is adopted by the HOD.
    • The Society strongly encourages—but does not require—that all resolutions contain a statement by the author about relevant existing policy or a statement that the Society does not have any current policy on the topic.
    • Resolutions that request the Society’s HOD to forward the policy item to the American Medical Association (AMA) House of Delegates for its consideration should contain a statement by the author about relevant existing AMA policy or a statement that the AMA does not have any current policy on the topic.

     
    If the implementation of an adopted item would require the expenditure of funds not normally included in the Society’s budget, the Society will add a fiscal note to it. Those who submit resolutions should ensure that a sponsor will attend the reference committee hearings to introduce the resolution and testify, providing background information and the rationale for the “Resolved” statements.

    Members who need help developing a resolution may contact Society staff for assistance or click here for a brief primer on resolution writing.

    Any resolution received after the Feb. 1 deadline will be considered a “late resolution,” unless it is presented by the Board of Directors, the Speaker, Vice Speaker, constitutional officer or by a council or committee of the Society or the HOD. All “late resolutions” will be forwarded to the Rules Committee for review. The Rules Committee will make recommendations to the HOD regarding the acceptance of any “late resolutions” at the April 7 opening session. Click here** for information about the late resolution process, including the information that must accompany a late resolution. The HOD is unable to accept late resolutions unless two-thirds of the Delegates present consent to the acceptance of the item.

    Submit resolutions for the 2019 House of Delegates to CEO, Clyde “Bud” Chumbley, MD, MBA, Wisconsin Medical Society, PO Box 1109, Madison, WI 53701 or via email to Noreen Krueger.

    The House of Delegates is only one avenue for raising issues or submitting resolutions. Members may submit issues or resolutions throughout the year via the Society’s year-round resolution process by using the online Member Communication Form. Members who have time-sensitive issues can opt to use the year-round submission process for prompt disposition rather than waiting for the next Annual Meeting. Issues submitted via the year-round process are referred to the Board for further study and recommendations.

    For more information about submitting resolutions for the 2019 HOD, contact Noreen Krueger at 608.442.3904 or 886.442.3800, ext. 3904 (toll-free).

    *According to the Society’s Bylaws, members must submit resolutions in proper form to the CEO’s office on Feb. 1 or 60 days prior to the first session of the HOD at its Annual Meeting, whichever date is earlier.


  • 11/16/2018 5:12 PM | Anonymous

    November 16, 2018, WMS Medigram  

    The American Medical Association (AMA) House of Delegates (HOD) voted to adopt several new policies on emerging health care topics during its Interim Meeting this week, including policies aimed at making e-cigarettes less appealing to youth as well as policy aimed at addressing intimate partner violence in the LGBTQ population.

    Other policies adopted by the AMA HOD include:

    • Protecting and Improving Access to Zero-dollar Preventive Care
    • Continued 9-1-1 Modernization and Implementation of Text-to-9-1-1 Service
    • Sexual Assault Education and Prevention in Public Schools
    • Affirming the Medical Spectrum of Gender
    • Opposing the Detention of Migrant Children
    • Increased Access to Identification Cards for the Homeless Population
    • Increasing Patient Access to Sexual Assault Medical Forensic Examinations and Post-Exposure Prophylaxis (PEP) for HIV in Emergency Departments

     
    Click here to read more about these policies.


  • 11/09/2018 2:33 PM | Anonymous

    November 9, 2018, WMS Medigram

    The Centers for Medicare and Medicaid Services (CMS) released its final rule for 2019 for the Physician Fee Schedule (PFS) and the Quality Payment Program (QPP) last Thursday. Based on a preliminary review, the biggest provisions in the 2,400 page final rule relate to changes for Evaluation and Management (E/M) codes, expanding the use of telehealth services, reweighting the components of the Merit and Incentive-Based Payment System (MIPS), adding an opt-in option for MIPS, raising the scoring threshold for MIPS and creating a new category under MIPS called “Promoting Interoperability” (PI).

    Under the 2019 PFS, CMS will begin a two-year transition process to a new documentation and reimbursement structure for E/M codes. Starting in calendar year (CY) 2021, clinicians will be able to document their E/M visits using any one of the following methods: 1995/1997 guidelines, medical decision making or time. In exchange for the flexibility and lowered administrative burden, CMS will reduce the number of reimbursement levels for E/M codes from to three. Level 1 and Level 5 will maintain their current reimbursement structure, while Levels 2 through 4 will be collapsed into a single rate. In the interim, the current reimbursement structure will remain in place, and clinicians should still use either 1995 or 1997 guidelines when billing E/M codes.

    This change is intended to decrease administrative burden for clinicians by reducing documentation requirements. CMS originally proposed collapsing Levels 2 through 5 into a single rate effective January 1, 2019. However, there was significant pushback from all national, state, and specialty medical societies, including the Wisconsin Medical Society.

    The PFS final rule also expands the use of telehealth services. New codes will now cover virtual check-ins, remote evaluation, substance use disorder and preventive services and will reimburse federally qualified health centers and rural health clinics for telehealth services when there is no billable visit.

    In terms of MIPS, the minimum threshold score is being raised from 15 points to 30, and individual scoring components will be reweighted as follows:

    • Quality: 45 percent
    • Cost: 15 percent
    • Improvement Activities: 15 percent
    • Promoting Interoperability (NEW): 25 percent

     
    The small practice bonus will be added to the Quality component score, rather than the overall MIPS score, as was the case previously. However, the complex patient bonus will remain as an addition to the final overall MIPS score.

    CMS is also reconfiguring the Advancing Care Information (ACI) category under MIPS. Starting in 2019, ACI will be identified as the Promoting Interoperability (PI) category. Under PI, the base, performance and bonus scores that existed under ACI are being eliminated and replaced with a single set of objectives and measures. However, the reweighting and exemption provisions that applied to ACI will continue with under the new PI category.

    Another change is that, for the first time, clinicians may opt-in to the MIPS provided they exceed one of the three low-volume thresholds:

    1. They have ≤$90,000 in Part B charges
    2. They provide services to ≤200 Part B beneficiaries
    3. They provide ≤200 Part B services.

    This change is intended to add flexibility to the MIPS process.

    There is little change to the Advanced Alternative Payment Models (APMs) for CY 2019. The nominal risk-based revenue thresholds will remain at 8 percent until 2024, although the certified electronic health record threshold will increase to 75 percent for all eligible APM clinicians. In addition, all measures used by APMs must be evidence-based, reliable and valid. Lastly, CMS will allow for a determination period for a new model of APM known as the “All-Payer Option” APM, which will be available in CY 2020 at the earliest.

    Society staff continue to analyze the final rule and provide updates as appropriate.

    Article source
  • 11/05/2018 11:12 AM | Anonymous

    Wisconsin’s Doctor Day has become one of the largest events of its kind across the country and serves as the premier advocacy event for physicians in our state. Over 500 physicians and medical students representing nearly every medical specialty participate in this annual event for an opportunity to learn the legislative process first-hand, and to make their voices heard at the State Capitol. Doctor Day 2019, scheduled for May 1 in Madison, will kick off with and advocacy primer followed by a briefing on current issues impacting physicians and the patients they serve. 

    In the afternoon, attendees will meet with their legislators and/or legislative staff at the State Capitol, and the day will conclude with a reception at Madison’s. Learn more and sign up at www.WIDoctorday.org.


  • 11/02/2018 11:02 AM | Anonymous

    November 2, 2018, Wisconsin Medical Society Medigram  

    Wisconsin has seen a 32% decrease in opioid prescriptions dispensed since January 2015, according to a report released this week by the Controlled Substances Board at the state’s Department of Safety and Professional Services (DSPS).

    The report, which analyzes data from the Wisconsin Prescription Drug Monitoring Program (PDMP) from July 1, 2018 to September 30, 2018, shows a continued decline in opioid and other monitored prescriptions throughout 2018.

    “The data in this report is very promising, and it also shows that there is still much work to do,” said Wisconsin Medical Society CEO Clyde “Bud” Chumbley, MD, MBA. “I’m optimistic that we will continue to see progress through ongoing collaboration among physicians, other health care professionals and state policymakers to develop smart public policy and strategies that can help prevent addiction and help those who have become addicted.”

    In the past 12 months:

    • 80,900 fewer opioid prescriptions were dispensed, representing a 9% reduction over the past 12 months.
    • There has been a 4% increase in Suboxone® prescriptions, one of the most common medications used as part of Medication-Assisted Treatment (MAT) for opioid use disorder.
    • All six types of data-driven alerts concerning patient history have declined in frequency.

     
    In addition to the decrease in opioid prescriptions over the past 12 months, the report also highlights:

    • A 25% decrease in the total number of monitored prescriptions dispensed, over 690,000 fewer prescriptions since Q1 2015.
    • A 22% decrease in benzodiazepine prescriptions dispensed or 131,700 fewer prescriptions since Q1 2015.

     
    The report also includes information on the number of requests for data made by health care professionals about their patients.


  • 11/02/2018 10:59 AM | Anonymous

    November 2, 2018, Wisconsin Medical Society Medigram  

    The Centers for Medicare and Medicaid Services (CMS) announced yesterday its approval for Wisconsin’s 1115 Medicaid demonstration waiver. The approved waiver makes Wisconsin the fourth state to implement work requirements for its childless adult population (adults between the ages of 19 and 64). The initial waiver application also included drug testing requirements, but CMS did not approve those provisions.

    The approved waiver also includes the following provisions:

    • Limits eligibility for childless adults to 48 continuous months for those who do not meet specified obligations such as work requirements, education or job training or do not have a specified exemption. At the end of the 48 months, the enrollee will lose Medicaid eligibility for 6 months, at which time they could re-enroll in Medicaid and the 48-month clock would restart.
    • Establishes monthly premiums of $8 per household (or less depending on income and healthy behaviors).
    • Requires members to complete a health and wellness questionnaire. Monthly premiums for enrollees who complete the questionnaire will be cut in half.
    • Expands coverage of residential treatment for substance use disorder.
    • Establishes an emergency department (ED) copayment of $8 for non-emergency use of the ED. If enrollees appropriately use the ED for an emergency health issue they will not be charged a copay.
    • Discontinues premiums for parents and caretaker relatives who qualify for transitional medical assistance.

     
    The Wisconsin Medical Society commented on all these proposals in its May 2017 letter, which expressed concerns about potential impacts on patients and physicians, while offering support for expansion of substance use disorder treatment. The Society’s House of Delegates also passed policy on the waiver during its 2018 meeting last April.

    1332 Waiver

    In addition to its action on the 1115 waiver, last week CMS issued new guidance on 1332 waivers. The new guidance, which went into effect immediately, loosens existing guardrails on the 1332 waiver process. States will no longer be required to demonstrate that their 1332 waiver would cover the same amount of people as would be required absent the waiver, only that the same number of people would have access to coverage. Further, access could be defined as acquiring coverage from a short-term limited duration health plan or an association health plan, which do not have to adhere to Affordable Care Act patient protections.

    Contact the Society’s Manager of Advocacy and Regulatory Affairs H.J. Waukau if you have questions about either waiver.


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