• 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

  • 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.

  • 10/26/2018 10:29 AM | Anonymous

    October 26, 2018, Wisconsin Medical Society Medigram  

    The Trump Administration this week proposed a new rule that would allow employers to offer employees tax-preferred health reimbursement accounts (HRA) as an alternative to traditional health insurance.

    The rule is intended to provide businesses a way to support their employees’ healthcare expenses without requiring employers to shoulder the administrative and financial burdens of offering health plans.

    HRAs have been a fixture of employer-based health plans, often as a supplement to existing employer-based insurance. Under the proposed rule, HRAs could be used to satisfy the Affordable Care Act’s employer mandate, as employers could direct HRA funds to help pay for employee coverage on the individual insurance market. The rule also creates an option for employees to use HRA funds to pay for premiums for a short-term limited duration plan (up to a total of $1,800 per year), provided that the employer also offers a group plan that is not an HRA.

    The Administration estimates that 800,000 employers will use HRAs as a way to provide coverage for approximately 10 million employees. See this Fact Sheet for more information.

    The Wisconsin Medical Society will prepare and offer comments on proposal. Contact H.J. Waukau, manager of advocacy and regulatory affairs if you have questions.

    Source: WMS Medigram 

  • 10/12/2018 11:00 AM | Anonymous

    October 12, 2018, Wisconsin Medical Society Medigram  

    Nominations are now being accepted for several Wisconsin Medical Society offices, and all nomination materials are due to the Society’s House of Delegates (HOD) Nominating Committee by Wednesday, Jan. 2, 2019. 

    Read more.

  • 09/17/2018 9:24 AM | Anonymous

    Join us Oct. 9 for our annual insurance CEO roundtable. Leaders will discuss the most pressing issues facing their industry, including the fate of the Affordable Care Act, prescription drug prices, value-based payments and more.


    • Coreen Dicus-Johnson, CEO, Network Health
    • Dustin Hinton, CEO, UnitedHealthcare of Wisconsin
    • Cathy Mahaffey, CEO, Common Ground Healthcare Cooperative

    The event is Tuesday, October 9 at the Wisconsin Club in Milwaukee (11:30am – 1pm).  Register now (link).

  • 07/16/2018 10:45 AM | Anonymous

    The annual Wisconsin Health News CEO Roundtable is August 14 in Madison. A panel of the state’s leading health system and hospital leaders will discuss the most pressing issues facing their industry.

    Panelists include:

    • Dr. Sue Turney, CEO, Marshfield Clinic Health System
    • Robert Van Meeteren, CEO, Reedsburg Area Medical Center
    • Dr. Alan Kaplan, CEO, UW Health

    Register now (link).

  • 06/27/2018 2:09 PM | Anonymous

    WMS Medigram Alert - June 27, 2018  

    In a decision released this morning, the Wisconsin Supreme Court restored the state’s $750,000 cap on noneconomic damages in medical liability cases.

    The decision in Mayo v. Wisconsin Injured Patients and Families Compensation Fund reverses a 2017 Court of Appeals decision that struck down the cap, which has been integral to Wisconsin’s well-balanced medical liability system and patients’ access to care since 2005.

    “We are very pleased with today’s decision,” said Society President Molli Rolli, MD, in this press release . “The Court clearly understands the importance of the cap to our state’s unique and comprehensive medical liability system—a system that provides unparalleled benefits to both patients and physicians.”

    The wisconsin Medical Society has been a strong and vocal proponent of the cap since it was created, and in the Mayo case, submitted three separate briefs—jointly with the AMA Litigation Center—articulating the important benefits of the cap as part of Wisconsin’s comprehensive medical liability system.

    “The cap helps our state attract and retain top quality physicians and keep medical costs in check, and ultimately ensures Wisconsin citizens’ access to high quality care,” said Society CEO Bud Chumbley, MD.

    Click here to read the press release in its entirety.
  • 05/21/2018 5:34 PM | Anonymous

    Join us June 12 for a Newsmaker Event with Mayo Clinic Vice President Dr. Bobbie Gostout. As the leader of Mayo Clinic Health System, Gostout oversees the organization’s hospitals in Wisconsin, Minnesota and Iowa. 

    11:45 a.m. -1:00 p.m. 

    Register here. 

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