Author: By WI Senator Rachael Cabral-Guevara (R-Appleton)

As a healthcare provider myself, I’ve seen firsthand the dramatic changes the industry has gone through in the last two decades. Digitization, growth in specialty care, and diversification of service models have all helped advance how providers deliver care to patients.

Then a pandemic hit. This dramatically increased burnout, wore on the mental health of staff, and others simply left because of overburdensome restrictions. As a result, the entire healthcare system is still reeling from historic drops in staffing levels, with the pipeline of students entering the profession not keeping up with demand.

Hospitals are now relying on traveling nurses, who can come at a cost almost three times as much as nursing staff. Nursing homes, who were struggling to recruit before the pandemic, are now closing entire wings of their facilities. Meanwhile, the shortage of providers in rural areas remains an issue and the pace of attracting professionals to Wisconsin has been slow.

What can be done? As chair of the Senate Committee on Health this session, I’ve made it my mission to address these workforce issues head-on. There is no “silver bullet” solution–both investment and regulatory reform is necessary to improve Wisconsin’s nation-leading healthcare system.

I’m focused on three specific areas to achieve this:

• Boosting the attractiveness of healthcare professions to students. By highlighting healthcare professions and the rewarding nature of care, we can and should do a better job encouraging internships and other work-based learning programs for students to be exposed to healthcare. We also have opportunities to offer some loan forgiveness for our highest-need professions, reducing the financial burden on those who wish to pursue a career in the field.

• Streamlining the school-to-work pipeline. I’ve proposed letting students who have completed their education and training to enter the workforce without waiting on a bureaucratic process that–in some cases–can last months. This would keep students here after college, allow them to enter the workforce immediately, and so long as their employer consents, start treating patients.

• Allowing healthcare professionals to practice at the full extent of their scope. This includes our nurses, who are now operating in an environment that hinders their ability to practice independently. By unleashing this group of healthcare professionals, we can help solve two issues: attract more nurses to Wisconsin (which is desperately needed) and expand the pool of providers able to set up shop in areas that need it most.

Though we can and should do more than this, we need to start somewhere. This is our opportunity to break down barriers, build a robust patient-focused system, and deliver more accessible care to Wisconsinites.

Let’s keep moving forward!

Sen. Rachael Cabral-Guevara (R-Appleton) served one term in the state assembly and currently represents the 19th Senate District in the Wisconsin State Senate. She serves as chair for the Senate Committee on Health and Vice Chair for the Senate Committee on Mental Health, Substance Abuse Prevention, Children, and Families.

The 2023-24 legislative session is in full swing, and although the state budget bill is consuming most of the attention and activity in the State Capitol, numerous stand-alone bills are being introduced and considered by lawmakers. The WISCA Government Affairs Team – helmed by Andy Engel at Hamilton Consulting – is actively lobbying on legislation of interest to WISCA members.

Members can follow the activity in the Capitol with the WISCA Legislative Tracker that provides key information on the bills WISCA is working on under the Capitol dome. The Bill Tracker, which you can find below, includes the bill number, a description of the bill, its status, and WISCA’s position on the proposal:

·        Bill: Assembly Bill 144 / Senate Bill 158

• Description: This legislation, which aims to expedite occupational licensing in Wisconsin, would require the state to grant preliminary occupational credentials to health care professionals. More specifically, the bill requires the Department of Safety and Professional Services to grant a preliminary credential to an individual who has met all the requirements for a permanent credential, including having completed all education, training, and supervised experience requirements. In addition, an applicant for a preliminary license must also: 1.) Attest that they do not have a disqualifying arrest or conviction record; 2.) Verify that the position they have been hired for is within the scope of their practice; and 3.) Confirm that they have applied for a permanent credential. Finally, the health care employer that hired the applicant must verify that the individual has – to the best of the health care employer's knowledge – completed the required education, training, and supervised experience necessary for a permanent credential. 

·     Status: AB 144 was introduced and referred to the Assembly Regulatory Licensing Reform Committee. The committee held a public hearing on the bill on 04/12/23. SB 158 was introduced and referred to the Senate Committee on Licensing, Constitution, and Federalism.

·     WAO Position: SUPPORT

The WISCA Government Affairs Team  is also closely watching legislation (AB 245 / SB 301) to eliminate the personal property tax in Wisconsin. The proposal, which is supported by WISCA, was passed by the full Assembly and is under further consideration by the Senate.

WISCA will continue to monitor these proposals and report back to the membership on their status in future editions of the WISCA Advocacy Newsletter.

Author: Andrew Engel - WISCA Lobbyist (Hamilton Consulting)

Several legislators have authored a bill to create hospital price transparency requirements in Wisconsin. The authors, Sens. Felzkowski (R-Irma) and Bradley (R-Franklin) and Reps. Brooks (R-Saukville) and Rozar (R-Marshfield), are referring to the legislation as the “Know Your Healthcare Costs Act.”

The bill, which would NOT apply to ASCs, requires hospitals to create a publicly available, machine-readable digital file containing a list of standard charges for certain items and services, and a consumer-friendly list of standard charges for “shoppable services.” These lists of standard charges must be made publicly, readily available on the hospital’s website and to internet search engines, and periodically updated.

The requirements are very similar to federal price transparency rules enacted in 2021, but with additional state-level enforcement provisions and penalties. Notably, the bill directs the Department of Health Services to levy daily fines against a noncompliant hospital. Similar legislation has been enacted on a bipartisan basis in Texas and Colorado.

Some observers have criticized the federal rules for a lack of “teeth,” so to speak, with insignificant penalties and a lack of enforcement against hospitals that fail to comply. Sen. Felzkowski has said that any hospital complying with the federal rules would be in compliance with her legislation.

A “shoppable service” refers to a nonemergency service that a hospital can schedule in advance, as opposed to emergency and acute care services. According to one estimate, cited by the bill’s authors, about 80 percent of healthcare goods and services are shoppable.

Wisconsin Manufacturers and Commerce, the state’s chamber of commerce and largest business association, released a statement in support of the bill: “Informed health care consumers create a competitive market. Therefore, it is vitally important for employers and their employees to have access to transparent and easily understood medical cost data.” The statement also notes that Wisconsin has the fourth highest hospital costs in the nation.

This week, a coalition of free-market policy advocates published a letter to legislators encouraging them to support the bill. The coalition includes the Wisconsin Institute for Law & Liberty (WILL), Institute for Reforming Government, Cicero Institute, Opportunity Solutions Project, Americans for Prosperity, and Badger Institute.

In October of last year, WILL released a report calling for the enactment of price transparency requirements in Wisconsin. For example, WILL found that a typical CT scan can cost anywhere from $858 to $2,803 in Wisconsin. The report notes that the rise of high-deductible health plans has incentivized many healthcare consumers to compare providers and choose those offering lower prices.

The Wisconsin Hospital Association is opposed to the bill.

WISCA President Amanda Sosnosky provided freshman state lawmaker Rep. Nate Gustafson (R-Neenah) with a tour of the Orthopedic Surgery Center of the Fox Valley.  In addition to a tour of the facility, there was great conversation about the benefits of patient care in an ACS setting, as well as some of the regulatory and workforce challenges faced by the industry.

The next deadline for submitting Ambulatory Surgical Center Quality Reporting (ASCQR) Program data for several measures is Monday, May 15.  ASCs must submit 2022 data via the Hospital Quality Reporting secure portal for ASC-9: Endoscopy/Polyp Surveillance: Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients, ASC-13: Normothermia and ASC-14: Unplanned Anterior Vitrectomy. In addition, the next quarterly data submission deadline for ASC-20: COVID-19 Vaccination Coverage Among Health Care Personnel is also Monday, May 15, and covers the data collected in the fourth quarter of 2022, October 1 through December 31. For ASC-20, facilities must select one week per month on which to report to meet the quarterly submission requirement.

The ASCQR Program provides a Web-Based Measure Status Listing that allows facilities to check their data submission status for web-based measures in the program. Enter your ASC’s NPI or CCN in the ASC Facility and CCN Lookup section to see your facility’s submission status. ASCs that fail to meet ASCQR Program requirements are subject to a 2 percent cut to their fee-for-service (FFS) Medicare reimbursements. ASCA has resources available to help, starting with the main Quality Reporting webpage. To ensure you are ready for compliance in 2023, the “How to Meet Medicare’s 2023 ASC Quality Reporting (ASCQR) Program Requirements” resource takes you through the measures that remain in the program for 2023 and what you need to do to avoid penalties in 2024. Additional resources, including the ASCQR Program Specifications Manual, are available on the ASCQR Program website. If you have questions, contact the ASCQR Program Support Contractor at 866.800.8756 or through the Quality Question and Answer Tool.

Sign-up to host a legislative tour of your ASC

With the 2023-24 legislative well underway – and legislators busy at work on critical health care policy – it is more important than ever for WISCA members to strengthen their relationships with their state lawmakers and educate them on the ASC model of care, the regulatory challenges we face, and the legislative solutions we need to increase access to affordable, quality care provided in the ASC setting. Rember, decisions state legislators make in the Capitol building can have a significant impact on the ASC industry, your organization, and your profession.

One of the best ways you – as a  WISCA member— can engage your local legislators is to invite them to tour your ASCs to illustrate firsthand the many benefits of surgery center care. These visits provide a tremendous advocacy opportunity, which is why WISCA members across the state have already hosted numerous successful legislative tours. But we need to maintain the enthusiasm for this critical grassroots advocacy program, and WISCA is excited and ready to set-up additional tours today.

If you would like to host a legislative tour at your site, please contact the WISCA office at WISCA@badgerbay.co. We will work with you and your legislators to coordinate the meetings and will provide participating members with full support, including legislator bios, advocacy tips, issue briefings, and supporting documents.   

WISCA works closely with our national association partner – the Ambulatory Surgery Center Association (ASCA) – on advocacy and other issues important to our members. In fact, the WISCA Government Affairs Team joins a national ASCA state chapter call twice a month for a federal regulatory and legislative briefing and closely follows their published Government Affairs Updates. Here is the latest government affairs news from ASCA:

• Update on CMS Meeting
• • On February 22, ASCA representatives met virtually with the Centers for Medicare & Medicaid Services (CMS) staff responsible for payment policies in ASCs. One topic of conversation was the ASC Covered Procedures List (ASC-CPL). ASCA representatives raised concerns with CMS using a “typical Medicare beneficiary” standard to determine what procedures should be added to the ASC-CPL, questioning who this description represents and arguing that clinicians should be given more discretion to determine the appropriate site of service. ASCA also mentioned the ASC-CPL survey results received from its members and indicated it would be submitting the list of requested procedures to the agency within the next few days. ASCA also asked about the future of the five-year pilot CMS established for updating ASC reimbursement from 2018–2023 using the hospital market basket instead of the Consumer Price Index for All Urban Consumers (CPI-U), which was used previously. ASCA is looking to evaluate the impact of this change on the payment system, but since CMS did not release 2020 data due to the pandemic and the pandemic itself has influenced volume, there is limited information that can be used to determine the impact of the policy. ASCA staff is hopeful that CMS will continue to use the hospital market basket beyond 2023, so there will be more data on the impact. Please contact Kara Newbury with any questions.
• ASC Quality Reporting Deadline Approaching
• • As a reminder, the next deadline for submitting Ambulatory Surgical Center Quality Reporting (ASCQR) Program data for several measures is Monday, May 15. ASCs must submit 2022 data via the Hospital Quality Reporting secure portal for ASC-9: Endoscopy/Polyp Surveillance: Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients, ASC-13: Normothermia and ASC-14: Unplanned Anterior Vitrectomy. In addition, the next quarterly data submission deadline for ASC-20: COVID-19 Vaccination Coverage Among Health Care Personnel is also Monday, May 15, and covers the data collected in the fourth quarter of 2022, October 1 through December 31. For ASC-20, facilities must select one week per month on which to report to meet the quarterly submission requirement.
  • • The ASCQR Program provides a Web-Based Measure Status Listing that allows facilities to check their data submission status for web-based measures in the program. Enter your ASC’s NPI or CCN in the ASC Facility and CCN Lookup section to see your facility’s submission status. ASCs that fail to meet ASCQR Program requirements are subject to a 2 percent cut to their fee-for-service (FFS) Medicare reimbursements. ASCA has resources available to help, starting with the main Quality Reporting webpage. To ensure you are ready for compliance in 2023, the “How to Meet Medicare’s 2023 ASC Quality Reporting (ASCQR) Program Requirements” resource takes you through the measures that remain in the program for 2023 and what you need to do to avoid penalties in 2024. Additional resources, including the ASCQR Program Specifications Manual, are available on the ASCQR Program website. 
    • If you have questions, contact the ASCQR Program Support Contractor at 866.800.8756 or through the Quality Question and Answer Tool.

To ensure the voice of citizens is heard across state government, it is critical for Wisconsin residents to understand our electoral process, and even more important for them to cast their vote on election day. And a big election is right around the corner… Wisconsin’s 2023 Spring Election will take place on Tuesday, April 4, and voters will head to the polls to cast their ballots in the WI Supreme Court Race, which could decide the ideological direction of the court for years to come.

In the Feb. 21 Spring primary, Milwaukee County Circuit Judge Janet Protasiewicz and former Supreme Court Justice Daniel Kelly captured the most votes in the four-way race and will face-off in the April 4 general election. Protasiewicz took 46% of total votes cast, with Kelly coming in a distant second, capturing 24% of the votes. Again, the winner of the general election will decide the ideological direction of the 7-seat high court, which is currently controlled 4-3 by conservative-leaning justices.

In addition, for those of you who live in the 8th Senate District (in southeastern Wisconsin), there is a special election to replace Sen. Alberta Darling (R) who retired from the Wi Senate late last year.  Republican State Representative Dan Knodl is running against Democrat environmental attorney Jodi Habush Sinykin.

For more information about the April 4 Spring Election, including your polling place and which candidates and referendum questions will be on your ballot, simply CLICK HERE.  

Earlier this month, longtime Wisconsin Secretary of State Doug La Follette announced his retirement. La Follette, who was recently reelected to another four-year term in Nov. 2022, was first elected to the office in 1974 and has held the position for 44 years. Gov. Tony Evers has appointed Former Wisconsin Treasurer Sarah Godlewski to replace La Follette and serve out the remainder of his term.

Earlier this month, WISCA had the opportunity to ask State Representative Clint Moses (R-Menomonie), Chair of the Assembly Health, Aging and Long-Term Care Committee, what his health care-related policy goals are for the 2023-24 legislative session. Here is what he had to say:

“My health priorities this session is to address the healthcare workforce shortage and to help make healthcare more affordable and accessible for Wisconsin citizens. Throughout Wisconsin, the health care workforce shortage has reduced accessibility to quality care. We have seen reduced service options and closures of clinics. In many cases, people are driving over an hour plus for a routine checkup. This creates a challenging situation for patients, especially for our aging population who face increasingly difficult decisions when it comes to their healthcare. I have been spending time learning about regulations surrounding Senior Care, IRIS, Nursing Homes, and Hospitals services across the state. I have also been on numerous tours in health care facilities and have met with many health care providers. I look forward to working with all the stakeholders to make Wisconsin a healthy state for all ages.”

Representative Clint Moses (R-Menomonie) represents the 29^th Assembly District in northwestern Wisconsin, which includes portions of Dunn and St. Croix Counties. He was first elected to the Assembly in 2020 and was reelected in 2022. He currently serves at the Chair of the Assembly Health, Aging and Long-Term Care Committee. Rep. Moses, who resides in Menomonie with his wife and four daughters, is a chiropractor by trade. He operates Red Cedar Chiropractic with his wife, Dr. Nora Moses, and has been caring for residents of Dunn County for 20 years. He is a member of the Chiropractic Society of Wisconsin, Community Foundation of Dunn County, lifetime alumni member of Northwestern Health Sciences University, and has served on the Colfax Health & Rehabilitation Board.