WiHPCA News

By Jim Parker | Hospice News | March 22, 2023

Despite years of scrutiny over the duration of hospice care, new data show that longer stays reduce health care costs in the last year of life by as much as 11%.

All told, hospice care — regardless of length of stay — saves Medicare approximately $3.5 billion for patients in their last year of life, a 3.1% reduction. But those with stays of six months or more yielded the highest percentage of savings.

A trio of organizations published these findings Wednesday in a joint report, including the National Hospice & Palliative Care Organization (NHPCO), the National Association for Home Care and Hospice (NAHC), and NORC at the University of Chicago. Read more…

Grassroots advocacy is the most powerful tool WiHPCA has at its disposal to shape public policy – and building relationships with lawmakers is the most important aspect of grassroots advocacy. In effort to capitalize on our greatest advocacy resource – our membership – WiHPCA has established our Coffee Conversations with Legislators advocacy program.

The initiative is designed  to help connect members with their local legislators. Under the program, the WiHPCA Government Affairs Team will set-up in-district meetings between WiHPCA members and state lawmakers who represent them in the Legislature. These meetings, which can be located at your facility, or a local coffee shop provide a tremendous opportunity for WiHPCA members to build or strengthen their relationships with local legislators and to educate them on hospice and palliative care policy issues important to you and the patients and families you serve.

Again, WiHPCA encourages all members to participate in this critical grassroots advocacy program. If you’re interested in participating, please contact the WiHPCA office at wihpca@badgerbay.co.

By Hoven Consulting – WiHPCA’s lobbying firm

• Governor Evers Submits FY2023-2025 Budget Request to Legislature

On Wednesday, February 15, Governor Tony Evers unveiled his budget bill proposal for the Fiscal Year 2023-2025 budget biennium. The budget bill outlines how the State of Wisconsin will administer tax dollars, program revenue, and federal aid dollars over the next two years. In total, the budget aims to spend $103.8 billion ($52.1 billion in FY2023-2024 and $51.7 billion in FY2024-2025) on state government programs.  For fiscal year 2023-2024, that's a $7.9 billion increase (17.9 percent) over the budget proposed by Evers in 2021. 

The most significant increase in state tax dollar spending is in the following state agencies/areas:

LARGEST BIENNIAL GPR (General Purpose Revenue) INCREASES OVER 2021-2023 FUNDING LEVELS

·        Department of Public Instruction:  $2.809 billion

·        Shared Revenue and Tax Relief:  $1.099 billion

·        Department of Administration:  $1.019 billion

·        Public Service Commission:  $755 million

·        Department of Health Services:  $716 million

·        Department of Children and Families:  $512 million

·        Department of Workforce Development:  $265 million

·        All Other Changes:  $1.656 billion

·        TOTAL:  $8.831 billion

The bill has now been sent to the Wisconsin legislature where it will be reviewed by the Joint Committee on Finance (JFC). The committee will review and amend the budget bill after having several public hearings across the state at which citizens may testify. After JFC has passed the bill, it will then be sent to the State Assembly and Senate for passage, likely in June.

It's important to note that Republican legislative leaders have stated publicly that they do not support the Governor's budget proposal.  Republicans control both houses of the legislature and major changes to the proposal are expected.

• WiHPCA Sends Legislative Priorities Letter to All Legislators

On February 2, WiHPCA’s lobbyists sent an introductory letter to all Wisconsin state legislators.  In the letter, we provided background information on the difference between hospice care and palliative care.  In addition, we shared WiHPCA’s legislative agenda for the 2023-2024 legislative session.  WiHPCA provided legislators with a “legislative leave-behind” document that includes background information on WiHPCA, as well as our legislative agenda.

• Former Milwaukee Health Commissioner Kirsten Johnson Appointed DHS Secretary

On February 6, Governor Tony Evers announced that he is appointing Kirsten Johnson as the new state Department of Health Services (DHS) Secretary.  Until recently, she served as the City of Milwaukee Health Commissioner.  She has over two decades of experience in the public health sphere, including as the head of the Washington-Ozaukee Public Health Department, an advisor for former Congressman Ron Kind, and a program manager at the Healthy Wisconsin Leadership Institute at the Medical College of Wisconsin.  Kirsten will start work on February 27, 2023.  She replaces DHS Secretary-designee Karen Timberlake, who resigned in early January 2023.

• DHS Releases State Health Improvement Plan

On February 2, DHS released its 2023-2027 State Health Improvement Plan.  Under state law, DHS is required to craft a public health agenda for the state at least once per decade – this plan meets that requirement.  Further, this plan helps maintain DHS as an accredited state health department, per the requirements of the Public Health Accreditation Board. 

In summary, the report recommends the following three “foundational shifts” in how Wisconsin addresses public health:

·        Institutional and systemic fairness

·        Representation and access to decision-making

·        Community-centered resources and services

Also, it highlights the following priority areas – areas that are critical to ensuring the wellness of Wisconsinites:

·        Social and community conditions

·        Physical, mental, and systemic safety

·        Person and community centered health care

·        Social connectedness and belonging

·        Mental and emotional health and well-being

The full report may be viewed on the DHS website. 

As mentioned above, Gov. Evers recently introduced his 2023-25 budget proposal – the state’s two-year spending plan – before a Joint Session of the Wisconsin Legislature. Although the Republican-controlled Legislature is expected to scrap most of the Evers budget and craft their own version by working off current spending levels, it is likely the Legislature will adopt some of the governor’s proposals.

According to Evers, his budget includes proposals that would increase access to affordable healthcare coverage, improve the quality of healthcare services in the state, and expand the scope of benefits available through Medicaid. Please find below a brief overview of items included in governor’s budget proposal that may be of interest to WiHPCA members:

• Expand Medicaid eligibility for parents and adults from 100% of the federal poverty line ($27,750 annually in 2022 for a family of four) to 138% of the federal poverty line ($38,300 annually in 2022 for a family of four). According to the Evers Administration, this expansion would result in 89,700 low-income individuals becoming eligible for Medicaid, of which approximately 30,300 are uninsured. Under this proposal, the state would realize a savings of over $1.6 billion and draw down an additional $2.2 billion in federal funding over the two-year budget cycle. Republicans who control the Legislature are firmly opposed to this proposal.

• Provide $200 million in additional funding for Wisconsin Innovation Grants, a current program previously funded with federal dollars to design and implement plans to address workforce challenges. This proposal includes a $100 million allocation to specifically focus on fortifying the state’s healthcare workforce by providing grants to healthcare employers and related organizations.

• Provide $22.5 million to establish an ongoing Innovation Grant program for healthcare employers to engage in improved recruitment and retention of long-term care providers.

• Provide $10 million to expand the state’s nurse educators program.

• Provide $5 million GPR in additional funding for the Worker Advancement Initiative to support efforts by technical colleges and nursing schools to reduce barriers to graduation and assist students in becoming career ready.

• Provide $8 million for continuation of the WisCaregiver Careers program, which aims to address the shortage of certified nursing assistants in the state by supporting recruitment, training and retention of individuals to care for nursing home residents across Wisconsin.

• Provide over $900,000 to the Department of Workforce Development to support healthcare profession apprenticeship curriculum development and to advance new collaborations related to healthcare workforce.

• Provide nearly $4 million and increased staffing to the Department of Safety and Professional Services to streamline the state’s credentialling process for licensed professionals and provide more efficient processing of license applications.

The WiHPCA Government Affairs Team will continue to analyze the recently introduced budget bill and keep the membership updated throughout the budget process.

Earlier this month, Gov. Tony Evers announced his appointment of Kirsten Johnson as the next secretary of the Wisconsin Department of Health Services (DHS). Johnson, who begins her new role on Feb. 27, will replace former Secretary Karen Timberlake’s who left the state agency at the end of 2022.

According to a press release issued by the governor’s office, Johnson has over 20 years of experience as a public health leader in local, state, national, and international organizations. Most recently, she served as the health commissioner for the city of Milwaukee following her appointment in January 2021. Prior to serving the city of Milwaukee, Johnson led the Washington-Ozaukee Public Health Department for more than a decade as the director and health officer. Johnson also served as a health policy fellow and advisor for U.S. Congressman Ron Kind and helped develop policy for the House Committee on Ways and Means.

“Over the past 20 years of my career in public health, I have worked to address the challenges and health disparities facing Wisconsin’s rural, urban, and suburban communities alike—disparities that were laid bare by the pandemic,” said Johnson. “I am excited and honored to join Gov. Evers’ administration to lead DHS, where I look forward to using my expertise and knowledge to continue this important work.” 

Johnson has her master’s degree in public health from Tulane University of Public Health and Tropical Medicine and holds certifications as a public health professional and certified education specialist.

In the closely watched Feb. 21 primary for the Wisconsin Supreme Court – which centered on the issue of abortion after the U.S. Supreme Court overturned Roe v. Wade in 2022 – liberal-leaning Milwaukee County Judge Janet Protasiewicz and conservative former Supreme Court Justice Daniel Kelly captured the most votes in the four-way race and will face-off in the April 4 general election. Protasiewicz took 46% of total votes cast, with Kelly coming in a distant second, capturing 24% of the votes. The winner of the general election will decide the ideological direction of the 7-seat high court, which is currently controlled 4-3 by conservative-leaning justices.

The other high-profile primary race saw Republican state Rep. Dan Knodl (R-Germantown) defeat fellow state Rep. Janel Brandtjen in the GOP primary for the 8th WI Senate District. Knodl will face Democrat Jodi Habush Sinykin in the April 4 spring election for the chance to replace former Republican Sen. Alberta Darling, who left office in Dec. 2022 after holding the senate seat for three decades. If Knodl ultimately wins the seat, Republicans will hold a veto-proof majority in the senate.

Grassroots advocacy is the most powerful tool WiHPCA has at its disposal to shape public policy – and building relationships with lawmakers is the most important aspect of advocacy. In effort to capitalize on our greatest advocacy resource – our membership – WiHPCA has unveiled our Coffee Conversations with Legislators advocacy program.

The initiative is designed  o help connect members with their local legislators. Under the program, the WiHPCA Government Affairs Team will set-up in-district meetings between WiHPCA members and state lawmakers who represent them in the Legislature. These meetings, which can be located at your facility, or a local coffee shop provide a tremendous opportunity for WiHPCA members to build or strengthen their relationships with local legislators and to educate them on hospice and palliative care and on policy issues important to hospice professionals and their patients.

WiHPCA encourages all members to participate in this critical grassroots advocacy program. If you’re interested in participating in the program, contact the WiHPCA office at wihpca@badgerbay.co .

·         Legislative Session

Both the State Senate and the State Assembly were on the floor this month, but only dealt with limited calendars. Both houses adopted an amendment to the constitution relating to bail imposed on defendants awaiting trial, as well as a resolution to create an advisory referendum to be held at the April non-partisan election on the issue of whether individuals receiving public assistance should be subject to a work requirement. The proposed constitutional amendment will also go before voters (to approve or deny) in April.

·         Protasiewicz with Early Supreme Court Fundraising Lead

The first campaign finance reports for WI Supreme Court candidates were due earlier this month, and Milwaukee County Circuit Court Judge Janet Protasiewicz reported raising $756,000 in the last 6 months of last year, more than doubling her next closest competitors.  Waukesha County Circuit Court Judge Jennifer Dorow raised $306,000, former Supreme Court Justice Dan Kelly raised $312,000 and Dane County Circuit Court Judge Everett Mitchell raised $115,000.  The four face off in a primary in February, with the top two vote getters moving on to the April General Election.  While the Supreme Court is nonpartisan, its members do loosely line up along ideological lines, with Conservatives holding a 4-3 advantage. For Conservatives to maintain their majority, either Dorow or Kelly would need to win the April Election.

·         Legislative Republicans circulate Tax Proposals

Legislative Republicans have proposed two bills early this session focusing on tax cuts, fulfilling campaign promises from last fall.  Earlier this month, Senate Majority Leader Devin LeMahieu circulated a bill that would phase in a flat tax over the next four years.  The State currently has four income tax brackets, and if this bill were to pass, everyone in Wisconsin would be paying a rate of 3.25%, down from 7.65%, which is what taxpayers in the upper bracket are currently paying.  Governor Evers has said he does not support this proposal, although he is likely to introduce his own income tax relief proposal in his budget bill.

Republicans have also re-introduced legislation to eliminate the personal property tax in Wisconsin.  While Evers vetoed a bill to repeal the personal property tax last session, Republicans hope a compromise on the issue can be reached this session.

Earlier this month, on Jan.12, WiHPCA held its latest quarterly meeting with the WI Department of Health Services’ Division of Quality Assurance (DQA), providing our members an opportunity to engage with agency staff and learn about DQA regulatory activity during the fourth quarter of 2022.  

If you have not had an opportunity to attend one of our past DQA meetings, we would encourage you to attend the next meeting in April and help the hospice industry build and maintain a strong working relationship with DQA staff. The meetings also provide WiHPCA members with valuable regulatory information and updates, as well as a unique chance to ask questions and request guidance from the agency.

For members who were not able to attend the Jan. 12 meeting, please find below a high-level overview of DQA’s quarterly report for fourth quarter 2022:

• Hospice Surveys

Total Surveys:  9
Recertification Surveys:  1
Complaint Surveys:  8

Complaints Overview:

Complaints investigated: 8

Unique allegations: 11
Substantiated complaints related to:
·         Quality of care and treatment
·         Nursing services
·         Patient rights
Citations Overview
o   No health citations were written in fourth quarter 2022
o   Life safety code violations included:
K281 – Exit lights not working
K354 – Insufficient sprinkler outage plan
K712 – Fire drill timing deficiencies
Other Key Information
o   DQA is currently up-to-date on recertification and complaint surveys.
o   DQA provided an overview of their efforts to review the Hospice-Nursing Home Interface document for possible revisions. DQA asked for feedback from call participants and announced there would be more opportunities for input on possible revisions.
o   There were 2 new hospice applications during fourth quarter 2022.

For more data and information, please CLICK HEREto visit the DHS Hospice Statistics webpage.

WiHPCA is happy to remind members about and provide links to the latest articles and information from Hospice News and other publications:

·         Hospice Advocacy Groups Call on CMS, Congress to Strengthen Program Integrity Oversight

• By Holly Vossel | January 19, 2022

Four national hospice and senior care industry groups have called on Congress and the U.S. Centers for Medicare & Medicaid Services (CMS) to make regulatory and legislative changes to instill stronger program integrity safeguards. The organizations penned a joint letter to CMS in November urging for increased oversight to help curb hospice frauds, including the National Association for Home Care & Hospice (NAHC), National Hospice and Palliative Care Organization (NHPCO), National Partnership for Healthcare and Hospice Innovation (NPHI) and LeadingAge. Read more…

·         NHPCO: Language, Mistrust, Lack of Diverse Staff Come Between Hospices and Underserved Populations

By Holly Vossel | January 17, 2023

Language barriers, mistrust of the health care system and a lack of diverse staff are the most common obstacles between hospice care and underserved communities, research from the National Hospice and Palliative Care Organization (NHPCO) recently found. Read more…

·         VA Study Finds 95% Increase in Palliative Care Utilization When Patients Have Access to Social Workers

• By Jim Parker | January 16, 2023

Patients are more likely to receive palliative care if they can access social workers through their primary care providers, Veterans Health Administration (VA) research has found. Researchers analyzed records for 43,200 veterans with prior hospitalization who had received primary care at a VA site between October 2016 and September 2019. They found a 95% increase in hospice or palliative utilization among veterans served by VA providers participating in the agency’s Social Work Patient Aligned Care Team (PACT). The average age among the veterans was about 65. Read more…

·         GAO: CMS Should Update Rules for Hospices Reporting Abuse or Neglect

• By Jim Parker | January 11, 2023

Hospices should be required to report all instances of abuse and neglect, even if the perpetrator was not an employee, the U.S. Government Accountability Office (GAO) has recommended.

The U.S. Centers for Medicare & Medicaid Services (CMS) requires operators to report incidents of patient abuse and neglect that involve their staff. If the agency follows the GAO’s recommendation, they would also have to notify survey agencies when others, like family members or caregivers, become abusive or neglectful. This would bring the hospice rules in line with those used in long term care. Read more…

·         FTC Proposes Rule that Would Ban Employee Noncompete Clauses

Associated Press – Alexandra Olson and Michelle Chapman| January 6, 2023

The Federal Trade Commission proposed a rule Thursday that would ban U.S. employers from imposing noncompete clauses on workers, a sweeping measure that could make it easier for people to switch jobs and deepen competition for labor across a wide range of industries. The proposed rule would prevent employers from imposing contract clauses that prohibit their employees from joining a competitor, typically for a period of time, after they leave the company. Read more…

·         New York Governor Vetoes Bill to Limit For-Profit Hospices

• By Jim Parker | January 3, 2023

New York Gov. Kathy Hochul (D) has vetoed legislation that would have effectively banned new, for-profit hospices in the state. The New York State Assembly passed the bill in June and submitted it to the governor’s office in mid-December. It would have prohibited the establishment of for-profit hospices in New York state and forbid current for-profit operators from increasing capacity. Read more…

Hospice News, which is part of the Aging Media Network, is a leading source for news and information covering the hospice industry.