November 3, WMS Medigram

The Wisconsin Medical Society Board of Directors has named Clyde “Bud” Chumbley, MD, MBA, chief executive officer of the Wisconsin Medical Society.

“I’m excited to have the opportunity to serve as the next CEO of the Wisconsin Medical Society; I consider it a tremendous honor,” said Dr. Chumbley, who will begin on November 27. “Having been a Society member for 37 years, I’m a firm believer in its mission to advance the health of the people of Wisconsin by ensuring access to high-quality, cost-efficient care. And I look forward to drawing on my experience to further strengthen the Society so we can continue to make a difference for our patients and our profession.”

In addition to caring for patients as a board-certified obstetrician/ gynecologist throughout his 36-year medical career, Dr. Chumbley has held numerous leadership and management positions, including serving nearly 20 years as president and CEO of a large, independent multi-specialty medical group practice. He currently serves as chief medical adviser for Wisconsin Medical Society Holdings and as chief medical officer for the Wisconsin Medical Society Holdings Association Health Plan.

Past leadership roles in Wisconsin include serving as chief medical officer/chief clinical integration officer for Aspirus Health and president of Aspirus Clinics, and as president and CEO of ProHealth Care Medical Associates. He also has served on the board of directors and as past chair and treasurer for the Wisconsin Collaborative for Healthcare Quality. In Texas, he served as chief medical officer for Scott & White Healthcare in the Austin region.  

Doctor Chumbley is a graduate of the University of Missouri School of Medicine and the Kellogg School of Management at Northwestern University and holds medical licenses in Wisconsin and Texas.

“We were fortunate to have a number of highly qualified candidates interested in this position,” said Jerry Halverson, MD, chair of the Society’s Board of Directors and co-chair of the search committee. “Doctor Chumbley is an excellent advocate for physicians and the patients we serve, and with his extensive administrative experience and medical expertise, we believe he is an outstanding choice to lead the Society. We look forward to all we can accomplish under his leadership.”

Doctor Chumbley is the eighth Society CEO in its 176-year history. Susan L. Turney, MD, MS, FACMPE, FACP, was the first physician to hold the position from 2004 to 2011.

Deputy Insurance Commissioner J.P. Wieske will outline what a Wisconsin version of the Affordable Care Act could look like at the Dec. 13 Wisconsin Health News Newsmaker Event.

Wieske announced this fall the state is considering applying for a 1332 waiver from the law, which allows states to develop unique solutions for providing affordable healthcare coverage. Wieske will discuss the state’s next steps, as well as provide an update on open enrollment and the current insurance market.

Wieske has served as the state's deputy insurance commissioner since 2016. Before that he was the department's legislative liaison and public information officer for five years. He previously served as the executive director of the Council of Affordable Health Insurance.

 Register here.

November 8, Wisconsin Health News 

Healthcare providers and the state’s business lobby sparred over a proposal that would establish a fee schedule for the workers’ compensation program at a Wisconsin Health News event Tuesday. 

Under the proposal, the Department of Workforce Development would build a fee schedule to approximate the average negotiated price of group health in the state. It would also provide an additional 2.5 percent to 10 percent increase to cover administrative costs. 

“Wisconsin’s costs have gone up pretty dramatically in the last 20 years,” said Chris Reader, director of health and human resources at Wisconsin Manufacturers and Commerce. “We’re now, if not the most expensive, we’re close to it in most areas.” 

Reader said that employers are seeing that they’re paying more for the same procedure compared to group health plans and other states. More than 40 other states have developed their own medical fee schedules. 

The Legislature didn’t enact a fee schedule four years ago. But this time is different because costs have gone up, according to Reader. 

Mark Grapentine, senior vice president of government relations for the Wisconsin Medical Society, called the proposal a “solution in search of a problem.” He said that Wisconsin provides wide access to high quality care, which helps workers get better quicker. 

Grapentine said there’s a lot of attention paid to individual codes for procedures as opposed to the cost per claim. Wisconsin’s cost for all workers’ compensation claims on the healthcare side is around the national average, he said. 

“When you look at the whole picture overall, the story is pretty good,” he said. “The rest of the country looks at Wisconsin workers’ comp. program as a national model.” 

But Charles Burhan, assistant vice president and senior public affairs officer for Liberty Mutual, said most employers cannot negotiate on workers’ compensation. 

“It’s a national model for high prices,” he said of Wisconsin’s current system. “Is there a need for a fee schedule? Yes." 

Joanne Alig, senior vice president of policy and research at the Wisconsin Hospital Association, said that group health has lower prices because of negotiations, such as prompt payment. 

She said that workers' compensation premiums in Wisconsin have declined the last two years too. “To say that costs are not coming down, we just disagree with that,” she said. 

Oct. 12, 2017 WMS Medigram

In partnership with the Wisconsin Department of Justice (DOJ) and the Drug Enforcement Administration (DEA), local law enforcement agencies will be holding Prescription Drug Take Back Day on Saturday, Oct. 28. Police and sheriffs’ departments will host events throughout Wisconsin as part of the Take Back Day.

In partnership with the Wisconsin Department of Justice (DOJ) and the Drug Enforcement Administration (DEA), local law enforcement agencies will be holding Prescription Drug Take Back Day on Saturday, Oct. 28. Police and sheriffs’ departments will host events throughout Wisconsin as part of the Take Back Day.

The goal of Prescription Drug Take Back Day is to provide a safe, convenient and responsible means of disposal of unused or expired prescription drugs, while also educating the community about the potential abuse and consequences of improper storage and disposal of these medications.

Drug take back days are held each spring and fall across the country, and according to Attorney General Brad Schimel, the April 2017 Drug Take Back events in Wisconsin reached a record-breaking collection of 66,830 pounds of unused medications. Wisconsin had more law enforcement agencies participate in the biannual event than any other state in the country with 267 police and sheriffs’ departments from 69 counties hosting 150 events.

In addition to the semiannual Take Back Day event, there are 328 permanent drug disposal drop boxes throughout Wisconsin, providing citizens a convenient, environmentally friendly and anonymous way to dispose of unused medications all year. Wisconsin has more drug disposal boxes than 46 other states, behind only California, Texas and Pennsylvania.

For more information, including a list of accepted medications, visit the DOJ’s website. Additional information also is available on the “Dose of Reality” website, which features an interactive map people can use to find a drug take-back location near them.

The deadline for Wisconsin medical license renewal is approaching—Oct. 31, 2017, for MDs and Feb. 28, 2018, for DOs—and new this cycle is the Medical Examining Board (MEB) requirement for most physicians to complete two CME credits on its Opioid Prescribing Guideline. 

Upon renewal, physicians must attest that they have completed the required opioid prescribing CME or will by Dec. 31, 2017. Only MEB-approved courses satisfy the mandate. All physicians should maintain a record of their participation; however, documentation is required only in the event of an audit.

Access a list of Board-approved courses here.

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 20^th 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

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.

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

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 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.