2020 District Public Policy Report
Summary report of the current status for Telemedicine, as impacted by both State and Federal initiatives.
SURPRISE MEDICAL BILLLINGS
What is it and why should we be concerned?
The term “surprise medical billing” describes charges arising when an insured person inadvertently receives care from an out-of network provider. These charges can arise in an emergency when the patient has no ability to select the emergency room, treating physicians, or ambulance providers. These surprise billings can also arise when a patient receives planned care. An example might be when a patient goes to an in-network facility, (hospital or ambulatory surgery center), but later finds out that the provider, providing treatment (e.g., an anesthesiologist or radiologist) does not participate in the patient’s health plan’s network. In this example, the patient again, is not in a position to choose the provider or to determine the status of the provider and its status in the insurance network and likely to receive a “surprise billing”.
Public Policy Education Chair
133 Canterbury Rd.
Eau Claire WI 54701
In June of this year, the WHA Transparency Task Force comprised of hospital and health system financial leaders across Wisconsin met regarding this issue. The group is comprised of experts in hospital billing, insurance contract negotiation, provider networks, and patient financial counseling. The Group’s objective is to document best practices that improve transparency in health care and provide feedback for policymakers on state and federal legislation under consideration.
In their June meeting, the task force agreed that using a median benchmark rate will have unintended consequences for health care. Once determined, this rate will create a ceiling for insurers offering no incentive to negotiate above that benchmark rate. A twofold effect will result; 1) an erosion of provider networks, and, 2) reduced options for patients. As a result, the unintended consequence could be for patients to lose access to some of their current in-network doctors and other health care providers.
Fortunately, Wisconsin is one of the states to experience low surprise billing issues; 5% in 2016. While Wisconsin supports Congressional efforts, legislation should not unfairly penalize positive results achieved. One such negative consequence is found in the State’s Critical Access Hospitals, those that exist in rural parts of the State. These rural hospitals do not consist of the same “payer mix” as urban hospitals and are paid close to break-even rates for Medicare patients, and on average only 70% of what it costs to provide Medicaid patient care. On June 26, 2019, the US Senate passed the “HEAT BILL”, the “Lower Health Care Costs Act”. Included in this Bill is a provision that makes it easier for insurers to steer patients away from rural providers, and thus increase the distance patients will need to travel to access care.
While WHA continues to support Congressional efforts to resolve balance, “surprise billing”, Congress should remove the component that creates a government-set benchmark rate for hospitals, as it is unnecessary to protect patients, and will only serve to enrich Insurers at the expense of hospitals and patients choice of providers. Alternative mechanisms, such as arbitration or mediation, while not perfect, have shown to work without adverse market impacts of government-set rates in the private market.
The ASK; “Please request that leadership strip the median in-network benchmark rate from this package before moving it to the floor”.
The preceding information was found in the following sources: Peterson-Kaiser- Health Tracker; An examination of surprise medical bills and proposals to protect consumers from them. By; Karen Politz, Matthew Rae, Gary Claxton, Cynthia Cox and Larry Levitt; Kaiser Family Foundation. August 13, 2019
WHA; The Valued Voice August 2, 2019.WHA on Capitol Hill to Discuss Surprise Billing; WHA”s Transparency Task Force is Working to Further Improve Transparency
From Bill McCullough, Public Policy Education Chair
WHA has released a great video about the link between Public Policy and our healthcare. Click here to go to the WHA You Tube link.
Public Policy Websites: There are a number of websites available to gather information regarding various political and health issues which impact Wisconsin Hospitals and communities. Listed below are several that might be of benefit:
www.legis.wisconsin.gov Information specific to Wisconsin Legislature
www.thehill.com Information specific to Washington Legislation
The Hill is an American newspaper published in Washington DC. It focuses on politics, policy, business and international relations. The Hill coverage includes Congress, the White House and federal campaigns. The website features 6 blogs specific to political and policy issues including The Ballot Box, Congress Blog, Floor Action, Blog Briefing Room, In the Know and Twitter Room.
www.senate.gov Information specific to the Senate Bills
www.house.gov Information specific to the House Bills
This United States House of Representatives site provides information on current legislation, votes and House documents. In addition you find information on FAQs about specific legislation and the legislative process as well as access to videos of House Floor Proceedings.
www.political.com General political information
www.thewheelerreport.com The Wheeler Report is a legislative news service covering the Wisconsin State Legislature. It tracks all legislation introduced including bill referrals, hearing notices, executive session action, floor action and action by the Governor.
www.wiseye.org The WisconsinEye provides the state’s most extensive coverage on Wisconsin legislative races. You can watch/listen to candidate interviews on this site. The interviews will be updated regularly. Coverage began in August and will continue through the inauguration of election winners in 2017.
www.wha.org The Valued Voice is posted every Friday. It provides current healthcare related news, legislative updates, annual reports, and educational opportunities pertinent to issues of interest/importance to Wisconsin hospitals, physicians, healthcare providers, volunteers and patients.
www.kff.org The Kaiser Family Foundation is a non-profit organization focusing on major health care issues facing the nation, as well as the US role in global health policy. It is a non-partisan source of facts and analysis, polling and journalism for policy makers, the media, the health care community and the general public. The Foundation is known for having the most up-to-date and accurate information on health policy
Advocacy Day: CANCELLED
Remember Advocacy Day will be March 18, 2020. It will be held at the Monona Terrace in Madison. The Program will likely be held from 9:00 AM to 1:45 PM. Legislative visits will follow from 2:15 PM to 3:30 PM. There is no registration fee but attendees must pre-register. Registration will be available online about six weeks before the event. Let’s all bring “Just one More” Advocacy Day guest!
Annual PPE Reports:
The 2019 Local Public Policy Education Report should be completed and three copies sent to the District Chair who will forward the Local PPE Reports to the District PPE Chair. This procedure was discussed and clarified at the Spring Partners Board Meeting.
The 2019 District Public Policy Education Report is to be complied by the District PPE Chair. This form is a compilation of the data submitted by the local PPE Chairs. The District Report along with a copy of each Local PPE Report should be sent to the State PPE Chair, Bill McCullough, 133 Canterbury Rd., Eau Claire WI 54701 or if submitting electronically email@example.com by March 1, 2020. Both report forms are available on the Partners web site under Resource Center - Forms.
HEAT Activity Report:
This report provides an accurate count of local volunteer members of HEAT. It provides names, addresses, email address status, and subscriber status. You can request this report from Kari Hofer at firstname.lastname@example.org. This report will be helpful to all PPEs when completing the annual reports.