News

  • October 11, 2017 12:48 PM | Anonymous

    Dear WSPS Member,

    Since the last update over the summer we have had no healthcare legislation passed.  It appears that Congress is having a difficult time defining priorities in a new healthcare bill.  From all perspectives, a consensus is not on the horizon either especially after the underwhelming response to the Graham-Cassidy bill.  ASPS’s stance includes a number of challenges to the current healthcare law as well as those proposed during recent months. Despite this uncertainty, insurance products in Wisconsin appear to be consistent as fears of widespread market withdrawal has subsided at least for the time being.

    On that note, a recent threat to our state’s tort climate has presented yet another example that any future federal healthcare legislation needs to address tort reform on a national level. A Wisconsin appellate court’s ruling that the current cap on noneconomic damages ($750,000) is unconstitutional (Mayo vs Wisconsin Injured Patients and Families Compensation Fund) now presents a challenge to what is considered a stable medicolegal environment.   This ruling puts the WIPFCF in peril and opens a door for frivolous litigation with unchecked settlements that at the end of the day make the practice of medicine more expensive for everyone in the state.  There is no evidence that removing caps on such settlements improves delivery or quality of health care.

    Currently, the Wisconsin Supreme Court has not indicated whether they will hear the case but most feel that this will be announced imminently.  WSPS, along with other subspecialty societies in the state, has committed to participating in the creation of an amicus brief outlining the concerns of these societies with the appellate court’s actions.  The American Medical Society and Wisconsin Medical Society have jointly filed an amicus brief to the Court of Appeals. 

    The impact of the appellate court’s actions certainly presents an obstacle in how medicine is practiced in this state.  Just talk to one of our colleagues in the state just south of us.  Make your voice known!  Regardless of your practice model or political preferences these legislative issues affect all our professional lives in a profound way!

    On a lighter note, October is Breast Cancer Awareness month.  Although we impact so many spheres of healthcare as plastic surgeons, our role in the treatment of breast cancer is front and center.  It’s important that we support the local, regional and national organizations that educate and support our patients facing this diagnosis.

    Just a reminder that the WSPS Annual Meeting is Friday, April 20th at the Milwaukee Marriott West.  We are excited to have Dr. Dan Del Vecchio visit us from Boston, MA.  We encourage everyone to attend as it will be a fruitful, intimate meeting.  More details will be revealed in the next couple of months but please mark your calendars!

    Best Wishes,

    John LoGiudice

  • October 05, 2017 9:30 AM | Anonymous

    September 19, Wisconsin Health News

    Attorney General Brad Schimel has joined the chief legal officers for 36 other states and territories to ask that insurers revise policies to reduce opioid prescribing. 

    Schimel and the other attorneys general wrote Marilyn Tavenner, the CEO of America's Health Insurance Plans, requesting that her members review payment and coverage policies to prioritize non-opioid pain management. 

    "We have witnessed firsthand the devastation that the opioid epidemic has wrought on our states in terms of lives lost and the costs it has imposed on our healthcare system and the broader economy," Schimel and others wrote. 

    They added that they'll soon be working with state insurance commissioners and others "to initiate a dialogue" with insurers to identify practices that can reduce opioid prescription and those that don't.

    "The status quo, in which there may be financial incentives to prescribe opioids for pain which they are ill-suited to treat, is unacceptable," the attorneys general wrote. "We ask that you quickly initiate additional efforts so that you can play an important role in stopping further deaths."

    Cathryn Donaldson, spokeswoman for America's Health Insurance Plans, said they share the attorneys general's commitment to addressing the opioid epidemic. Health plans cover approaches to pain management that include more cautious opioid prescribing, careful patient monitoring and other treatments, she said.

    Many health plans have already instituted programs that are helping to "dramatically reduce how much - and how often - opioids are prescribed," she said. 

    "By working together, doctors, hospitals, health plans and policy leaders can provide people with better pathways to healing - without putting their lives in danger because of opioids," she said.
  • August 16, 2017 5:47 PM | Anonymous

    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.
    REGISTER NOW
  • July 31, 2017 7:26 AM | Anonymous

    ASPS Advocacy Summit Update
    By John LoGiudice, MD

    Dear Colleagues,

    Shortly before the July 4th Congressional recess, members of the American Society of Plastic Surgeons convened on Capital Hill to address issues facing our members as well as medicine as a whole.  I attended this event the last week of June as the sole Wisconsin representative.   For those unfamiliar, ASPS has organized “Fly Ins” to Washington, D.C. for a number of years allowing members to meet with their congressional representatives.   This inaugural Advocacy Summit is simply an evolution of the “Fly In,” allowing members to be educated about policy, while facilitating a forum to discuss new problems facing plastic surgeons, and coordinating meetings with respective representatives in the House and Senate for members to discuss matters impacting the practice of medicine.  Organized months in advance, it was fortuitous that the Advocacy Summit was scheduled while healthcare was the main topic of discussion on Capital Hill and nationally.

    ASPS has identified five main federal policy issues that directly impact our constituents across the country. I will provide a brief summary.

    1. Network Adequacy - In response to mandates by the Affordable Care Act (ACA), insurers have created products that have narrow networks particularly as it pertains to specialty care.  This has resulted in unexpected out-of-pocket costs to patients for out-of-network care. These plans may leave patients with limited options to see specialists in their own region or may limit the patient to access an unqualified specialist.  ASPS has proposed mandating transparency by payers, implementing available directories to patients to make choices about specialists with appropriate practice scope, and allow coverage of out of network care if a specialist is not available in a given region.
    2. Ambulatory Surgical Center Quality and Access Act – Ambulatory Surgical Centers (ASC) have transformed the delivery of outpatient surgical care comparable to hospital based outpatient departments (HOPD) for considerably cheaper.  The cost of goods and services in ASCs and HOPDs is the same yet the rate of reimbursement is lower in ASC’s due to discrepant metrics to determine reimbursement.  Currently, Medicare reimburse an ASC 53% the HOPD rate for the same procedure.  Bipartisan legislation has been proposed to address this disparity. 
    3. Protecting Access to Care Act – This is proposed legislation addressing the lack of medical malpractice liability reform nationally.  It proposes a statute of limitation from date of incident, a cap on non-economic damages, and limiting attorneys’ contingency fees.  Bipartisan bills have been proposed. 
    4. Repeal of the Independent Advisory Board (IPAB) – Under the ACA, an IPAB would be formed if Medicare spending exceeds target growth rates.  This non-elected 15-member board would convene and ultimately yield power to adjust the Medicare fee schedule or access to qualified providers with no transparency to the process.  In essence, the IPAB can ration.  Interestingly a practicing physician cannot be on the IPAB but an insurance executive can be involved.  The IPAB would likely be convened this year due to higher medical cost inflation projected.  
    5. Graduate Medical Education – This proposed bill addresses the limitations in Medicare funding of graduate medical education (residency positions) in the US despite an increase a nationwide increase in medical school training positions.  The number of funded residency spots has been frozen since 1997.

    I had the opportunity to meet with Congresswoman Gwen Moore as well as members of Senators Ron Johnson and Tammy Baldwin’s offices.  With our neighbors in Michigan I also visited house and senate leadership representatives from that respective state.  Although Plastic Surgery isn’t foremost on these folk’s radar, it was effective to relay the problems that many of us encounter regardless of practice model.  Since we have the unique opportunity to work from head to toe in the young and old treating a broad spectrum of diagnoses with a variety of referring physicians, we see how the above issues impact delivery of care. 

    Many have asked about the sentiment on Capital Hill regarding legislation to repeal and replace or modify the ACA.  Whether it be a lobbyist or a congressional staffer, the expectation is that any attempts at redefining healthcare will be a long process.  Our daily news sources remind us of this debacle.  Although these observations are not substantiated by any poll or data, there is a theme regardless of party.  Congress will likely not accept drastic cuts in coverage resulting in millions of uninsured.  Quality measures will be part of an equation to reimburse regardless of name (MACRA).  Legislation allowing an insurer to deny / cancel policies for pre-existing conditions or to institute lifetime caps is not popular.   If you watch the news none of this seems profound.  In the weeks after the GOP initially attempted to pass their version of healthcare law, it seems inevitable that the only way the ACA will be repealed or modified, it is going to have to be a bipartisan effort like it’s supposed to be.

    Clearly, the federal policy issues that ASPS has identified are not the only problems we are facing in delivering care.  I would ask that you contact WSPS regarding practice issues that may be brought to the attention of our state and federal representatives.  

    All ASPS members are welcome to attend these Advocacy Summits which take place throughout the year.  It is an efficient way to get “face time” with your congressional representatives.  WSPS plans to send a board member annually to an Advocacy Summit to represent our interests.  Many of us look at the political process that is impacting healthcare with great skepticism.  Other than our patients, nobody has a bigger stake in the outcome but us.  We feel that regardless of your practice model it is best stay involved. 

    Best Wishes,

    John LoGiudice, MD FACS
    President, WSPS

  • July 14, 2017 10:33 AM | Anonymous

    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 injuries...it'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 12:06 PM | Anonymous

    Mark your calendars and plan to participate in Doctor Day 2018 on January 30, 2018 in Madison! 

    Doctor Day began informally five years ago, drawing roughly 80 physicians to a joint legislative day involving the Wisconsin Medical Society and a handful of specialty societies. Now, Doctor Day has grown by more than 500%! In 2017, more than 480 physicians and medical students were registered for the event, which came together in an effort to maximize physician visibility in Wisconsin's legislative arena, and therefore enhance our collective ability to advocate on health-care issues. 

    Unique in the nation, the equal-partnership, multi-specialty nature of Doctor Day has quickly become one of the largest Legislative Day events in Wisconsin. Plan to join your physician colleagues and participate in in Doctor Day 2018.

  • June 29, 2017 12:00 PM | Anonymous

    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.

  • June 15, 2017 10:45 AM | Anonymous

    June 8, Wisconsin Health News 

    Gov. Scott Walker's Department of Health Services officially asked the federal government Wednesday to allow Wisconsin to become the first state to drug screen adult Medicaid enrollees without children. The waiver amendmentalso caps eligibility, imposes work requirements and charges premiums to members living below the poverty line.

    DHS pared back some of the changes after receiving more than 1,000 pages of comments on the proposal. 

    That includes shrinking the income tiers for premiums from four tiers to two and not making anyone under 50 percent of the poverty level pay premiums. Childless adults with household incomes between 51 percent and 100 percent of the poverty level would pay $8 a month. Walker originally proposed a range of $1 a month to $10 a month for members making between 21 percent of the poverty level and 100 percent. DHS is also considering a grace period of 12 months for members that miss a payment. 

    In addition, the application decreases a copay for subsequent visits to the emergency room. And members who skip a drug screening can sign back up for coverage as soon as they consent to treatment, instead of waiting six months. 

    Walker called the application "a step in the right direction." "We're continuing to build on Wisconsin's legacy as a leader in welfare reform," he said in a statement Wednesday. 

    Jon Peacock, research director for the Wisconsin Council on Children and Families, said the latest changes to the proposal were "modest improvements." But they don't "change the basic problem that the waiver would add new barriers to BadgerCare participation that increase administrative costs and keep people from getting the care they need." 

    Last month, the state's budget committee voted to require that the panel approve the waiver amendment before it's implemented. At a Wisconsin Health News event Monday, Joint Finance Co-Chair Rep. John Nyrgen, R-Marinette, said he overall supported Walker's plan, but "there's still a lot of unanswered questions in the proposal." "For us to feel comfortable that we're moving in the right direction, we believe the proposal should come back to Joint Finance and we have the opportunity to vote it up or down," he said.

  • May 31, 2017 12:52 PM | Anonymous

    Rep. John Nygren, R-Marinette, and Sen. Alberta Darling, R-River Hills, the influential co-chairs of the Joint Finance Committee, will provide an update on the state budget, discuss a proposal to self-insure the state employee health plan, preview what's next for the Heroin, Opioid Prevention and Education agenda and highlight other healthcare legislation at a Wisconsin Health News Newsmaker Event.

    The event is Monday, June 5 at the Madison Club (5 E Wilson Street, Madison).  Lunch begins at 11:45; conversation starts at 12:15pm and adjourns by 1pm.

    Register now.

  • May 30, 2017 12:50 PM | Anonymous

    May 18, Wisconsin Health News

    The management side of a council charged with developing changes to the state's workers' compensation system has proposed creating a fee schedule for healthcare services.

    The Worker's Compensation Advisory Council, which consists of representatives from management and labor, crafts a bill that updates state law around workers' compensation every two years. Management and labor introduced their proposals at a meeting last week.

    Management is calling for setting initial rates at 150 percent of Medicare rates starting in 2017. The schedule would adjust each year with the medical consumer price index.

    The proposal differs from a measure that was pursued by the council four years ago but failed to make it into law, which was based on rates for surgeries and procedures negotiated by group health plans. 

    "The goal is the same, which is to bring cost containment to the state," said Chris Reader, an advisory council member and director of health and human resources policy at Wisconsin Manufacturers and Commerce.

    He said it's easier to construct the fee schedule using Medicare as it's difficult for the state to obtain average group health plan rates. More than 40 other states have fee schedules, he said.

    Mark Grapentine, Wisconsin Medical Society senior vice president of government relations and liaison to the council, questioned why Wisconsin would want to mimic other states when it already has a successful system.

    "The value of the current workers' comp system as it exists is by just about every measure fantastic," he said. "For whatever reason, the management side tends to have this fascination with sticker prices of individual procedures and not the overall cost of care."

    Reader pointed to other proposals from management they believe could help with costs. That includes allowing employers to direct workers to healthcare providers and requiring providers to follow treatment guidelines.

    If a provider decides to deviate from the guidelines, they would have to get prior approval. That ensures providers get employees back to work as soon as possible, he said.

    "Let me be clear - most do an excellent job of getting workers back to work," he said. "But having strong treatment guidelines will ensure that everybody has to do that unless there's a good reason not to."

    Grapentine said they're concerned about both proposals. Treatment guidelines could make it inefficient and frustrating for physicians to provide care to injured workers, he said.

    The proposal relating to guidelines, he said, is coupled with the fee schedule approach. States with fee schedules aren't as efficient in providing care, and treatment guidelines can cut utilization. He compared it to pushing on both sides of a balloon at the same time.

    "If you push on both sides of the balloon really hard, you know what happens," he said. "Why on earth would you do that to a system that people across the board think is a national model?"

    Management and labor are set to negotiate over the coming months to craft an agreed-upon bill for introduction to the Legislature. 

    Stephanie Bloomingdale, secretary-treasurer of the AFL-CIO and an advisory council member, declined to comment through a spokeswoman.

Wisconsin Society of Plastic Surgeons
563 Carter Court, Suite B, Kimberly, WI 54136
Phone: 920-750-7721 | Email: WSPS@badgerbay.co

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