With the end of 2021 in sight, WHA President and CEO Eric Borgerding began his report to the WHA board of directors on Oct. 27 by reflecting on the association’s goals for the year, noting that COVID-19 has slightly “crowded out” some planned activities, even as unpredicted and urgent matters have arisen requiring significant attention by the WHA team.
“No one could foresee 13,000 Afghans, the equivalent of adding the cities of Tomah and Sparta in that area, arriving at Fort McCoy with very little notice and then relying very heavily on the local health care system,” Borgerding said. “Nonetheless, our members responded, and WHA stepped up to engage directly with the many layers of federal government involved and to be their advocate. One of several examples of unforeseen developments that became significant priorities for our team.”
Post-acute care discharge challenges, which have long been a focus of WHA and its members, took on even greater importance in 2021 as successive surges of COVID-19 filled Wisconsin hospital beds. This issue combined with the unique stresses of a sustained global pandemic, a long-felt health care workforce shortage and other challenges to cause one board member to reflect on the “perfect storm” of conditions hospitals are operating under.
The way in which hospitals and health systems have responded to such pressures is not only taken for granted, but it also often goes unnoticed by the public and elected officials. “Hospitals and health systems have been taking on more roles, more responsibilities in the past 18 months,” Borgerding said. “They are being relied on more and more to fulfill basic government and public health tasks, whether that be testing and vaccinating their communities during COVID, providing resources and health care services, with little notice, to help implement the federal government’s foreign policy decisions, or becoming de-facto nursing homes when those facilities bog down. These are all massive challenges anytime, but especially during a pandemic, and Wisconsin hospitals have stepped up, have been there. That service is counted on, but that capacity is not limitless, and I’m not sure that is widely understood.”
Insurance Company-Mandated White Bagging “Crossed a Line”
Much of WHA’s advocacy report focused on the rising incidence of an insurance company tactic called “white bagging” and a WHA-organized, coalition-led effort to put a stop to the practice in Wisconsin.
Insurance company-mandated white bagging requires certain medications to be purchased through specialty pharmacies often owned by the insurance company, instead of the patient’s preferred local health care provider.
Borgerding noted that white bagging is one of many examples of insurers implementing unilateral “policy changes” during the tumult of COVID. While WHA has not sought legislative solutions to all such policies, white bagging affects patient care and “crossed a line,” Borgerding noted, leading WHA to support a bipartisan bill making the practice illegal in Wisconsin.
WHA Senior Vice President of Public Policy Joanne Alig and Senior Vice President of Government Relations Kyle O’Brien detailed the increasing trend of white bagging nationwide and in Wisconsin and discussed the creation of Koreen’s Law, named for an Eau Claire cancer patient whose health insurer’s specialty drug policy needlessly threatened the quality and reliability of the life-saving medication she desperately needed.
O’Brien summarized a comprehensive public education campaign under the brand name
Patients First Wisconsin aimed at building support for Koreen’s Law. The coalition includes the Pharmacy Society of Wisconsin; the Rural Wisconsin Health Cooperative; the Wisconsin Dermatological Society; the Coalition of Wisconsin Aging & Health Groups; the Wisconsin Association of Hematology and Oncology; ASHP; the National Infusion Center Association; the Infusion Access Foundation; the Coalition of State Rheumatology Organizations; and the Association of Community Cancer Centers. Patients First Wisconsin’s advocacy of Koreen’s law has garnered significant
media coverage, extensive
social media activity and more than
2,000 contacts to state legislators encouraging support for the bill, an unprecedented response and strong indication of the frustration and opposition to this insurer practice, O’Brien noted.
COVID-Exacerbated Challenges
WHA is
raising awareness of and working to address delays in discharging hospital patients to post-acute care facilities, including by advocating for greater use of the EMResource bed tracking system by nursing homes and hospitals and amplifying calls by the Wisconsin Office of the Commissioner of Insurance to remove barriers to transferring patients to post-acute care facilities when possible, WHA Policy Counsel Laura Leitch reported.
Leitch outlined a series of statewide initiatives geared toward stabilizing post-acute care facilities and addressing their workforce challenges. These include efforts by the Wisconsin Department of Health Services (DHS) to increase the number of certified nursing assistants and to provide nursing homes access to agency staffing services. DHS has also provided a number of waivers to increase facility capacity and provide certain workforce flexibilities.
Leitch also provided information on the Acute Hospital Care at Home program. Under 2021 Wisconsin Act 10, Wisconsin adopted the program’s federal standards as the state standards. Four systems in Wisconsin have been approved by the Centers for Medicare & Medicaid Services to provide hospital at home services: Mayo Clinic Health System, Marshfield Clinic Health System, Bellin Health System and Gundersen Health System. Others have expressed interest in the program. While the Act 10 hospital at home provisions sunset at the end of the year, WHA and the participating systems are pursuing legislation that would continue the authority currently in the statute, Leitch noted.
WHA Senior Vice President of Clinical Practice and Workforce Ann Zenk provided an update on WHA’s work with the Evers administration to establish another state contract with a health care staffing agency based on the documented needs of WHA members. A new health services agency staffing resources assistance contract was launched on Oct. 4. As of Oct. 19, 188 facility requests were submitted to the four DHS contracted staffing vendors. As of Oct. 22, 23 facility agreements were signed, resulting in nearly 300 staff being deployed to hospitals, skilled nursing facilities and assisted living facilities throughout the state.
Zenk also reported on WHA’s efforts to streamline health care licensure at the Wisconsin Department of Safety and Professional Services (DSPS). This outreach has led to the identification and prioritization of 188 health care licenses, 112 of which had been approved as of Oct. 27. WHA continues to work with DSPS on system and process improvements that will create even greater efficiencies in health care licensure in Wisconsin.
Federal Update
WHA Vice President of Federal and State Relations Jon Hoelter reflected on federal budgetary initiatives working their way through Congress, including the $3.5 trillion reconciliation “human infrastructure package,” the $1 trillion bipartisan infrastructure package and negotiations related to raising the federal debt ceiling. All three interrelated issues have been in a holding pattern since summer, and the impasse continues as of press time.
Hoelter recapped points made in an
Oct. 15 WHA letter to members of Wisconsin's federal congressional delegation urging lawmakers to make supporting Wisconsin's health care system a priority in the federal budget reconciliation package. The six priorities WHA listed in that letter include:
- Prioritizing Affordable Care Act (ACA) plan subsidies over Medicaid lookalike plans that will not benefit Wisconsin;
- Permanently removing Medicare’s statutory barriers to telehealth;
- Providing one-time flexibility for 340B eligibility due to COVID patient-mix changes;
- Helping to ensure the health care workforce can catch up to demand for care;
- Adequately reimbursing new rural health clinics that submit quality metrics; and
- Making hospitals whole for the cost of aiding Operation Allies Welcome.
Hoelter also summarized ongoing federal Medicaid expansion efforts and where different lawmakers stand on these. “WHA remains concerned that such proposals do not take into account Wisconsin’s unique situation of having no coverage gap despite not taking federal dollars for Medicaid expansion,” he said.