Wisconsin Medical Journal
108 #9
108 #9
Capitol Insider
Capitol Insider is a feature of Medigram, a weekly Society newsletter. Capitol Insider focuses on recent political developments impacting health care in Wisconsin.
The Wisconsin Medical Society has joined a wide and diverse group of health care professionals, including dentists, hospitals and others, to sponsor a bill requiring insurance companies to follow a patients’ wishes when completing an AOB. The legislation, Senate Bill 453, has two powerful cosponsors: Finance Committee Co-chair Mark Pocan (D-Madison) and Senate Health Committee Chair Jon Erpenbach (D-Waunakee). The bill has been assigned to Sen. Erpenbach’s committee.
Not surprisingly, the insurance industry is vigorously opposing the measure, alleging that the current practice lowers health care costs for the patient. Physicians contacting their state legislators can help build support for this policy improvement. Contact information for your state senators and representatives is available here.
For more information on this issue, contact Mark Grapentine, JD.
The 2009-2011 biennial budget included cuts to Medicaid funding, leaving a $633 million deficit for the biennium. As efforts continue to find ways to cover that shortfall, the state is expanding the program’s coverage even further; the BadgerCare Plus Core Plan for childless adults was promoted as a “budget neutral” proposal. However, the state’s nonpartisan Legislative Fiscal Bureau (LFB) has estimated that based on current data, the plan will cost $20 to $25 million more than expected. You can read an LFB paper on both the Medicaid deficit and the Core Plan projections here.
The Society believes full and frank audit of the program could be critical if fiscal catastrophe forces difficult Medicaid coverage and funding decisions. A copy of the Society’s written testimony is available here.
For more information, contact Tim Bartholow, MD, Chris Rasch or Mark Grapentine, JD.
The bill would also overturn two Wisconsin Supreme Court cases that ruled that broad public interest bars such damages when all parties are adults. Click here to read a memo about this issue that the Wisconsin Medical Society sent to the Senate previously.
Please call your state senator and ask him or her to vote “no” on Senate Bill 203. The following talking points can be helpful as you speak with your senator or your senator’s staff:
Please take the time to call your state senator. You can verify your senator’s contact information here. If you have questions, contact Mark Grapentine, JD, or Chris Rasch.
Doctor Miller’s testimony included relevant materials from the Society, the American Medical Association (AMA) and the American Society of Addiction Medicine. Doctor Miller also cited a new federal study of nearly 50,000 students that found teen marijuana use is on the rise. Click here to read story about that study, along with Dr. Miller’s comments.
Under the legislation, individuals would qualify for the defense if a physician provides written certification that the person suffers from a “debilitating medical condition or treatment.” The bill defines such conditions (including cancer, glaucoma and post-traumatic stress disorder) while empowering the state’s Department of Health Services to establish other qualifying conditions through administrative rulemaking.
Society and AMA policy both state that scientific studies should predate establishing “medical marijuana” programs such as that proposed in AB 554 and SB 368. Society policy also emphasizes the harmful effects of the usual marijuana delivery method: smoking.
Click here to find a video of the entire hearing (titled “12.15.09 l Joint Committee on Health”) on the WisconsinEye website. (Note: A free download of Windows Media Player software is required to view the video.)
For more information on this legislation, contact Mark Grapentine, JD, at the Society.
While the Society does not have policy on sales of raw milk, the American Medical Association (AMA) does:
H-150.980 Milk and Human Health
The AMA reaffirms its policy that all milk sold for human consumption should be required to be pasteurized. (Sub. Res. 67, I-85; Reaffirmed by CLRPD Rep. 2, I-95; Reaffirmed: CSA Rep. 8, A-05)
The Council believes state legislators would benefit from hearing from physicians in their districts, should those physicians have concerns regarding the safety of raw milk. The U.S. Food and Drug Administration's “Food Facts” website, for example, warns of “serious” health risks associated with consuming raw milk.
Some recent media stories about the issue may be found here and here. In addition, the La Crosse Tribune recently published an editorial supporting the bills.
For more information, contact Mark Grapentine, JD.
This eHealth board replaces the eHealth Quality and Safety Board. Its duties will include:
To implement this health information exchange, Wisconsin will receive $9.44 million from the American Reinvestment and Recovery Act of 2009 (ARRA). Gov. Doyle is hopeful that this effort will position Wisconsin to receive more money from the additional $34 billion available through ARRA.
The governor noted that the new executive order is to be used as a “framework” for legislative action that Rep. Jon Richards and Sen. Pat Kreitlow will develop when the legislature reconvenes in January. Stay tuned to Medigram for details as this plan takes shape.
For more information on the state’s eHealth initiative, click here and here or contact Chris Rasch in the Society’s Government Relations department.
Bruce Kruger, executive vice president of the Medical Society of Milwaukee County, and others also testified in favor of the bill.
SB 362 contains two major benefits. First, it would close the “donut hole” of coverage that remains, even following the passage of landmark federal legislation (the Wellstone-Domenici Act). The donut hole leaves nearly 700,000 Wisconsin citizens without mental health and substance abuse disorder coverage because of an exemption that applies to employers of 51 or fewer people.
The bill also requires that health insurance companies provide coverage for mental health and substance abuse problems just as they cover physical ailments. Under current state law, a group health insurance policy that provides coverage for any inpatient hospital service must cover mental health services. This bill removes the specified minimum amounts of coverage that a group health insurance policy must provide but retains the requirement to provide the coverage. Therefore, SB 362 requires that out-of-pocket expenses (copays, premiums and deductibles) for mental health coverage cannot be more restrictive than benefits for other types of medical coverage.
The Senate Health Committee is expected to vote soon on SB 362. For more information, contact Chris Rasch at the Society.
Senate Bill 384, dubbed the “Freedom of Choice of Faith Act” by primary author Sen. Lena Taylor (D-Milwaukee), would create an “affirmative defense” for criminal cases arising from choosing spiritual “treatment” over medical care for a minor. While the bill has some positive elements, such as amending current statutes related to Christian Science practitioners to make it easier for the state to take a child into custody when a child is suffering from “immediate danger” or a condition requiring “either prompt diagnosis or prompt treatment,” the bill’s dramatic change in adding “reasonable use of spiritual, prayer or religious treatment in lieu of medical treatment” as an affirmative defense for any statutory offense is troublesome.
The Society opposes the bill and submitted this testimony to the committee. Other organizations raising concerns about the bill include the Wisconsin Chapter of the American Academy of Pediatrics, the Wisconsin District Attorneys Association and the Wisconsin Chapter of the National Association of Social Workers.
For more information, contact Mark Grapentine, JD.
Besides calling for greater emphasis on rewarding value instead of volume and an end to the current Medicare reimbursement formula’s reliance on unfair-to-Wisconsin geographic factors, the Coalition is urging reforms that would make insurance more affordable and accessible to most citizens. Since Wisconsin provides the highest-quality health care in the nation (as recently rated in the federal Agency for Healthcare Research and Quality’s National Healthcare Quality & Disparities Reports) at a more reasonable cost than other areas of the country, our state’s health care leaders have a tremendous story to tell policymakers.
The Society’s trip to Capitol Hill included visits to the following legislators and/or their staff:
This delay reveals the tenuous support for the bill; the absence of Sen. Kathleen Vinehout (D-Alma) may have prompted the delay, although she is one of the senators whose current stance on the bill is not known for certain. The other two are Sen. Julie Lassa (D-Stevens Point) and Sen. Jim Holperin (D-Conover). Many physicians and others working to defeat the bill made dozens of phone calls to their state legislators this week, helping put the bill’s fate in doubt.
On Nov. 5, the full Senate will meet for the last time this calendar year, then break until mid-January. If you haven’t yet contacted your state senator to voice your opposition to SB 203, now is still a very effective time to do so. You can verify the contact information for your state senator here.
For more information on this issue, contact Mark Grapentine, JD, or Chris Rasch.
The bill, authored by Rep. Terese Berceau (D-Madison) and Sen. Fred Risser (D-Madison), would make grant funding available to government entities for fighting alcohol-related crimes and would provide funding for community alcohol and drug abuse treatment services. The proposed per-barrel beer tax increase from $2 to $10 would raise an estimated $40 million annually.
University of Wisconsin School of Medicine and Public Health (UWSMPH) Dean Robert Golden, MD, spoke on behalf of the AWARE (All-Wisconsin Alcohol Risk Education) Coalition, to which the Society belongs. Other physicians testifying at the hearing in support of the proposal included Society Vice-Speaker and American Medical Association Delegate Michael Miller, MD, and Medical College of Wisconsin Associate Professor Tim Corden, MD. A number of UWSMPH medical students also testified.
To watch the testimony, click on the following links (a free download of Microsoft Silverlight is required):
In other news, a bill prohibiting minors from drinking in bars—even with their parents' consent, as the current law allows—is headed to the state Senate after being passed by a committee on Oct. 6. An identical Assembly bill on this issue is still being considered by a committee. The Society supports these bills.
Click here to read an Associated Press story on this bill, published last Friday on the website of Milwaukee's WTMJ news station.
For more information on these issues, contact Mark Grapentine, JD.
The two sides negotiate every two years on potential changes to the state's worker's compensation law; the Wisconsin Medical Society is one of three non-voting health care liaisons to the WCAC, along with the Wisconsin Hospital Association and the Wisconsin Chiropractic Association.
The Society has worked with the other WCAC liaisons to shield the state's health care professionals from the imposition of a draconian medical fee schedule similar to those that have been adopted in other states for worker's compensation care.
In the past, Management has proposed a "one-size-fits-all" schedule that would be based on Medicare reimbursement rates, or some other arbitrary measure. This session, Management made clear its intention to propose a "cost containment" strategy that included a cut to current reimbursement rates. Knowing this, the liaisons re-introduced a "Freeze and Grow" proposal, in which worker's compensation rates would be established at current allowable charge levels and could grow at the rate of the Medical portion of the Consumer Price Index (MCPI).
The WCAC met Oct. 6 to continue bargaining; it will negotiate further later this month.
For more information, contact Mark Grapentine, JD.
The vote was 3-2, with Sen. Lena Taylor (D-Milwaukee), Sen. Jim Sullivan (D-Wauwatosa) and Sen. Jon Erpenbach (D-Waunakee) voting in favor of passage. Sen. Glenn Grothman (R-West Bend) and Sen. Randy Hopper (R-Fond du Lac) voted against.
Last week the Society alerted its physician Key Contacts about the Tuesday vote in the Senate Judiciary, and many Society members reached out to their State Assembly and State Senate representatives. There is still time to make your voice heard: The more legislators who hear from their physician constituents, the more likely these bills will never reach the Assembly and Senate floors. Click here to find your legislators' contact information. If you are not yet a Key Contact, click here to learn how to sign up.
For more information on SB 203 and its potential ramifications, contact Mark Grapentine, JD.
Society members Ed Krall, MD, and Sandra Osborn, MD, both serve as members of a special task force charged with recommending how to bolster the program (a.k.a. "the Impaired Professionals Procedure") so physicians and other license holders can get help with chemical dependency problems without automatically risking their licenses.
At its monthly meeting Wednesday, the Medical Examining Board (MEB) received a report from DRL Secretary Celia Jackson regarding the task force's recommendations to create a "Professional Assistance Program." Participation in the proposed program would be kept confidential from the general public, and participants would be part of the program for up to five years. Those who wished to stay longer could do so voluntarily.
How this program would be financed remains an unresolved question. The Society will continue its collaboration with DRL and MEB as this effort evolves.
Contact Mark Grapentine, JD, for more information on this issue.
Dubbed the "Family Justice Bill," the legislation would essentially overturn two Wisconsin Supreme Court cases and allow for "loss of society and companionship" damages involving parents and their adult children. The Society has opposed the bill for many legislative sessions; there is a much greater likelihood the bill could advance through both houses this session.
If you are a constituent of an Assembly Judiciary Committee member, please take a moment to contact them and communicate the Society's opposition to the bill. Committee members include:
Rep. Gary Hebl (D-Sun Prairie), committee chair
Rep. Pedro Colon (D-Milwaukee), committee vice-chair
Rep. Fred Kessler (D-Milwaukee)
Rep. David Cullen (D-West Allis)
Rep. Jon Richards (D-Milwaukee)
Rep. Bob Turner (D-Racine)
Rep. Mark Gundrum (R-New Berlin)
Rep. Samantha Kerkman (R-Powers Lake)
Rep. Bill Kramer (R-Waukesha)
Rep. Rich Zipperer (R-Pewaukee)
Click here to find each legislator's contact information. You may also read the Society's testimony on this bill here. This testimony was provided to both the Assembly and Senate committees deliberating on AB 291 and Senate Bill 203, the Senate companion bill.
For more information, contact Mark Grapentine, JD.
The letter warns that any proposal basing payments on the faulty Medicare payment system "will have a severe negative impact on access to physician practices in our states and lead to further cost shifting." The letter also points out a fundamental flaw in the current Medicare physician payment formula: a geographic adjustment based on variables bearing little relationship to providing health care.
Rather than build any new system based on current weaknesses, this group of state societies urges Congress to consider a Value Index calculation that rewards quality of care rather than incent quantity of care.
For more information, contact Tim Bartholow, MD or Mark Grapentine, JD.
At this time, case law does not allow parents to recover damages for “loss of society and companionship” of an adult child and does not allow an adult child to recover these kinds of damages when a parent is injured due to medical negligence.
The Society provided testimony to the Senate Judiciary Committee Tuesday, highlighting the fragile nature of Wisconsin’s medical liability system. This testimony was similar to the July 14 testimony the Society provided to the Assembly Judiciary Committee, which addressed the Assembly companion bill, AB 291. Tuesday’s testimony also included excerpts from specific sections of Wisconsin Supreme Court case law highlighting the reasons the Court has set the current limits.
If you are a constituent of a Senate Judiciary member, consider contacting them with your thoughts on how to preserve Wisconsin’s favorable medical liability environment. To verify the contact information for your state senator, click here.
For more information on this issue, contact Mark Grapentine, JD.
The Society’s Council on Legislation will discuss the proposed legislation at its August 28 meeting. As of press time, the bill had not yet been officially introduced. For more information, contact Mark Grapentine, JD.
The Society’s testimony emphasized that any physician making a good faith effort to comply with a PDMP should be immune from any civil, criminal or administrative liability, a protection Minnesota and other states provide as part of their programs. Legislators should also be wary of unintended consequences the bill may have on Wisconsin’s medical records privacy and access laws, the Society advised, as well as considering how physicians not currently using an electronic medical records system could comply with any statewide participation mandate.
For more information, contact Mark Grapentine, JD.
The MEB voted Wednesday to bring back the digest and has asked the Society to help distribute the publication electronically to be more economical. The first edition is available here.
For more information, contact Mark Grapentine, JD.
Current law allows joint and several liability attachment at 51 percent. In other words, any defendant found at least 51 percent negligent may be held responsible for 100 percent of damages. This 51 percent threshold has been part of state statutes since 1995 and has helped keep Wisconsin’s medical liability climate relatively calm. Gov. Jim Doyle’s 2009-2011 state biennial budget proposal essentially eliminated the 51 percent threshold, while the Legislature’s Joint Committee on Finance proposed a 20 percent attachment level. The State Assembly eliminated the provision when it acted on the budget last week, and the Senate followed suit Wednesday evening. Read more about the Senate’s action here.
Elimination of the provision has been a priority for the Society in recent weeks. Therefore, Society President Robert Jaeger, MD, made a statement following the Senate’s action, praising legislators’ decision to protect Wisconsin’s liability environment.
Because the two legislative houses approved different versions of the budget, a Conference Committee will be formed from Assembly and Senate leadership. Such a committee could be formed as soon as today, and deliberations could be completed by the weekend. Both houses would then need to approve a Conference Committee agreement, with no amendments allowed.
For more information, contact Mark Grapentine, JD.
No later than August 1 of this year, the Wisconsin Department of Regulation and Licensing (DRL) will consider certain application requirements automatically completed if the Minnesota physician holds a full, unrestricted Minnesota license to practice medicine. A DRL review of Minnesota and Wisconsin physician license applications found similar requirements for certain application elements, such as medical school verification and postgraduate training, prompting the Board to allow an expedited application process for Minnesota physicians.
The Board also heard from DRL staff about the new “e-credential” option for license renewals. Those applying on-line for license renewal may receive their credentials via e-mail. The program, described in detail on the DRL Web site, takes effect July 1.
For more information, contact Mark Grapentine, JD.
This change in "joint and several liability" would undo a legislative change passed in 1995 and would result in medical malpractice plaintiffs seeking the entire award from the defendant with the deepest pockets. Read the nonpartisan Legislative Fiscal Bureau’s analysis of this budget provision here.
While legislators from both parties are uncomfortable that such a dramatic policy item resides in the budget, those wary of removing a change coveted by Governor Doyle must hear from their constituents.
More on the coalition's opposition to the lawsuit policy change—including a statement from Dr. Luetzow—is available here.
Members of the Society’s Key Contacts program received a special alert this week that urged them to contact their legislators about this issue. If you aren’t yet a part of this free program, click here to learn more about it. To sign up, contact Mark Grapentine, JD, or Beth Alvin.
The Fund’s Board of Governors voted 7-4 last December to approve the 9.9 percent increase. Society representatives Susan Turney, MD, and Robert Jaeger, MD, voted against the increase. The Society then appeared at an Office of the Commissioner of Insurance (OCI) hearing on the proposed increase in March, asking that the Commissioner not raise rates while the Society’s lawsuit disputing the $200 million raid of the Fund is pending. The Commissioner declined to reconsider its decision, and OCI promulgated the rule, Clearinghouse Rule 09-004. Today’s hearing was the final option for delaying the implementation of the fees increase.
The vote to waive jurisdiction and allow the fees increase was 4 to 3 along party lines. For more information, contact Mark Grapentine, JD.
The Committee released the third paper Monday, describing HCR financing possibilities. The other two papers relate to improving patient care while reducing health care costs and expanding coverage.
For more information, contact Tim Bartholow, MD, or Mark Grapentine, JD.
Following last week’s announcement of an agreement among legislators, public health advocates (including the Society) and the Tavern League of Wisconsin, the greatest threat to the bill becoming law was the possibility that a slew of amendments could upend that compromise. Seventeen separate amendments were proposed in the Senate, and 30 more were proposed in the Assembly. While some votes were extremely close, the bill ultimately passed along the lines of the compromise. The final vote was 25-8 in the State Senate and 61-38 in the Assembly.
The bill now goes to Governor Jim Doyle, who has indicated he will sign the bill into law. If signed, it will go into effect July 5, 2010.
Society members should send their thanks to Sen. Fred Risser (D-Madison), Rep. Jon Richards (D-Milwaukee), Sen. Jon Erpenbach (D-Waunakee) and Rep. Al Ott (R-Forest Junction), who all worked many hours in the last several weeks to convince a majority of their colleagues to vote for the bill. Special thanks should also go to Society Key Contacts who reached out to their Assembly and Senate representatives.
For more information, contact Mark Grapentine, JD.
While the numbers won’t be released until early next week, the shortfall is expected to add another $750 million to $1.25 billion to the $5.7 billion deficit. Joint Committee on Finance Co-Chair Senator Mark Miller (D-Monona) has said that the committee may be forced to revisit actions it has taken so far on the budget to address the additional shortfall. To view his statement, click here.
This afternoon, Governor Jim Doyle announced potential cuts to state government—including employee furloughs and potential cuts to Medicaid reimbursements—as a way to address the larger deficit without raising taxes.
The deficit news only exacerbates a looming $415 million deficit in the state’s Medicaid program. The Society continues to collaborate with different health care groups statewide to educate state officials and legislators on how “easier” solutions to this deficit, such as reimbursement cuts, could affect access to Medicaid services. The Society also continues to press the Wisconsin Department of Health Services for additional collaboration on the Medicaid program overall.
For more information, contact Mark Grapentine, JD.
Once JCF finishes its work on the budget, the bill—officially 2009 Assembly Bill 75—heads to the State Assembly and State Senate for further deliberations. For more information, contact Mark Grapentine, JD.
Society Key Contacts will be notified when it is the best time to contact your state legislators—which could be as soon as early next week. For more information, contact Mark Grapentine, JD.
The Society is part of the AWARE (All-Wisconsin Alcohol Risk Education) coalition, which supports this effort. If you wish your legislators to cosponsor the Berceau/Risser bill, contact them. Verify your legislators’ contact information here. Contact Mark Grapentine, JD, for more information.
Wisconsin and Minnesota also consistently rank high in independent measures of health care quality, so the Public Citizen conclusions about the MEB are questionable. Minnesota’s reaction, for example, is essentially dismissive. Former MEB chairs Darold Treffert, MD, and Sidney Johnson, MD, coauthored a 2005 Wisconsin Medical Journal article strongly criticizing Public Citizen’s past conclusions.
For more information, contact Mark Grapentine, JD.
Labor representatives expressed their concerns about the protocols proposal at Monday’s WCAC meeting, stressing that any change to the current system should not adversely affect WC patient outcomes or decrease patient satisfaction with the quality and timeliness of care. Negotiations are expected to continue for several weeks. If the WCAC’s voting members reach consensus, legislation is drafted and presented to the legislature, which generally passes the agreed-to bill in original form.
You can read Management’s proposal here (the provision on protocols begins on the second page). The Society is one of three non-voting health care liaisons to the WCAC, along with the Wisconsin Hospital Association and the Wisconsin Chiropractic Association. For more information, contact Mark Grapentine, JD.
As mentioned in previous editions of Medigram, the budget contains numerous items of interest to physicians and their patients. If you would like to receive an alert when the legislature is preparing to vote on those issues and you would like your voice to be heard, join the Society’s Key Contact program for e-mailed alerts.
For more information, contact Mark Grapentine, JD or Beth Alvin.
One item of concern is a set of changes to the state’s comparative negligence statutes. The LFB description of the changes are here. As described in a previous issue of Medigram, this provision could mean a dramatic change in medical liability awards, with a physician potentially forced to pay 100 percent of a medical liability decision even if that physician was less than 51 percent negligent in a particular case. The budget proposal essentially allows a plaintiff to seek the entire award from the defendant with the deepest pockets, even if that defendant was the least negligent among those at fault.
The Society believes this provision does not belong in a biennial budget bill and is calling on the Legislature to remove it from the budget. If you would like to weigh in with your Capitol representatives, call them with your opinion. Check your State Senate and State Assembly Representatives contact numbers here. Contact Mark Grapentine, JD, with any questions.
While Sen. Robson and Rep. Pasch allege that the bill is intended to relieve an access problem for this kind of treatment, American Medical Association data show that psychologists tend to practice in the same geographic area as psychiatrists and family practice physicians. The Wisconsin Psychiatric Association (WPA) has collected information related to how the proposal would affect quality, access and costs; WPA strongly disagrees with the premise that the bill’s education requirements can foster safe and effective mental health prescribing decisions as there will be no physician supervising the prescribing. The WPA acknowledges that access to mental health care is a significant problem, but believes the proposed bill would not help solve that issue safely and effectively.
If you wish to contact your State Senate or Assembly Representatives to share your views on the bill, verify their contact information here.
For more information, contact Mark Grapentine, JD.
At its meeting, the MEB:
The nonpartisan Legislative Fiscal Bureau has released its 706-page summary of the budget proposal, which is officially titled 2009 Assembly Bill 75. Next week JCF begins its “road show,” giving members of the public the opportunity to speak on issues contained in the budget. Next week’s meetings are in Sparta, West Allis and Eau Claire, with a special listening session scheduled for March 28 in Ashland. The week of March 30 will take the committee to Racine, Appleton and Cambridge.
For more information, contact Mark Grapentine, JD.
UW School of Medicine and Public Health medical student Jonathan Knoche testified on AB 56, which would place restrictions on direct-to-consumer drug advertising in Wisconsin. Society policy supports federal efforts to control such advertising. While some provisions of AB 56 have raised constitutional concerns, the core issue falls within the realm of Society policy and this warrants the Society's support.
Knoche gave to the Committee an abbreviated version of a DTCA presentation he presented to the Society’s Council on Ethics on February 20. The Committee also received these handouts. The Assembly Public Health Committee is chaired by Society member and Rep. Chuck Benedict, MD (D-Beloit). You can watch Tuesday’s hearing on the Wisconsin Eye Web site by clicking on the listing for the Assembly Committee on Public Health for March 10, 2009.
For more information, contact Mark Grapentine, JD.
For more information, contact Mark Grapentine, JD.
The federal plan’s ramifications on Wisconsin’s biennial budget are enormous. Governor Doyle’s budget proposal, scheduled for delivery to the State Legislature via a budget address next Tuesday evening, will tackle a reported $5.7 billion deficit for 2009-2011. Estimates on how much Wisconsin will receive in federal stimulus funds to help offset that deficit have varied day-by-day, but have ranged anywhere from $2 billion to $3.5 billion.
Next week will be a busy one for the state's budget; prior to the Governor's Tuesday evening budget address the State Legislature’s Joint Finance Committee is expected to pass a budget-repair bill aimed at starting work on balancing a reported $600 million deficit at the tail-end of the current budget biennium. The bill will contain a variety of state spending cuts and revenue enhancers, including the much-debated Hospital Assessment, designed to capture additional federal funds for the state’s Medicaid program.
The deeper analysis begins following release of the 2009-2011 budget next Tuesday. Contact Mark Grapentine, JD, for more information.
The psychologists’ arguments are typical for these scope issues: expanding scope would allow for better access while touting extra education that “equals or exceeds that of most currently licensed prescribers.” (To see an example of the types of information that lobbyists are distributing to legislators, click here. The e-mail in this link is a matter of open record because it was sent to a state office.)
While this issue is a top priority for psychiatrists, all physicians should contact their state legislators to register their concerns over a dramatic broadening of prescriptive powers for a non-medically-trained group attempting to equate their training to that of a physician. Click here for your legislators’ contact information. You can review talking points that psychologists are using here.
For more information, contact Mark Grapentine, JD.
Stay tuned to future editions of Medigram for more information about the state budget. For more information, contact Mark Grapentine, JD.
To amend the Wisconsin Constitution, two consecutive sessions of the Wisconsin Legislature must pass the exact same resolution language. Then, the question must pass a statewide referendum. This year’s effort is similar to last session’s AJR 34, which also enjoyed broad bipartisan support. That measure passed the Assembly 91-6 late in December 2007, but failed to get a vote in the State Senate.
While this resolution will not undo the 2007 raid on the IPFCF (the Society’s lawsuit continues), the Society strongly supports this effort; call your State Senator and State Assembly Representative and ask them not only to support the measure, but to push their leadership to schedule a vote on the resolution. Visit the State Legislature’s Web site to get your legislator’s contact information.
For more information, contact Mark Grapentine, JD.
The Department reported positive progress: the time lag between receipt of a license application and the beginning of application processing has dropped dramatically. The Department began tracking this process time at the request of MEB chair Gene Musser, MD, who also attended the meeting.
The Society has noticed a drop in the number of complaints from physicians and clinics regarding the Department’s processing time and responsiveness, and will continue to closely monitor member satisfaction and communicate regularly with the Department on this issue.
For more information, contact Mark Grapentine, JD.
Senate
Committee on Health, Health Insurance, Privacy, Property Tax Relief, and Revenue
Committee on Public Health, Senior Issues, Long-Term Care, and Job Creation
Assembly
Committee on Health and Healthcare Reform
Committee on Public Health
If you'd like more information about these or any other legislators, go to the Legislature's Web site. To find out who represents you, click here.
Society member Rep. Chuck Benedict, MD (D-Beloit) will chair the Public Health Committee. Benedict was the ranking minority party member of the committee this past session; the committee handles a wide variety of issues.
For a list of all committees and chairs, see Speaker-elect Sheridan’s press release. For more information, contact Mark Grapentine, JD.
Senate Finance chairman Max Baucus (D-Montana) released a 98-page proposal for health care reform called “Call to Action: Health Care Reform 2009.” While he explicitly states in the paper that the plan “is not intented to be a legislative proposal,” it is certainly an influential senator planting his marker for where the health reform debate should begin. Major elements of the plan include requiring all Americans to have health insurance (a major difference with President-elect Obama’s plan), increased emphasis on preventive care and moving physician payment away from procedure-based to quality-based reimbursement.
Meanwhile, Senate Health Committee chairman Edward Kennedy (D-Mass), battling a malignant brain tumor for much of 2008, made health news simply for making an appearance at the Capitol this week, countering those who assumed he would be giving up his chair next session to concentrate on his personal battle. While praising Baucus for his effort, Kennedy told reporters he plans to introduce his own bill to provide universal health care and be the Senate lead in partnering with the Obama administration. The Washington Post, however, reports that some on the Obama team are now considering expanded coverage “a longer-term goal” due to economic constraints.
The insurance industry added itself into the mix late Wednesday, with two major insurance groups stating that they would be willing to accept all who apply for insurance as long as the government mandates that all citizens must have insurance. Such a mandate differs from President-elect Obama’s health care proposal, which held such a mandate for children but not adults.
The Society is working with the AMA in analyzing the Baucus plan and will do the same as other federal legislation is introduced. For more information, contact Mark Grapentine, JD.
Abrahamson was first appointed to the court in 1976 by then-Governor Patrick Lucey. She has stood for reelection three times since that appointment, winning a healthy majority of votes each time: 65 percent in 1979, 55 percent in 1989 and 63 percent in 1999. She became Chief Justice in 1996, and was the first woman justice elected to the court.
In his press conference announcing his candidacy, Koschnick told reporters that his “conservative judicial philosophy” separates him from the incumbent, and cited the Ferdon v. Patients Compensation Fund Supreme Court opinion as an example of Abrahamson’s differing philosophy. The 2005 Ferdon decision, in which Abrahamson wrote the majority opinion, removed the state’s cap on noneconomic damages in medical liability cases. (Nine months after the Supreme Court decision the State Legislature reinstated a cap of $750,000 for noneconomic damages, the culmination of significant efforts from the Society and other health care entities.)
With 2007 and 2008 Supreme Court elections noted for their rancor, the 2009 campaign has at least started off politely. Abrahamson welcomed Koschnick into the race in a statement stressing the desire for a nonpartisan contest. Koschnick’s approach reached for the same theme, including offering a clean campaign pledge.
For more information, contact Mark Grapentine, JD.
Last session the committee saw an 8-8 partisan split. With the Assembly swinging to Democratic control, JCF will now have 12 Democratic and 4 Republican members. Senate membership is the same as last session: Co-chair Mark Miller (D-Monona), Dave Hansen (D-Green Bay), Lena Taylor (D-Milwaukee), John Lehman (D-Racine), Judy Robson (D-Beloit), Julie Lassa (D-Stevens Point), Alberta Darling (R-River Hills) and Luther Olsen (R-Ripon). The Assembly co-chair is now Mark Pocan (D-Madison), with Pedro Colón (D-Milwaukee), Cory Mason (D-Racine), Jennifer Shilling (D-La Crosse), Gary Sherman (D-Port Wing) and Tamara Grigsby (D-Milwaukee) comprising the majority party Assembly members. Reps. Robin Vos (R-Racine) and Phil Montgomery (R-Green Bay) represent the Assembly minority party.
Other full committee memberships are forthcoming. Society members are reminded that any relationships with Joint Finance legislators can help aid in shaping the state's budget to a more patient- and physician-friendly final product. If you have such a relationship, please let Society staff know about it.
(Note: In a press conference this afternoon, Governor Doyle announced that the state's biennial budget deficit now stands at $5.4 billion. Doyle said he will submit a budget repair bill to the legislature in early 2009. Stay tuned to future Medigrams for the latest updates.)
Democrats will hold a 52-46-1 majority in the Assembly, allowing Democratic leadership—led by Rep. Sheridan—to establish committees and chairpersons as well as decide what legislative bills will receive a full Assembly vote during floor sessions.
Earlier in the week Senator Russ Decker (D-Weston) was named Senate Majority Leader for the next session, continuing in the position he assumed in late 2007. Decker will preside over an 18-15 majority, the same margin as last biennium.
Senator Scott Fitzgerald (R-Juneau) will once again serve as Senate Minority Leader. His younger brother, Rep. Jeff Fitzgerald (R-Horicon), was selected as Minority Leader by Assembly Republicans. Former Assembly Speaker Rep. Michael Huebsch (R-West Salem) chose not to run for a leadership position.
For more information, contact Mark Grapentine, JD, Jeremy Levin, or Beth Alvin.
For more information, contact Mark Grapentine, JD, or Jeremy Levin.
Until the rule change passes, the current requirements for proof of successful medical school experience remain in effect.
In another MEB development, DRL Secretary Celia Jackson informed the Board that she is considering holding MEB meetings around the state. These meetings would allow license holders, hospital and clinic officials and the public to share any concerns with the Board, Jackson said. Stay tuned to future editions of Medigram for information on where and when any such meetings are scheduled.
For more information, contact Mark Grapentine, JD.
Democrats will control the State Assembly for the first time since Republicans gained a majority in 1994. A combination of defeating Republican incumbents and winning open seats gives Democrats a recount-pending 52-46-1 margin starting in 2009 (former Republican Jeff Wood is the first Independent to go to Madison in 62 years). Up next for both parties: selecting caucus leaders, establishing committee chairs and memberships. Democrats will select a Speaker and Majority Leader, whose powers rest in setting the agenda for Assembly floor sessions and managing floor procedure. Republicans will select a minority leader, who generally has two primary assignments: 1) be the voice of the opposition party on the floor and to the media, and 2) figure out a way to get back into the majority.
The departure of Society member Sheldon Wasserman, MD, (D-Milwaukee) from the Assembly (see Senate results below) leaves open the question of which Democrat will chair the Assembly Health Committee. That may not be decided until the next session of the legislature is organized in January. Wasserman’s departure leaves Society member Chuck Benedict, MD, (D-Beloit) as the lone physician in either house.
The State Senate will look much the same as it did last session, with Democrats maintaining an 18-15 majority in that house. Three Republican incumbents facing tough challengers kept their seats, with Sheila Harsdorf (R-River Falls), Dan Kapanke (R-La Crosse) and Alberta Darling (R-River Hills) returning for another four-year team. Darling, wife of Society member Bill Darling, MD, had to wait until Wednesday to declare victory in her race against Wasserman, as many absentee ballots in Milwaukee and Shorewood wards were outstanding until the day after election night. Republican Randy Hopper (R-Fond du Lac) and Democrat Jim Holperin (D-Conover) each won close open-seat races, maintaining their party’s control in each district. Hopper’s 180-vote win over Jessica King (D-Oshkosh) will likely undergo a recount.
Senate Democrats had originally scheduled a caucus today to elect a leader for the 2009-2010 session, but have postponed that election pending a recount in the Hopper-King race. Earlier today, Senate Republicans re-elected Scott Fitzgerald (R-Juneau) as minority leader.
Federally, all eight of Wisconsin’s incumbents in the U.S. House of Representatives won reelection to two-year terms, including Society member Steve Kagen, MD, (D-Appleton), who defeated former State Assembly Speaker John Gard (R-Suamico) by a 54-46 percent margin. Wisconsin’s eight House members are five Democrats (Tammy Baldwin, Ron Kind, Gwen Moore, Dave Obey and Kagen) and three Republicans (Paul Ryan, Tom Petri and F. James Sensenbrenner). Neither Wisconsin senator faced reelection on Tuesday; Russ Feingold (D-Middleton) will run again in 2010, while Herb Kohl (D-Milwaukee) next runs in 2012. Democrats increased their majority in both the Senate and the House.
Finally, Society lobbyist Jeremy Levin won election to the Dane County Board of Supervisors with a 53-46 percent win.
For more information, contact Mark Grapentine, JD, or Jeremy Levin.
State Democrats hope to gain seats in both the State Senate and State Assembly. Democrats control the Senate by an 18-15 margin and look to increase that spread with five seats in play: incumbent Republicans face stiff challenges in three races and two seats are open (see previous Medigram articles on those contests). Republicans hold the Assembly on a razor-thin 51-47-1 margin, with all 99 Assembly seats in play for 2009-2010.
If you have any questions about Tuesday’s elections, contact Mark Grapentine, JD, Jeremy Levin or Beth Alvin.
A deficit of that size will force Capitol policymakers to make difficult taxing and spending decisions, regardless of which political parties control the State Assembly and State Senate. Making budgeting more difficult: the vast majority of state general fund spending (primarily income and sales tax-supported) lies in just five areas: Elementary and School Aids (37.9 percent of the 2007-2009 biennial budget), Medical Assistance (11.9 percent), the University of Wisconsin system (7.8 percent), Shared Revenue payments to local government (6.7 percent) and Corrections (6.7 percent). The Legislative Fiscal Bureau’s “top 10” chart from the last budget shows the 10 programs making up about 80 percent of this general fund spending; none are in areas where cuts are likely to engender warm and fuzzy political sentiment.
For more information, contact Mark Grapentine, JD.
For more information on these or other state legislative races, contact Mark Grapentine, JD, Jeremy Levin or Beth Alvin.
The Eighth State Senate District stretches from the northern tip of the city of Milwaukee to the North and West, reaching parts of Ozaukee, Waukesha and Washington Counties. This district hosts what is perhaps the most talked-about Senate race this year, with incumbent Sen. Alberta Darling (R-River Hills) facing Assembly Rep. Sheldon Wasserman, MD, (D-Milwaukee). Both candidates have a wealth of health care policy experience, and both have been extremely good friends of the Society and medicine generally.
Sen. Darling has been in the State Senate since first elected in 1992 after spending a bit more than one term in the State Assembly. She is married to long-time Society member Bill Darling, MD, an otolaryngologist. She currently sits on the Joint Committee on Finance, the legislature’s bipartisan, bicameral budget-writing committee.
On her Web site, Darling details her past work on health care issues, and has called for improvements in access and affordability. “Wisconsin needs health care reform that gives people more control of their coverage, their dollars and their medical decisions,” the site says. “The focus of Senator Darling’s health care agenda is to reduce the cost of medical care, increase access to affordable coverage, and improve the quality of health care services.”
Rep. Wasserman, an OB-GYN, has been in the State Assembly since 1994, and a Society member since 1991. One of only two physicians in the State Legislature (both in the Assembly), Dr. Wasserman has been the health care “go-to” person for Assembly Democrats. As such, he has been the ranking member on the Assembly Health and Health Care Reform Committee. He is giving up his seat in the Assembly to run for the Senate.
On his Web site, Dr. Wasserman includes lowering the cost of pharmaceutical drugs as one of the issues he will tackle in the Senate. “Patients should be able to fill a prescription knowing that they can afford it,” the site says. “I introduced legislation that would lower drug costs by exempting pharmaceutical medications from Wisconsin’s minimum markup law.”
The race will also be one of the most expensive in the state, with both candidates purchasing major television time in the expensive Milwaukee market. You can view Dr. Wasserman’s ads here and here. Darling’s ads can be seen here and here. A joint appearance on WISN-TV’s UPFRONT with Mike Gousha can be seen here.
Senate District 18
Retirement of longtime Sen. Carol Roessler (R-Oshkosh) earlier this year created an open seat in the 18th Senate District, which stretches from the northern reaches of Oshkosh and curls along the western shore of Lake Winnebago, reaching south to Fond du Lac and parts of Waupun.
The contest has two well-spoken and energetic candidates: radio station-owner Randy Hopper (R-Fond du Lac) and Oshkosh Common Council Member and Attorney Jessica King (D-Oshkosh).
King’s Web site concentrates on her educational background, various media coverage of the race and endorsements. It does not delve into specific issues. Hopper’s Web site states that “[o]ne of the most pressing issues facing both families and employers is the rising cost of health care. Every family deserves access to affordable, quality health care.”
Democrats currently control the Senate on an 18-15 margin and see this open seat as an opportunity to win a district that has been in the other party’s column for many years. Since Roessler was first elected to the Senate in 1987, the district has moved from solid Republican to closer to leans Republican, as highlighted in 2006 with the election of Oshkosh Democrat Gordon Hintz to the State Assembly.
For more information on these or other state legislative races, contact Mark Grapentine, JD, Jeremy Levin or Beth Alvin.
With the elections less than three weeks away, physicians can still have an impact on races around the state, as well as enhance the reputation physicians have regarding political awareness. The Society’s Government Relations staff has been in contact with leaders from each major political party in both legislative houses, and know which races are considered to be most important. As you make your contributions to candidates for office, please do so through your WISMedDIRECT account. If you would like to know where your contributions can have the most impact, contact Mark Grapentine, JD, Jeremy Levin or Beth Alvin.
Senate District 12 seat became vacant last May when then-Senator Roger Breske (D-Eland) was appointed the state’s railroads commissioner. Now former State Representative and Tourism Secretary Jim Holperin (D-Conover) and small business owner Tom Tiffany (R-Hazelhurst) are vying to fill the seat, which represents the large district in northeastern Wisconsin that stretches from the Upper Peninsula border southwest into Lincoln and Langlade Counties
Tiffany says his experience as a small business owner makes him very aware of the challenges of finding affordable health care. According to his Web site, Tiffany’s health care proposals “includ[e] consumer-driven reforms and full disclosure of all costs for you in the health care system.”
Holperin’s Web site does not contain any description of health care opinions—the site purports itself as “simple and to the point.” It does, however, have pages related to logging, energy and other issues.
The seat is a particular target of Senate Republicans, because all three State Assembly seats in the district were Republican in 2007-2008, and could therefore result in a Republican Senate seat in an election where Democrats are expected to fare well.
Recent news coverage of the race from the Lakeland Times can be found here and here.
Senate District 32
Senate District 32, which stretches from La Crosse County in the north to the confluence of the Wisconsin and Mississippi Rivers at its southern border, is another hotly contested seat. The Coulee Region has been an epicenter of sorts in Wisconsin politics, with the state Senate seat switching between Republican and Democratic control and its role as a destination point for presidential candidates in the last three elections.
Incumbent Senator Dan Kapanke (R-La Crosse), currently seeking his second term, is a former regional sales manager for Kaltenberg Seed Farms and is well-known for owning the La Crosse Loggers baseball team. His Web site has links to recent campaign television ads and a biography.
Challenger Tara Johnson (D-La Crosse) is a current La Crosse County Board member, and arguably represents the Democrats’ biggest hope for unseating a sitting Republican Senate incumbent. Information about her campaign can be found on her Web site.
A recent La Crosse Tribune news story about the race concentrated on the two candidates’ opinions on health care. Other area news stories on the race can be seen here and here.
For more information on these or other state legislative races, contact Mark Grapentine, JD, Jeremy Levin or Beth Alvin.
To read the memo, click here.
The incumbent State Senator is Sheila Harsdorf (R-River Falls), seeking her third term in the Senate following 10 years in the State Assembly. Harsdorf served on the Senate Committee on Agriculture and Higher Education, and the Committee on Commerce, Utilities and Rail.
According to her campaign Web site, Harsdorf believes that "[e]scalating health care costs are taking a toll on our nation, our state and our communities." She believes that "expanding options to increase affordability for working families and small businesses must be a legislative priority."
Challenger Alison Page (D-River Falls) comes from health care job experience, having been a senior administrator for Fairview Health Services (Minnesota) and a registered nurse. As such, health care is a major slice of her campaign platform. According to her Web site, Page believes that health care is a "basic human right," and that "[w]e don't have to spend more money on health care—in fact, we can spend less money on health care than we do right now. We just have to change the way in which we spend it."
For more information about this or other hot legislative races, contact Mark Grapentine, JD, Jeremy Levin or Beth Alvin. Stay tuned to future editions of Medigram for more campaign briefs.
Wednesday night the Senate—reportedly in an attempt to put pressure on their House counterparts—passed the $700+ billion bill on a 74-25 vote. Wisconsin’s senators were split: Sen. Herb Kohl (D-Milwaukee) voted for the bill while Sen. Russ Feingold (D-Middleton) voted against. Presidential candidates John McCain (R-AZ) and Barack Obama (D-IL) both voted in favor.
The House may take up the bill late tonight or tomorrow; the first version of the bailout failed Monday in that house on a 205-228 tally. In order for mental health parity to become law, both houses must pass the exact same language.
For more information, contact Mark Grapentine.
Candidates Web sites Think Tanks American Medical Association For more information, contact Mark Grapentine.
The separate bills—the Renewable Energy and Job Creation Act of 2008 (H.R. 6049) and the Mental Health Parity and Addiction Equity Act (H.R. 6983)—have broad bipartisan support, evidenced by the lopsided votes: 376-47 in the House and 93-2 in the Senate. All 10 members of the Wisconsin Congressional delegation voted for passage; Wisconsin Medical Society President Steven Bergin, MD, faxed a letter of appreciation to each Wisconsin member.
That letter also points out that there is still critical work to be done: while each house approved separate bills, including parity provisions, the House and Senate must agree on a single bill in order for the language to get to the President’s desk for final approval. As this Washington Post story points out, getting anything through the Senate is a difficult task at this time. Therefore, it would be helpful if physicians across Wisconsin would follow Dr. Bergin’s lead and contact our members of Congress, urging them to not waste this opportunity. For a list of Congressional contacts, click here.
For more information, contact Mark Grapentine.
Congressional seats
In one primary of note, long-time Republican incumbent Rep. James Sensenbrenner of the 5th Congressional District is being challenged by Jim Burkee (R-Cedarburg), a professor at Concordia University. The district is considered Republican, and the winner will not face a general election opponent. Another primary of note is the Democratic primary in the 1st Congressional District, where three Democrats are vying for the right to challenge five-term incumbent Paul Ryan (R-Janesville). Click here for a local news summary of the Democratic primary.
State Senate and Assembly
Primaries are being held across the state. (For a list by district click here.) Republicans currently control the Assembly 52-47, and this close margin will mean even more contested primaries. All seats are technically up in November, and a few incumbents do not face a general election opponent. Eleven of the Assembly seats will have new representation due to retirements and other vacancies; six of those seats are currently under GOP control. The State Senate is under Democratic control by an 18-15 margin. About half of the chamber’s 33 seats are up this November, but because there are no contested primaries the November ballot has already been set.
Get Involved!
It is critical that physicians get involved in the political process, including joining the Wisconsin Medical Society’s political giving efforts. Through WISMedPAC and WISMedDirect, physicians can make the most of their political donations and take an active role in the state political process and the future of health care in Wisconsin.
Because a crucial new state budget cycle begins in 2009 and the candidates elected this November will have a tremendous impact on that budget and what it means for medicine in Wisconsin, your involvement is more important than ever. To join WISMedPAC, contact Jeremy Levin, Beth Alvin or Mark Grapentine, JD.
For example, the report recommends physicians demonstrate competence in areas such as medical knowledge, communications skills and practice-based-learning, among other areas. But the AMA’s Council on Medical Education says, “There is no current evidence that physicians’ skills in the areas identified for maintenance of licensure decay at a constant rate.” The report, however, suggests all areas should be reviewed every time a doctor renews his or her license.
Because of these concerns, the AMA recommends physicians review this report carefully and express concerns to your medical society and licensing board. Both ethics subgroups in the Wisconsin Medical Society will be reviewing the report.
“Any process as potentially far-reaching for the medical profession as this should be subject to careful analysis and broad scrutiny,” says AMA CEO Michael Maves, MD. For more information, contact Daniel Winship, MD, AMA Council on Medical Education Secretary, or Mark Grapentine, JD, Society Senior Vice President of Government Relations.
The Society will continue efforts to work with the Department while expecting progress toward improving the licensing process.
Make your voice heard and join other Society members in making campaign contributions to state policymakers. Physicians are encouraged to participate in WISMedPAC and WISMedDIRECT—help strengthen the voice of medicine in the Capitol!
One group the Society will monitor is the Special Committee on School Safety, co-chaired by Sen. John Lehman (D-Racine) and Rep. Don Pridemore (R-Hartford). The group includes various representatives from a diverse array of educational backgrounds, all with a keen interest in public school safety. At its initial meeting on July 22, the committee briefly discussed the possibility of drafting mental health parity legislation in the coming legislative year, citing many students who cannot afford mental health coverage. The committee also discussed whether the benefits of sharing private mental health records with key individuals in the given child’s educational setting would outweigh privacy concerns. The group is still working toward defining the scope of their future work and plans to meet again in September 2008.
The Society will also follow the Special Committee on Performance-Based Disease Management Programs for Large Populations, which holds its initial meeting on July 24. For more information, contact Beth Alvin.
Senate debate began on another motion for “cloture,” or an end to debate, which requires 60 votes. Before leaving for the July 4 recess, the Senate mustered only 59 votes for cloture—an extremely close margin, especially considering the absence of a sure “aye” vote: that of Sen. Ted Kennedy (D-Mass.) who has been recovering from June brain surgery and was not expected to return to the Senate until September.
Rhetoric beginning the debate was much the same as it was for the failed June vote: Democrats decrying the scheduled cuts as disastrous to Medicare access, and some Republicans lamenting the bill’s cuts to Medicare Advantage plans and an inability to offer amendments to the bill. Another close-but-not-enough vote tally seemed certain. Roll call on the cloture vote began at 3:10 p.m.
Roll call votes in the Senate are still done by hand, with a clerk checking a box on a long sheet of paper. The process takes a while. At 3:15 p.m., Sen. Kennedy made a dramatic entrance onto the Senate floor, with a prolonged standing ovation spreading through the chamber. After a few minutes of greetings, Kennedy went to the clerk’s table, voted “aye,” and pumped both fists in the air.
A group of Republicans who had not yet voted then convened on one corner of the Senate floor. Among the group were senators from states where the AMA had targeted grassroots and media efforts in support of the bill—states where Republican senators are facing reelection (including Texas, Georgia, Tennessee and Florida). It became clear that the cloture motion would prevail on the strength of Sen. Kennedy’s arrival, and these senators each went to the clerk, voting “aye.”
Wisconsin’s Senators Feingold and Kohl once again listened to physicians asking for “aye” votes. Both voted to end debate and for passage of the bill. HR 6331 extends current reimbursement levels through the end of the year, and adds a 1.1 percent increase for 2009. To read a section-by-section summary of the bill, click here. Read a reaction to the vote from Wisconsin Medical Society President Steven Bergin, MD, here. Read the AMA’s reaction to the vote here. For more background on the flawed Medicare reimbursement system, click here and here to read articles written by Iowa physician Michael Kitchell, MD.
What’s next?
President Bush could follow through on his veto threat, meaning an override vote would be required in both chambers. But with the margins for passage (the bill passed 355-59 in the House two weeks ago) surpassing the two-thirds total needed for an override, prospects are good that the bill could become law, notwithstanding the President’s objections.
Wednesday’s vote is a major victory for organized medicine. It shows the power physicians can wield when raising their voice and getting involved in the political process. Please take the time to contact Senator Kohl (202.224.5653) and Senator Feingold (202.224.5323) to thank them for their votes on HR 6331. Congressional offices rarely get thank you calls from constituents; doing so is easy and can have long-lasting positive effects.
Stay tuned to Medigram to learn if or when it is time to contact your U.S. House members to ask for an override vote. For more information, contact Mark Grapentine.
Three physicians have filed for election: incumbent Rep. Chuck Benedict, MD, (D-Beloit) is running for a third two-year term. Rep. Sheldon Wasserman, MD, (D-Milwaukee) has left his State Assembly seat to run for the 8th Senate District slot currently held by Sen. Alberta Darling (R-River Hills). Former Society Board Chairman Thomas Luetzow, MD, (R-Watertown) faces a three-way Republican primary in a bid to unseat incumbent Democrat Andy Jorgensen (D-Fort Atkinson).
Individual races determine which party will control each of the two legislative houses. Conventional wisdom says Democrats will likely continue to hold the majority in the State Senate, although the current 18-15 margin could change. The State Assembly is the wild card this election season, with the slim 52-47 Republican majority up for grabs. An extra twist was revealed yesterday, when incumbent State Rep. Jeff Wood (I-Chippewa Falls) announced that he would run for reelection as an independent, shedding his former Republican affiliation. Read an article about that decision from the Leader-Telegram here.
On the federal front, all eight Wisconsin members of the U.S. House of Representatives face challengers: Rep. Jim Sensenbrenner (R-Menomonee Falls) has both a primary and an independent challenger; Rep. Gwen Moore (D-Milwaukee) drew an independent opponent. The most hotly contested general election race will likely be seen in the 8th House district, with freshman Rep. Steve Kagen, MD (D-Appleton) facing a rematch against former State Assembly Speaker John Gard (R-Suamico). Kagen prevailed in the 2006 contest on a 51-49 percent margin.
For a list of all candidates, including links to campaign Web sites, click here. For more information, contact Mark Grapentine, Jeremy Levin or Beth Alvin.
While both Wisconsin Senators Herb Kohl (D-Milwaukee) and Russ Feingold (D-Middleton) voted to move the bill forward, not enough senators voted with them to allow a final vote on HR 6331. In response, the AMA has turned up the political heat on a variety of senators by launching television and radio ads in states where senators facing reelection this November voted “no” on the motion to end debate on HR 6331 (read the AMA’s press release here). Some state medical societies have taken their own political action, including the Texas Medical Association’s Political Action Committee (PAC) withdrawing its endorsement of Senator John Cornyn (R-TX).
Opposition to the bill has centered around Medicare Advantage funding; the insurance industry has also purchased time to air its own media campaign (see the Wall Street Journal’s health blog story on the media escalation, and another from the Washington Post). The Senate could bring HR 6331 back to the floor on Monday, or attempt to find a compromise that would avert a threatened presidential veto. Much will depend on the pressure targeted senators endure during July 4th festivities in their districts (see one prediction of that pressure in this blog’s headline). Senate Republican leaders are apparently feeling the pressure, urging at least a short-term solution (see story here). Stay tuned to Medigram for continuing coverage of the Medicare reimbursement issue.
For more information, contact Mark Grapentine.
Nonetheless, relentless media coverage of the 2008 presidential race means television talking heads need to fill airtime with analysis of what’s available at the time, and that includes a myriad of polls. Wisconsin has a connection to one of the most comprehensive poll analysis sources around—one of the co-developers of Pollster.com is University of Wisconsin-Madison political science professor Charles Franklin. For a look at the site’s current summary of the presidential tracking polls, click here.
On the presidential campaign front, Wisconsin’s status as a battleground state is once again confirmed; the Republican National Committee is spending $3 million for an anti-Obama ad to air in four states, including Wisconsin, beginning this Sunday.
Physicians can become more involved in the political season by joining WISMedPAC and WISMedDIRECT programs. Help strengthen the voice of physicians and patients and participate in organized medicine’s political voice by joining WISMedPAC/WISMedDIRECT. Contact Mark Grapentine, Jeremy Levin or Beth Alvin with any questions.
HR 6331 would, among many other provisions, continue reimbursement rates at current levels through the end of the year, then increase reimbursement by 1.1 percent for 2009. There is also the threat of a Presidential veto. Tuesday’s House vote was more than enough to overcome a veto in that chamber, which strengthens chances that the bill could get broad Senate support. Senate sources say there is a good chance there are 60 votes to end debate; it is still questionable if there are the 67 votes necessary to override a veto.
Earlier in the week there were rumors of a compromise between Senate Finance Members Charles Grassley (R-Iowa) and Max Baucus (D-Mont.) on an omnibus Medicare package, including a reimbursement fix. Those rumors were apparently premature. Moreover, the strength of Tuesday's House vote has emboldened Senate Democratic leadership to pursue final passage of HR 6331 rather than seek a "compromise."
Society members are encouraged to contact Wisconsin Senators Herb Kohl and Russ Feingold and ask their support in preventing the 10.6 percent cut and passing HR 6331. Contact Senator Kohl directly at 202.224.5653 and Senator Feingold directly at 202.224.5323. While it is expected that both Wisconsin senators will vote in favor of the bill, calls to their offices are still helpful.
For more information, contact Mark Grapentine.
Senator Charles Grassley (R-IA), ranking minority member of Senate Finance, on June 11 announced his intention to introduce his own Medicare omnibus bill, which would include a reimbursement fix similar to that in S 3101. It appears that the Senate will need to find a compromise in order for a fix to take effect before the July 1 deadline.
Society members are encouraged to contact Wisconsin Senators Herb Kohl and Russ Feingold and ask their support in preventing the 10.6 percent cut. You can contact them through the American Medical Association’s Action site or by calling the AMA hotline at 800.833.6354.
For more information, contact Mark Grapentine.
While the MEB asked staff from the Department of Regulation and Licensing to further research the potential effects of certain changes (such as combining hospital privilege and employment verification forms, for example), the Board did make one immediate change: extending the time period from six months to one year for the department's acceptance of various application items. Many physicians and organizations have expressed frustration over the previous six month limitation. The Board said it would also look at potentially modifying reporting requirements for post-graduate training, medical liability history and items used to verify medical school graduation.
For more information, contact Mark Grapentine.
Wisconsin's swing state status also means that Wisconsin TV audiences are seeing some of the first Obama vs. McCain election ads of the season. See a McCain effort to separate himself from President Bush on the environment here. Independent liberal group MoveOn.org is airing its own ad, an anti-McCain message tied to the Iraq war. And just today, the Obama campaign debuted this one-minute general biography piece.
For more information about how you can help strengthen the voice of physicians in the state and U.S. Capitols, contact Mark Grapentine, Jeremy Levin or Beth Alvin.
At a meeting with DRL officials this week, the Society and WHA shared evidence of the concerns. This memo describes some specific instances of delays or DRL-caused confusion, while this PowerPoint summarizes results of a poll the Society conducted with the Wisconsin Medical Group Managers Association (WMGMA) of many clinics around the state regarding licensing time and experience. The DRL staff acknowledged problems with timeliness, accuracy and customer service in this area, and described present and future efforts to address the problems. DRL is already studying the Medical Examining Board's (MEB) requirements for different forms and information to gauge if there are redundancies that can be eliminated. The MEB is scheduled to discuss the issue at its next meeting on June 18, and the DRL plans to move one full-time staff member to assist the licensing effort.
The meeting results were positive; the Society expects DRL to achieve measurable short- and long-term improvements that allow license applications to be processed in a more reasonable timeframe. The Society will continue its positive relationship with DRL to ensure that this mutual desire for progress leads to actual results.
For more information, contact Mark Grapentine.
The 2006 elections are remembered for the “Democratic tsunami” that washed across the national and state elections landscape. The Wisconsin results—with the State Senate swinging from Republican to Democratic leadership and Republicans losing eight seats from their Assembly majority—set up an 18-15 Democratic majority in the Senate and 52-47 Republican majority in the Assembly entering into this election cycle.
Like 2006, a number of seats will be wide-open races with no incumbent, as some legislators have opted to retire or run for a different legislative office. Sen. Roger Breske (D-Eland) will be the state’s new railroad commissioner and Sen. Carol Roessler (R-Oshkosh) is retiring. Current Assembly minority leader, Rep. Jim Kreuser (D-Kenosha) is running unopposed for Kenosha County executive. Rep. Sheldon Wasserman, MD, (D-Milwaukee) is running for the 8th Senate District against incumbent Sen. Alberta Darling. Additionally, the following representatives are retiring: Rep. Sue Jeskewitz (R-Menomonee Falls), Rep. Eugene Hahn (R-Cambria), Rep. Sheryl Albers (R-Reedsburg), Rep. Carol Owens (R-Oshkosh), Rep. Steve Wieckert (R-Appleton), Rep. Frank Boyle (D-Superior), Rep. Dave Travis (D-Waunakee), Rep. Barb Gronemus (D-Whitehall), and Rep. Terry Musser (R-Black River Falls).
The 13 announced vacancies are a bit more than the 12 from 2006, but are split more evenly between the parties. In 2006, 11 of the 12 vacancies were in Republican-held seats, while this year seven Democrats and six Republicans are moving on. Both parties are ramping up their election efforts, seeking to expand or seize a majority for their caucus.
With nearly 12,000 members across the state, Wisconsin Medical Society members have the opportunity to make the physicians’ voice well-heard in all 99 State Assembly and 16 State Senate races. The grassroots potential for medicine is spectacular, whether via political contributions through WISMedPAC or WISMedDIRECT, having candidates visit your clinic or office or simply requesting more information about the candidates (Society staff are happy to help). Click on the link to the left to start your political contribution account, and help strengthen the voice of medicine in the State Capitol.
For more information, contact Mark Grapentine, Jeremy Levin or Beth Alvin.
Rep. Sheldon Wasserman, MD, (D-Milwaukee) appeared before the MEB regarding “expedited partner therapy” (EPT), which would allow a physician to write prescriptions or provide medications not only for patients with chlamydia or gonorrhea, but for the patient’s partner without the physician first examining the partner. Doctor Wasserman has authored legislation on EPT (most recently this past session as 2007 Assembly Bill 318), but those efforts have not resulted in a new law; his appearance before the MEB was to request willingness to explore potential rulemaking or policy statement solutions. The AMA has policy supporting EPT, citing a 2006 white paper on the topic from the Centers for Disease Control and Prevention. The Society has supported Dr. Wasserman’s legislative efforts. The MEB asked its legal counsel to research Wisconsin law to determine what actions it can take supporting EPT.
Also of note, MEB (and Society) member Sujatha Kailas, MD, MBA, was elected to the Federation of State Medical Board’s nominating committee at the 2008 FSMB annual meeting earlier this month. The two-year term bolsters Wisconsin’s national presence in a well-regarded organization.
For more information, contact Mark Grapentine.
If these or other topics affecting the practice of medicine interest you, consider joining a council or sitting in on one when you see an interesting topic. For more information on Society councils, contact Karen Carney, Mark Grapentine or Merry Earll.
Gov. Doyle is expected to make changes to the bill; Thursday morning he said the vetoes could be announced very soon. At a press conference earlier this week, Doyle strongly criticized the actions on tobacco settlement funds and the school aids delay, instead stating that better options included cuts to transportation spending and creation of a tax on hospital gross receipts designed to capture federal matching funds for Medical Assistance. While the Governor’s veto power has been reduced slightly (a referendum ending the “Frankenstein veto” power passed the state in April), conventional wisdom predicts the Governor will use vetoes to dramatically change the final product.
Read a story about the bill from the Appleton Post-Crescent here. Another article from the Wisconsin State Journal notes that future budget problems could emerge pending resolution of various lawsuits against the state, including the Society’s effort to reverse a $200 million raid on the Injured Patients and Families Compensation Fund.
See legislative reaction from those voting for the bill (Speaker Huebsch, Senate Majority Leader Decker, Rep. Stone) and those voting against (Senators Ellis/Cowles, Sen. Darling, Rep. Wasserman).
For more information, contact Mark Grapentine or Jeremy Levin.
Following completion of this mailed survey in June, the Wisconsin Survey Center will conduct an interactive Web site survey utilizing the same format. This will provide an opportunity for all Wisconsin physicians to express their attitudes regarding our health care system. The UWSMPH Population Health Institute staff will analyze all survey data.
The Society anticipates that the principles that are formed from any consensus from survey respondents will have a major impact on future health care reform legislation. If you were randomly selected to receive the mailed survey, please respond promptly. If you do not receive a survey in the mail, watch your e-mail for the Web survey next month.
If you have questions about the survey, please contact Mark Grapentine.
Some news coming from the talks centers on areas of disagreement rather than accord. A weekend story in the Wisconsin State Journal suggested that a tax on hospital gross receipts—an option supported by the Governor and Senate Democrats—could be dead. Meanwhile, the Governor frowns upon one of the lone areas of DEM-GOP legislative agreement: postponing a school aids payment from this biennium into the next.
As the calendar moves toward election season (which historically kicks into full gear during July 4 parades), legislators face the possibly conflicting desires of fixing the budget deficit quickly, but doing so in a way that does not run afoul of political philosophy. Stay tuned to future Medigrams for the Society’s analysis of what potential impact a budget deficit agreement could mean for physicians and medicine.
For more information, contact Mark Grapentine or Jeremy Levin.
If you haven’t yet called Sen. Kohl or Sen. Feingold asking them to support Senator Debbie Stabenow’s S. 2785 (see an earlier issue of Medigram), which rolls back a scheduled 10.6 percent Medicare reimbursement cut, calling about both bills is timely. Contact them through the American Medical Association’s Action site or by calling the AMA hotline at 800.833.6354.
The poll by The Mellman Group and Public Opinion Strategies shows that a statewide smoking ban has gained an additional five percentage points since February 2007, with 69 percent of those polled now in support of the ban.
While the possibility of a statewide smoking ban will have to wait for the next legislative session, two Wisconsin communities, Eau Claire and Marshfield, passed local ordinances last week requiring all public places to be 100 percent smokefree for their 80,000 combined residents. A smoking ban also went into effect in Fitchburg, although some public places are exempt.
Read press coverage about the bans in Eau Claire, Marshfield and Fitchburg.
For more information, contact Jeremy Levin.
A table will be set up during this Friday’s Society Annual Meeting at Monona Terrace convention Center in Madison. Stop by to learn more about what your contribution can do to help advance health care issues in Wisconsin. Or click here to contribute on-line.
For more information, contact Jeremy Levin.
The Society was well represented at the conference. Attendees included AMA Trustee Cyril “Kim” Hetsko, MD, Society President Clarence Chou, MD, President-Elect Steven Bergin, MD, Past President and AMA delegate Paul Wertsch, MD, Society CEO/EVP Susan Turney, MD, WISMedPAC Chair Sridhar Vasudevan, MD, AMA delegate Mike Miller, MD, and UW resident Claudia Louise Reardon, MD. Alliance President Sherry Clarke and Alliance member Gina Daly also joined the meetings as did medical students Cheryl Maenpaa, Jack Bagley and Richard Leake of the Medical College of Wisconsin and Jennifer Jenkins of the University of Wisconsin School of Medicine and Public Health, who also raised the issue of the financial burden of medical student loans. The trip was organized by Jeremy Levin of the Society’s Government Relations staff as part of that department’s continuous lobbying efforts.
Although the Congressional meetings are over, it’s not too late to add your voice to the dialogue about Medicare physician reimbursement cuts. Contact your Congress members and urge them to prevent the July cut. Just click here to access your members of Congress.
For more information, contact Jeremy Levin or Mark Grapentine, JD.
This legislation would stop payment cuts for 18 months, giving Congress time to replace the current flawed sustainable growth rate (SGR) formula with a more equitable reimbursement methodology.
A recent AMA survey revealed that 60 percent of physicians reported that they would have to limit the number of new Medicare patients they treat if payments are cut 10 percent in 2008. More than half of physicians report that they cannot meet their payroll and will have to reduce their practice staff so it is critical that Congress take action to replace cuts with positive updates based on practice cost increases.
Society members are encouraged to contact Wisconsin Senators Herb Kohl and Russ Feingold by Monday, March 31 to urge them to co-sponsor S2785. You can also contact them through the American Medical Association Action Alert Web site by clicking here.
Both Roessler and Wieckert are longtime friends of the Society and have been supportive of its issues. Most recently, they were lead authors of the smoke-free workplace legislation. Although it did not pass this session, it has had broad public support. Others legislators that have announced their retirement include Reps. Barb Gronemus (D-Whitehall), Eugene Hahn (R-Cambria), Carol Owens (R-Oshkosh), and Dave Travis (D-Waunakee).
Act 109 is the result of work conducted under Wisconsin’s Health Information Security and Privacy Project, which involved numerous workgroups comprised of key advocacy and provider organizations, including the Society. The Society participated in the 51.30 workgroup, which set the initial framework for the bill.
Except under limited circumstances, Chapter 51.30 of Wisconsin law prohibits disclosure of mental health, alcohol and other drug abuse, and developmental disability health information without written consent. Certain elements of a patient’s treatment record, such as name, address, date of birth, date of service, diagnosis, and medications can be released without written consent to health care providers in a related health care entity. The legislation also permits sharing diagnostic test results and symptoms with any health care provider treating the patient even if the provider is outside the related health care entity without written consent. Sharing any other health care information under Chapter 51.30 would still require written consent.
To read a detailed explanation of the legislation prepared by the Department of Health and Family Services (DHFS), click here. More information is also available in this DHFS press release. For more information, contact Jeremy Levin.
Another $330 million will come from various administration spending cuts and a “transfer” from the transportation fund. Additional spending cuts (since the original budget passed in October 2007) complete the Governor’s balancing plan.
Late Wednesday night, Republicans in the State Assembly amended Doyle's plan and removed the hospital tax. The Assembly plan requires the Doyle administration to cut $250 million in state spending, taps into a “rainy day” fund and pushes a general school aids payment into a future fiscal year. That plan passed on a 51-46 vote, primarily along party lines. As of Thursday morning, Democratic leadership in the State Senate has said that house will not address the amended bill today, instead referring the measure (now known as 2008 Special Session Assembly Bill 1 to the bipartisan, bicameral Joint Committee on Finance.
For more information, contact Mark Grapentine or Jeremy Levin.
The initial version of Healthy Wisconsin was introduced in the midst of the biennial budget process, raising criticisms that the plan was more political in nature than a realistic policy proposal. Support for the original version was primarily limited to the Senate Democratic caucus, as Governor Doyle and some Assembly Democrats distanced themselves from the proposal.
The current proposal creates a Governor-appointed 16-member board of trustees that holds tremendous power over how health care would exist in Wisconsin, and is tasked with creating and administering a health care program covering all Wisconsin citizens. Four additional members would come from a special Health Care Advisory Committee but would not have voting power. Physicians could theoretically have input on the Advisory Committee but are specifically excluded from the voting membership.
A vigorous financial analysis of the plan has not yet been done; one estimate is that a $15.2 billion payroll tax can pay for the plan, but the Society believes a more significant fiscal breakdown is needed.
Senator Jon Erpenbach (D-Middleton) is the author of the bill; you can read his press release here. An Associated Press article about the legislature’s work on “health care reform” during the remainder of the session is here.
For more information, contact Mark Grapentine or Jeremy Levin.
State statutes require the Governor to submit legislation that will rectify the deficit. To that end, he has called the legislature into special session next Thursday, March 13 to begin the legislative process of debating and approving a repair bill. Details of the Governor’s proposal are not yet known; a plan will be forthcoming next week. Reports are that a hospital tax will be the centerpiece of the plan; a spokesperson for Assembly Speaker Mike Huebsch (R-West Salem) has said the Republican-controlled Assembly will not a pass a bill that includes such a tax.
For more information, contact Mark Grapentine or Jeremy Levin.
AB 834 is the Assembly companion to Senate Bill 150. However, the effective date of AB 834 is January 1 2009, a year earlier than the Senate Public Health Committee had compromised on during their executive session of SB 150. The next step is to get one of the bills through both legislative chambers before session ends next week.
For more information, contact Jeremy Levin.
Society members who want to be politically active can also be members of the Society’s WISMedPAC/WISMedDIRECT. Our 2008 membership year is underway and we need your help going into the Fall elections.
For more information, contact Jeremy Levin.
AB 834 is the Assembly companion to Senate Bill 150. However, the effective date of AB 834 is January 1 2009, a year sooner than the Senate Public Health Committee had agreed on during its executive session for SB 150. It appears that the Assembly Public Health Committee will meet Tuesday to take executive action on AB 834. If the bill passes at that time, advocates will have roughly two weeks to get the bill through both legislative houses before session ends.
In support of a smoke-free state, Citizens for Smoke-free Air is holding a day at the Capitol and a rally at the Monona Terrace Tuesday, March 4. Seven-time Tour de France winner, cancer survivor and cancer advocate Lance Armstrong will appear with Governor Jim Doyle to urge approval of The Breathe Free Wisconsin Act during the rally at Monona Terrace from noon to 12:45 p.m. Armstrong is the founder and chairman of the Lance Armstrong Foundation, which supports cancer research.
Society members are encouraged to participate in the rally. Registration begins at 10:30 a.m. and the rally and group visits to legislative offices will wrap up around 3 p.m. Free buses are available for those traveling from Eau Claire, La Crosse, Wausau, Green Bay and Milwaukee.
For more information, contact Jeremy Levin.
Participants are hopeful Wisconsin will join 42 other states which have already enacted mental health parity. For more information, contact Jeremy Levin.
For more information, contact Jeremy Levin.
For more details, contact Jeremy Levin.
AB 793 builds on the Legislature and Governor's efforts to encourage the implementation of health care information technology through incentives, such as tax credits for providers who invest in electronic medical record (EMR) systems and tax deductibility for bonds issued through the Wisconsin Health and Educational Facilities Authority.
Specifically, the bill makes changes regarding the disclosure of patient health care records and mental health treatment records to health care providers, or persons acting under the supervision of health care providers without patient consent. These provisions make Wisconsin law more consistent with federal HIPAA privacy laws and the patient protections inherent in them.
This bill is the result of work conducted under Wisconsin’s Health Information Security and Privacy Project, which involved numerous workgroups formulated by the eHealth Board and comprised of key advocacy and provider organizations who met regularly, including the Society.
The Society participated in the 51.30 workgroup that set the initial framework for AB 793. The representatives in the workgroup sought to balance patient privacy issues and the importance of access to limited, but key patient health care information in providing safe and complete care for the patient. The group identified a series of issues, including stigma and disclosure rights, related to mental health records. They also believed there were issues that warranted further discussion, including the need for education for health care professionals regarding the changes. Because of the broad range of issues raised by this workgroup, the group agreed on a delayed effective date for the changes related to mental health treatment records. The later effective date gives patients and health care professionals time to adjust and ensures the Department of Health and Family Services has time to address any outstanding issues.
The 51.30 workgroup included stakeholders representing consumers and providers of mental health, AODA, and developmental disability treatment services as well as individuals with expertise in health information administration and technology, privacy law, and data quality.
If you have questions, contact Jeremy Levin.
“Our coalition has an excellent bill drafted, an impressive list of sponsors, and now we invite all who understand the importance of this legislation—to Wisconsin’s economy and to our families—to be part of Mental Health Parity Action Day,” Lawton said. Senate Bill 375 requires that insurance policies provide the same coverage for mental health and mental illness as they do for physical health, illness or injury. SB 375 had a public hearing in January and was voted out of committee on a bipartisan vote.
For more information, visit http://ltgov.wisconsin.gov and click on the “Mental Health” button, call 608.266.3516 or contact Jeremy Levin. Click here to view the day’s agenda, which will include advocacy training, a networking lunch and appointments arranged with legislators.
The Society’s Council on Legislation discussed both bills (as well as a third version by Sen. Jim Sullivan [D-Wauwatosa]) at its February 8 meeting. The Council unanimously supported the strategy to raise concerns on the bills’ content while making it clear the Society supports thoughtful transparency. Assembly Republicans met in closed caucus on Wednesday in part to discuss which transparency bill—if any—it would rally behind. The Society’s Government Relations staff will continue to monitor the fate of these bills.
For more information, contact Mark Grapentine or Jeremy Levin.
See a statement from the Congressman on his legislation here and a story regarding the proposed legislation from the Appleton Post-Cresent here. For more information, visit Congressman Kagen’s Web site.
Currently, the coalition is meeting with Senate leadership, who is seeking a compromise between the coalition and the Wisconsin Tavern League. Discussions are ongoing, with the leaders cognizant of the waning session days left to pass a bill.
For more information, contact Jeremy Levin.
Senator Jim Sullivan’s (D-Wauwatosa) Senate Bill 377, Rep. Steve Wieckert’s (R-Appleton) Assembly Bill 729 and a still-to-be-introduced proposal from Rep. Leah Vukmir (R-Wauwatosa) all would require physicians to provide patients with various cost information related to procedures, services or diagnostic tests.
Rep. Vukmir’s effort is titled “The Patients’ Right to Know Act,” and states that there is “general, bipartisan consensus that tools like these help put patients in charge of their health care while encouraging them to become more conscious of health care costs.” While the general consensus indeed agrees that cost information can be valuable, policymakers also need to acknowledge that health care costs can vary widely based on the patient and the care needed. The Society has partnered with various health care entities across the state to coordinate the physicians’ message to our state policymakers and to explain the real-world effects of these bills.
If you haven’t paid much attention to this race, there is still time to familiarize yourself with the two candidates. While government’s involvement in your practice has generally come from the executive and legislative branches of government, the judicial branch is becoming more of a factor.
Wisconsin Supreme Court justices are elected to 10-year terms, so your vote on April 1 could have long-lasting impact. To learn more about the candidates, visit their Web sites:
For more information about either of these issues, e-mail Mark Grapentine.
Current Issue: January 14, 2010
Society teams with other health care entities to improve Assignment of Benefits law
Currently the law does not require insurance companies to honor Assignment of Benefits forms (AOBs) signed by patients. AOBs authorize the insurance company to make payments directly to the physician instead of the patient. AOBs simplify the billing process for the patients (e.g., not required to make payments at the time of service and/or submit their own claims to their insurance company) and physicians (e.g., reducing administrative burden and overall cost of health care). Insurance companies often use AOBs as a bargaining chip, honoring them only if a physician has contracted with the insurance company.The Wisconsin Medical Society has joined a wide and diverse group of health care professionals, including dentists, hospitals and others, to sponsor a bill requiring insurance companies to follow a patients’ wishes when completing an AOB. The legislation, Senate Bill 453, has two powerful cosponsors: Finance Committee Co-chair Mark Pocan (D-Madison) and Senate Health Committee Chair Jon Erpenbach (D-Waunakee). The bill has been assigned to Sen. Erpenbach’s committee.
Not surprisingly, the insurance industry is vigorously opposing the measure, alleging that the current practice lowers health care costs for the patient. Physicians contacting their state legislators can help build support for this policy improvement. Contact information for your state senators and representatives is available here.
For more information on this issue, contact Mark Grapentine, JD.
Society testifies in support of Medicaid audit
As Wisconsin’s Medicaid program struggles amid soaring enrollment and a funding deficit, the Wisconsin Medical Society and others have pressed the State Legislature to request a full audit of the Medical Assistance (MA or Medicaid) program. Society Vice President Tim Bartholow, MD, testified Wednesday at a hearing of the Joint Committee on Audit, expressing physicians’ concern that the state is not living up to its promise to deliver a program that serves its sickest and poorest citizens.The 2009-2011 biennial budget included cuts to Medicaid funding, leaving a $633 million deficit for the biennium. As efforts continue to find ways to cover that shortfall, the state is expanding the program’s coverage even further; the BadgerCare Plus Core Plan for childless adults was promoted as a “budget neutral” proposal. However, the state’s nonpartisan Legislative Fiscal Bureau (LFB) has estimated that based on current data, the plan will cost $20 to $25 million more than expected. You can read an LFB paper on both the Medicaid deficit and the Core Plan projections here.
The Society believes full and frank audit of the program could be critical if fiscal catastrophe forces difficult Medicaid coverage and funding decisions. A copy of the Society’s written testimony is available here.
For more information, contact Tim Bartholow, MD, Chris Rasch or Mark Grapentine, JD.
State Senate to vote on medical liability expansion bill Tuesday
This week the Senate Organization Committee scheduled Senate Bill 203—the so-called “Family Justice” bill—for a full Senate vote next Tuesday, Jan. 19. The bill would expand all physicians’ potential medical liability exposure by allowing recovery for “loss of society and companionship” damages for adult children and their parents.The bill would also overturn two Wisconsin Supreme Court cases that ruled that broad public interest bars such damages when all parties are adults. Click here to read a memo about this issue that the Wisconsin Medical Society sent to the Senate previously.
Please call your state senator and ask him or her to vote “no” on Senate Bill 203. The following talking points can be helpful as you speak with your senator or your senator’s staff:
- The national health care reform debate has drawn new attention to “defensive medicine.” Members of Congress and President Obama have acknowledged that defensive medicine is real. The Congressional Budget Office in 2009 issued an analysis of certain malpractice law reforms and found that enactment of certain reforms could reduce the federal deficit by $54 billion over the next 10 years. Senate Bill 203 moves Wisconsin in exactly the opposite direction by increasing potential lawsuit exposure. That does nothing to help stem the cost of health care.
- Rather than engage in partisan fights, the Legislature should work with physicians on ways to improve Wisconsin’s already remarkable achievements in providing the nation’s best health care quality. Some of those ways include strengthening peer review and enacting laws that will foster better communications between physicians and the families of patients when negative outcomes occur (e.g., “I’m Sorry” legislation).
Please take the time to call your state senator. You can verify your senator’s contact information here. If you have questions, contact Mark Grapentine, JD, or Chris Rasch.
December 17, 2009
Society testifies at ‘medical marijuana’ hearing
A physician addiction expert and Wisconsin Medical Society leader testified on behalf of the Society Tuesday at a State Capitol hearing about legislation that would create a “medical necessity” defense for marijuana-related prosecutions and/or forfeitures. Society Vice Speaker and addiction medicine expert Michael Miller, MD, appeared in front of a joint meeting of the Assembly Public Health and Senate Health committees. He provided both committees with this testimony, which opposes the proposed legislation (Assembly Bill 554 and Senate Bill 368).Doctor Miller’s testimony included relevant materials from the Society, the American Medical Association (AMA) and the American Society of Addiction Medicine. Doctor Miller also cited a new federal study of nearly 50,000 students that found teen marijuana use is on the rise. Click here to read story about that study, along with Dr. Miller’s comments.
Under the legislation, individuals would qualify for the defense if a physician provides written certification that the person suffers from a “debilitating medical condition or treatment.” The bill defines such conditions (including cancer, glaucoma and post-traumatic stress disorder) while empowering the state’s Department of Health Services to establish other qualifying conditions through administrative rulemaking.
Society and AMA policy both state that scientific studies should predate establishing “medical marijuana” programs such as that proposed in AB 554 and SB 368. Society policy also emphasizes the harmful effects of the usual marijuana delivery method: smoking.
Click here to find a video of the entire hearing (titled “12.15.09 l Joint Committee on Health”) on the WisconsinEye website. (Note: A free download of Windows Media Player software is required to view the video.)
For more information on this legislation, contact Mark Grapentine, JD, at the Society.
Council on Legislation recommends close examination of raw milk legislation
At its Dec. 4 meeting, the Society’s Council on Legislation requested that Society members be alerted to legislation that would allow farmers to sell raw milk to consumers. The bills, which do not yet have official bill numbers, will be authored by Rep. Chris Danou (D-Trempealeau) and Sen. Pat Kreitlow (D-Chippewa Falls). The bills are in response to reports of increased enforcement by the state’s Department of Agriculture, Trade and Consumer Protection against those selling raw milk illegally.While the Society does not have policy on sales of raw milk, the American Medical Association (AMA) does:
H-150.980 Milk and Human Health
The AMA reaffirms its policy that all milk sold for human consumption should be required to be pasteurized. (Sub. Res. 67, I-85; Reaffirmed by CLRPD Rep. 2, I-95; Reaffirmed: CSA Rep. 8, A-05)
The Council believes state legislators would benefit from hearing from physicians in their districts, should those physicians have concerns regarding the safety of raw milk. The U.S. Food and Drug Administration's “Food Facts” website, for example, warns of “serious” health risks associated with consuming raw milk.
Some recent media stories about the issue may be found here and here. In addition, the La Crosse Tribune recently published an editorial supporting the bills.
For more information, contact Mark Grapentine, JD.
December 3, 2009
Gov. Doyle creates new eHealth board to develop statewide EMR system
The Wisconsin Medical Society this week attended Gov. Doyle’s public announcement about the formation of a new eHealth board. At the event, the governor signed into law Executive Order 303, which officially creates a new board and outlines plans for creating a statewide, integrated and interoperable electronic medical records (EMR) exchange known as the Wisconsin Relay of Electronic Data (WIRED). If all goes according to plan, WIRED will be the first statewide EMR system in the nation.This eHealth board replaces the eHealth Quality and Safety Board. Its duties will include:
- Outlining provisions for oversight and accountability.
- Identifying, securing and providing funding to build capacity and ensure long-term sustainability.
- Providing a technical infrastructure.
- Helping health care professionals use and exchange electronics records.
- Providing for the operation and flow of information.
- Creating a common set of rules for exchanging health information while protecting patient interests.
To implement this health information exchange, Wisconsin will receive $9.44 million from the American Reinvestment and Recovery Act of 2009 (ARRA). Gov. Doyle is hopeful that this effort will position Wisconsin to receive more money from the additional $34 billion available through ARRA.
The governor noted that the new executive order is to be used as a “framework” for legislative action that Rep. Jon Richards and Sen. Pat Kreitlow will develop when the legislature reconvenes in January. Stay tuned to Medigram for details as this plan takes shape.
For more information on the state’s eHealth initiative, click here and here or contact Chris Rasch in the Society’s Government Relations department.
November 12, 2009
Wisconsin physicians testify in favor of mental health parity bill
The State Senate’s Health Committee heard physician testimony for mental health parity at a Tuesday public hearing for SB 362. Wisconsin Medical Society member Rich Brown, MD, testified in favor of achieving health insurance parity for nervous and mental disorders, alcoholism and other drug abuse problems; the Society also supports this bill.Bruce Kruger, executive vice president of the Medical Society of Milwaukee County, and others also testified in favor of the bill.
SB 362 contains two major benefits. First, it would close the “donut hole” of coverage that remains, even following the passage of landmark federal legislation (the Wellstone-Domenici Act). The donut hole leaves nearly 700,000 Wisconsin citizens without mental health and substance abuse disorder coverage because of an exemption that applies to employers of 51 or fewer people.
The bill also requires that health insurance companies provide coverage for mental health and substance abuse problems just as they cover physical ailments. Under current state law, a group health insurance policy that provides coverage for any inpatient hospital service must cover mental health services. This bill removes the specified minimum amounts of coverage that a group health insurance policy must provide but retains the requirement to provide the coverage. Therefore, SB 362 requires that out-of-pocket expenses (copays, premiums and deductibles) for mental health coverage cannot be more restrictive than benefits for other types of medical coverage.
The Senate Health Committee is expected to vote soon on SB 362. For more information, contact Chris Rasch at the Society.
Spiritual healing bill receives Senate hearing this week
Last year, Wausau 11-year-old Madeline Kara Neumann died from untreated diabetes, drawing attention to the issue of spiritual treatment of illness and the potential penalties parents face for failing to seek medical care for their children. (Click here to read a summary of the Neumann case and its legal implications in the Wisconsin Medical Journal.) The case has also prompted dueling legislation in the State Legislature, including Tuesday’s public hearing before the Senate Judiciary Committee.Senate Bill 384, dubbed the “Freedom of Choice of Faith Act” by primary author Sen. Lena Taylor (D-Milwaukee), would create an “affirmative defense” for criminal cases arising from choosing spiritual “treatment” over medical care for a minor. While the bill has some positive elements, such as amending current statutes related to Christian Science practitioners to make it easier for the state to take a child into custody when a child is suffering from “immediate danger” or a condition requiring “either prompt diagnosis or prompt treatment,” the bill’s dramatic change in adding “reasonable use of spiritual, prayer or religious treatment in lieu of medical treatment” as an affirmative defense for any statutory offense is troublesome.
The Society opposes the bill and submitted this testimony to the committee. Other organizations raising concerns about the bill include the Wisconsin Chapter of the American Academy of Pediatrics, the Wisconsin District Attorneys Association and the Wisconsin Chapter of the National Association of Social Workers.
For more information, contact Mark Grapentine, JD.
November 5, 2009
Society takes part in U.S. Capitol ‘fly in’ on health system reform
Society CEO and Executive Vice President Susan Turney, MD, and Senior Vice President Tim Bartholow, MD, visited Washington, D.C., this week as part of the Healthcare Quality Coalition, a diverse mix of physician advocates, hospitals and health care systems promoting value in health care and geographic fairness in health care reimbursements. The visit is quite timely as the U.S. House of Representatives prepares to vote on HR 3962, the Democrats’ comprehensive health care reform legislation, as soon as this weekend.Besides calling for greater emphasis on rewarding value instead of volume and an end to the current Medicare reimbursement formula’s reliance on unfair-to-Wisconsin geographic factors, the Coalition is urging reforms that would make insurance more affordable and accessible to most citizens. Since Wisconsin provides the highest-quality health care in the nation (as recently rated in the federal Agency for Healthcare Research and Quality’s National Healthcare Quality & Disparities Reports) at a more reasonable cost than other areas of the country, our state’s health care leaders have a tremendous story to tell policymakers.
The Society’s trip to Capitol Hill included visits to the following legislators and/or their staff:
- Senate Finance Committee Chair Max Baucus (D-Montana)
- House Appropriations Committee Chair David Obey (D-WI)
- Senate Health, Education, Labor and Pensions Committee Chair Tom Harkin (D-Iowa)
- Sen. Ben Nelson (D-Neb)
- Sen. Herb Kohl (D-WI)
- Sen. Russ Feingold (D-WI)
- Sen. George Voinovich (R-OH)
- Sen. Chuck Grassley (R-IA)
- Sen. Amy Klobuchar (D-MN)
- Sen. Ben Nelson (D-NE)
- Rep. Thomas Petri (R-WI)
- Rep. Bruce Braley (D-IA)
- Rep. Ron Kind (D-WI)
- Rep. Gwen Moore (D-WI)
- Rep. Earl Pomeroy (D-ND)
- Rep. Paul Ryan (R-WI)
- Rep. Steve Kagen, MD (D-WI)
- Rep. Tammy Baldwin (D-WI)
October 29, 2009
Senate Democrats delay vote on medical liability expansion legislation (SB 203)
State Senate Democratic leaders have delayed a full Senate floor vote on Senate Bill 203 (SB 203), the so-called “Family Justice Bill” that would increase potential medical liability exposure on physicians by allowing parents and adult children to sue for “loss of society and companionship” damages in certain medical negligence cases. The bill was originally scheduled for a Tuesday, Oct. 27 vote.This delay reveals the tenuous support for the bill; the absence of Sen. Kathleen Vinehout (D-Alma) may have prompted the delay, although she is one of the senators whose current stance on the bill is not known for certain. The other two are Sen. Julie Lassa (D-Stevens Point) and Sen. Jim Holperin (D-Conover). Many physicians and others working to defeat the bill made dozens of phone calls to their state legislators this week, helping put the bill’s fate in doubt.
On Nov. 5, the full Senate will meet for the last time this calendar year, then break until mid-January. If you haven’t yet contacted your state senator to voice your opposition to SB 203, now is still a very effective time to do so. You can verify the contact information for your state senator here.
For more information on this issue, contact Mark Grapentine, JD, or Chris Rasch.
October 15, 2009
Physicians testify at beer-tax hearing
The physician voice was well-represented at Tuesday's Assembly Public Safety Committee hearing on AB 287, which would increase the state's beer tax for the first time since 1969.The bill, authored by Rep. Terese Berceau (D-Madison) and Sen. Fred Risser (D-Madison), would make grant funding available to government entities for fighting alcohol-related crimes and would provide funding for community alcohol and drug abuse treatment services. The proposed per-barrel beer tax increase from $2 to $10 would raise an estimated $40 million annually.
University of Wisconsin School of Medicine and Public Health (UWSMPH) Dean Robert Golden, MD, spoke on behalf of the AWARE (All-Wisconsin Alcohol Risk Education) Coalition, to which the Society belongs. Other physicians testifying at the hearing in support of the proposal included Society Vice-Speaker and American Medical Association Delegate Michael Miller, MD, and Medical College of Wisconsin Associate Professor Tim Corden, MD. A number of UWSMPH medical students also testified.
To watch the testimony, click on the following links (a free download of Microsoft Silverlight is required):
- Testimony of Dean Robert Golden, MD
- Testimony of Michael Miller, MD
- Testimony of Tim Corden, MD
- Testimony of UWSMPH students
In other news, a bill prohibiting minors from drinking in bars—even with their parents' consent, as the current law allows—is headed to the state Senate after being passed by a committee on Oct. 6. An identical Assembly bill on this issue is still being considered by a committee. The Society supports these bills.
Click here to read an Associated Press story on this bill, published last Friday on the website of Milwaukee's WTMJ news station.
For more information on these issues, contact Mark Grapentine, JD.
October 8, 2009
Labor and Management nears agreement on worker's compensation bill
While the process has been delayed recently, Labor and Management representatives on the state's Worker's Compensation Advisory Council (WCAC) appear close to an accord on an "agreed-to" bill for the 2009-2010 biennium.The two sides negotiate every two years on potential changes to the state's worker's compensation law; the Wisconsin Medical Society is one of three non-voting health care liaisons to the WCAC, along with the Wisconsin Hospital Association and the Wisconsin Chiropractic Association.
The Society has worked with the other WCAC liaisons to shield the state's health care professionals from the imposition of a draconian medical fee schedule similar to those that have been adopted in other states for worker's compensation care.
In the past, Management has proposed a "one-size-fits-all" schedule that would be based on Medicare reimbursement rates, or some other arbitrary measure. This session, Management made clear its intention to propose a "cost containment" strategy that included a cut to current reimbursement rates. Knowing this, the liaisons re-introduced a "Freeze and Grow" proposal, in which worker's compensation rates would be established at current allowable charge levels and could grow at the rate of the Medical portion of the Consumer Price Index (MCPI).
The WCAC met Oct. 6 to continue bargaining; it will negotiate further later this month.
For more information, contact Mark Grapentine, JD.
September 17,2009
Bill expanding medical liability damages progressing through legislature
Earlier this week the Senate Judiciary Committee narrowly approved 2009 Senate Bill 203, which expands the types of noneconomic damages an adult plaintiff can claim in medical liablity cases.The vote was 3-2, with Sen. Lena Taylor (D-Milwaukee), Sen. Jim Sullivan (D-Wauwatosa) and Sen. Jon Erpenbach (D-Waunakee) voting in favor of passage. Sen. Glenn Grothman (R-West Bend) and Sen. Randy Hopper (R-Fond du Lac) voted against.
Last week the Society alerted its physician Key Contacts about the Tuesday vote in the Senate Judiciary, and many Society members reached out to their State Assembly and State Senate representatives. There is still time to make your voice heard: The more legislators who hear from their physician constituents, the more likely these bills will never reach the Assembly and Senate floors. Click here to find your legislators' contact information. If you are not yet a Key Contact, click here to learn how to sign up.
For more information on SB 203 and its potential ramifications, contact Mark Grapentine, JD.
Society, DRL collaborate to bolster assistance program for chemically dependent professionals
The Wisconsin Department of Regulation and Licensing (DRL), with assistance from the Wisconsin Medical Society, is proposing to dramatically bolster its program that provides assistance to license holders facing chemical dependency and other impairments.Society members Ed Krall, MD, and Sandra Osborn, MD, both serve as members of a special task force charged with recommending how to bolster the program (a.k.a. "the Impaired Professionals Procedure") so physicians and other license holders can get help with chemical dependency problems without automatically risking their licenses.
At its monthly meeting Wednesday, the Medical Examining Board (MEB) received a report from DRL Secretary Celia Jackson regarding the task force's recommendations to create a "Professional Assistance Program." Participation in the proposed program would be kept confidential from the general public, and participants would be part of the program for up to five years. Those who wished to stay longer could do so voluntarily.
How this program would be financed remains an unresolved question. The Society will continue its collaboration with DRL and MEB as this effort evolves.
Contact Mark Grapentine, JD, for more information on this issue.
September 3, 2009
Assembly committee to vote on expanding medical liability exposure
The Wisconsin State Assembly's Judiciary Committee has scheduled a vote on AB 291 for next Wednesday, Sept. 9. The current version of the bill would increase physicians' exposure to potential liability by expanding the spectrum of damages available to adult plaintiffs in medical liability cases.Dubbed the "Family Justice Bill," the legislation would essentially overturn two Wisconsin Supreme Court cases and allow for "loss of society and companionship" damages involving parents and their adult children. The Society has opposed the bill for many legislative sessions; there is a much greater likelihood the bill could advance through both houses this session.
If you are a constituent of an Assembly Judiciary Committee member, please take a moment to contact them and communicate the Society's opposition to the bill. Committee members include:
Rep. Gary Hebl (D-Sun Prairie), committee chair
Rep. Pedro Colon (D-Milwaukee), committee vice-chair
Rep. Fred Kessler (D-Milwaukee)
Rep. David Cullen (D-West Allis)
Rep. Jon Richards (D-Milwaukee)
Rep. Bob Turner (D-Racine)
Rep. Mark Gundrum (R-New Berlin)
Rep. Samantha Kerkman (R-Powers Lake)
Rep. Bill Kramer (R-Waukesha)
Rep. Rich Zipperer (R-Pewaukee)
Click here to find each legislator's contact information. You may also read the Society's testimony on this bill here. This testimony was provided to both the Assembly and Senate committees deliberating on AB 291 and Senate Bill 203, the Senate companion bill.
For more information, contact Mark Grapentine, JD.
August 27, 2009
Society teams with 11 other state medical societies on health system reform position statement
Joining with 11 other state physician groups from Oregon to Maine, the Society led the latest effort to help Congress understand the effects of proposed health system reform legislation, pointing out policy areas that any reform proposal should address.The letter warns that any proposal basing payments on the faulty Medicare payment system "will have a severe negative impact on access to physician practices in our states and lead to further cost shifting." The letter also points out a fundamental flaw in the current Medicare physician payment formula: a geographic adjustment based on variables bearing little relationship to providing health care.
Rather than build any new system based on current weaknesses, this group of state societies urges Congress to consider a Value Index calculation that rewards quality of care rather than incent quantity of care.
For more information, contact Tim Bartholow, MD or Mark Grapentine, JD.
August 20, 2009
Society leads opposition to bill expanding medical liability exposure
On Tuesday the Society led opposition to Senate Bill 203, which would expand damages in medical liability cases beyond the level the Wisconsin Supreme Court currently allows.At this time, case law does not allow parents to recover damages for “loss of society and companionship” of an adult child and does not allow an adult child to recover these kinds of damages when a parent is injured due to medical negligence.
The Society provided testimony to the Senate Judiciary Committee Tuesday, highlighting the fragile nature of Wisconsin’s medical liability system. This testimony was similar to the July 14 testimony the Society provided to the Assembly Judiciary Committee, which addressed the Assembly companion bill, AB 291. Tuesday’s testimony also included excerpts from specific sections of Wisconsin Supreme Court case law highlighting the reasons the Court has set the current limits.
If you are a constituent of a Senate Judiciary member, consider contacting them with your thoughts on how to preserve Wisconsin’s favorable medical liability environment. To verify the contact information for your state senator, click here.
For more information on this issue, contact Mark Grapentine, JD.
August 6, 2009
Bill repealing religious exemptions nearing introduction; Society’s Council on Legislation will review
A bill proposal in the state legislature would remove certain exemptions from criminal or civil penalties that exist for individuals and parents making health care treatment decisions in part due to religious or spiritual beliefs. The bill, authored by Rep. Terese Berceau (D-Madison), would remove the following exceptions:- A person cannot be found guilty of physical abuse of a child solely because that person provides spiritual treatment in lieu of medical or surgical treatment.
- A government entity deciding whether protective services for a child are needed may not do so solely because a child's parent relies on prayer or other religious means to treat a disease or condition.
- A child may not be compelled to submit to medical treatment and may choose Christian Science treatment instead. The bill would continue to allow an adult patient to make such a decision.
The Society’s Council on Legislation will discuss the proposed legislation at its August 28 meeting. As of press time, the bill had not yet been officially introduced. For more information, contact Mark Grapentine, JD.
July 30, 2009
Society recommends changes to prescription drug monitoring bill
A bill requiring the Pharmacy Examining Board to create a prescription drug monitoring program (PDMP) to help identify “doctor shoppers” needs amending to better protect physician liability exposure and patient record privacy protections, the Society said in testimony delivered to the Assembly Public Health Committee on Tuesday. The bill, Assembly Bill 227, would add Wisconsin to the list of 39 other states with such a program.The Society’s testimony emphasized that any physician making a good faith effort to comply with a PDMP should be immune from any civil, criminal or administrative liability, a protection Minnesota and other states provide as part of their programs. Legislators should also be wary of unintended consequences the bill may have on Wisconsin’s medical records privacy and access laws, the Society advised, as well as considering how physicians not currently using an electronic medical records system could comply with any statewide participation mandate.
For more information, contact Mark Grapentine, JD.
July 16, 2009
Society joins forces with DRL to distribute regulatory digest via web
For years, the Department of Regulation and Licensing (DRL) mailed to licensed physicians a regulatory digest that provided information regarding the discipline of physicians and other Medical Examining Board (MEB) actions. However, the practice was suspended due to budget concerns.The MEB voted Wednesday to bring back the digest and has asked the Society to help distribute the publication electronically to be more economical. The first edition is available here.
For more information, contact Mark Grapentine, JD.
July 2, 2009
Biennial budget signed: Progress made, but challenges ahead
Gov. Jim Doyle, after making 81 vetoes Monday, signed the $61 billion state biennial budget into law as 2009 Act 28. Here are some highlights from the bill:- The state’s Medical Examining Board (MEB) will become a dedicated work unit within the Department of Regulation and Licensing (DRL). This means that for the first time, the license fees physicians pay will go solely to MEB operations, not to the other boards within DRL.
- The Department of Health Services (DHS) is required to find about $600 million in savings from the Medicaid program. The Society will continue to press Medicaid staff for greater collaboration as this savings target looms this biennium.
- The budget includes an expansion of the state’s Medicaid program to include childless adults who fall below a certain income threshold and meet other requirements. The BadgerCare Plus Core Plan takes effect July 15 and is funded primarily through the new tax on hospital revenues. Click here to read an article describing the program.
- A number of changes were made to the state laws related to health care records, including a change in the maximum fees that can be charged for copies of health care records. Watch for additional information on these changes in future editions of Medigram.
- Other provisions include a 75-cent increase in the per-pack cigarette tax and a provision for law enforcement officers to pull over drivers solely for not wearing a seatbelt.
- Gov. Doyle’s proposal to lower the attachment threshold for joint and several liability from 51 percent liability to 1 percent liability was rejected. The Joint Committee on Finance initially floated the compromise of a 20 percent attachment point, but both the Assembly and Senate removed that provision in their separate versions of the budget.
- A statewide smoking ban had been a part of the initial budget proposal but was pulled from the bill and instead enacted as standalone legislation. Read the Legislative Council summary of 2009 Act 12 here. That ban takes effect July 5, 2010.
June 18, 2009
Senate axes joint and several liability provision; Conference committee next
The Wisconsin State Senate Wednesday night followed the State Assembly’s lead and passed a biennial budget bill removing the governor’s proposal to alter current law concerning joint and several liability. The controversial budget item could have increased physicians’ medical liability exposure by forcing a defendant to pay an entire lawsuit judgment even if that defendant was determined to be minimally negligent.Current law allows joint and several liability attachment at 51 percent. In other words, any defendant found at least 51 percent negligent may be held responsible for 100 percent of damages. This 51 percent threshold has been part of state statutes since 1995 and has helped keep Wisconsin’s medical liability climate relatively calm. Gov. Jim Doyle’s 2009-2011 state biennial budget proposal essentially eliminated the 51 percent threshold, while the Legislature’s Joint Committee on Finance proposed a 20 percent attachment level. The State Assembly eliminated the provision when it acted on the budget last week, and the Senate followed suit Wednesday evening. Read more about the Senate’s action here.
Elimination of the provision has been a priority for the Society in recent weeks. Therefore, Society President Robert Jaeger, MD, made a statement following the Senate’s action, praising legislators’ decision to protect Wisconsin’s liability environment.
Because the two legislative houses approved different versions of the budget, a Conference Committee will be formed from Assembly and Senate leadership. Such a committee could be formed as soon as today, and deliberations could be completed by the weekend. Both houses would then need to approve a Conference Committee agreement, with no amendments allowed.
For more information, contact Mark Grapentine, JD.
Medical Examining Board streamlines cross-border physician licensing
As part of its monthly meeting yesterday in Madison, the state Medical Examining Board acted to streamline the process for Minnesota physicians to qualify for a Wisconsin license.No later than August 1 of this year, the Wisconsin Department of Regulation and Licensing (DRL) will consider certain application requirements automatically completed if the Minnesota physician holds a full, unrestricted Minnesota license to practice medicine. A DRL review of Minnesota and Wisconsin physician license applications found similar requirements for certain application elements, such as medical school verification and postgraduate training, prompting the Board to allow an expedited application process for Minnesota physicians.
The Board also heard from DRL staff about the new “e-credential” option for license renewals. Those applying on-line for license renewal may receive their credentials via e-mail. The program, described in detail on the DRL Web site, takes effect July 1.
For more information, contact Mark Grapentine, JD.
May 21, 2009
Society urges Legislature to remove major lawsuit policy change from budget
Society President-Elect Tom Luetzow, MD, represented physicians this morning at a Capitol news conference urging the State Legislature to remove a budget item that would dramatically change who could be responsible for lawsuit damages. The Society was one of 40 organizations calling attention to the policy item, which, if enacted as part of the biennial budget, could force a physician found as little as 1 percent liable for a patient’s injury to pay 100 percent of damages.This change in "joint and several liability" would undo a legislative change passed in 1995 and would result in medical malpractice plaintiffs seeking the entire award from the defendant with the deepest pockets. Read the nonpartisan Legislative Fiscal Bureau’s analysis of this budget provision here.
While legislators from both parties are uncomfortable that such a dramatic policy item resides in the budget, those wary of removing a change coveted by Governor Doyle must hear from their constituents.
More on the coalition's opposition to the lawsuit policy change—including a statement from Dr. Luetzow—is available here.
Members of the Society’s Key Contacts program received a special alert this week that urged them to contact their legislators about this issue. If you aren’t yet a part of this free program, click here to learn more about it. To sign up, contact Mark Grapentine, JD, or Beth Alvin.
Assembly’s insurance committee votes to allow Fund fees increase
The Assembly Committee on Insurance waived its jurisdiction over a proposed administrative rule that would raise physicians’ Injured Patients and Families Compensation Fund (Fund) rates 9.9 percent. The increase is set to take effect July 1, 2009. The Society was the lone health care entity to testify before the Committee and provided written testimony as well, asking the committee to object to the rule.The Fund’s Board of Governors voted 7-4 last December to approve the 9.9 percent increase. Society representatives Susan Turney, MD, and Robert Jaeger, MD, voted against the increase. The Society then appeared at an Office of the Commissioner of Insurance (OCI) hearing on the proposed increase in March, asking that the Commissioner not raise rates while the Society’s lawsuit disputing the $200 million raid of the Fund is pending. The Commissioner declined to reconsider its decision, and OCI promulgated the rule, Clearinghouse Rule 09-004. Today’s hearing was the final option for delaying the implementation of the fees increase.
The vote to waive jurisdiction and allow the fees increase was 4 to 3 along party lines. For more information, contact Mark Grapentine, JD.
U.S. Senate Finance Committee releases final Health Care Reform Options paper
The U.S. Senate Finance Committee will likely be one of the major players as Congress works toward a proposal on Health Care Reform (HCR). To that end, the Committee has released a series of policy options papers related to coverage, costs and financing.The Committee released the third paper Monday, describing HCR financing possibilities. The other two papers relate to improving patient care while reducing health care costs and expanding coverage.
For more information, contact Tim Bartholow, MD, or Mark Grapentine, JD.
May 14, 2009
Workplace smoking-ban bill heads to governor’s desk
After more than 10 hours of debate in both houses of the State Legislature yesterday, a workplace smoking ban bill, Senate Bill 181, is now headed to the governor’s desk for his signature.Following last week’s announcement of an agreement among legislators, public health advocates (including the Society) and the Tavern League of Wisconsin, the greatest threat to the bill becoming law was the possibility that a slew of amendments could upend that compromise. Seventeen separate amendments were proposed in the Senate, and 30 more were proposed in the Assembly. While some votes were extremely close, the bill ultimately passed along the lines of the compromise. The final vote was 25-8 in the State Senate and 61-38 in the Assembly.
The bill now goes to Governor Jim Doyle, who has indicated he will sign the bill into law. If signed, it will go into effect July 5, 2010.
Society members should send their thanks to Sen. Fred Risser (D-Madison), Rep. Jon Richards (D-Milwaukee), Sen. Jon Erpenbach (D-Waunakee) and Rep. Al Ott (R-Forest Junction), who all worked many hours in the last several weeks to convince a majority of their colleagues to vote for the bill. Special thanks should also go to Society Key Contacts who reached out to their Assembly and Senate representatives.
For more information, contact Mark Grapentine, JD.
May 7, 2009
State deficit reportedly growing; Medicaid reimbursement cuts coming?
Legislative work on the state’s 2009-2011 biennial budget ground to a halt this week upon news that tax collections are substantially behind levels predicted when the budget was first submitted in February.While the numbers won’t be released until early next week, the shortfall is expected to add another $750 million to $1.25 billion to the $5.7 billion deficit. Joint Committee on Finance Co-Chair Senator Mark Miller (D-Monona) has said that the committee may be forced to revisit actions it has taken so far on the budget to address the additional shortfall. To view his statement, click here.
This afternoon, Governor Jim Doyle announced potential cuts to state government—including employee furloughs and potential cuts to Medicaid reimbursements—as a way to address the larger deficit without raising taxes.
The deficit news only exacerbates a looming $415 million deficit in the state’s Medicaid program. The Society continues to collaborate with different health care groups statewide to educate state officials and legislators on how “easier” solutions to this deficit, such as reimbursement cuts, could affect access to Medicaid services. The Society also continues to press the Wisconsin Department of Health Services for additional collaboration on the Medicaid program overall.
For more information, contact Mark Grapentine, JD.
April 30, 2009
Legislature’s Finance Committee to vote on efforts to improve MEB
In a meeting late this afternoon, the legislature's Joint Committee on Finance (JCF) is expected to approve Governor Jim Doyle’s proposal—as part of the 2009-2011 biennial budget—to better dedicate fees physicians pay for initial or renewed medical licenses for the Medical Examining Board (MEB). Society membership and staff have worked closely with the Department of Regulation and Licensing and the MEB to improve DRL’s customer service, which in recent history has left applicants waiting months for licenses. The proposal would add staff to work solely on MEB licensing and discipline activities, rather than the current system of sharing time among more than 60 boards, councils and advisory committees.Once JCF finishes its work on the budget, the bill—officially 2009 Assembly Bill 75—heads to the State Assembly and State Senate for further deliberations. For more information, contact Mark Grapentine, JD.
Senate leader wants action on smoking ban bill by mid-May
Senate Majority Leader Russ Decker (D-Schofield) told his Democratic colleagues in a closed-door caucus Tuesday that he would like to see a workplace smoke-free bill get a full Senate vote by mid-May. The bill, which should officially be introduced soon, is separate from the smoking ban contained in the 2009-2011 biennial state budget. Joint Committee on Finance co-chair Rep. Mark Pocan (D-Madison) told the Milwaukee Journal Sentinel that the smoking ban provision will remain in the budget proposal even when a separate bill is introduced to ensure a better chance for eventual enactment into law.Society Key Contacts will be notified when it is the best time to contact your state legislators—which could be as soon as early next week. For more information, contact Mark Grapentine, JD.
Legislators propose first beer tax increase in 40 years
Two Madison legislators are proposing legislation to raise the state’s tax on beer, which hasn’t seen an increase since 1969. Rep. Terese Berceau (D-Madison) and Sen. Fred Risser (D-Madison) want to raise the per-barrel tax from $2 to $10, with the additional revenue going to increased drunk driving enforcement and alcohol abuse treatment. Read about the proposal in a Milwaukee Journal Sentinel article here.The Society is part of the AWARE (All-Wisconsin Alcohol Risk Education) coalition, which supports this effort. If you wish your legislators to cosponsor the Berceau/Risser bill, contact them. Verify your legislators’ contact information here. Contact Mark Grapentine, JD, for more information.
April 23, 2009
Medical Examining Board criticized in national study
Wisconsin’s Medical Examining Board (MEB) received a dose of criticism Tuesday as the group Public Citizen released its 2009 analysis of the nation’s medical examining boards. Because Public Citizen ranks the boards based on the rate of "serious disciplinary actions"—defined as revocations, suspensions, surrenders and probations/restrictions—and partly due to the MEB’s historic philosophy of education and rehabilitation rather than automatic punitive action, Wisconsin consistently ranks near the bottom of Public Citizen’s reports. This year is no different, with the MEB ranked 49th out of 51 entities; only South Carolina and Minnesota had a lower rate of serious disciplinary actions.Wisconsin and Minnesota also consistently rank high in independent measures of health care quality, so the Public Citizen conclusions about the MEB are questionable. Minnesota’s reaction, for example, is essentially dismissive. Former MEB chairs Darold Treffert, MD, and Sidney Johnson, MD, coauthored a 2005 Wisconsin Medical Journal article strongly criticizing Public Citizen’s past conclusions.
For more information, contact Mark Grapentine, JD.
April 16, 2009
Worker’s Compensation update: Management proposes treatment protocols
As part of negotiations over potential changes to the state’s Worker’s Compensation (WC) laws, Management representatives to the Worker’s Compensation Advisory Council (WCAC) this week proposed that current treatment guidelines be converted to strict protocols, with patients needing prior authorization for any care beyond those protocols. The negotiations happen every two years; the treatment guidelines took effect in November 2007, and are used when Worker’s Compensation treatment disputes occur.Labor representatives expressed their concerns about the protocols proposal at Monday’s WCAC meeting, stressing that any change to the current system should not adversely affect WC patient outcomes or decrease patient satisfaction with the quality and timeliness of care. Negotiations are expected to continue for several weeks. If the WCAC’s voting members reach consensus, legislation is drafted and presented to the legislature, which generally passes the agreed-to bill in original form.
You can read Management’s proposal here (the provision on protocols begins on the second page). The Society is one of three non-voting health care liaisons to the WCAC, along with the Wisconsin Hospital Association and the Wisconsin Chiropractic Association. For more information, contact Mark Grapentine, JD.
Legislature’s Finance Committee starts voting on biennial budget—What you can do
The State Legislature’s powerful Joint Committee on Finance (JCF) began its work today on approving Governor Jim Doyle’s 2009-2011 $64.6 billion biennial budget proposal. While there will undoubtedly be some changes to the governor’s bill, wholesale amendments are not expected. Today’s topics centered on the Department of Transportation (including a proposal to make vehicle seatbelt use a primary enforcement offense, which passed today on a 14-1 vote) and various government operations and procedures. For a list of budget papers from the nonpartisan Legislative Fiscal Bureau, click here. These papers provide JCF members with background information and potential options for voting on each budget item; for example, the primary enforcement paper is here.As mentioned in previous editions of Medigram, the budget contains numerous items of interest to physicians and their patients. If you would like to receive an alert when the legislature is preparing to vote on those issues and you would like your voice to be heard, join the Society’s Key Contact program for e-mailed alerts.
For more information, contact Mark Grapentine, JD or Beth Alvin.
April 9, 2009
Some policy—but not all—pulled from state budget; major tort policy remains
As the State Legislature’s powerful Joint Committee on Finance (JCF) prepares to start voting on the $64.6 billion 2009-2011 biennial state budget late next week, legislators are grappling with dozens of policy provisions Governor Jim Doyle included in the bill but have no fiscal effect on the state’s finances. The nonpartisan Legislative Fiscal Bureau has penned two memos (here and here) to different JCF members, listing budget items fitting certain policy-only parameters.One item of concern is a set of changes to the state’s comparative negligence statutes. The LFB description of the changes are here. As described in a previous issue of Medigram, this provision could mean a dramatic change in medical liability awards, with a physician potentially forced to pay 100 percent of a medical liability decision even if that physician was less than 51 percent negligent in a particular case. The budget proposal essentially allows a plaintiff to seek the entire award from the defendant with the deepest pockets, even if that defendant was the least negligent among those at fault.
The Society believes this provision does not belong in a biennial budget bill and is calling on the Legislature to remove it from the budget. If you would like to weigh in with your Capitol representatives, call them with your opinion. Check your State Senate and State Assembly Representatives contact numbers here. Contact Mark Grapentine, JD, with any questions.
Psychologists introduce independent prescribing bill
A bill allowing psychologists to independently write prescriptions is currently circulating in the Wisconsin State Legislature. Senator Judy Robson (D-Beloit) and Representative Sandy Pasch (D-Whitefish Bay), the primary authors of the bill (see a draft of the bill here), are soliciting their peers to cosponsor the bill. Wisconsin Medical Society policy (MEN-003) opposes this independent prescribing power.While Sen. Robson and Rep. Pasch allege that the bill is intended to relieve an access problem for this kind of treatment, American Medical Association data show that psychologists tend to practice in the same geographic area as psychiatrists and family practice physicians. The Wisconsin Psychiatric Association (WPA) has collected information related to how the proposal would affect quality, access and costs; WPA strongly disagrees with the premise that the bill’s education requirements can foster safe and effective mental health prescribing decisions as there will be no physician supervising the prescribing. The WPA acknowledges that access to mental health care is a significant problem, but believes the proposed bill would not help solve that issue safely and effectively.
If you wish to contact your State Senate or Assembly Representatives to share your views on the bill, verify their contact information here.
For more information, contact Mark Grapentine, JD.
March 19, 2009
Wasserman appointed to MEB
Former State Assembly Representative and Society member Sheldon Wasserman, MD, is the newest member of the Medical Examining Board (MEB), as Governor Jim Doyle nominated the longtime legislator to the MEB earlier this month. The Senate Health Committee and then the full Senate will act upon Dr. Wasserman's nomination soon; in the meantime, he attended his first meeting Wednesday.At its meeting, the MEB:
- acted favorably on a Society-supported proposal to update administrative rules related to physician assistant prescribing procedures. The rule-change proposal is the culmination of years of collaboration between the Society and the Wisconsin Academy of Physician Assistants.
- approved exploring the possibility of creating an endorsement mechanism for easier cross-border medical licensing with Minnesota. The Society’s Council on Legislation recently reviewed the proposal, which came from past president Mark Belknap, MD. While the Council was generally positive, some aspects of the plan need further exploration, including potential effects on the Injured Patients and Families Compensation Fund. The Council’s concerns were shared with the MEB, and will be part of further discussions.
Legislature’s Joint Committee on Finance begins budget work
The Wisconsin Legislature’s Joint Committee on Finance (JCF) this week started work on Governor Jim Doyle’s $64.6 billion biennial budget as agency secretaries testified in support of the proposal. It is the first opportunity for the 16-member committee to present questions on the spending bill; the hearings extended into the evening hours.The nonpartisan Legislative Fiscal Bureau has released its 706-page summary of the budget proposal, which is officially titled 2009 Assembly Bill 75. Next week JCF begins its “road show,” giving members of the public the opportunity to speak on issues contained in the budget. Next week’s meetings are in Sparta, West Allis and Eau Claire, with a special listening session scheduled for March 28 in Ashland. The week of March 30 will take the committee to Racine, Appleton and Cambridge.
For more information, contact Mark Grapentine, JD.
March 12, 2009
Society appears before Assembly Public Health Committee
At the first meeting of the Assembly Public Health Committee this legislative session on Tuesday, the Society voiced support for two bills—Assembly Bill 44 and Assembly Bill 56. AB 44 grants wider protections for health care professionals under the state’s Volunteer Health Care Provider Program. Rep. Dean Kaufert (R-Neenah) authored the bill after hearing concerns from physicians in his district that medical liability insurance rates would rise if they participated in the state program.UW School of Medicine and Public Health medical student Jonathan Knoche testified on AB 56, which would place restrictions on direct-to-consumer drug advertising in Wisconsin. Society policy supports federal efforts to control such advertising. While some provisions of AB 56 have raised constitutional concerns, the core issue falls within the realm of Society policy and this warrants the Society's support.
Knoche gave to the Committee an abbreviated version of a DTCA presentation he presented to the Society’s Council on Ethics on February 20. The Committee also received these handouts. The Assembly Public Health Committee is chaired by Society member and Rep. Chuck Benedict, MD (D-Beloit). You can watch Tuesday’s hearing on the Wisconsin Eye Web site by clicking on the listing for the Assembly Committee on Public Health for March 10, 2009.
For more information, contact Mark Grapentine, JD.
February 26, 2009
Biennial budget raises important questions for physicians
As the Society continues to analyze Governor Jim Doyle’s 2009-2011 biennial budget submission (see last week’s Medigram for the initial review), some proposals hidden in the 1,743 page bill raise questions that could be of concern to physicians and their patients. Here are two key issues at stake:- Changes to negligence treatment in circuit court cases. This area is difficult to summarize due to its complexity but could mean a dramatic change in how medical liability awards are apportioned. Here’s an example of how it could work:
A patient sues three physicians as a result of an injury. After trial, a jury determines that Physician Smith was 30 percent negligent, Physician Jones was 25 percent negligent and Physician Brown was 45 percent negligent. Under the current law, each physician and his or her insurer would be liable to pay based on their percentage of negligence because each physician was less than 51 percent negligent. In this example, none of the three physicians would be required to pay the entire award.
The proposed change in the law removes the 51 percent negligence threshold for joint and several liability to apply. Therefore, under the new proposal, any of the physicians could be required to pay the entire award because of joint and several liability. This could have dramatic impact on the business community and, as a result, has received some media coverage. It is not hard to imagine health care scenarios under the new proposal in which there might be an enhanced incentive to sue everyone involved in the care of the patient, even if potential for liability is very slim.
For some years, the Society has collaborated with others organizations that have an interest in maintaining a reasonable liability environment. This consortium is now called the Wisconsin Civil Justice Council, Inc., and Society Senior Vice President Mark Grapentine, JD, has been invited to serve on the group’s board. - Budget-deficit issues within the Department of Health Services. The Wisconsin Constitution requires that the State Legislature pass a balanced budget. While there is no constitutional requirement that the governor submit a truly “balanced” budget to the Legislature, governors have always submitted a balanced budget according to a publication by the nonpartisan Legislative Fiscal Bureau.
The 2009-2011 budget proposal technically balances, but there are some built-in holes. Look no further than the governor’s recommendations for the Department of Health Services, which include a $62.7 million cut as part of the 1 percent reduction all agencies received (Decision Item 3), a $27 million cut for “government efficiency measures” (Decision Item 1) and a whopping $100.7 million reduction in Medicaid funding “to reflect savings achieved through operational efficiencies and other reductions” (Decision Item 2).
Some are concerned that the Department could fill these gaps with physician-reimbursement reductions for Medicaid services. Society staff have begun talking with legislators about woeful physician-reimbursement rates and how these cuts could result in access-to-care issues.
February 19, 2009
Biennial budget proposal unveiled
Governor Jim Doyle’s 2009-2011 biennial budget proposal was unveiled Tuesday night in an address to a joint session of the Wisconsin Legislature. The Milwaukee Journal Sentinel has a tremendous thumbnail summary of the 1,743-page bill, which is 2009 Assembly Bill 75. (For a more specific look at tax treatment in the budget, check out this Wisconsin State Journal story.) Among the health care highlights:- Medical Examining Board Resources: The bill requires the Department of Regulation and Licensing (DRL) to create a new work unit within the department dedicated to the activities of the Medical Examining Board (MEB), including credentialing and discipline investigations. The Society has long supported segregating fees physicians pay for the MEB’s work, and has been working closely with DRL on the department’s efforts to improve service to physicians applying for licensure. This proposal would add additional staff specifically for MEB activities and provide additional spending authority to ensure better service.
- Statewide workplace smoking ban: The bill prohibits smoking in workplaces, including bars and restaurants. Whether this provision remains in the budget bill is still in question, as non-fiscal items are often pulled from the budget bill. Legislative authors of the proposal still intend to introduce stand-alone legislation in case the provision does not remain in AB 75.
- Cigarette tax increase: The bill would raise the tax on a pack of cigarettes from $1.77 to $2.52. In his speech, Governor Doyle offered a correlation between the last cigarette tax increase taking effect and a huge increase in the number of people calling the state’s “Quit Line” seeking help to stop smoking.
- Primary Enforcement for seat belt use: The bill would allow law enforcement to stop a driver for failing to wear a seat belt. Currently, law enforcement can cite a driver for failure to wear a belt, but must have an alternate reason to pull over a driver.
- No raid on the IPFCF: The budget bill does not include an overt raid on the Injured Patients and Families Compensation Fund (Fund). As the Society’s lawsuit against the state over the $200 million raid in the 2007-2009 biennial budget is still pending, it is not surprising that policymakers would be hesitant to raid again. As the economy continues to weaken, however, we will continue our vigilance in defending the Fund.
For more information, contact Mark Grapentine, JD.
February 12, 2009
State, federal lawmakers finalizing stimulus, budget plans
Policymakers’ agendas in Madison and Washington, D.C. are dominated by federal and state stimulus packages aimed at getting the economy back on track. The approximately $790 billion federal package, agreed to Wednesday, is expected to make it through Congress in the next two days and to President Obama’s desk by next Monday. The bill holds numerous health-related initiatives, including incentives for physicians to computerize medical records systems and billions in additional Medicaid funding to states. Read more in this Washington Post article.The federal plan’s ramifications on Wisconsin’s biennial budget are enormous. Governor Doyle’s budget proposal, scheduled for delivery to the State Legislature via a budget address next Tuesday evening, will tackle a reported $5.7 billion deficit for 2009-2011. Estimates on how much Wisconsin will receive in federal stimulus funds to help offset that deficit have varied day-by-day, but have ranged anywhere from $2 billion to $3.5 billion.
Next week will be a busy one for the state's budget; prior to the Governor's Tuesday evening budget address the State Legislature’s Joint Finance Committee is expected to pass a budget-repair bill aimed at starting work on balancing a reported $600 million deficit at the tail-end of the current budget biennium. The bill will contain a variety of state spending cuts and revenue enhancers, including the much-debated Hospital Assessment, designed to capture additional federal funds for the state’s Medicaid program.
The deeper analysis begins following release of the 2009-2011 budget next Tuesday. Contact Mark Grapentine, JD, for more information.
February 5, 2009
Psychologist prescribing bill looming—Grassroots contacts needed
Every legislative biennium non-medical health care groups introduce legislation aimed at broadening their scope of practice. One such bill is already imminent: allowing psychologists prescription privileges. The Society has been working since last September with physician leaders from the Wisconsin Psychiatric Association to help prepare strategy and advocacy materials aimed at educating lawmakers about the issue. The Society is also working closely with the American Medical Association’s Advocacy Research Center to learn the experiences in other states.The psychologists’ arguments are typical for these scope issues: expanding scope would allow for better access while touting extra education that “equals or exceeds that of most currently licensed prescribers.” (To see an example of the types of information that lobbyists are distributing to legislators, click here. The e-mail in this link is a matter of open record because it was sent to a state office.)
While this issue is a top priority for psychiatrists, all physicians should contact their state legislators to register their concerns over a dramatic broadening of prescriptive powers for a non-medically-trained group attempting to equate their training to that of a physician. Click here for your legislators’ contact information. You can review talking points that psychologists are using here.
For more information, contact Mark Grapentine, JD.
January 29, 2009
Governor’s State of the State address touches health care issues
There were no surprises in last night’s State of the State address, with Governor James E. Doyle painting a grim picture of the state’s economy. In the address, Gov. Doyle referred to estimates of a $5.4 billion budget deficit for the upcoming biennium. Today, the Legislative Fiscal Bureau revised that number to $5.7 billion due to lower-than-expected tax collections. As other states have reduced their Medical Assistance programs because of growing deficits, Gov. Doyle perhaps foreshadowed proposing a similar path when he gives his budget address in February: “I am not going to say we won’t make reductions in Medicaid,” Doyle said, “but I will not allow cuts to undermine our ability to get a sick kid to a doctor.” State of the State speeches are usually the vehicle for announcing major new proposals or programs, none of which were mentioned last night. Gov. Doyle did highlight some legislative priorities where Society policy is in agreement:- Requiring private insurance to cover autism treatment
- Authorizing sobriety checkpoints to combat the state's drinking problem
- Making a third OWI offense a felony; state law currently makes 5th offense OWI a felony
- Instituting a statewide workplace smoking ban
Stay tuned to future editions of Medigram for more information about the state budget. For more information, contact Mark Grapentine, JD.
Bipartisan effort to constitutionally protect IPFCF-like state funds underway
Legislators will soon introduce a resolution that would amend the state constitution to protect monies in segregated funds—like the Injured Patients and Families Compensation Fund—from being used for purposes other than original intent. Rep. Gary Tauchen (R-Bonduel) and Sen. Jeff Plale (D-South Milwaukee) announced Wednesday their intention to “prevent Wisconsin governors and legislators from using segregated funds as a piggy bank to solve the state’s fiscal problems.” The Legislative Fiscal Bureau provided Rep. Tauchen with a list showing more than a billion dollars in such recent transfers and raids.To amend the Wisconsin Constitution, two consecutive sessions of the Wisconsin Legislature must pass the exact same resolution language. Then, the question must pass a statewide referendum. This year’s effort is similar to last session’s AJR 34, which also enjoyed broad bipartisan support. That measure passed the Assembly 91-6 late in December 2007, but failed to get a vote in the State Senate.
While this resolution will not undo the 2007 raid on the IPFCF (the Society’s lawsuit continues), the Society strongly supports this effort; call your State Senator and State Assembly Representative and ask them not only to support the measure, but to push their leadership to schedule a vote on the resolution. Visit the State Legislature’s Web site to get your legislator’s contact information.
For more information, contact Mark Grapentine, JD.
Medical license process improving
The Society met with senior staff from the Department of Regulation and Licensing (Department) January 23 to receive a progress report on efforts to improve customer service for physicians applying for their initial Wisconsin medical license. The Department, responding to concerns raised in 2008 by both the Society and the Wisconsin Hospital Association, shifted internal staff to concentrate on physician licensing while collaborating with the Medical Examining Board (MEB) on ways to streamline the application process.The Department reported positive progress: the time lag between receipt of a license application and the beginning of application processing has dropped dramatically. The Department began tracking this process time at the request of MEB chair Gene Musser, MD, who also attended the meeting.
The Society has noticed a drop in the number of complaints from physicians and clinics regarding the Department’s processing time and responsiveness, and will continue to closely monitor member satisfaction and communicate regularly with the Department on this issue.
For more information, contact Mark Grapentine, JD.
January 22, 2009
Medical Examining Board update: January meeting
The first Medical Examining Board meeting of the calendar year—held yesterday in Madison—provided a glimpse of what could be on the MEB agenda for the rest of 2009 beyond the typical case investigations and disciplines. Society member Gene Musser, MD, was reelected as chair, while Society members Sujatha Kailas, MD, and Ian Munro, MD, were reelected vice-chair and secretary, respectively. Following his reelection, Dr. Musser outlined some potential issue areas the Board may tackle as part of its responsibilities in the upcoming year:- Assess the potential for increasing the amount of post-graduate training required before the Board grants a medical license. Current state law requires 12 months of such training in a Board-approved facility. As this may negatively affect the state’s medical schools, the Board may consider adding a new class of medical license—such as a training license—if post-graduate training requirements are increased.
- Explore increasing the required amount of Continuing Medical Education hours required for license renewal; current statutes require 30 hours every two calendar years. The Board may also discuss that some amount of CME hours be in specific issue areas.
- Work with the Department of Regulation and Licensing (DRL), the state agency that administers the MEB, to treat the MEB as a separate and distinct unit within the DRL, with staff and resources dedicated solely to the MEB. Currently the MEB is one of 64 different boards for which DRL must provide administrative services, and physician license fees are comingled with other license and credential holders’ fees. The Society has also been discussing this potential concept with the Department.
January 8, 2009
State Senate and Assembly Committee rosters announced
2009-2010 biennium is underway, with all legislators sworn in on Monday. Rosters are now set for committee membership; here are health-related committees and rosters:Senate
Committee on Health, Health Insurance, Privacy, Property Tax Relief, and Revenue
Committee on Public Health, Senior Issues, Long-Term Care, and Job Creation
Assembly
Committee on Health and Healthcare Reform
Committee on Public Health
If you'd like more information about these or any other legislators, go to the Legislature's Web site. To find out who represents you, click here.
December 11, 2008
Assembly health committees, chairs named
State Assembly Speaker-Elect Mike Sheridan (D-Janesville) on Monday announced the committees and chairs for that house in the 2009-2010 biennial session. Of the 31 committees, two pertain directly to health care: the Health and Health Care Reform Committee and the Public Health Committee. Rep. Jon Richards (D-Milwaukee) will chair the former; one of his major health care reform efforts came in 2006, partnering with former Rep. Curt Gielow (R-Mequon) on the “Wisconsin Health Plan.” Introduced as 2005 Assembly Bill 1140, the plan was one of the first legislative forays into large-scale reform. As such, it engendered its share of support and criticism.Society member Rep. Chuck Benedict, MD (D-Beloit) will chair the Public Health Committee. Benedict was the ranking minority party member of the committee this past session; the committee handles a wide variety of issues.
For a list of all committees and chairs, see Speaker-elect Sheridan’s press release. For more information, contact Mark Grapentine, JD.
November 20, 2008
Federal health proposals already emerging
As President-elect Barack Obama prepares to become the 44th President of the United States, critical White House staff and Cabinet positions are the order of business; yesterday Obama named former U.S. Senate Majority Leader Tom Daschle his incoming Secretary of Health and Human Services (a quick review of his health policy work here). Some of Daschle’s former peers are not waiting for the official beginning of the Obama Administration to launch their plans for reforming the nation’s health care system—two major players in the Democratic Senate are making waves over their health proposals.Senate Finance chairman Max Baucus (D-Montana) released a 98-page proposal for health care reform called “Call to Action: Health Care Reform 2009.” While he explicitly states in the paper that the plan “is not intented to be a legislative proposal,” it is certainly an influential senator planting his marker for where the health reform debate should begin. Major elements of the plan include requiring all Americans to have health insurance (a major difference with President-elect Obama’s plan), increased emphasis on preventive care and moving physician payment away from procedure-based to quality-based reimbursement.
Meanwhile, Senate Health Committee chairman Edward Kennedy (D-Mass), battling a malignant brain tumor for much of 2008, made health news simply for making an appearance at the Capitol this week, countering those who assumed he would be giving up his chair next session to concentrate on his personal battle. While praising Baucus for his effort, Kennedy told reporters he plans to introduce his own bill to provide universal health care and be the Senate lead in partnering with the Obama administration. The Washington Post, however, reports that some on the Obama team are now considering expanded coverage “a longer-term goal” due to economic constraints.
The insurance industry added itself into the mix late Wednesday, with two major insurance groups stating that they would be willing to accept all who apply for insurance as long as the government mandates that all citizens must have insurance. Such a mandate differs from President-elect Obama’s health care proposal, which held such a mandate for children but not adults.
The Society is working with the AMA in analyzing the Baucus plan and will do the same as other federal legislation is introduced. For more information, contact Mark Grapentine, JD.
Wisconsin Supreme Court race shapes up for Spring 2009
While the November elections are still in the rear view mirror, another important election is just over the horizon: a seat on the Wisconsin Supreme Court. For the third straight year the state will see a competitive battle for a 10-year term on the seven-seat court, as Jefferson County Circuit Court Judge Randy Koschnick announced he will seek the seat currently held by longtime incumbent Chief Justice Shirley Abrahamson. The general election is April 7, 2009; if more than one challenger emerges, a primary will be held on February 17, 2009.Abrahamson was first appointed to the court in 1976 by then-Governor Patrick Lucey. She has stood for reelection three times since that appointment, winning a healthy majority of votes each time: 65 percent in 1979, 55 percent in 1989 and 63 percent in 1999. She became Chief Justice in 1996, and was the first woman justice elected to the court.
In his press conference announcing his candidacy, Koschnick told reporters that his “conservative judicial philosophy” separates him from the incumbent, and cited the Ferdon v. Patients Compensation Fund Supreme Court opinion as an example of Abrahamson’s differing philosophy. The 2005 Ferdon decision, in which Abrahamson wrote the majority opinion, removed the state’s cap on noneconomic damages in medical liability cases. (Nine months after the Supreme Court decision the State Legislature reinstated a cap of $750,000 for noneconomic damages, the culmination of significant efforts from the Society and other health care entities.)
With 2007 and 2008 Supreme Court elections noted for their rancor, the 2009 campaign has at least started off politely. Abrahamson welcomed Koschnick into the race in a statement stressing the desire for a nonpartisan contest. Koschnick’s approach reached for the same theme, including offering a clean campaign pledge.
For more information, contact Mark Grapentine, JD.
Wisconsin legislative committees beginning to take shape
The organization of the 2009-2010 session of the Wisconsin Legislature continues with announcements of who will serve on various legislative committees. The first committee to be filled is also arguably the most important: the budget-writing Joint Committee on Finance. Unique in the nation, the JCF is a 16-member committee with membership coming from both legislative houses and both political parties. Besides handling substantive spending requests from the governor's administration, the JCF is the main legislative body that tackles the governor's biennial budget proposal, which is usually released in Februrary of odd-numbered years.Last session the committee saw an 8-8 partisan split. With the Assembly swinging to Democratic control, JCF will now have 12 Democratic and 4 Republican members. Senate membership is the same as last session: Co-chair Mark Miller (D-Monona), Dave Hansen (D-Green Bay), Lena Taylor (D-Milwaukee), John Lehman (D-Racine), Judy Robson (D-Beloit), Julie Lassa (D-Stevens Point), Alberta Darling (R-River Hills) and Luther Olsen (R-Ripon). The Assembly co-chair is now Mark Pocan (D-Madison), with Pedro Colón (D-Milwaukee), Cory Mason (D-Racine), Jennifer Shilling (D-La Crosse), Gary Sherman (D-Port Wing) and Tamara Grigsby (D-Milwaukee) comprising the majority party Assembly members. Reps. Robin Vos (R-Racine) and Phil Montgomery (R-Green Bay) represent the Assembly minority party.
Other full committee memberships are forthcoming. Society members are reminded that any relationships with Joint Finance legislators can help aid in shaping the state's budget to a more patient- and physician-friendly final product. If you have such a relationship, please let Society staff know about it.
(Note: In a press conference this afternoon, Governor Doyle announced that the state's biennial budget deficit now stands at $5.4 billion. Doyle said he will submit a budget repair bill to the legislature in early 2009. Stay tuned to future Medigrams for the latest updates.)
November 13, 2008
Legislators pick leaders for 2009-2010
One of the first orders of business for state legislators following November's elections is selecting leaders for the next biennium. On Wednesday afternoon, Assembly Democrats selected Rep. Mike Sheridan (D-Janesville) as Speaker for 2009-2010. Taking a page from a national-level Democratic victor, Sheridan promised to “change politics as usual” in the Capitol, describing his leadership style as “one of teamwork, problem-solving and cooperation.” Read Speaker-elect Sheridan’s statement following the caucus election here.Democrats will hold a 52-46-1 majority in the Assembly, allowing Democratic leadership—led by Rep. Sheridan—to establish committees and chairpersons as well as decide what legislative bills will receive a full Assembly vote during floor sessions.
Earlier in the week Senator Russ Decker (D-Weston) was named Senate Majority Leader for the next session, continuing in the position he assumed in late 2007. Decker will preside over an 18-15 majority, the same margin as last biennium.
Senator Scott Fitzgerald (R-Juneau) will once again serve as Senate Minority Leader. His younger brother, Rep. Jeff Fitzgerald (R-Horicon), was selected as Minority Leader by Assembly Republicans. Former Assembly Speaker Rep. Michael Huebsch (R-West Salem) chose not to run for a leadership position.
For more information, contact Mark Grapentine, JD, Jeremy Levin, or Beth Alvin.
Democratic leaders lay out initial policy agenda amid budget deficit growth
As Democratic leaders prepare for unified control in both state legislative houses, initial agenda highlights are beginning to emerge. According to an article in The Capital Times on-line newspaper, Democrats intend to pass items that previously failed due to ideological differences between the political parties. Those items include:- A statewide smoking ban (although not all Democrats are united on the issue)
- Domestic partner health care benefits for University of Wisconsin employees
- Hospital tax designed to capture federal Medicaid matching funds
- Mandate health insurance coverage for autism
- An increase in the minimum wage and indexed for inflation
For more information, contact Mark Grapentine, JD, or Jeremy Levin.
Medical Examining Board takes action
Responding to concerns raised by the Society and others, the Medical Examining Board (MEB) took action Wednesday to continue efforts to streamline the initial licensing process (see previous editions of Medigram for other MEB actions). In its latest move, the MEB unanimously voted to start the administrative rule process to remove the current requirement that physician applicants submit a verified copy of the applicant’s medical school diploma to the Department of Regulation and Licensing (DRL). Current rules require submission of both the diploma copy and documentary evidence of graduation; the Board has decided that requiring both is needlessly duplicative.Until the rule change passes, the current requirements for proof of successful medical school experience remain in effect.
In another MEB development, DRL Secretary Celia Jackson informed the Board that she is considering holding MEB meetings around the state. These meetings would allow license holders, hospital and clinic officials and the public to share any concerns with the Board, Jackson said. Stay tuned to future editions of Medigram for information on where and when any such meetings are scheduled.
For more information, contact Mark Grapentine, JD.
November 6, 2008
Tuesday elections wrap-up
The 2008-2009 biennium will feature Democratic Party control across the board, with the President, Wisconsin’s Governor, both houses of Congress and both houses of the Wisconsin Legislature all held by Democrats.Democrats will control the State Assembly for the first time since Republicans gained a majority in 1994. A combination of defeating Republican incumbents and winning open seats gives Democrats a recount-pending 52-46-1 margin starting in 2009 (former Republican Jeff Wood is the first Independent to go to Madison in 62 years). Up next for both parties: selecting caucus leaders, establishing committee chairs and memberships. Democrats will select a Speaker and Majority Leader, whose powers rest in setting the agenda for Assembly floor sessions and managing floor procedure. Republicans will select a minority leader, who generally has two primary assignments: 1) be the voice of the opposition party on the floor and to the media, and 2) figure out a way to get back into the majority.
The departure of Society member Sheldon Wasserman, MD, (D-Milwaukee) from the Assembly (see Senate results below) leaves open the question of which Democrat will chair the Assembly Health Committee. That may not be decided until the next session of the legislature is organized in January. Wasserman’s departure leaves Society member Chuck Benedict, MD, (D-Beloit) as the lone physician in either house.
The State Senate will look much the same as it did last session, with Democrats maintaining an 18-15 majority in that house. Three Republican incumbents facing tough challengers kept their seats, with Sheila Harsdorf (R-River Falls), Dan Kapanke (R-La Crosse) and Alberta Darling (R-River Hills) returning for another four-year team. Darling, wife of Society member Bill Darling, MD, had to wait until Wednesday to declare victory in her race against Wasserman, as many absentee ballots in Milwaukee and Shorewood wards were outstanding until the day after election night. Republican Randy Hopper (R-Fond du Lac) and Democrat Jim Holperin (D-Conover) each won close open-seat races, maintaining their party’s control in each district. Hopper’s 180-vote win over Jessica King (D-Oshkosh) will likely undergo a recount.
Senate Democrats had originally scheduled a caucus today to elect a leader for the 2009-2010 session, but have postponed that election pending a recount in the Hopper-King race. Earlier today, Senate Republicans re-elected Scott Fitzgerald (R-Juneau) as minority leader.
Federally, all eight of Wisconsin’s incumbents in the U.S. House of Representatives won reelection to two-year terms, including Society member Steve Kagen, MD, (D-Appleton), who defeated former State Assembly Speaker John Gard (R-Suamico) by a 54-46 percent margin. Wisconsin’s eight House members are five Democrats (Tammy Baldwin, Ron Kind, Gwen Moore, Dave Obey and Kagen) and three Republicans (Paul Ryan, Tom Petri and F. James Sensenbrenner). Neither Wisconsin senator faced reelection on Tuesday; Russ Feingold (D-Middleton) will run again in 2010, while Herb Kohl (D-Milwaukee) next runs in 2012. Democrats increased their majority in both the Senate and the House.
Finally, Society lobbyist Jeremy Levin won election to the Dane County Board of Supervisors with a 53-46 percent win.
For more information, contact Mark Grapentine, JD, or Jeremy Levin.
October 30, 2008
November elections finally imminent
Next Tuesday Wisconsin voters will join those around the country in casting ballots for federal, state and local elections. Besides the race for President, 35 U.S. Senate seats are up for grabs, with Republicans facing the daunting task of protecting 23 of those seats. (Wisconsin’s U.S. Senators are not up for reelection this cycle; Senator Russ Feingold’s six-year term expires in 2010, and Senator Herb Kohl faces reelection in 2012). All 435 U.S. House of Representatives seats are up for another two-year term; the most competitive race in the state is in the 8th Congressional District, with Rep. Steve Kagen, MD (D-Appleton) facing former Wisconsin Assembly Speaker John Gard (R-Suamico) in a rematch of the 2006 race.State Democrats hope to gain seats in both the State Senate and State Assembly. Democrats control the Senate by an 18-15 margin and look to increase that spread with five seats in play: incumbent Republicans face stiff challenges in three races and two seats are open (see previous Medigram articles on those contests). Republicans hold the Assembly on a razor-thin 51-47-1 margin, with all 99 Assembly seats in play for 2009-2010.
If you have any questions about Tuesday’s elections, contact Mark Grapentine, JD, Jeremy Levin or Beth Alvin.
State Commerce Secretary: Budget deficit could be $4 billion
In remarks at a recent economic development conference, Wisconsin Department of Commerce Secretary Richard Leinenkugel warned that Governor Jim Doyle’s statement earlier this month of a possible $3 billion state biennial budget deficit could actually underestimate the size of the funding hole. According to Wisbusiness.com, Leinenkugel told the conference that with state tax receipts continuing to lag, Doyle “easily could have said $4 billion.”A deficit of that size will force Capitol policymakers to make difficult taxing and spending decisions, regardless of which political parties control the State Assembly and State Senate. Making budgeting more difficult: the vast majority of state general fund spending (primarily income and sales tax-supported) lies in just five areas: Elementary and School Aids (37.9 percent of the 2007-2009 biennial budget), Medical Assistance (11.9 percent), the University of Wisconsin system (7.8 percent), Shared Revenue payments to local government (6.7 percent) and Corrections (6.7 percent). The Legislative Fiscal Bureau’s “top 10” chart from the last budget shows the 10 programs making up about 80 percent of this general fund spending; none are in areas where cuts are likely to engender warm and fuzzy political sentiment.
For more information, contact Mark Grapentine, JD.
For more information on these or other state legislative races, contact Mark Grapentine, JD, Jeremy Levin or Beth Alvin.
October 23, 2008
Campaign Focus: Senate Districts 8 and 18
Medigram has been highlighting the most competitive races for State Senate elections this November. For a recap of the previous articles, click here.The Eighth State Senate District stretches from the northern tip of the city of Milwaukee to the North and West, reaching parts of Ozaukee, Waukesha and Washington Counties. This district hosts what is perhaps the most talked-about Senate race this year, with incumbent Sen. Alberta Darling (R-River Hills) facing Assembly Rep. Sheldon Wasserman, MD, (D-Milwaukee). Both candidates have a wealth of health care policy experience, and both have been extremely good friends of the Society and medicine generally.
Sen. Darling has been in the State Senate since first elected in 1992 after spending a bit more than one term in the State Assembly. She is married to long-time Society member Bill Darling, MD, an otolaryngologist. She currently sits on the Joint Committee on Finance, the legislature’s bipartisan, bicameral budget-writing committee.
On her Web site, Darling details her past work on health care issues, and has called for improvements in access and affordability. “Wisconsin needs health care reform that gives people more control of their coverage, their dollars and their medical decisions,” the site says. “The focus of Senator Darling’s health care agenda is to reduce the cost of medical care, increase access to affordable coverage, and improve the quality of health care services.”
Rep. Wasserman, an OB-GYN, has been in the State Assembly since 1994, and a Society member since 1991. One of only two physicians in the State Legislature (both in the Assembly), Dr. Wasserman has been the health care “go-to” person for Assembly Democrats. As such, he has been the ranking member on the Assembly Health and Health Care Reform Committee. He is giving up his seat in the Assembly to run for the Senate.
On his Web site, Dr. Wasserman includes lowering the cost of pharmaceutical drugs as one of the issues he will tackle in the Senate. “Patients should be able to fill a prescription knowing that they can afford it,” the site says. “I introduced legislation that would lower drug costs by exempting pharmaceutical medications from Wisconsin’s minimum markup law.”
The race will also be one of the most expensive in the state, with both candidates purchasing major television time in the expensive Milwaukee market. You can view Dr. Wasserman’s ads here and here. Darling’s ads can be seen here and here. A joint appearance on WISN-TV’s UPFRONT with Mike Gousha can be seen here.
Senate District 18
Retirement of longtime Sen. Carol Roessler (R-Oshkosh) earlier this year created an open seat in the 18th Senate District, which stretches from the northern reaches of Oshkosh and curls along the western shore of Lake Winnebago, reaching south to Fond du Lac and parts of Waupun.
The contest has two well-spoken and energetic candidates: radio station-owner Randy Hopper (R-Fond du Lac) and Oshkosh Common Council Member and Attorney Jessica King (D-Oshkosh).
King’s Web site concentrates on her educational background, various media coverage of the race and endorsements. It does not delve into specific issues. Hopper’s Web site states that “[o]ne of the most pressing issues facing both families and employers is the rising cost of health care. Every family deserves access to affordable, quality health care.”
Democrats currently control the Senate on an 18-15 margin and see this open seat as an opportunity to win a district that has been in the other party’s column for many years. Since Roessler was first elected to the Senate in 1987, the district has moved from solid Republican to closer to leans Republican, as highlighted in 2006 with the election of Oshkosh Democrat Gordon Hintz to the State Assembly.
For more information on these or other state legislative races, contact Mark Grapentine, JD, Jeremy Levin or Beth Alvin.
October 16, 2008
WISMedPAC Board responds to HOD Resolution; no endorsements for 2008 cycle
At its October 9 meeting, the WISMedPAC Board of Directors voted to not make political endorsements for the November 2008 elections. In April 2008, the Society’s House of Delegates (HOD) passed Resolution 11, urging WISMedPAC to “consider adopting strategies for lobbying that do not include formal political endorsements.” A petition to the WISMedPAC Board of Directors was also circulated at the HOD, with those signing pledging to donate to the PAC or Conduit (WISMedDIRECT) should a decision be made not to issue endorsements. Taking those opinions into consideration, the Board voted to not make endorsements this cycle and gauge whether it has any effect on physician involvement with WISMedDIRECT.With the elections less than three weeks away, physicians can still have an impact on races around the state, as well as enhance the reputation physicians have regarding political awareness. The Society’s Government Relations staff has been in contact with leaders from each major political party in both legislative houses, and know which races are considered to be most important. As you make your contributions to candidates for office, please do so through your WISMedDIRECT account. If you would like to know where your contributions can have the most impact, contact Mark Grapentine, JD, Jeremy Levin or Beth Alvin.
Campaign Focus: State Senate Districts 12 and 32
Medigram has been highlighting competitive races for State Senate elections this November. For a recap of last week's article, click here.Senate District 12 seat became vacant last May when then-Senator Roger Breske (D-Eland) was appointed the state’s railroads commissioner. Now former State Representative and Tourism Secretary Jim Holperin (D-Conover) and small business owner Tom Tiffany (R-Hazelhurst) are vying to fill the seat, which represents the large district in northeastern Wisconsin that stretches from the Upper Peninsula border southwest into Lincoln and Langlade Counties
Tiffany says his experience as a small business owner makes him very aware of the challenges of finding affordable health care. According to his Web site, Tiffany’s health care proposals “includ[e] consumer-driven reforms and full disclosure of all costs for you in the health care system.”
Holperin’s Web site does not contain any description of health care opinions—the site purports itself as “simple and to the point.” It does, however, have pages related to logging, energy and other issues.
The seat is a particular target of Senate Republicans, because all three State Assembly seats in the district were Republican in 2007-2008, and could therefore result in a Republican Senate seat in an election where Democrats are expected to fare well.
Recent news coverage of the race from the Lakeland Times can be found here and here.
Senate District 32
Senate District 32, which stretches from La Crosse County in the north to the confluence of the Wisconsin and Mississippi Rivers at its southern border, is another hotly contested seat. The Coulee Region has been an epicenter of sorts in Wisconsin politics, with the state Senate seat switching between Republican and Democratic control and its role as a destination point for presidential candidates in the last three elections.
Incumbent Senator Dan Kapanke (R-La Crosse), currently seeking his second term, is a former regional sales manager for Kaltenberg Seed Farms and is well-known for owning the La Crosse Loggers baseball team. His Web site has links to recent campaign television ads and a biography.
Challenger Tara Johnson (D-La Crosse) is a current La Crosse County Board member, and arguably represents the Democrats’ biggest hope for unseating a sitting Republican Senate incumbent. Information about her campaign can be found on her Web site.
A recent La Crosse Tribune news story about the race concentrated on the two candidates’ opinions on health care. Other area news stories on the race can be seen here and here.
For more information on these or other state legislative races, contact Mark Grapentine, JD, Jeremy Levin or Beth Alvin.
October 9, 2008
DHS: Act 108 now allows sharing of patient test results and symptoms
The Department of Health Services (DHS) distributed a memo October 3 providing guideance on recent changes to Wisconsin law regarding disclosure of health care information for treatment purposes without patient consent. The memo outlines the changes related to Wis. Stat. s 51.30, which took effect October 1, 2008, and the changes to Wis. Stat. s 146.82, which took effect April 1, 2008.To read the memo, click here.
Campaign focus: Senate District 10
The northwestern Wisconsin district is one of the more hotly contested races of those seeking election to a four-year term this election cycle. The district is dominated by the Minneapolis/St. Paul media market, making any media purchases in a campaign quite expensive.The incumbent State Senator is Sheila Harsdorf (R-River Falls), seeking her third term in the Senate following 10 years in the State Assembly. Harsdorf served on the Senate Committee on Agriculture and Higher Education, and the Committee on Commerce, Utilities and Rail.
According to her campaign Web site, Harsdorf believes that "[e]scalating health care costs are taking a toll on our nation, our state and our communities." She believes that "expanding options to increase affordability for working families and small businesses must be a legislative priority."
Challenger Alison Page (D-River Falls) comes from health care job experience, having been a senior administrator for Fairview Health Services (Minnesota) and a registered nurse. As such, health care is a major slice of her campaign platform. According to her Web site, Page believes that health care is a "basic human right," and that "[w]e don't have to spend more money on health care—in fact, we can spend less money on health care than we do right now. We just have to change the way in which we spend it."
For more information about this or other hot legislative races, contact Mark Grapentine, JD, Jeremy Levin or Beth Alvin. Stay tuned to future editions of Medigram for more campaign briefs.
October 2, 2008
Mental health parity bill becomes vehicle for bailout package
In an example of how just about anything can happen in politics—and especially in Washington, D.C.—federal legislation to mandate mental health parity insurance coverage (H.R. 1424) became the vehicle for Congress’s second attempt at passing a financial bailout bill. U.S. Senate leaders used the popular parity bill (see last week’s Medigram for news on that passage) and amended it to include the massive bailout measure, hoping to garner enough votes for final approval in both houses.Wednesday night the Senate—reportedly in an attempt to put pressure on their House counterparts—passed the $700+ billion bill on a 74-25 vote. Wisconsin’s senators were split: Sen. Herb Kohl (D-Milwaukee) voted for the bill while Sen. Russ Feingold (D-Middleton) voted against. Presidential candidates John McCain (R-AZ) and Barack Obama (D-IL) both voted in favor.
The House may take up the bill late tonight or tomorrow; the first version of the bailout failed Monday in that house on a 205-228 tally. In order for mental health parity to become law, both houses must pass the exact same language.
For more information, contact Mark Grapentine.
Where are the Presidential candidates on health care issues?
With 33 days left until election day, many physicians are searching for additional information on the Presidential candidates’ views on health care. Below are a variety of sources you can use to learn more.Candidates Web sites Think Tanks American Medical Association For more information, contact Mark Grapentine.
September 25, 2008
Congress close to passing mental health parity law
Ending discrimination for coverage of mental illness is close to becoming a federal law following federal legislative action Tuesday. Acting on two separate bills, both the House and Senate overwhelmingly approved provisions that would require private insurers to match mental health coverage with current coverage for physical illness.The separate bills—the Renewable Energy and Job Creation Act of 2008 (H.R. 6049) and the Mental Health Parity and Addiction Equity Act (H.R. 6983)—have broad bipartisan support, evidenced by the lopsided votes: 376-47 in the House and 93-2 in the Senate. All 10 members of the Wisconsin Congressional delegation voted for passage; Wisconsin Medical Society President Steven Bergin, MD, faxed a letter of appreciation to each Wisconsin member.
That letter also points out that there is still critical work to be done: while each house approved separate bills, including parity provisions, the House and Senate must agree on a single bill in order for the language to get to the President’s desk for final approval. As this Washington Post story points out, getting anything through the Senate is a difficult task at this time. Therefore, it would be helpful if physicians across Wisconsin would follow Dr. Bergin’s lead and contact our members of Congress, urging them to not waste this opportunity. For a list of Congressional contacts, click here.
For more information, contact Mark Grapentine.
September 4, 2008
Primary elections Tuesday
The Fall primary election will be held Tuesday, September 9 and will finalize the ballot for the November partisan elections. Below is a quick summary of the upcoming races:Congressional seats
In one primary of note, long-time Republican incumbent Rep. James Sensenbrenner of the 5th Congressional District is being challenged by Jim Burkee (R-Cedarburg), a professor at Concordia University. The district is considered Republican, and the winner will not face a general election opponent. Another primary of note is the Democratic primary in the 1st Congressional District, where three Democrats are vying for the right to challenge five-term incumbent Paul Ryan (R-Janesville). Click here for a local news summary of the Democratic primary.
State Senate and Assembly
Primaries are being held across the state. (For a list by district click here.) Republicans currently control the Assembly 52-47, and this close margin will mean even more contested primaries. All seats are technically up in November, and a few incumbents do not face a general election opponent. Eleven of the Assembly seats will have new representation due to retirements and other vacancies; six of those seats are currently under GOP control. The State Senate is under Democratic control by an 18-15 margin. About half of the chamber’s 33 seats are up this November, but because there are no contested primaries the November ballot has already been set.
Get Involved!
It is critical that physicians get involved in the political process, including joining the Wisconsin Medical Society’s political giving efforts. Through WISMedPAC and WISMedDirect, physicians can make the most of their political donations and take an active role in the state political process and the future of health care in Wisconsin.
Because a crucial new state budget cycle begins in 2009 and the candidates elected this November will have a tremendous impact on that budget and what it means for medicine in Wisconsin, your involvement is more important than ever. To join WISMedPAC, contact Jeremy Levin, Beth Alvin or Mark Grapentine, JD.
August 28, 2008
Review of draft policy on physician licensure urged
The Federation of State Medical Boards (FSMB) has taken on the task of determining how well physicians are maintaining their competence and how frequently their skills and knowledge should be assessed during re-licensure. But the American Medical Association says the report from a special committee of the FSMB contains areas of concern.For example, the report recommends physicians demonstrate competence in areas such as medical knowledge, communications skills and practice-based-learning, among other areas. But the AMA’s Council on Medical Education says, “There is no current evidence that physicians’ skills in the areas identified for maintenance of licensure decay at a constant rate.” The report, however, suggests all areas should be reviewed every time a doctor renews his or her license.
Because of these concerns, the AMA recommends physicians review this report carefully and express concerns to your medical society and licensing board. Both ethics subgroups in the Wisconsin Medical Society will be reviewing the report.
“Any process as potentially far-reaching for the medical profession as this should be subject to careful analysis and broad scrutiny,” says AMA CEO Michael Maves, MD. For more information, contact Daniel Winship, MD, AMA Council on Medical Education Secretary, or Mark Grapentine, JD, Society Senior Vice President of Government Relations.
August 21, 2008
Medical Examining Board August meeting: A wrap-up
At its August 20 meeting, the Wisconsin Medical Examining Board:- Approved a policy statement endorsing the practice of Expedited Partner Therapy, a Centers for Disease Control-endorsed action where a physician provides two prescriptions to a single patient: one for personal use and the other to be filled by a sexual partner who likely suffers from chlamydia or gonorrhea but is not examined by the physician. The policy statement, which will be published on the MEB’s Web site, is the result of effort by Rep. Sheldon Wasserman, MD (D-Milwaukee), who recently appeared before the Board to ask for action on EPT, citing physicians’ fears of discipline should prescriptions be written in such a way.
- Continued efforts to streamline the application process for new physicians. Responding to complaints from the Society, the Wisconsin Hospital Association and the Wisconsin Medical Group Management Association (WMGMA), the Department of Regulation and Licensing (which administrates the MEB) has begun examining methods for improving what has historically been less-than-stellar customer service for physicians in this area.
The Society will continue efforts to work with the Department while expecting progress toward improving the licensing process.
- Agreed to stay in communication with the Society’s Council on Ethics to examine how legislation could improve how the MEB functions, including exploring if the MEB could operate independently of the state. A subcommittee of the Ethics Council is also examining the need for a statewide impaired physician program.
August 7, 2008
November Elections: Spotlight on State Assembly
Control for the State Assembly may be up for grabs in the November elections, and both sides are beginning to speculate about what may happen. Republicans controlled that house with a 52-47 margin during the 2007-08 legislative session, but they face three difficult factors:- The Democratic “brand” continues to lead the Republican “brand” by double-digit margins, although how this translates to more local races like State Assembly is debatable,
- Momentum is on the Democratic side, with Assembly Republicans dropping eight seats in the 2006 election, and
- Assembly Republicans have already seen one incumbent depart their camp. Rep. Jeff Wood (I-Chetek) switched party identification from Republican to Independent in a much-publicized breakup on the day nomination papers needed to be filed to run for office.
Make your voice heard and join other Society members in making campaign contributions to state policymakers. Physicians are encouraged to participate in WISMedPAC and WISMedDIRECT—help strengthen the voice of medicine in the Capitol!
July 24, 2008
Special Committee on School Safety meets at Capitol
While election-year summers generally mean slow times at the Capitol, special legislative study committees meet to examine specific issues and gauge the need for future legislation. The nonpartisan Legislative Council organizes these meetings, which generally last through the fall, and a committee of state senators and Assembly representatives approves the topics (see that list here).One group the Society will monitor is the Special Committee on School Safety, co-chaired by Sen. John Lehman (D-Racine) and Rep. Don Pridemore (R-Hartford). The group includes various representatives from a diverse array of educational backgrounds, all with a keen interest in public school safety. At its initial meeting on July 22, the committee briefly discussed the possibility of drafting mental health parity legislation in the coming legislative year, citing many students who cannot afford mental health coverage. The committee also discussed whether the benefits of sharing private mental health records with key individuals in the given child’s educational setting would outweigh privacy concerns. The group is still working toward defining the scope of their future work and plans to meet again in September 2008.
The Society will also follow the Special Committee on Performance-Based Disease Management Programs for Large Populations, which holds its initial meeting on July 24. For more information, contact Beth Alvin.
July 10, 2008
Stunning Senate Medicare vote would prevent reimbursement cut; veto coming?
In a dramatic series of events, the U.S. Senate voted Wednesday 69-30 to approve HR 6331, which prevents the 10.6 percent Medicare physician reimbursement cut scheduled to take effect July 1. The margin is considered “veto-proof”—greater than the 67 votes needed to override a threatened presidential veto.Senate debate began on another motion for “cloture,” or an end to debate, which requires 60 votes. Before leaving for the July 4 recess, the Senate mustered only 59 votes for cloture—an extremely close margin, especially considering the absence of a sure “aye” vote: that of Sen. Ted Kennedy (D-Mass.) who has been recovering from June brain surgery and was not expected to return to the Senate until September.
Rhetoric beginning the debate was much the same as it was for the failed June vote: Democrats decrying the scheduled cuts as disastrous to Medicare access, and some Republicans lamenting the bill’s cuts to Medicare Advantage plans and an inability to offer amendments to the bill. Another close-but-not-enough vote tally seemed certain. Roll call on the cloture vote began at 3:10 p.m.
Roll call votes in the Senate are still done by hand, with a clerk checking a box on a long sheet of paper. The process takes a while. At 3:15 p.m., Sen. Kennedy made a dramatic entrance onto the Senate floor, with a prolonged standing ovation spreading through the chamber. After a few minutes of greetings, Kennedy went to the clerk’s table, voted “aye,” and pumped both fists in the air.
A group of Republicans who had not yet voted then convened on one corner of the Senate floor. Among the group were senators from states where the AMA had targeted grassroots and media efforts in support of the bill—states where Republican senators are facing reelection (including Texas, Georgia, Tennessee and Florida). It became clear that the cloture motion would prevail on the strength of Sen. Kennedy’s arrival, and these senators each went to the clerk, voting “aye.”
Wisconsin’s Senators Feingold and Kohl once again listened to physicians asking for “aye” votes. Both voted to end debate and for passage of the bill. HR 6331 extends current reimbursement levels through the end of the year, and adds a 1.1 percent increase for 2009. To read a section-by-section summary of the bill, click here. Read a reaction to the vote from Wisconsin Medical Society President Steven Bergin, MD, here. Read the AMA’s reaction to the vote here. For more background on the flawed Medicare reimbursement system, click here and here to read articles written by Iowa physician Michael Kitchell, MD.
What’s next?
President Bush could follow through on his veto threat, meaning an override vote would be required in both chambers. But with the margins for passage (the bill passed 355-59 in the House two weeks ago) surpassing the two-thirds total needed for an override, prospects are good that the bill could become law, notwithstanding the President’s objections.
Wednesday’s vote is a major victory for organized medicine. It shows the power physicians can wield when raising their voice and getting involved in the political process. Please take the time to contact Senator Kohl (202.224.5653) and Senator Feingold (202.224.5323) to thank them for their votes on HR 6331. Congressional offices rarely get thank you calls from constituents; doing so is easy and can have long-lasting positive effects.
Stay tuned to Medigram to learn if or when it is time to contact your U.S. House members to ask for an override vote. For more information, contact Mark Grapentine.
Election matchups set for November
The November election slate is now almost completely set, as candidates for state and federal offices were required to file nomination papers with the state's Government Accountability Board on July 8. At least five state senators and 17 State Assembly representatives are will run unopposed, leaving 11 Senate and 82 Assembly races contested this fall. That number may be reduced, however, if some filings fail to reach the minimum number of required signatures (this could affects one senate primary and two assembly races).Three physicians have filed for election: incumbent Rep. Chuck Benedict, MD, (D-Beloit) is running for a third two-year term. Rep. Sheldon Wasserman, MD, (D-Milwaukee) has left his State Assembly seat to run for the 8th Senate District slot currently held by Sen. Alberta Darling (R-River Hills). Former Society Board Chairman Thomas Luetzow, MD, (R-Watertown) faces a three-way Republican primary in a bid to unseat incumbent Democrat Andy Jorgensen (D-Fort Atkinson).
Individual races determine which party will control each of the two legislative houses. Conventional wisdom says Democrats will likely continue to hold the majority in the State Senate, although the current 18-15 margin could change. The State Assembly is the wild card this election season, with the slim 52-47 Republican majority up for grabs. An extra twist was revealed yesterday, when incumbent State Rep. Jeff Wood (I-Chippewa Falls) announced that he would run for reelection as an independent, shedding his former Republican affiliation. Read an article about that decision from the Leader-Telegram here.
On the federal front, all eight Wisconsin members of the U.S. House of Representatives face challengers: Rep. Jim Sensenbrenner (R-Menomonee Falls) has both a primary and an independent challenger; Rep. Gwen Moore (D-Milwaukee) drew an independent opponent. The most hotly contested general election race will likely be seen in the 8th House district, with freshman Rep. Steve Kagen, MD (D-Appleton) facing a rematch against former State Assembly Speaker John Gard (R-Suamico). Kagen prevailed in the 2006 contest on a 51-49 percent margin.
For a list of all candidates, including links to campaign Web sites, click here. For more information, contact Mark Grapentine, Jeremy Levin or Beth Alvin.
July 3, 2008
More Medicare fireworks after congress’ July 4 recess?
When Congress returns from the July 4th break next Monday, another Medicare showdown is likely in the U.S. Senate. The Senate’s failure to end debate on HR 6331 on June 26 (see previous Medigrams) allowed a scheduled 10.6 percent Medicare physician reimbursement cut to take effect July 1. While the Centers for Medicare and Medicaid Services (CMS) has acted to delay processing Medicare payments for 10 business days, the echoes from last week’s rancorous Senate floor debate on HR 6331 still reverberate (see some coverage here and here). For the AMA’s section-by-section summary of HR 6331, click here.While both Wisconsin Senators Herb Kohl (D-Milwaukee) and Russ Feingold (D-Middleton) voted to move the bill forward, not enough senators voted with them to allow a final vote on HR 6331. In response, the AMA has turned up the political heat on a variety of senators by launching television and radio ads in states where senators facing reelection this November voted “no” on the motion to end debate on HR 6331 (read the AMA’s press release here). Some state medical societies have taken their own political action, including the Texas Medical Association’s Political Action Committee (PAC) withdrawing its endorsement of Senator John Cornyn (R-TX).
Opposition to the bill has centered around Medicare Advantage funding; the insurance industry has also purchased time to air its own media campaign (see the Wall Street Journal’s health blog story on the media escalation, and another from the Washington Post). The Senate could bring HR 6331 back to the floor on Monday, or attempt to find a compromise that would avert a threatened presidential veto. Much will depend on the pressure targeted senators endure during July 4th festivities in their districts (see one prediction of that pressure in this blog’s headline). Senate Republican leaders are apparently feeling the pressure, urging at least a short-term solution (see story here). Stay tuned to Medigram for continuing coverage of the Medicare reimbursement issue.
For more information, contact Mark Grapentine.
July 4 holiday kicks off election season
Two summer holidays serve as unofficial mileposts for major political elections. July 4th, with a plethora of local parades centered around civic patriotism, is the natural time for politicians to fully ramp up election efforts. The other summer holiday of note comes near the end of the season; Labor Day signals the time when voters begin to pay serious attention to November elections. This is why most political pundits review summertime polls warily, as results in July do not necessarily predict November tallies.Nonetheless, relentless media coverage of the 2008 presidential race means television talking heads need to fill airtime with analysis of what’s available at the time, and that includes a myriad of polls. Wisconsin has a connection to one of the most comprehensive poll analysis sources around—one of the co-developers of Pollster.com is University of Wisconsin-Madison political science professor Charles Franklin. For a look at the site’s current summary of the presidential tracking polls, click here.
On the presidential campaign front, Wisconsin’s status as a battleground state is once again confirmed; the Republican National Committee is spending $3 million for an anti-Obama ad to air in four states, including Wisconsin, beginning this Sunday.
Physicians can become more involved in the political season by joining WISMedPAC and WISMedDIRECT programs. Help strengthen the voice of physicians and patients and participate in organized medicine’s political voice by joining WISMedPAC/WISMedDIRECT. Contact Mark Grapentine, Jeremy Levin or Beth Alvin with any questions.
June 26, 2008
Medicare reimbursement fix close; physician calls needed!
The U.S. Senate will likely work into the weekend for a last-chance attempt to prevent a 10.6 percent Medicaid physician reimbursement cut from taking effect July 1. Senate sources tell the Society that Senate Majority Leader Harry Reid (D-Nev.) will make a motion after midnight to close debate on HR 6331—legislation that passed the House Tuesday on a 355-59 vote. This means that action on the bill may not happen until Sunday.HR 6331 would, among many other provisions, continue reimbursement rates at current levels through the end of the year, then increase reimbursement by 1.1 percent for 2009. There is also the threat of a Presidential veto. Tuesday’s House vote was more than enough to overcome a veto in that chamber, which strengthens chances that the bill could get broad Senate support. Senate sources say there is a good chance there are 60 votes to end debate; it is still questionable if there are the 67 votes necessary to override a veto.
Earlier in the week there were rumors of a compromise between Senate Finance Members Charles Grassley (R-Iowa) and Max Baucus (D-Mont.) on an omnibus Medicare package, including a reimbursement fix. Those rumors were apparently premature. Moreover, the strength of Tuesday's House vote has emboldened Senate Democratic leadership to pursue final passage of HR 6331 rather than seek a "compromise."
Society members are encouraged to contact Wisconsin Senators Herb Kohl and Russ Feingold and ask their support in preventing the 10.6 percent cut and passing HR 6331. Contact Senator Kohl directly at 202.224.5653 and Senator Feingold directly at 202.224.5323. While it is expected that both Wisconsin senators will vote in favor of the bill, calls to their offices are still helpful.
For more information, contact Mark Grapentine.
June 19, 2008
Medicare cut still looms, Congress considering options
Congress continues to work on a legislative solution to prevent a looming 10.6 percent cut in Medicare payments to physicians. On June 6, U.S. Senate Finance chair Max Baucus (D-MT) introduced S 3101, which includes continuation of current payment rates through the end of the year and a 1.1 percent increase for 2009. On June 12 the Senate failed to pass a cloture motion that would end debate on the bill and allow a vote for passage (the vote was 54-39, with 60 votes needed).Senator Charles Grassley (R-IA), ranking minority member of Senate Finance, on June 11 announced his intention to introduce his own Medicare omnibus bill, which would include a reimbursement fix similar to that in S 3101. It appears that the Senate will need to find a compromise in order for a fix to take effect before the July 1 deadline.
Society members are encouraged to contact Wisconsin Senators Herb Kohl and Russ Feingold and ask their support in preventing the 10.6 percent cut. You can contact them through the American Medical Association’s Action site or by calling the AMA hotline at 800.833.6354.
For more information, contact Mark Grapentine.
MEB begins to address license time issue
The state’s Medical Examining Board (MEB) has started to examine its licensing requirements with an eye on shortening the time it takes to acquire a Wisconsin medical license. These efforts, spurred by concerns the Society and other organizations raised over the current length of time for new applications, began in earnest at the MEB’s monthly meeting on June 18. (Click here to view a previous story about this issue in the June 6 Medigram.)While the MEB asked staff from the Department of Regulation and Licensing to further research the potential effects of certain changes (such as combining hospital privilege and employment verification forms, for example), the Board did make one immediate change: extending the time period from six months to one year for the department's acceptance of various application items. Many physicians and organizations have expressed frustration over the previous six month limitation. The Board said it would also look at potentially modifying reporting requirements for post-graduate training, medical liability history and items used to verify medical school graduation.
For more information, contact Mark Grapentine.
November 2008 elections: Wisconsin poll shows Obama +9
Most state legislative races won’t start in earnest until the July 4 parades, but the presidential race is in full swing—especially in Wisconsin, considered one of the key "swing states" for November. A recent Survey USA poll of 538 likely Wisconsin voters shows presumptive Democratic nominee Barack Obama leading Republican counterpart John McCain by a 52-43 margin. Polls this early in an election season don't necessarily hold throughout the upcoming months, but may provide some insight. You can read more about the poll and some of the demographic breakdowns here.Wisconsin's swing state status also means that Wisconsin TV audiences are seeing some of the first Obama vs. McCain election ads of the season. See a McCain effort to separate himself from President Bush on the environment here. Independent liberal group MoveOn.org is airing its own ad, an anti-McCain message tied to the Iraq war. And just today, the Obama campaign debuted this one-minute general biography piece.
For more information about how you can help strengthen the voice of physicians in the state and U.S. Capitols, contact Mark Grapentine, Jeremy Levin or Beth Alvin.
June 6, 2008
Society asks State for licensing delay answers
The Society has been hearing a growing number of complaints that the state’s licensing process for physicians new to Wisconsin is too lengthy and unresponsive. The wait for licenses can sometimes approach six months, with physicians or office staff unclear regarding what was causing delays. This confusion has been compounded due to difficulty reaching appropriate staff at the state’s Department of Regulation and Licensing (DRL), which administers the licensing process. While Society staff have helped many clinics gain licenses for their new physicians on an ad hoc basis, it became clear that DRL was experiencing some systemic problems in need of great improvement. The Society joined the Wisconsin Hospital Association in requesting a meeting with DRL to share these concerns.At a meeting with DRL officials this week, the Society and WHA shared evidence of the concerns. This memo describes some specific instances of delays or DRL-caused confusion, while this PowerPoint summarizes results of a poll the Society conducted with the Wisconsin Medical Group Managers Association (WMGMA) of many clinics around the state regarding licensing time and experience. The DRL staff acknowledged problems with timeliness, accuracy and customer service in this area, and described present and future efforts to address the problems. DRL is already studying the Medical Examining Board's (MEB) requirements for different forms and information to gauge if there are redundancies that can be eliminated. The MEB is scheduled to discuss the issue at its next meeting on June 18, and the DRL plans to move one full-time staff member to assist the licensing effort.
The meeting results were positive; the Society expects DRL to achieve measurable short- and long-term improvements that allow license applications to be processed in a more reasonable timeframe. The Society will continue its positive relationship with DRL to ensure that this mutual desire for progress leads to actual results.
For more information, contact Mark Grapentine.
May 29, 2008
Election races taking shape; physician involvement needed!
Now that that State Legislature wrapped up its final business this week—approval of state employment contracts and a failed veto override effort—the Capitol halls will be filled with tour groups rather than legislators and lobbyists. Elections this November will have a dramatic effect on the legislature’s 2009-2010 activities, with control of both houses in play (perhaps more so in the Republican-controlled Assembly than the Democratic-controlled Senate).The 2006 elections are remembered for the “Democratic tsunami” that washed across the national and state elections landscape. The Wisconsin results—with the State Senate swinging from Republican to Democratic leadership and Republicans losing eight seats from their Assembly majority—set up an 18-15 Democratic majority in the Senate and 52-47 Republican majority in the Assembly entering into this election cycle.
Like 2006, a number of seats will be wide-open races with no incumbent, as some legislators have opted to retire or run for a different legislative office. Sen. Roger Breske (D-Eland) will be the state’s new railroad commissioner and Sen. Carol Roessler (R-Oshkosh) is retiring. Current Assembly minority leader, Rep. Jim Kreuser (D-Kenosha) is running unopposed for Kenosha County executive. Rep. Sheldon Wasserman, MD, (D-Milwaukee) is running for the 8th Senate District against incumbent Sen. Alberta Darling. Additionally, the following representatives are retiring: Rep. Sue Jeskewitz (R-Menomonee Falls), Rep. Eugene Hahn (R-Cambria), Rep. Sheryl Albers (R-Reedsburg), Rep. Carol Owens (R-Oshkosh), Rep. Steve Wieckert (R-Appleton), Rep. Frank Boyle (D-Superior), Rep. Dave Travis (D-Waunakee), Rep. Barb Gronemus (D-Whitehall), and Rep. Terry Musser (R-Black River Falls).
The 13 announced vacancies are a bit more than the 12 from 2006, but are split more evenly between the parties. In 2006, 11 of the 12 vacancies were in Republican-held seats, while this year seven Democrats and six Republicans are moving on. Both parties are ramping up their election efforts, seeking to expand or seize a majority for their caucus.
With nearly 12,000 members across the state, Wisconsin Medical Society members have the opportunity to make the physicians’ voice well-heard in all 99 State Assembly and 16 State Senate races. The grassroots potential for medicine is spectacular, whether via political contributions through WISMedPAC or WISMedDIRECT, having candidates visit your clinic or office or simply requesting more information about the candidates (Society staff are happy to help). Click on the link to the left to start your political contribution account, and help strengthen the voice of medicine in the State Capitol.
For more information, contact Mark Grapentine, Jeremy Levin or Beth Alvin.
May 22, 2008
MEB to review licensure process
At its May meeting Wednesday, the Medical Examining Board (MEB) took up some issues beyond the usual discussions over individual discipline cases. Responding to concerns the Society and others have repeatedly raised regarding the length of time it often takes for a physician to obtain a license in Wisconsin, the MEB began a process to assess whether current law and administrative rules regarding licensing allow for a more efficient and streamlined process while still fulfilling the need to protect the public. Physician members of the MEB raised concerns similar to those the Society has heard from across the state—too often the licensing process is slow and unresponsive, leading to physician staffing delays and thus less patient access to care. While the MEB’s action is a sign of progress, results must follow. To that end, Society CEO/EVP Susan Turney, MD, and leadership from the Wisconsin Hospital Association have scheduled a meeting with Department of Regulation and Licensing Secretary Celia Jackson to get a report on progress the Department is making in its administration of the MEB.Rep. Sheldon Wasserman, MD, (D-Milwaukee) appeared before the MEB regarding “expedited partner therapy” (EPT), which would allow a physician to write prescriptions or provide medications not only for patients with chlamydia or gonorrhea, but for the patient’s partner without the physician first examining the partner. Doctor Wasserman has authored legislation on EPT (most recently this past session as 2007 Assembly Bill 318), but those efforts have not resulted in a new law; his appearance before the MEB was to request willingness to explore potential rulemaking or policy statement solutions. The AMA has policy supporting EPT, citing a 2006 white paper on the topic from the Centers for Disease Control and Prevention. The Society has supported Dr. Wasserman’s legislative efforts. The MEB asked its legal counsel to research Wisconsin law to determine what actions it can take supporting EPT.
Also of note, MEB (and Society) member Sujatha Kailas, MD, MBA, was elected to the Federation of State Medical Board’s nominating committee at the 2008 FSMB annual meeting earlier this month. The two-year term bolsters Wisconsin’s national presence in a well-regarded organization.
For more information, contact Mark Grapentine.
Society councils taking on the tough issues
At the direction of the Executive Committee of the Society’s Board of Directors, the Society’s policy-making councils are tackling issues important to physicians and patients alike. The Executive Committee has asked the Council on Health Care Quality and Population Health to examine the issue of “adverse events,” a topic garnering much attention in Wisconsin and nationwide. The Health Care Access Council will study various aspects of health care reform proposals, including results from the survey recently mailed to 2,500 physicians statewide gauging physician attitudes about reform. Health Care Ethics is tackling physician discipline and impaired physician topics, including examining whether the state’s Medical Examining Board should return to independent status rather than remain a state-run entity. Finally, the Council on Legislation will continue its work on health care “transparency” issues that were such a hot topic in the State Capitol in 2008. These specific subjects are in addition to the councils’ typical policy deliberations.If these or other topics affecting the practice of medicine interest you, consider joining a council or sitting in on one when you see an interesting topic. For more information on Society councils, contact Karen Carney, Mark Grapentine or Merry Earll.
May 15, 2008
Budget repair bill now in Gov. Doyle’s hands
This week, the State Legislature worked to fill a $652 million state funding shortfall, sending a budget repair bill to the Governor. The bill’s major components include the following:- Taking an advance on tobacco settlement payments: $209 million
- Delay in school aids payment to next biennium: $125 million
- Administration lapses (cuts in spending): $69 million
- Use of “rainy day” fund and decrease in required statutory balance: $97 million
- MA benefits reduction (per DHFS estimated “efficiencies”): $10 million
Gov. Doyle is expected to make changes to the bill; Thursday morning he said the vetoes could be announced very soon. At a press conference earlier this week, Doyle strongly criticized the actions on tobacco settlement funds and the school aids delay, instead stating that better options included cuts to transportation spending and creation of a tax on hospital gross receipts designed to capture federal matching funds for Medical Assistance. While the Governor’s veto power has been reduced slightly (a referendum ending the “Frankenstein veto” power passed the state in April), conventional wisdom predicts the Governor will use vetoes to dramatically change the final product.
Read a story about the bill from the Appleton Post-Crescent here. Another article from the Wisconsin State Journal notes that future budget problems could emerge pending resolution of various lawsuits against the state, including the Society’s effort to reverse a $200 million raid on the Injured Patients and Families Compensation Fund.
See legislative reaction from those voting for the bill (Speaker Huebsch, Senate Majority Leader Decker, Rep. Stone) and those voting against (Senators Ellis/Cowles, Sen. Darling, Rep. Wasserman).
For more information, contact Mark Grapentine or Jeremy Levin.
May 8, 2008
Wisconsin’s chance to be heard, survey in the mail
In the next few days, a survey asking for opinions on health care reform will be mailed to a random sample of 2,500 Wisconsin physicians who represent primary care and various other specialties. This survey is an essential step toward establishing Wisconsin physicians as leaders in the development of state and national health policy. It was developed through a partnership between the Wisconsin Medical Society and the University of Wisconsin School of Medicine and Public Health (UWSMPH), with additional support from the Wisconsin chapter of the American College of Physicians to accurately assess the attitudes of Wisconsin physicians regarding the basic principles involved in achieving health care reform in Wisconsin.Following completion of this mailed survey in June, the Wisconsin Survey Center will conduct an interactive Web site survey utilizing the same format. This will provide an opportunity for all Wisconsin physicians to express their attitudes regarding our health care system. The UWSMPH Population Health Institute staff will analyze all survey data.
The Society anticipates that the principles that are formed from any consensus from survey respondents will have a major impact on future health care reform legislation. If you were randomly selected to receive the mailed survey, please respond promptly. If you do not receive a survey in the mail, watch your e-mail for the Web survey next month.
If you have questions about the survey, please contact Mark Grapentine.
April 24, 2008
Budget repair agreement: still waiting
While talks apparently continue among Senate Majority Leader Russ Decker (D-Weston), Assembly Speaker Mike Huebsch (R-West Salem) and Governor Jim Doyle over how to fix a $652 million biennial budget deficit (or $525 million, depending how different media outlets total the deficit), it is unclear if an actual agreement is imminent despite some of the players professing progress. The Legislature could come back to Madison as soon as next week to vote on a Great Lakes compact, so action on a budget agreement during that special session would be convenient.Some news coming from the talks centers on areas of disagreement rather than accord. A weekend story in the Wisconsin State Journal suggested that a tax on hospital gross receipts—an option supported by the Governor and Senate Democrats—could be dead. Meanwhile, the Governor frowns upon one of the lone areas of DEM-GOP legislative agreement: postponing a school aids payment from this biennium into the next.
As the calendar moves toward election season (which historically kicks into full gear during July 4 parades), legislators face the possibly conflicting desires of fixing the budget deficit quickly, but doing so in a way that does not run afoul of political philosophy. Stay tuned to future Medigrams for the Society’s analysis of what potential impact a budget deficit agreement could mean for physicians and medicine.
For more information, contact Mark Grapentine or Jeremy Levin.
April 17, 2008
Society calls on Kohl/Feingold to support new Medicare bill
New Society President Steven Bergin, MD, sent Senators Herb Kohl and Russ Feingold this letter today asking support for Senate Bill 2786, which would revise portions of the Medicare physician reimbursement formula that currently penalize rural physicians in particular. Senator Charles Grassley (R-IA), ranking minority member of the Senate Finance Committee, is the author.If you haven’t yet called Sen. Kohl or Sen. Feingold asking them to support Senator Debbie Stabenow’s S. 2785 (see an earlier issue of Medigram), which rolls back a scheduled 10.6 percent Medicare reimbursement cut, calling about both bills is timely. Contact them through the American Medical Association’s Action site or by calling the AMA hotline at 800.833.6354.
April 10, 2008
Smokefree poll shows strong bipartisan support
Due to a strong statewide campaign that included support from more than 30 Wisconsin newspaper editorials and a rally led by seven-time Tour de France winner Lance Armstrong, the idea of a statewide smoking ban is becoming more popular, even across party lines, according to a new poll released Tuesday.The poll by The Mellman Group and Public Opinion Strategies shows that a statewide smoking ban has gained an additional five percentage points since February 2007, with 69 percent of those polled now in support of the ban.
While the possibility of a statewide smoking ban will have to wait for the next legislative session, two Wisconsin communities, Eau Claire and Marshfield, passed local ordinances last week requiring all public places to be 100 percent smokefree for their 80,000 combined residents. A smoking ban also went into effect in Fitchburg, although some public places are exempt.
Read press coverage about the bans in Eau Claire, Marshfield and Fitchburg.
For more information, contact Jeremy Levin.
Contribute to WISMedPAC / WISMedDIRECT at Friday’s Annual Meeting
With more than 100 seats in the legislature up for election this year, physicians have many opportunities to support candidates that understand and speak for health care issues. Your contributions to WISMedPAC or WISMedDIRECT help support these candidates and also demonstrate the strong voice of physicians throughout the state.A table will be set up during this Friday’s Society Annual Meeting at Monona Terrace convention Center in Madison. Stop by to learn more about what your contribution can do to help advance health care issues in Wisconsin. Or click here to contribute on-line.
For more information, contact Jeremy Levin.
April 3, 2008
Society physicians visit Congress to highlight Medicare concerns
Society members traveled to Washington, DC, this week for face-to-face meetings with Wisconsin’s Congressional delegation, urging a fix for a looming 10.6 percent Medicare physician reimbursement cut scheduled to take effect July 1. The visits with Congress members and their staffs, as part of the American Medical Association’s annual National Advocacy Conference, highlighted the dramatic effects such a cut could have for medical practices and patients’ availability of care. (Click here to see a Wisconsin-specific fact sheet describing the impact the scheduled cut would have.)The Society was well represented at the conference. Attendees included AMA Trustee Cyril “Kim” Hetsko, MD, Society President Clarence Chou, MD, President-Elect Steven Bergin, MD, Past President and AMA delegate Paul Wertsch, MD, Society CEO/EVP Susan Turney, MD, WISMedPAC Chair Sridhar Vasudevan, MD, AMA delegate Mike Miller, MD, and UW resident Claudia Louise Reardon, MD. Alliance President Sherry Clarke and Alliance member Gina Daly also joined the meetings as did medical students Cheryl Maenpaa, Jack Bagley and Richard Leake of the Medical College of Wisconsin and Jennifer Jenkins of the University of Wisconsin School of Medicine and Public Health, who also raised the issue of the financial burden of medical student loans. The trip was organized by Jeremy Levin of the Society’s Government Relations staff as part of that department’s continuous lobbying efforts.
Although the Congressional meetings are over, it’s not too late to add your voice to the dialogue about Medicare physician reimbursement cuts. Contact your Congress members and urge them to prevent the July cut. Just click here to access your members of Congress.
For more information, contact Jeremy Levin or Mark Grapentine, JD.
March 27, 2008
Ask Senators Kohl and Feingold to support the ‘Save Medicare Act of 2008’
Medicare’s scheduled 10.6 percent cut to the physician reimbursement rate will go into effect July 1 unless Congress intervenes. Last week, U.S. Senator Debbie Stabenow (D-MI) introduced Senate Bill 2785, otherwise known as the Save Medicare Act of 2008.This legislation would stop payment cuts for 18 months, giving Congress time to replace the current flawed sustainable growth rate (SGR) formula with a more equitable reimbursement methodology.
A recent AMA survey revealed that 60 percent of physicians reported that they would have to limit the number of new Medicare patients they treat if payments are cut 10 percent in 2008. More than half of physicians report that they cannot meet their payroll and will have to reduce their practice staff so it is critical that Congress take action to replace cuts with positive updates based on practice cost increases.
Society members are encouraged to contact Wisconsin Senators Herb Kohl and Russ Feingold by Monday, March 31 to urge them to co-sponsor S2785. You can also contact them through the American Medical Association Action Alert Web site by clicking here.
Legislative retirements abound
Several legislators have announced plans to retire from office now that both the State Senate and Assembly have concluded their regular session. (The special session on the budget repair bill is ongoing.) In the last 10 days alone, two legislators from the Fox Valley area have said they will not seek re-election: long-time Senator Carol Roessler (R-Oshkosh) and Representative Steve Wieckert (R-Appleton).Both Roessler and Wieckert are longtime friends of the Society and have been supportive of its issues. Most recently, they were lead authors of the smoke-free workplace legislation. Although it did not pass this session, it has had broad public support. Others legislators that have announced their retirement include Reps. Barb Gronemus (D-Whitehall), Eugene Hahn (R-Cambria), Carol Owens (R-Oshkosh), and Dave Travis (D-Waunakee).
March 20, 2008
Governor signs patient sharing data bill into law
Governor Doyle on Monday signed Senate Bill 487 into law. Now Act 109, this legislation (outlined as Assembly Bill 793 in the February 21 Medigram) is intended to facilitate sharing of “need-to-know” information among health care professionals by removing existing barriers and more closely aligning Wisconsin privacy laws with federal HIPPA rules.Act 109 is the result of work conducted under Wisconsin’s Health Information Security and Privacy Project, which involved numerous workgroups comprised of key advocacy and provider organizations, including the Society. The Society participated in the 51.30 workgroup, which set the initial framework for the bill.
Except under limited circumstances, Chapter 51.30 of Wisconsin law prohibits disclosure of mental health, alcohol and other drug abuse, and developmental disability health information without written consent. Certain elements of a patient’s treatment record, such as name, address, date of birth, date of service, diagnosis, and medications can be released without written consent to health care providers in a related health care entity. The legislation also permits sharing diagnostic test results and symptoms with any health care provider treating the patient even if the provider is outside the related health care entity without written consent. Sharing any other health care information under Chapter 51.30 would still require written consent.
To read a detailed explanation of the legislation prepared by the Department of Health and Family Services (DHFS), click here. More information is also available in this DHFS press release. For more information, contact Jeremy Levin.
March 13, 2008
Hospital tax is budget repair centerpiece
In an effort to fill a biennial budget deficit of more than $650 million, Governor Doyle released his plan Tuesday to rectify the state’s books. The proposal’s centerpiece: a tax on hospitals’ gross patient revenues designed to capture additional federal money, which will help increase Medicaid hospital reimbursement and apply $125 million in proceeds toward the deficit. The proposal would sunset the tax at the end of the biennium. Citing the need for a Medicaid reimbursement update, the Wisconsin Hospital Association and various individual hospitals support the proposal.Another $330 million will come from various administration spending cuts and a “transfer” from the transportation fund. Additional spending cuts (since the original budget passed in October 2007) complete the Governor’s balancing plan.
Late Wednesday night, Republicans in the State Assembly amended Doyle's plan and removed the hospital tax. The Assembly plan requires the Doyle administration to cut $250 million in state spending, taps into a “rainy day” fund and pushes a general school aids payment into a future fiscal year. That plan passed on a 51-46 vote, primarily along party lines. As of Thursday morning, Democratic leadership in the State Senate has said that house will not address the amended bill today, instead referring the measure (now known as 2008 Special Session Assembly Bill 1 to the bipartisan, bicameral Joint Committee on Finance.
For more information, contact Mark Grapentine or Jeremy Levin.
March 6, 2008
“Healthy Wisconsin 2.0” introduced
The long-awaited update to the Senate Democratic “Healthy Wisconsin” universal health care coverage plan has been introduced as Senate Bill 562. It features some changes to the requirements for small business participation and sets a cap on the amount dual-income families will pay annually.The initial version of Healthy Wisconsin was introduced in the midst of the biennial budget process, raising criticisms that the plan was more political in nature than a realistic policy proposal. Support for the original version was primarily limited to the Senate Democratic caucus, as Governor Doyle and some Assembly Democrats distanced themselves from the proposal.
The current proposal creates a Governor-appointed 16-member board of trustees that holds tremendous power over how health care would exist in Wisconsin, and is tasked with creating and administering a health care program covering all Wisconsin citizens. Four additional members would come from a special Health Care Advisory Committee but would not have voting power. Physicians could theoretically have input on the Advisory Committee but are specifically excluded from the voting membership.
A vigorous financial analysis of the plan has not yet been done; one estimate is that a $15.2 billion payroll tax can pay for the plan, but the Society believes a more significant fiscal breakdown is needed.
Senator Jon Erpenbach (D-Middleton) is the author of the bill; you can read his press release here. An Associated Press article about the legislature’s work on “health care reform” during the remainder of the session is here.
For more information, contact Mark Grapentine or Jeremy Levin.
Governor initiates budget repair process
Anticipated since the nonpartisan Legislative Fiscal Bureau announced in mid-February a dramatic state deficit figure, Governor Doyle’s administration officially notified legislative leaders that a budget repair bill is necessary. In a March 5, 2008 letter to legislators, Department of Administration Secretary Michael Morgan put the deficit at $350.9 million through the end of the 2008-2009 biennium (the number would be higher, but DOA has ordered departments to “lapse” $111 million in state spending and roll over $125.4 million in debt payments).State statutes require the Governor to submit legislation that will rectify the deficit. To that end, he has called the legislature into special session next Thursday, March 13 to begin the legislative process of debating and approving a repair bill. Details of the Governor’s proposal are not yet known; a plan will be forthcoming next week. Reports are that a hospital tax will be the centerpiece of the plan; a spokesperson for Assembly Speaker Mike Huebsch (R-West Salem) has said the Republican-controlled Assembly will not a pass a bill that includes such a tax.
For more information, contact Mark Grapentine or Jeremy Levin.
Lance Armstrong joins fight to make Wisconsin Smoke Free
Seven-time Tour de France winner, cancer survivor and advocate Lance Armstrong appeared with Governor Jim Doyle on Tuesday to urge approval of the “Breathe Free Wisconsin Act.” During the Citizens for Smoke Free Air Rally at Monona Terrace, Armstrong addressed the crowd of over 1,000 people, who then took the Capitol by storm to meet with their legislators. Media coverage included: On the same day, the Assembly Public Health Committee passed Assembly Bill 834, the “Breathe Free Wisconsin Act”, which would require every workplace in Wisconsin–including bars and restaurants–to become smoke-free. Many Society members testified and registered in support of the bill at the public hearing. The committee passed the bill on a strong bipartisan vote of 6-3. The members who supported the bill include Representatives J.A. “Doc” Hines (R-Oxford), Terry Moulton (R-Chippewa Falls), Sheldon Wasserman, MD (D-Milwaukee), Chuck Benedict, MD (D-Beloit), Marlin Schneider (D-Wisconsin Rapids) and Spencer Black (D-Madison).AB 834 is the Assembly companion to Senate Bill 150. However, the effective date of AB 834 is January 1 2009, a year earlier than the Senate Public Health Committee had compromised on during their executive session of SB 150. The next step is to get one of the bills through both legislative chambers before session ends next week.
For more information, contact Jeremy Levin.
Campaign season quickly approaching
With one week of legislative session left, campaign season isn’t far behind. Every two years all 99 state representatives are up for election, along with half of the state senate. All even-numbered districts are up for election this year. Things won’t officially get underway until candidates start circulating nomination papers in June. However, campaign fundraising is always in season.Society members who want to be politically active can also be members of the Society’s WISMedPAC/WISMedDIRECT. Our 2008 membership year is underway and we need your help going into the Fall elections.
For more information, contact Jeremy Levin.
February 28, 2008
Assembly version of statewide smoking ban heard in committee
The Assembly Public Health Committee held a public hearing yesterday on Assembly Bill 834, the “Breathe Free Wisconsin Act”, which would require every workplace in Wisconsin – including bars and restaurants – to become smoke-free. Society members who were at the four-hour hearing to testify in support of the bill included Patrick Remington, MD, MPH, Michael Fiore, MD, MPH, Frank Byrne, MD, Todd Mahr, MD, Robert Phillips, MD, and Robert Feulner, MD.AB 834 is the Assembly companion to Senate Bill 150. However, the effective date of AB 834 is January 1 2009, a year sooner than the Senate Public Health Committee had agreed on during its executive session for SB 150. It appears that the Assembly Public Health Committee will meet Tuesday to take executive action on AB 834. If the bill passes at that time, advocates will have roughly two weeks to get the bill through both legislative houses before session ends.
In support of a smoke-free state, Citizens for Smoke-free Air is holding a day at the Capitol and a rally at the Monona Terrace Tuesday, March 4. Seven-time Tour de France winner, cancer survivor and cancer advocate Lance Armstrong will appear with Governor Jim Doyle to urge approval of The Breathe Free Wisconsin Act during the rally at Monona Terrace from noon to 12:45 p.m. Armstrong is the founder and chairman of the Lance Armstrong Foundation, which supports cancer research.
Society members are encouraged to participate in the rally. Registration begins at 10:30 a.m. and the rally and group visits to legislative offices will wrap up around 3 p.m. Free buses are available for those traveling from Eau Claire, La Crosse, Wausau, Green Bay and Milwaukee.
For more information, contact Jeremy Levin.
February 21, 2008
Mental Health Parity Action Day draws big crowd
Hundreds of Wisconsinites visited the Capitol yesterday as part of Mental Health Parity Action Day. They were there to voice their support for Senate Bill 375. Many members of the Wisconsin Medical Society and the Wisconsin Psychiatric Association came out in a strong show of force, including Society President Clarence Chou, MD; Molli Rolli, MD; Ken Casimir, MD; Laura Roberts, MD; Ronald Diamond, MD; Kenneth Robbins, MD; Peter Lake, MD; and Jerry Halverson, MD. Medical residents Rachel Molander, MD; Erin Curtis, MD; and Carrie Palmer, MD, and medical student Philip Zimmermann also joined the group.Participants are hopeful Wisconsin will join 42 other states which have already enacted mental health parity. For more information, contact Jeremy Levin.
Update: Statewide Smoking Ban—Assembly public hearing
While discussion of the statewide smoking ban is not moving quickly in the Senate (Senate Bill 150), a bill has now developed in the Assembly (Assembly Bill 834). A hearing before the Assembly Public Health committee is set for noon on Wednesday, February 27, 2008. Supporters are encouraged to attend.For more information, contact Jeremy Levin.
Citizens for Smoke-free Air to hold rally at the Capitol
Society members are encouraged to participate in a rally Tuesday, March 4 to support a smoke-free law for Wisconsin. Registration begins at 10:30 a.m. and the rally and group visits to legislative offices will wrap up around 3 p.m. Free buses are available for those traveling from Eau Claire, La Crosse, Wausau, Green Bay, and Milwaukee.For more details, contact Jeremy Levin.
Mental Health Records Bill passes Committee
The Assembly Public Health Committee held a public hearing last week on Assembly Bill 793, which proposes changes to laws related to the confidentiality and disclosure of patient health care and mental health treatment records (specifically Wisconsin Statutes 51.30, 146.82, and 655.275). On Wednesday, the bill was passed out of the Assembly Public Health Committee and will be available to be scheduled for a floor vote.AB 793 builds on the Legislature and Governor's efforts to encourage the implementation of health care information technology through incentives, such as tax credits for providers who invest in electronic medical record (EMR) systems and tax deductibility for bonds issued through the Wisconsin Health and Educational Facilities Authority.
Specifically, the bill makes changes regarding the disclosure of patient health care records and mental health treatment records to health care providers, or persons acting under the supervision of health care providers without patient consent. These provisions make Wisconsin law more consistent with federal HIPAA privacy laws and the patient protections inherent in them.
This bill is the result of work conducted under Wisconsin’s Health Information Security and Privacy Project, which involved numerous workgroups formulated by the eHealth Board and comprised of key advocacy and provider organizations who met regularly, including the Society.
The Society participated in the 51.30 workgroup that set the initial framework for AB 793. The representatives in the workgroup sought to balance patient privacy issues and the importance of access to limited, but key patient health care information in providing safe and complete care for the patient. The group identified a series of issues, including stigma and disclosure rights, related to mental health records. They also believed there were issues that warranted further discussion, including the need for education for health care professionals regarding the changes. Because of the broad range of issues raised by this workgroup, the group agreed on a delayed effective date for the changes related to mental health treatment records. The later effective date gives patients and health care professionals time to adjust and ensures the Department of Health and Family Services has time to address any outstanding issues.
The 51.30 workgroup included stakeholders representing consumers and providers of mental health, AODA, and developmental disability treatment services as well as individuals with expertise in health information administration and technology, privacy law, and data quality.
If you have questions, contact Jeremy Levin.
February 14, 2008
Reminder: Mental Health Parity Action Day is Feb. 20
Lt. Governor Barbara Lawton is leading efforts to make Mental Health Parity Action Day Wednesday, Feb. 20 a day for employers and workers, health care professionals and advocates, and all citizens to make the case for mental health parity legislation in Wisconsin. Wisconsin is one of only eight states in the nation without mental health parity.“Our coalition has an excellent bill drafted, an impressive list of sponsors, and now we invite all who understand the importance of this legislation—to Wisconsin’s economy and to our families—to be part of Mental Health Parity Action Day,” Lawton said. Senate Bill 375 requires that insurance policies provide the same coverage for mental health and mental illness as they do for physical health, illness or injury. SB 375 had a public hearing in January and was voted out of committee on a bipartisan vote.
For more information, visit http://ltgov.wisconsin.gov and click on the “Mental Health” button, call 608.266.3516 or contact Jeremy Levin. Click here to view the day’s agenda, which will include advocacy training, a networking lunch and appointments arranged with legislators.
Society testifies on two ‘cost transparency’ bills
The Society led the physician-oriented discussion earlier this week on two bills that would increase physicians’ responsibility to disclose information related to the costs of medical procedures, tests, and the like. Representative Steve Wieckert’s (R-Appleton) Assembly Bill 729 and a Rep. Leah Vukmir (R-Wauwatosa) still-to-be-introduced bill draft have differing requirements of what must be disclosed and when. In both verbal and written testimony before the Assembly Health Committee (which heard Rep. Vukmir's bill) and the Assembly Small Business Committee (hearing Rep. Wieckert’s updated version of AB 729), the Society stressed that the best patient is an informed patient, and the patient must know both cost and quality in order to determine value—the most important piece of information a patient can have. Both bills potentially increase the administrative burden for physicians and their staffs in complying with the mandates. You can read the Society’s testimony on AB 729 here and on Rep. Vukmir’s bill here.The Society’s Council on Legislation discussed both bills (as well as a third version by Sen. Jim Sullivan [D-Wauwatosa]) at its February 8 meeting. The Council unanimously supported the strategy to raise concerns on the bills’ content while making it clear the Society supports thoughtful transparency. Assembly Republicans met in closed caucus on Wednesday in part to discuss which transparency bill—if any—it would rally behind. The Society’s Government Relations staff will continue to monitor the fate of these bills.
For more information, contact Mark Grapentine or Jeremy Levin.
Congressman Kagen introduces ‘No Discrimination in Health Insurance Act’
US Congressman Steve Kagen, MD, (D-Appleton) introduced today legislation that will ensure citizens have access to affordable health care and end the insurance industry’s practice of denying health coverage due to a pre-existing medical condition.See a statement from the Congressman on his legislation here and a story regarding the proposed legislation from the Appleton Post-Cresent here. For more information, visit Congressman Kagen’s Web site.
Update: Statewide smoking ban
For nearly a year the Society has called for legislation banning smoking in all public places as part of the “It’s Time to Breathe Free Wisconsin” coalition. Senate Bill 150 (the “Breathe Free Wisconsin Act”), which would require every workplace in Wisconsin—including bars and restaurants—to become smoke-free, has been supported by team of health organizations, including the Society, business and hospitality groups.Currently, the coalition is meeting with Senate leadership, who is seeking a compromise between the coalition and the Wisconsin Tavern League. Discussions are ongoing, with the leaders cognizant of the waning session days left to pass a bill.
For more information, contact Jeremy Levin.
February 7, 2008
Various cost ‘transparency’ bills abound in Capitol
As the State Legislature heads toward the end of its regular session in mid-March, various bills aimed at providing patients with health care cost information will soon receive public hearings in the Capitol.Senator Jim Sullivan’s (D-Wauwatosa) Senate Bill 377, Rep. Steve Wieckert’s (R-Appleton) Assembly Bill 729 and a still-to-be-introduced proposal from Rep. Leah Vukmir (R-Wauwatosa) all would require physicians to provide patients with various cost information related to procedures, services or diagnostic tests.
Rep. Vukmir’s effort is titled “The Patients’ Right to Know Act,” and states that there is “general, bipartisan consensus that tools like these help put patients in charge of their health care while encouraging them to become more conscious of health care costs.” While the general consensus indeed agrees that cost information can be valuable, policymakers also need to acknowledge that health care costs can vary widely based on the patient and the care needed. The Society has partnered with various health care entities across the state to coordinate the physicians’ message to our state policymakers and to explain the real-world effects of these bills.
Supreme Court election April 1
While the national race for president has dominated most election headlines and stories, an important race for a seat on the state’s Supreme Court headlines Wisconsin’s general election on April 1. Sitting Justice Louis Butler will face Barron County Circuit Court Judge Mike Gableman.If you haven’t paid much attention to this race, there is still time to familiarize yourself with the two candidates. While government’s involvement in your practice has generally come from the executive and legislative branches of government, the judicial branch is becoming more of a factor.
Wisconsin Supreme Court justices are elected to 10-year terms, so your vote on April 1 could have long-lasting impact. To learn more about the candidates, visit their Web sites:
- Justice Butler: http://www.louisbutler.com/index.cfm
- Judge Gableman: http://www.gablemanforsupremecourt.com/
For more information about either of these issues, e-mail Mark Grapentine.
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