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In response to the COVID‐19 pandemic, ForwardHealth is temporarily altering certain procedures in order to prevent further spread of the disease and effectively treat existing cases. These altered procedures will only be in effect during the public health emergency declared by Governor Tony Evers for the State of Wisconsin under Executive Order 72.

Temporary Phone Number Change for Urgent Prior Authorization Requests

For urgent prior authorization requests for fee‐for‐service members, contact ForwardHealth Provider Services at 800‐947‐9627 for assistance with expediting the prior authorization process. An urgent, medically necessary situation is one where a delay in authorization would result in undue hardship for the member or unnecessary costs for Wisconsin Medicaid as determined by the Division of Medicaid Services. In general, urgent requests will receive a response within five business days. Additional information regarding urgent services is available.

Note: Prior authorization is not required for emergency services, defined as services that are necessary to prevent the death or serious impairment of the health of the individual. Reimbursement is not guaranteed for services that normally require prior authorization that are provided in emergency situations; those services still must meet all ForwardHealth coverage requirements, including medical necessity.

Wisconsin Health News, March 27, 2020

UW Health, UnityPoint Health-Meriter and Epic are opening a temporary child care center for children of healthcare workers, according to a Thursday statement.

Epic is providing the use of its former headquarters in Madison for free as well as free meals by its culinary team. UW Health is providing furniture and other essential teams. The space will be designed with social distancing in mind.

Employees from the health systems will provide care for children ages six to 13. They're working with other front-line provider organizations in the community to join the effort.

“Right now, it's paramount that we remove barriers so that our healthcare teams can come to work if they're able," Meriter CEO Sue Erickson said. "This partnership has stepped up to help make that possible."

They expect to open the center as soon as updates to the space acre completed within the next few weeks.

Some health systems in the state have issued calls for community support to help with child care, while employees at others are looking at ways to support one another. 

Governor Evers directed the Wisconsin Department of Health Services (DHS) Secretary-designee Andrea Palm to temporarily order the suspension of evictions and foreclosures amid the COVID-19 public health emergency. The full order is available online (link).

The order prohibits landlords from evicting tenants for any reason unless failure to proceed with the eviction will result in an imminent threat of serious physical harm to another person and mortgagees from commencing civil action to foreclose on real estate for 60 days. Wisconsinites who are able to continue to meet their financial obligations are urged to do so. This order does not in any way relieve a person's obligation to pay their rent or mortgages.

The full press release is available on the Governor’s website (link).

Wisconsin Health News, March 24, 2020

Wisconsin hospitals and health systems have canceled elective procedures and delayed other non-essential care as they prepare for a surge of COVID-19 patients. The actions, which health systems said are necessary, could strain their bottom lines as they work to address the pandemic.  "Canceling was the right decision for the health of the community," said Children's Wisconsin spokesman Andy Brodzeller. He noted that the cancellation of non-time sensitive surgeries - as well as non-sensitive appointments in speciality and primary care - will have significant financial implications. The Wisconsin Hospital Association estimates that the weekly impact of not performing elective procedures is around $150 million. The procedures make up around 25 percent of a hospital and health system’s revenue.   “We’re trying to establish lines of credit in the tens of millions of dollars to accommodate what we believe to be a long timeline that we are going to have to manage a surge of patients,” said Jim Dietsche, Bellin Health's chief operating officer. Dietsche said they haven’t finalized how much they think they need.  Dietsche said the challenge goes beyond elective surgeries and impacts Bellin’s other lines of business, like clinics, occupational health, specialty practices, therapy and testing, in part because of supply limitations and patients avoiding care out of fear of exposure. Bellin expects an over 60 percent reduction in their revenues on a monthly basis.  On Monday, Mercyhealth instituted a temporary furlough program for employees not providing direct patient care and providing services that can be delayed. They don't expect the furlough to last for more than a few weeks. "These are unprecedented times," the statement noted. "In order to make sure we are positioned to meet our patients’ expected needs for critical care services and survive the economic challenges presented by this COVID-19 situation, Mercyhealth had to make difficult decisions." Brian Potter, WHA's senior vice president of finance, noted that as revenues go down, hospitals are also increasing expenses as they redeploy staff for testing, screening and incident response.  They’re also working to protect the healthcare workforce, patients and community and spending limited resources to prepare for the surge expected in the next couple of weeks, he said. “While everyone and every industry is hurting from the financial impact of COVID-19, healthcare is unique,” Potter said in a statement. “There are legislative efforts underway to help ease some of this burden on the healthcare system, but those efforts must be appropriate and done quickly to support this indispensable work on behalf of Wisconsin’s communities." Tim Size, Rural Wisconsin Health Cooperative executive director, said that while margins for rural hospitals are thinner, Wisconsin hasn’t seen the number of closures that other states have seen.  “Without assistance from Washington and Madison, this will be a tipping point for a great many rural hospitals,” Size said.  He said that policymakers looking at financial support should look at it proportional to size and budgets, not overweighting it to places that see a lot of cases.   “I don’t think we can minimize the impact,” he said. “And it isn’t just for rural Wisconsin, but it’s around the country.”  Dennis Reilly, executive director of the Wisconsin Health and Educational Facilities Authority, said delaying the procedures is a concern for the future financial strength of the hospitals.  Reilly said they support requests from the American Hospital Association for additional resources for hospitals to fight the epidemic. The association wrote congressional leaders last week that supporting hospitals could also provide a stimulus to communities looking for financial stability.  The letter also calls for restoring the ability of hospitals and others to advance refunding of tax-exempt bonds, which Reilly said would give hospitals more flexibility to refinance with lower rates. And the association also called for allowing authorities like WHEFA to issue bonds with lower interest rates and higher borrowing limits. Both could help in the long term, he said. Brodzeller said that Children's is trying to look past the immediate reaction and toward the long-term impact on families. That will require significant, long-term financial support at the state and federal levels. "We know that kids’ health is dependent on the health of their families, neighborhood and community," he said. "We are engaged with our local, state and federal officials, as well as corporate leaders, on ways to address the impact this will have."

Wisconsin Health News, March 24, 2020 Gov. Tony Evers’ administration issued an order on Tuesday that will require people to mostly stay at home except for essential travel like buying groceries, visiting the doctor, picking up medicine or caring for others. The order, aimed at limiting the spread of COVID-19, will take effect 8 a.m. on Wednesday and remain in effect through 8 a.m. Friday, April 24 or until a superseding order is issued, according to Evers' statement. Healthcare operations, banks, child care facilities, grocery stores and other essential businesses will be allowed to operate, the statement noted. "Let’s all do our part and work together," Evers said. There were 416 positive tests of COVID-19 across 30 counties in the state as of Monday afternoon, the Department of Health Services said. There have been five deaths, including a 54-year-old Milwaukee man who died Monday. So far, 7,050 have tested negative.  The City of Milwaukee issued its own nine-page, stay-at-home order late Monday night, with exemptions for essential business and operations. The city plans to modify its order to align with Evers' order when it's released. Local law enforcement will enforce the governor's order, Ryan Nilsestuen, Evers’ chief legal counsel, told reporters Monday. Evers said that he was acting on the advice of public health experts and that on a call Sunday night, business leaders "were insistent" he move forward with the order.  "Issuing a safer-at-home order isn't something I thought we'd have to do," he told reporters Monday. "It's not something that I wanted to do. And it's not something that I take lightly. We're all in this together and we need to help stop the spread of COVID-19 and flatten the curve to ensure that our doctors and nurses and healthcare workers have the opportunity to do their important work." Evers said that as of Monday, they were still deciding what businesses will be considered essential.  “It’s not soup yet,” he told reporters on the call. “Otherwise, I would tell you it is soup. But it will be close to being soup tomorrow.”   Senate Majority Leader Scott Fitzgerald, R-Juneau, and Assembly Speaker Robin Vos, R-Rochester, said Evers’ Monday announcement “created mass amounts of confusion" and came as a "surprise" to the Legislature. “The governor’s sudden change of course and lack of specific guidance have increased the level of uncertainty and anxiety in our state,” they said in a statement Monday afternoon. “It was a complete reversal from his repeated assurances. It should be noted that legislative leaders have asked on a daily basis whether or not this was the direction the governor was headed, and we were told it was not.”  Other updates on COVID-19: The National Guard and the State Emergency Operations Center have been working on a personal protective equipment buyback program, said Major General Paul Knapp, Wisconsin's Adjutant General. He said they’d accept donations or will buy back the equipment from businesses that have closed as a result of the outbreak and no longer have use for the equipment. They’ll be able to get those out to first responders and medical workers that need it the most.  Evers credited private businesses for their help on Monday's press call, including Epic, which is providing project managers and data to help determine capacity in the state. He also singled out Exact Sciences for boosting lab testing capabilities and Promega for producing ingredients for the tests. He also said they’re asking experts from the University of Wisconsin and the Wisconsin Hospital Association to be part of the state’s emergency operations center.  Evers said they’ve created “strike teams” to focus on specimen collection and laboratory capacity; personal protective equipment and essential supplies; isolation facilities; surge capacity; healthcare worker child care; and contact tracing and surveillance. The task forces will ensure the healthcare workforce have the resources they need to serve across the state, he said. A coalition of healthcare groups, including the Wisconsin Hospital Association, Wisconsin Primary Health Care Association, Rural Wisconsin Health Cooperative, Wisconsin Medical Society, LeadingAge Wisconsin, Wisconsin Health Care Association/Wisconsin Center for Assisted Living and the Wisconsin Nurses Association expressed support for the safer-at-home order. The Medical College of Wisconsin said Wednesday they back the order too.

Wisconsin Health News, March 11, 2020 

An outbreak of coronavirus could worsen existing shortages of healthcare providers and supplies, panelists said Tuesday. The state also announced its third confirmed case of the illness in a Dane County resident. 

Ann Zenk, vice president of workforce and clinical practice at the Wisconsin Hospital Association, said that the coronavirus is likely to “magnify shortages” that providers already know exist in the workforce and supplies. 

“But this isn’t our first rodeo,” she said at a Wisconsin Health News event Tuesday. “We’re ready.” 

Hospitals, nursing homes and clinics are important partners in county and local emergency preparedness efforts, she said. She noted they practice their communication, supply chain and transportation year-round.

Michael Pochowski, Wisconsin Assisted Living Association CEO, said his members’ biggest concern is obtaining personal protective equipment. 

“They’re hearing from their medical suppliers that everything is being rationed right now,” he said. 

Lisa Pugh, executive director of The Arc Wisconsin, said a concern is getting good information out to the public and preventing panic among vulnerable populations. 

Department of Workforce Development Chief Economist Dennis Winters agreed that an outbreak could further increase workforce shortages. He added the economic effects aren’t known yet, although they’re projecting a turndown in economic activity. 

Wisconsin received $1 million in immediate federal assistance last week for the coronavirus. It’s also slated to receive more than $10 million in emergency funding approved by Congress and President Donald Trump last week.

Sen. Patrick Testin, R-Stevens Point, credited the Department of Health Services with informing lawmakers and the public on the virus. Wisconsin is at low risk right now, he said, and it’s incumbent on the people to wash their hands and limit contact if they’re ill. 

“As it stands right now, I think Wisconsin is well positioned to weather the storm,” he said. If that changes and there’s a need for lawmakers’ help, “the Legislature would answer the call,” he added. 

State health officials announced the third confirmed case of coronavirus in Wisconsin on Tuesday morning. The Dane County resident caught the illness while traveling in the U.S and is in isolation at home. The second case, announced Monday, is in Pierce County. 

Dane and Pierce counties are trying to determine who the patients had contact with and determine whether they should be tested and isolated to contain the illness.

“The news of new confirmed cases is not unexpected,” State Health Officer Jeanne Ayers told reporters on a press call. “We’ve been working with our laboratory partners over the past weeks to expand our ability to identify cases early. And we are expecting that as we expand our testing capacity, we will be able to identify any new cases as soon as they are present.”

Early identification of cases allows DHS and its partners to move quickly to isolate the patient and prevent the spread, she added.

She said Wisconsinites should use their best judgment when it comes to their spring travel plans. Those with pre-existing conditions like diabetes, lung disease and heart disease should be “very judicious in any non-essential travel.”

She said that they expect at some point Wisconsin will have broader spread.

Curtis Cunningham, assistant administrator of long-term care benefits and programs at the DHS Division of Medicaid Services, told members of the Long Term Care Advisory Council that they’ve formed work groups throughout the agency to focus on the virus.

He added that the department could pursue permission available in emergencies under Medicaid that would allow them to waive provider requirements and other Centers for Medicare and Medicaid Services requirements and still get a federal match. 

Happy New Year as we go roaring into the new 20’s! I would like to introduce myself as your new WisHHRA Board president and I am so excited to begin my first year in this role. I have been a member of the WisHHRA board for a four years as a regional representative/Director-At-Large for the southeast region and I hope that you all feel the same way I do about the excellent value that your WisHHRA membership brings to you and your organizations. Before I go any further, I would like to thank our outgoing president, Robbi Bos on her contributions to WisHHRA over the past two years. Robbi took on her president role a little earlier than expected due to a job change of the former president so she did not have the benefit of a past-president to assist her, but she really didn’t need any assistance! Under Robbi’s tenure, we began to do a more formal strategic planning process to think of ways that we can continue to expand our service offering to our members and to make WisHHRA a successful organization for years to come. Robbi was also responsible for the transition of our board management activities to Badger Bay, which has brought about a lot of enhancements and administrative ease to our processes. In addition, we welcome two new members to our board this year and some role transitions for some of our Board members. Christopher Schmitz has transitioned from the treasurer role to the Membership Chair, and Jessica Fox has moved from the Membership Chair role to the treasurer role. Thank you to both Chris and Jessica for taking on these new responsibilities. In addition, Robert Stapel (Black River Falls Memorial) and John Konicek (Froedtert Health) have both joined the Board as Directors – At-Large.

I love the start of every new year because it brings with it a fresh slate, a new perspective and an excitement about what’s to come in the year ahead. As we all know, the human resources function is constantly changing as is our industry and sometimes I think that the ever evolving change is why we do what we do. The other exciting thing that will be happening this year is the 2020 WisHHRA Annual Conference at the beautiful Osthoff Resort in Elkhart Lake from April 22 – 24^th. Please watch your emails for the registration information. I would love to meet as many of you there as possible and hear your thoughts and ideas on how WisHHRA can best meet your needs. We have a great day and half of sessions and key- note speakers planned and I think that you will find the content of great value to you in these changing times. Please do not hesitate to connect with me regarding WisHHRA and I look forward to seeing you all in a few months.

As I write my last newsletter as President, I am struck by the fact that we are mere days from a new decade.  2020 seemed a long, long way away when I took the presidency in late 2017 – I just can’t believe how the years have flown by.  In the last two years, I’ve been privileged to serve on the WisHHRA Board with some of the finest healthcare HR professionals in the state and I’ve enjoyed working with them to focus on some key areas over the last two years.  I was particularly excited to be part of the decision to contract with Badger Bay, who now handles much of the day-to-day administrative tasks of the Board.  This has really freed us up to focus on the needs of the organization to a much greater degree.  We’ve brought you webinars and conferences and I’m sure you’ll agree that our new website is a significant improvement.  If you haven’t seen it lately, check it out at wishhra.org.  We updated the bylaws to encourage greater participation on the Board.  And the listserve continues to be a value added benefit to our members.

I look forward to stepping into my new role of past president and helping our new president, Nicole Berlowski and the rest of the Board as they take us into a new decade of change.  If you’ve never served on the WisHHRA Board before, I encourage you to step outside your comfort zone and give it a try.  Not only would you be sharing your knowledge with your peers, you’d be helping our newer HR professionals build that base body of knowledge they’ll need to succeed in healthcare human resources.  But most of all, serving on the Board allows you to build amazing, enduring relationships.  It’s the people that make an organization great.  I can honestly say that I would do it all over again just to ensure I’d have that professional connection with all of you.  Thank you for letting me serve.

I wish you the happiest of holidays and look forward to seeing you in the new, roaring twenties!

Wisconsin Hospital Associaiton, December 2, 2019

Aging Population, Shrinking Workforce and Increased Regulations

WHA Health Care Workforce Report Reveals Current Challenges, Suggests Solutions

Facts and data detailed in WHA’s latest health care workforce report point to the continuation of concerning demographic, employment and regulatory trends in Wisconsin that could threaten access to care unless wise policy strategies are embraced.

The 2019 Wisconsin Health Care Workforce Report is the 16th annual report designed to assist health care entities and elected policymakers in helping to maintain Wisconsin as a source for nation-leading high-quality, high-value health care. The report draws from national and state data and studies, reports from other associations and findings in the field to offer recommendations for action.

Among the major challenges identified in this year’s report:

• The escalating demands of an aging population – the population over age 75 will increase by 75% from 2017-2032, increasing the number of those requiring more intensive health care.
• Increased competition over a shrinking workforce – the population under 18 will grow by only 3.5% from 2017-2032.
• A rapidly changing environment – hospitals have moved from paper to electronic health records in just a decade, and 75% of hospitals now provide access through telemedicine. With rapid technology changes come challenges.
• Increased regulatory demand – meeting regulatory demands requires 59 FTEs for an average-sized hospital; physicians and advanced practice clinicians devote more time to the electronic health record than they do face-to-face with patients.

WHA’s 2019 Health Care Workforce Report provides a snapshot and future projections for Wisconsin’s health care labor force while describing the current environment affecting this workforce. WHA analysis, along with the expertise and experience of WHA member hospitals, offers potential solutions for health care leaders, educators and policymakers to achieve a workforce of highly skilled professionals serving patients as coordinated teams working across the continuum of care to the top of their training and experience supported by effective technology.

Key among the recommendations: state and federal policymakers must weigh any proposed regulation against the expected benefit. Even regulations proposed for a seemingly-positive purpose can instead hinder hospital and health system efforts that reflect the unique needs of their communities. Wisconsin’s health care system has evolved throughout the state via different strategies – and usually in ways that are not the result of “one size fits all” regulations.

The report is available on WHA’s website. 

Wisconsin hospitals earned $1.95 billion in net income in fiscal year 2018, around $280 million less than they did in 2017, according to a report published Friday by the Wisconsin Hospital Association.
 
The net-income percentage fell from 9.8 percent to 8.3 percent during the period.
 
Forty-one hospitals lost money in FY 2018, eight more than the prior year. Total hospital revenue was $23.4 billion, up about $1 billion from FY 2017.
 
“It’s a tougher environment,” said Brian Potter, WHA chief financial officer. “Healthcare is not inexpensive, and so there’s a lot of pressure from all payers to try to reduce the costs.”
 
Potter noted that net income has been trending down in the last couple of years. He cited Medicare cuts, which helped fund the Affordable Care Act's coverage expansion, as a big driver in the decline.
 
He noted that they’re also seeing a larger portion of a hospital’s business coming from Medicare, given an aging population.
 
Medicare accounted for 45.3 percent of patient revenue in FY 2018, up from 44.4 percent in the prior year. Meanwhile, commercial payments fell from 36.5 percent in FY2017 to 35.8 percent in FY2018. 
 
“You’ve got Medicare, who’s paying worse than it has in the past, and you have more of your business now being in Medicare than in commercial, which commercial pays significantly better,” Potter said. “I think that payer mix component is really one of the big drivers.”
 
Potter said planned further Medicare payment cuts will put more pressure on hospitals to do more on expenses to maintain a margin that allows them to continue operating.
 
Operating margins are also declining at health systems, Potter said. The report noted that Wisconsin hospitals often provide the operating margin that allows health systems to support unprofitable services that are necessary for patients, like nursing homes, physician clinics and home healthcare.
 
WHA also surveyed 19 of the state’s largest healthcare systems, comprising 104 hospitals. While the average operating margin for hospitals within the systems was 8.8 percent, the systems as a whole had margins averaging 3.6 percent.
 
For FY 2017, WHA surveyed 18 of the state’s largest healthcare systems, representing 96 hospitals. The average operating margins for the hospitals and the health systems were 9.6 percent and 4.6 percent, respectively.
 
A rise in uncompensated care has also played a role in decreasing margins, Potter said. Uncompensated care charges went up 7.6 percent in FY 2018 to $1.2 billion, according to a separate report from WHA. Charity care amounted to $590.2 million, while bad debt was at $633.4 million. 
 
Part of the reason for the change could be rate increases, according to Potter.
 
There was a $20.2 million increase in uncompensated care at cost, which was $436.8 million in FY 2018. That broke down to $209.1 million in charity care at cost and $227.7 million in bad debt at cost.
 
The main reason for the increase is plan design changes, with patients having to bear a higher portion of their healthcare costs through deductibles, coinsurance and copayments, Potter said.
 
ABC for Health Executive Director Bobby Peterson said “myopic policy decisions” by state and federal lawmakers have resulted in more people lacking medical coverage for needed care. He said expanding Medicaid and strong consumer protections could help.
 
“Bad debt and uncompensated care expenses hurt the bottom line for patients and hospitals, especially people affected by health disparities," he said in a statement.