Leading health experts have grave concerns over AB260, mandating Wisconsin’s schools and colleges to accept physical exams completed by chiropractors. Currently primary care providers examine students for clearance to compete in athletic programs.
The coalition opposing the measure includes 19 key physician organizations, other health care providers, health systems, hospitals, academic centers and other parties with a vested interest in the health and well-being of Wisconsin’s student athletes.
“Chiropractors do not have the comprehensive medical training to provide the wrap-around care provided in the primary care office,” said Dr. David Bernhardt, a team physician for the University of Wisconsin-Madison and pediatric and adolescent sports medicine expert. “The safety of youth athletes is at stake.”
During public testimony on the bill in April, some commented that chiropractors “often have more training than physicians in certain areas,” a claim contested by physicians and others.
In contrast, a 2016 American Medical Association issue brief reports that while physicians complete 10,000+ clinical patient care hours (plus additional classroom and laboratory experience), chiropractors are required only to complete 4,200 hours of combined classroom, laboratory and clinical experience.
Dr. Kevin Walter, Program Director for Children’s Hospital of Wisconsin’s Primary Care Sports Medicine program, also cautioned against the proposal. "We want these young athletes to have quality screening by medical experts. When medical professionals are evaluating their health and physical readiness to participate in a sport, the exam includes so much more such as their cardiovascular condition, mental and behavioral health as well as educating them on health issues. The goal should be what is best for Wisconsin's kids and this proposal to allow chiropractors to handle these exams misses that mark."
The Assembly Committee on Health has scheduled a vote on the measure on Tuesday, June 13.
Now is the time for physicians concerned about this bill to contact your State Assembly representatives—please feel free to use the coalition’s April 26, 2017 memo as a source for talking points; you also can share the document with your representative. To verify the contact information for your elected officials, visit the State Legislature’s website and enter your address into the box under the “Find My Legislators” section at the right of the screen.
The Legislature's budget-writing committee has amended the state's next budget to expand the number of dementia care specialists in the state, rejecting the state's plans to end the program.
The Dementia Care Specialist Program embeds specialists that support those with dementia and their families as well as help foster dementia friendly communities in Aging and Disability Resource Centers.
The program is set to end this year, and Gov. Scott Walker's 2017-19 state budget didn't include funding to continue it. Department of Health Services Secretary Linda Seemeyer said in March that the department wouldn't oppose continuing the program.
The Joint Finance Committee approved a motion last month that amends the budget to provide $3.1 million over the next biennium to support the current 19 dementia specialist positions. The amendment would add an additional four positions that would start July 1, 2018.
Most of that funding, which is ongoing rather than one-time, comes through general purpose revenue, with some coming from the federal government.
"The number of Wisconsinites living with Alzheimer's and dementia continues to grow and we must ensure that these individuals and their families have adequate support," JFC member Rep. Mike Rohrkaste, R-Neenah, said in a statement. Rohrkaste led the Speaker's Task Force on Alzheimer's and Dementia last legislative session.
The retention of the program was a priority for the Alzheimer's Association, Southeastern Wisconsin Chapter. Tom Hlavacek, executive director, said the specialists are playing a greater role in identifying people with dementia and connecting caregivers with resources. They often work with the association, he added.
While they requested expanding the program statewide, the addition of new staff "is a step in the right direction," he said.
"We felt that the victory was important not just for these positions, not just for expanding the program, but because it acknowledges the fact that we have an epidemic on our hands in the state of Wisconsin and across the country," he said.
Rob Gundermann, public policy director at Alzheimer's & Dementia Alliance of Wisconsin, said they were a "little disappointed" with the committee's decision.
"If they're going to spend that kind of money we would have rather have seen that go into respite," he said. "We administer it for Dane County here and we're already out of money this year. There's just such a need for that and it keeps people in their homes."
Gundermann said it's "ridiculous" that the state will be spending more money on the specialists than on respite care. "We need to incentivize home care over institutionalization," he said. "That's the way you save money with this population and you do that by providing respite."
The committee also approved $100,000 over the next two years to support the Wisconsin Alzheimer's Disease Research Center, which was requested by Gov. Scott Walker. The proposal mirrors a bill that was introduced last year by the Speaker's Task Force but didn't make it into law.
Gov. Scott Walker's Department of Health Services officially asked the federal government Wednesday to allow Wisconsin to become the first state to drug screen adult Medicaid enrollees without children. The waiver amendment also caps eligibility, imposes work requirements and charges premiums to members living below the poverty line.
DHS pared back some of the changes after receiving more than 1,000 pages of comments on the proposal.
That includes shrinking the income tiers for premiums from four tiers to two and not making anyone under 50 percent of the poverty level pay premiums. Childless adults with household incomes between 51 percent and 100 percent of the poverty level would pay $8 a month. Walker originally proposed a range of $1 a month to $10 a month for members making between 21 percent of the poverty level and 100 percent. DHS is also considering a grace period of 12 months for members that miss a payment.
In addition, the application decreases a copay for subsequent visits to the emergency room. And members who skip a drug screening can sign back up for coverage as soon as they consent to treatment, instead of waiting six months.
Walker called the application "a step in the right direction." "We're continuing to build on Wisconsin's legacy as a leader in welfare reform," he said in a statement Wednesday.
Jon Peacock, research director for the Wisconsin Council on Children and Families, said the latest changes to the proposal were "modest improvements." But they don't "change the basic problem that the waiver would add new barriers to BadgerCare participation that increase administrative costs and keep people from getting the care they need."
Last month, the state's budget committee voted to require that the panel approve the waiver amendment before it's implemented. At a Wisconsin Health News event Monday, Joint Finance Co-Chair Rep. John Nygren, R-Marinette, said he overall supported Walker's plan, but "there's still a lot of unanswered questions in the proposal." "For us to feel comfortable that we're moving in the right direction, we believe the proposal should come back to Joint Finance and we have the opportunity to vote it up or down," he said.
We are flying in a full slate of national speakers to provide in-depth perspective on the latest updates and developments. That includes:
They will be joining vice presidents from the American Medical Association and America's Health Insurance Plans, as well as influential experts from Wisconsin, including:
We've also expanded network opportunities throughout the day and expect CEOs, executives and senior leaders from across the state to attend. This will be an event you don't want to miss.
State Legislative Update
If you have any questions or would like to discuss how to improve your advocacy efforts, contact Grant Niver.
Federal Legislative Update
Stay up-to-date on #AANAdvocacy by reading the Capitol Hill Report and following the AAN’s Senior Legislative Counsel Mike Amery on Twitter at @MikeAmeryDC.
Medical Economics Update
AAN Membership Update
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As you put together the agenda for your 2016 meetings, consider taking advantage of the AAN’s speaker program! We have expert speakers on topics such as ICD-10, MACRA, practice management, quality measures, telemedicine, and much more. To secure a speaker for your state meeting, please refer to the State Neurosociety Speaker Request Form.
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The Wisconsin Neurological Society is now accepting applications for the Bennett Hiner Research Award. The Award is presenting to a medical student enrolled at one of the state’s medical schools in recognition for extra-ordinary service, leadership and research in the neurosciences.
This award is in memory of Bennett Hiner, son of long time Society member Dr. Bradley Hiner. Bennett passed away unexpectedly in November 2011. He was an enthusiastic and accomplished young man who was a leader in his medical school class at the University of Southern California and actively involved in neuroscience research.
Qualified applicants are medical students must be enrolled at either the University of Wisconsin School of Medicine and Public Health, or the Medical College of Wisconsin; have completed neuroscience research within two (2) years of application for this award; have demonstrated leadership experience while enrolled in medical school; and have submitted the application and research abstract. An application form is available by clicking here.
Medical students should submit their applications and abstracts to the WNS Office by July 31, 2017. A winner will be selected by August 31, and notified in early September. The Society will invite the Award winner to the WNS Annual Conference, during lunch on Saturday, October 28 at the Osthoff Resort in Sheboygan.
Please contact the WNS office at firstname.lastname@example.org or 920-560-5622 with any questions.
MAY 22, 2017 - By Mike Amery, Esq., Senior Legislative Counsel
Congress is back in action after a short break and first up last week was a hearing and a vote on a top AAN priority, the Furthering Access to Stroke Telemedicine (FAST) Act.
Senate Finance Committee Votes on the CHRONIC Care Act
Senate version of FAST Act Now Has Seven Cosponsors
The House Version of the FAST Act Is up to 85 Cosponsors
With the addition of:
VA Developing National Telestroke Center
Drug Pricing Discussions Heat Up
AAN Agrees to Support S. 771 by Sen. Al Franken (D-MN)
HELP Committee Announces Plans to Hold Hearing on US Drug Prices
Senate Confirms Commissioner of the FDA
PALF Grad Highlighted by People Magazine
The management side of a council charged with developing changes to the state's workers' compensation system has proposed creating a fee schedule for healthcare services.
The Worker's Compensation Advisory Council, which consists of representatives from management and labor, crafts a bill that updates state law around workers' compensation every two years. Management and labor introduced their proposals at a meeting last week.
Management is calling for setting initial rates at 150 percent of Medicare rates starting in 2017. The schedule would adjust each year with the medical consumer price index.
The proposal differs from a measure that was pursued by the council four years ago but failed to make it into law, which was based on rates for surgeries and procedures negotiated by group health plans.
"The goal is the same, which is to bring cost containment to the state," said Chris Reader, an advisory council member and director of health and human resources policy at Wisconsin Manufacturers and Commerce.
He said it's easier to construct the fee schedule using Medicare as it's difficult for the state to obtain average group health plan rates. More than 40 other states have fee schedules, he said.
Mark Grapentine, Wisconsin Medical Society senior vice president of government relations and liaison to the council, questioned why Wisconsin would want to mimic other states when it already has a successful system.
"The value of the current workers' comp system as it exists is by just about every measure fantastic," he said. "For whatever reason, the management side tends to have this fascination with sticker prices of individual procedures and not the overall cost of care."
Reader pointed to other proposals from management they believe could help with costs. That includes allowing employers to direct workers to healthcare providers and requiring providers to follow treatment guidelines.
If a provider decides to deviate from the guidelines, they would have to get prior approval. That ensures providers get employees back to work as soon as possible, he said.
"Let me be clear - most do an excellent job of getting workers back to work," he said. "But having strong treatment guidelines will ensure that everybody has to do that unless there's a good reason not to."
Grapentine said they're concerned about both proposals. Treatment guidelines could make it inefficient and frustrating for physicians to provide care to injured workers, he said.
The proposal relating to guidelines, he said, is coupled with the fee schedule approach. States with fee schedules aren't as efficient in providing care, and treatment guidelines can cut utilization. He compared it to pushing on both sides of a balloon at the same time.
"If you push on both sides of the balloon really hard, you know what happens," he said. "Why on earth would you do that to a system that people across the board think is a national model?"
Management and labor are set to negotiate over the coming months to craft an agreed-upon bill for introduction to the Legislature.
Stephanie Bloomingdale, secretary-treasurer of the AFL-CIO and an advisory council member, declined to comment through a spokeswoman.
Joint Finance Committee Co-Chair Rep. John Nygren, R-Marinette, will provide an update on the state budget, preview what's next for the HOPE agenda and discuss the outlook for other pressing healthcare legislation at a Wisconsin Health News Newsmaker Event, Monday, June 5 in Madison at the Madison Club.
The event is Monday, June 5 at the Madison Club (5 E Wilson Street, Madison). Lunch begins at 11:45; conversation starts at 12:15pm and adjourns by 1pm.
Doctors and acupuncturists oppose a bill that would allow chiropractors to perform physical examinations for student athletes and practice "chiropractic acupuncture" and "chiropractic dry needling" if they receive additional training.
The bill received a public hearing Wednesday before the Assembly Committee on Health.
Under the proposal, schools that require a pupil to have a physical examination to participate in sports and other activities will have to accept a physical examination completed by a chiropractor the same way it accepts those completed by doctors. The chiropractor would have to hold a certificate in health or physical examinations.
The same requirement would apply to the state's technical colleges or a two-year campus within the University of Wisconsin System that require physical examinations for students to participate in sports.
"With some additional training, doctors of chiropractic could provide a high quality exam," Mark Cassellius, a chiropractor practicing in Onalaska, told lawmakers.
Dr. Tosha Wetterneck, past president of the Wisconsin Medical Society, opposes the bill.
The physical examination isn't just focused on the athletics, but on at-risk behaviors, immunizations and other factors that might impact sports participation, she said. That requires extensive training.
"This is rocket science," she said. "This is difficult."
The bill would also allow chiropractors to practice "chiropractic acupuncture" if they complete at least 200 hours of instruction and the acupuncture examination administered by the National Board of Chiropractic Examiners.
The bill would also allow chiropractors to practice "chiropractic dry needling," which involves puncturing the skin with needles to treat "neuromusculoskeletal pain and performance," if they complete 50 hours of postgraduate study.
Shawano-based chiropractor Brian Grieves said the bill could help address the opioid epidemic by increasing access to alternatives pain treatments.
"We have very limited, proven, effective non-drug options to offer people for pain," he said. "Being able to augment that by offering chiropractic acupuncture would greatly expand that access."
Elissa Gonda, chair of the legislative committee for The Wisconsin Society of Certified Acupuncturists, opposes the bill.
"Acupuncture is a serious and rigorous profession," she said. "It's not a method or technique that can be employed on an occasional basis by another healthcare practitioner."
Steve Conway, executive director of the Chiropractic Society of Wisconsin, said they're generally supportive of the bill but they're still vetting it.
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Phone: 920-560-5622 | Fax: 920-882-3655