Membership-based direct primary care models are rising in popularity. What’s driving this growth and what does it mean for the rest of the healthcare system?
A Wisconsin Health News Panel on Nov. 13 in Madison, The Netflixing of healthcare: The rise of direct primary care and what it means for the rest of the healthcare system, will take a deep dive into this emerging model, which was the focus of a recent legislative study committee and has spurred legislation. Panelists include:
Nov. 8, Wisconsin Health News
Gov.-elect Tony Evers is poised to dramatically alter Wisconsin’s approach to Medicaid and the Affordable Care Act, a move that could reshape parts of the state’s healthcare market.
Gov. Scott Walker, a longtime foe of Obamacare, conceded Wednesday afternoon to Evers, the state superintendent who ran a campaign focused on healthcare and expanding coverage under the ACA.
“The results of this election in Wisconsin are very consequential with regard to health policy,” said Donna Friedsam, health policy programs director at the University of Wisconsin Population Health Institute. “There’s going to be a number of substantial changes.”
Evers will have to work with a Republican-controlledLegislature. He told reporters Wednesday that he wants to meet with legislative leaders to discuss moving forward on healthcare and other issues.
“I would really like to talk to them about how we can kind of set the stage going forward so we can find common ground,” he said.
Assembly Speaker Robin Vos, R-Burlington, said in a statement that he’d work to find “common ground when possible.”
“While yesterday was a win for Gov.-elect Evers, it cannot be seen as any kind of mandate for change,” he said. “Assembly Republicans will continue to deliver on our conservative promises to our constituents and won’t allow Wisconsin to slide backward.”
Dr. Bud Chumbley, Wisconsin Medical Society CEO, said that divided government at the state level could lead to gridlock and slow efforts to reduce the uninsured rate.
But he noted that the divided federal government, with Democrats controlling the House and Republicans controlling the Senate, will likely halt efforts to repeal and replace the Affordable Care Act, protecting people who gained coverage under the law.
“It’s hard to say,” he said. “A lot of things are said in campaigns. It’s hard to sort out what people are going to do."
The Wisconsin Hospital Association sees a bipartisan way forward on increasing the number of healthcare workers to meet demand and promoting use of telemedicine.
“We are confident that all of us will remain focused on enacting bipartisan public policy that maintains Wisconsin’s high-quality healthcare system,” WHA CEO Eric Borgerding said in a statement.
Medicaid expansion could come with the next budget
Healthcare experts expect Evers will propose expanding Medicaid in his first biennial budget.
While Republican lawmakers have long opposed accepting federal money for expansion, they may have a difficult time filling a hole that could amount to more than $200 million.
There’s also enthusiasm among voters nationwide to take the money. Idaho, Nebraska and Utah voters all approved expanding Medicaid Tuesday.
“Yesterday’s election results substantially increased the chances of expanding BadgerCare,” Jon Peacock, Kids Forward research director, wrote in an email. “The approval of referendums to expand Medicaid in three very red states shows how popular that policy is.”
Also at stake are the state’s efforts to require that some childless adults work, pay premiums and take a health risk assessment to qualify for BadgerCare. Wisconsin received approval on the waiver last week.
According to the Centers for Medicare and Medicaid Services, governors may decide not to implement Medicaid waivers. If states choose to change how their Medicaid program operates, they would need to renegotiate with federal officials.
“Although the state now has authority to make these changes, the new governor could potentially withdraw, amend or not implement the waiver,” the Kaiser Family Foundation noted in a brief released Wednesday.
State could shift attitude toward Affordable Care Act
Evers vowed during his campaign that he’d withdraw Wisconsin from a lawsuit seeking to invalidate the ACA on his first day in office.
Democratic Madison attorney Josh Kaul declared victory in the state’s attorney general race Wednesday morning. Republican Attorney General Brad Schimel acknowledged Kaul’s lead but didn’t concede, saying he’ll wait until every vote is counted.
Peacock expects that Evers and Kaul will “put some muscle” into the campaign rhetoric around coverage of pre-existing conditions. He predicted that Wisconsin will “switch sides by backing the state attorneys general that are defending the law.”
Friedsam of the UW Population Health Institute said that Evers’ pick for insurance commissioner could take a different approach to regulating insurance in Wisconsin, particularly around the individual market.
That could have an impact on how plans that don’t comply with the ACA are promoted or to the degree that they’re offered in the state. And the state could end up playing a greater role in outreach and promoting enrollment, she said.
Friedsam also said there’s “opportunities to use the purchasing power of the state” through Medicaid and the state employee health plan “to try to help control healthcare prices generally.”
The National Prescription Drug Take Back Day aims to provide a safe, convenient, and responsible means of disposing of prescription drugs, while also educating the general public about the potential for abuse of medications.
National Prescription Drug Take-Back Day is Saturday, October 27, 2018 from 10:00 a.m. - 2:00 p.m. National Take-Back Day is a safe, convenient, and responsible way to dispose of unused or expired prescription drugs.
Learn more about Drug Take-Back Day in Wisconsin, and find a location near you to safely drop off your unwanted or unneeded prescription painkillers and other drugs.
Oct. 25, WMS Medigram
The Wisconsin Medical Society’s popular Medical Records and the Law seminar is returning—as a new webinar series, available live and on-demand. Featuring presentations by health care law attorneys from Quarles and Brady, LLC., the seven-part series will address the following issues important to physicians and their practices:
During the November 7 webinar, Sarah Coyne, JD, will discuss changes to state and federal legal requirements involving the disclosure of health information to law enforcement and offer practical answers to questions about when a physician CAN or MUST disclose information. Registration information is available here.
Each webinar in the series has been approved for AMA PRA Category 1 Credit™ and is intended for physicians, practice managers, compliance staff and other health care professionals.
Email firstname.lastname@example.org if you have questions about this series or would like more information.
The WCMS Legislative Forum at the Delafield hotel on September 5th was a resounding success. We had a record number of members and guests, with 66 people in attendance. Once again, the venue provided excellent fare and and attentive staff.
There was an informative update about pending and proposed legislation in Madison, followed by a lively Q&A session which gave members an opportunity to voice questions, concerns, and suggestions to our legislative representatives, State Senator Chris Kapenga and State Representative Cindi Duchow. This event remains one of the premier events sponsored by WCMS.
Our Stop the Bleed campaign progresses, with two Board members scheduled to attend a “train the trainer” course, and with the medical students and residents, we have dates scheduled for faculty training at several area high schools.
As always, your support is crucial to our mission, and members are welcome to reach me at WaukeshaCMS@badgerbay.co.
With warm regards,
Jon Brodie, M.D., FAAFP
Waukesha County Medical Society
“It’s not the price of membership; it’s the price you paid to become eligible.”
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.
Candidates are sought for the following offices:
• President-Elect for 2019-2020.
• Speaker for 2020 and 2021—to succeed Michael Miller, MD, of Middleton. (Doctor Miller is eligible for reelection.)
• AMA Delegate for 2020 and 2021 (two positions)—George M. Lange, MD, River Hills; Charles Rainey, MD, River Hills (incumbents).
• AMA Alternate Delegate for 2019 and 2020 (one position)—currently vacant.
• AMA Alternate Delegate for 2020 and 2021–Nameeta Dookeran, MD, West Allis; Don Lee, MD, Milwaukee (incumbents).
All candidates must submit a curriculum vitae not to exceed three pages, a cover letter no longer than one page, a completed candidate questionnaire for the office the candidate is seeking and a completed Disclosure of Significant Affiliations (conflict of interest) form. The candidate questionnaire forms are available here.*
The House of Delegates Nominating Committee will meet Friday, Jan. 25, 2019, at 4 p.m. at Society Headquarters in Madison. The Committee will interview and evaluate the candidates for Society offices and prepare a slate of nominees for presentation to the House of Delegates on Sunday, April 7, 2019, at the Annual Meeting in Madison.
October 4, WMS Medigram
A bill that aims to address the opioid crisis at the national level has overwhelmingly passed in both the U.S. House of Representatives and Senate. Last Friday, lawmakers in the House passed the bill 393-8, and yesterday the Senate followed suit, with a 98-1. The bill now goes to President Trump for his signature.
The Substance Use–Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (H.R. 6) is a cumulation of House and Senate opioid efforts over the last year. The bill encompasses more than 170 distinct provisions, which include regulatory measures as well as guidance on existing programs, grants, prescribing practices and procedures related to handling and disposing of opioids.
Prior to the Congressional votes, the Wisconsin Medical Society weighed in on in some of the bill’s provisions in a letter from Michael McNett, MD, chair of the Society’s Opioid Task Force to Speaker Paul Ryan. In it, Dr McNett asked for support of the temporary repeal of the Institutes for Mental Diseases exclusions for Medicaid beneficiaries, increased Medicare payments for non-opioid treatments for post-surgical pain, and increased access to medication assisted therapy (MAT) and codifying increasing patient caps on MAT.
“Much work remains to be done in fighting the opioid crisis. Specifically, the Society would like to see increased and continued funding for MAT and non-opioid treatments for pain, along with grants for training both physicians and medical students on proper prescribing methods,” Dr. McNett wrote. “The current actions of both the House and the Senate represent a positive step in addressing opioid crisis and lay the foundation for future efforts.”
With an overall fiscal impact estimated at $1.024 billion by the Congressional Budget Office, H.R. 6 authorizes over $850 million in new grants to create projects aimed at increasing access to substance use disorder (SUD) treatment, first responder training, creating recovery centers and education programs. It also requires that the Department of Health and Human Services (HHS) and its subsequent agencies conduct studies, issue reports and collect data to better understand the opioid epidemic, determine possible solutions and facilitate data sharing.
H.R. 6 is organized into to the following sections.
Medicaid—The Medicaid provisions of H.R. 6 consist of the following categories: coverage and access to services for children and mothers, increasing access to substance use disorder (SUD) and MAT treatments, improving data and data sharing/reporting as it relates to the opioid crisis and changing regulations surrounding exclusions for the Institutes for Mental Diseases (IMD). There are also provisions to allow Medicaid SUD services to be provided via telehealth and to require prescribers to check a prescription drug monitoring program when prescribing a Schedule II controlled substance for Medicaid beneficiaries.
Medicare—Similar to the Medicaid provisions, the Medicare aspects of H.R. 6 expand access to treatment, including MAT, for both traditional Medicare recipients and those with Medicare Advantage plans. H.R. 6 also places an emphasis on the secure prescribing of opioids under Medicare, including a provision that by 2021 all opioid prescriptions be prescribed electronically. These provisions also place an emphasis on opioid education for both prescribers and patients pertaining to proper prescribing protocols, alternative nonopioid treatments and storage and disposal of opioids. Other provisions include specific requests for studies and programs aimed at either creating new payment models under Medicare, studying prescribing incentives under Medicare or creating new opioid prescribing models/education for Medicare patients.
Food and Drug Administration (FDA) & Controlled Substances—The FDA section of H.R. 6 also contains provisions related to MAT, specifically codifying into law caps on the number of patients a trained and certified physician can treat with MAT. It also lifts the time limits on MAT prescribing for nurse practitioners and physician assistants and would allow clinical nurse specialists, certified nurse midwives and certified nurse anesthetists to prescribe MAT for five years. These provisions also include significant guidance and regulation of pain medicines, safety packaging, importation of illegal narcotics, safety and disposal and data sharing to help prevent diversion of opioid medications.
Public Health—The public health provisions of H.R. 6 aim to address numerous issues including the following: improving awareness and training for first responders; indexing narcotics, fentanyl and opioids; pain research; communication of patient records during emergencies; studies and guidance for programs aimed at helping pregnant women and infants; SUD and workforce concerns; emergency department procedures; funding for comprehensive opioid recovery centers; trauma informed care procedures; and peer supports. This section also reauthorizes the targeted state response grants from the 21st Century Cures Act.
Miscellaneous—H.R. 6 also features a number of “miscellaneous” provisions that include addressing trafficking concerns and overdose protections; fraud prevention; grants for workforce improvement; peer supports for veterans; pilot housing programs; residential treatment; drug testing; and reauthorization of funds for existing federal offices and programs such as the Office of National Drug Control Policy, Drug Free Communities and the High Intensity Drug Trafficking Areas program.
The Wisconsin Medical Society, in partnership with the Medical College of Wisconsin and the University of Wisconsin School of Medicine and Public Health, will host a two-day conference April 5-6, 2019 focused on emerging health care trends and preparing for summer.
The conference has been approved for AMA PRA Category 1™ credit and will address three areas of health care especially relevant during the summer months: environmental health, trauma and Infectious disease.
“We’ve heard over and over from physicians across the state that they really value coming together face-to-face, and this event will provide an opportunity for physicians from all specialties to network, socialize and gain valuable insight on topics that are relevant across specialties and geography,” said Society CEO Clyde “Bud” Chumbley, MD, MBA. “We’re very excited about how this conference is coming together and especially thankful to the medical schools for their leadership and involvement. It’s going to be a great program.”
The conference will precede the Society’s annual House of Delegates meeting, which is Sunday, April 7. The inaugural ceremony will be held Saturday evening after the conference concludes, and the Wisconsin Medical Society Foundation’s Annual Fundraising event is Friday, April 5 beginning at 5 p.m.
Sept. 14 News Alert, Wisconsin Health News
Gov. Scott Walker would call a special legislative session if necessary to ensure that those with pre-existing conditions have access to health coverage, a spokesman for his re-election campaign said Friday.
“Everyone with pre-existing conditions in Wisconsin is already covered,” spokesman Brian Reisinger said in a statement. “If something were to change, Scott Walker would call a special session in a heartbeat and get it passed.”
The announcement follows a back-and-forth between Walker's campaign and that of his challenger Superintendent Tony Evers and other Democrats over the governor’s position on insurance protections for those with pre-existing conditions.
“Walker has no credibility on the issue, and Wisconsinites have no reason to trust him and these hollow election-year promises,” Sam Lau, Tony for Wisconsin spokesperson, said in a statement.
Democrats have raised concerns about a lawsuit filed by Republican Attorney General Brad Schimel and other conservative attorneys general that seeks to invalidate the Affordable Care Act.
The Trump administration has declined to defend the law, but said the court should only strike down some provisions, like those guaranteeing coverage for people with pre-existing conditions. Attorneys general from other states like Minnesota and Illinois are defending the law.
Wisconsin Health News will present its annual insurance CEO Roundtable. Insurance leaders on Tuesday, October 9 in Milwaukee.
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. Panelists include:
Register here to attend.
Contact WCMS563 Carter Court, Suite B, Kimberly, WI 54136
Ph: 920-560-5641 | Fax: 920-882-3655Email: WaukeshaCMS@badgerbay.co
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