Assembly approves CARES Act, PBM bill
Two bills that the Wisconsin Medical Society has been tracking received votes on the Assembly floor this week.

Society members discuss health care with Representative Kind
On Tuesday, February 18, Congressman Ron Kind and his regional staff person, Mark Aumann, joined 15 physicians and leaders from the Wisconsin Medical Society at Stella Blues in Eau Claire for a Health Care Forum.

RFS and YPS nominations due Feb. 28
Nominations are being accepted for a variety of leadership positions within the Resident Fellow Section (RFS) and the Young Physician Section (YPS) of the Wisconsin Medical Society.

Resolutions for 2020 House of Delegates now available online
Resolutions to be considered at the 2020 Wisconsin Medical Society House of Delegates (HOD) are now available online through WisMed Community Virtual Reference Committees (VRCs).

Term life insurance
“How much can I get for how little?” This is the usual question from a potential buyer of “Term” Life insurance—but for our residents, fellows and young physicians who want to protect their life and their family, it’s an incomplete question.

La Follette School of Public Affairs to host inaugural policy forum
With generous support from Herb Kohl Philanthropies, the La Follette School of Public Affairs at the University of Wisconsin–Madison is pleased to announce its inaugural La Follette Forum.

Recommended by Wisconsin Medical Society CEO Bud Chumbley, MD, MBA

 

The American College of Physicians released four white papers as part of a proposed framework to achieve a better health care system.

The final white paper explores health care delivery and payment system reforms.

Assembly approves CARES Act, PBM bill

Two bills that the Wisconsin Medical Society has been tracking received votes on the Assembly floor this week. The first was the CARES Act (AB 575) which passed on a voice vote on the floor. The version that passed was the amended version that the Society worked on with the bill authors, physician assistants and hospitals. The Society was neutral on this amended version. Information on the parameters of the amended bill can be found here.

The second bill that passed related to pharmacy benefit managers or PBMs (AB 114). Like the CARES Act, the PBM bill that passed was a substitute amendment and involved significant changes to the initial bill after substantial discussions between the PBMs, pharmacies and insurers.

Highlights of the PBM bill include:

  • new licensing and registration requirements created for PBMs
  • “gag clauses” repealed
  • list of audit requirements of PBMs
  • transparency requirements
  • drug substitution provisions
  • cost-sharing limitations

The substitute amendment kept similar language to the original bill regarding prohibitions on gag clauses (which prevent pharmacists from informing patients that a given medication would be cheaper if they paid for it out-of-pocket rather than with insurance). Similar language was also maintained regarding cost-sharing limitations, whereby PBMs would not be able to require patients to pay more than the lower amount of either their copay, or what they would pay had they not used insurance to purchase the drug. There is also language prohibiting PBMs from rejecting a pharmacy claim without due cause.

The two versions differed significantly on the other provisions in the bill. Regarding licensure, the amended bill only requires PBMs to be licensed by the state, but not registered. PBMs would also not have to adhere to a list of rules that would have been created by the Office of the Commissioner of Insurance (OCI). The network requirements also differed in that rather than adhere to stipulations regarding network adequacy and distance, PBMs would only be required to provide pharmacies with a written notice of certification and accreditation requirements. There were also significant differences between the two bills on the audit requirements and processes of PBMs.

On the transparency end, PBMs will be required to submit reports to OCI on the aggregate rebates they received from manufacturers and did not pass through to insurers. These reports will not be made public on the grounds that they are “trade secrets” under the amended bill. Conversely, pharmacies will have to make publicly available the retail price of the 100 most commonly prescribed drugs on a monthly basis.

The PBM passed the Assembly 96-0 on Tuesday and will head to the Senate for its final floor session.

Please contact HJ Waukau with any questions.

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Society members discuss health care with Representative Kind

Representative Kind addressing WisMed members
Rep. Kind addressing WisMed members at a health care forum in Eau Claire

On Tuesday, February 18, Congressman Ron Kind and his regional staff person, Mark Aumann, joined 17 physicians and leaders from the Wisconsin Medical Society at Stella Blues in Eau Claire for a Health Care Forum.

After about 15 minutes of informal visiting, Rep. Kind addressed the audience with a very thorough update of current legislation affecting our patients, practices and profession. He then took questions from the physicians with a very frank give and take on issues ranging from drug shortages and pricing to concerns about veterans’ health care. It was a very informative hour of interaction with a senior legislator who sits on the powerful Ways and Means Committee and Health subcommittee.

Tri County Medical Society president Donn Dexter, MD, introducing Rep. Kind
Tri County Medical Society president Donn Dexter, MD, introducing Rep. Kind

“It was quite clear that he valued our participation and input,” said Donn Dexter, MD, “This is just one more example of the incredible value we get from being a part of the Wisconsin Medical Society.”

It was quite clear that he valued our participation and input... This is just one more example of the incredible value we get from being a part of the Wisconsin Medical Society.

WisMed member Donn Dexter, MD

Many of the attendees then joined the congressman at a fundraiser at a nearby establishment where there was more time to informally discuss issues important to medicine and our community.

Rep. Kind has a very good understanding of the issues facing physicians and expressed interest in continuing the dialog with WisMed members in the future.

Involvement by physicians is vital to making and maintaining these important relationships with our legislators. Special thanks to the Eau Claire, Dunn, Pepin County Medical Society for sponsoring this forum and to those whose strong contributions from across the state provided support via their WISMedPAC conduit accounts.

Reach out to Anne Hauer to get involved with the Society’s advocacy efforts.

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RFS and YPS nominations due Feb. 28

Nominations are being accepted for a variety of leadership positions within the Resident Fellow Section (RFS) and the Young Physician Section (YPS) of the Wisconsin Medical Society.

Both sections are accepting applications until February 28 and the nominees’ statements of interest will be posted to the respective WisMed Communities.

Positions within RFS include the following one-year terms:

  • RFS representative to the Society’s Board of Directors
  • Chair
  • Vice-chair
  • Secretary-editor
  • At-large governing council member (two positions)
  • American Medical Association (AMA) RFS delegate (13 positions)
  • District regional councilor (eight positions—one from each Society-designated state region)
  • RFS Delegate/Alternate to the Society’s House of Delegates (31)

Click here to complete an RFS application.

Positions within YPS include the following:

  • YPS representative to the Society’s Board of Directors—one position, three-year term
  • Chair-elect—one-year term as chair-elect and one-year term as chair
  • YPS Alternate Delegate to the Society’s House of Delegates—one position, two-year term
  • American Medical Association (AMA) YPS Alternate Delegates—two positions, each with a two-year term
  • At-Large member—one position, two-year term.

 Click here to complete a YPS application.

Please email Anne Hauer or call her at 608.442.3749 with any questions.

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Resolutions for 2020 House of Delegates now available online

Resolutions to be considered at the 2020 Wisconsin Medical Society House of Delegates (HOD) are now available online through WisMed Community Virtual Reference Committees (VRCs).* The VRCs provide an opportunity for Society members who are unable to participate in the live Reference Committees to express their views and submit comments to foster greater discussion. A video tutorial on navigating WisMed Community can be found on the Annual Meeting page.

More information about VRCs, including instructions, can be found here.*

Comments must be submitted by 4 p.m. on March 27 for consideration by the Reference Committees, which will hold live hearings on March 28 beginning at 9 a.m. Following the Reference Committee hearings, committee members will convene in closed session to provide recommendations to the HOD on their respective items of business. Reports will be emailed to Delegates, Alternate Delegates and Society Officers, and made available to all members on WisMed Community in advance of the Annual Meeting. Members interested in serving on a Reference Committee are asked to email HJ Waukau for details.

All resolutions and comments will remain viewable to Society members through the HOD, which convenes on Sunday, April 19 following the Society’s two-day Annual Meeting Conference on April 17-18: Navigating the Transition Zone: from adolescence through young adulthood.

In addition to the VRCs and live Reference Committees, Society members can review and discuss resolutions prior to the HOD during their district caucus meetings which begin Wednesday, March 6 in District 6. Click here for a complete schedule and all locations.

For more information about the 2020 Annual Meeting, including information about hotel accommodations, click here.

To download the HOD handbook in its entirety, click here.*

*WisMed Community is a members-only resource and will require you to log in. For questions or assistance please contact Anne Hauer.

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Term life insurance

"How much can I get for how little?”

This is the usual question from a potential buyer of “Term” Life insurance—but for our residents, fellows and young physicians who want to protect their life and their family, it’s an incomplete question.

The better question is, “How can I inexpensively protect my family from bad consequences while we buy time for our assets to grow to a point where we won’t need Life Insurance anymore?”

Thinking through potential bad things that can happen is no fun, especially with the understanding that the probability of something catastrophic happening (other than death) is highly unlikely to happen to you.

And you’re right. It is not going to happen to you. That’s right… it is statistically NOT going to happen to you. But it does happen to some, and when it does, the consequences are either tolerable or devastating, leaving one either emotionally comfortable or severely distressed. Keeping in mind that insurance, by nature, is intended to cover “low probability/highly severe financial consequences”, there is a difference between “inexpensive” Life Insurance (the goal) and “cheap” Life Insurance (the mistake).

So, what makes term life insurance “cheap”?

After 24 years of working exclusively with physicians, I’ve experienced a lot. The issues that follow are very real. (We’ll just leave it at that… but I can tell you that I am much more “mindful” of structuring Term Life Insurance now than I was 24 years ago…) Let’s look at an example of this low probability circumstance happening to someone like you.

A physician, age 30, buys a $1,000,000, 20-year Level Term Life Insurance policy. She is delighted because, after a comprehensive search, she found the least expensive contract. She got the best rating class possible: only $25.73 a month. Such a deal! Then, at age 42, with three young children, she is diagnosed with MS and is partially disabled and can practice only part time. By age 45, she is totally disabled and not working at all.

So here’s the situation... Typically, if one is disabled early in one’s career, one has not enough time to attain enough assets for retirement (and other objectives, such as a child’s college tuition).  This is because the monthly benefits being received from one’s disability insurance benefits leaves little to save. There simply is not enough money. This was the reason for purchasing the Term Life Insurance 15 years ago.

Now the life insurance takes on greater value. It’s there to do what was intended: to make sure there are assets there for the family. But does it? Here is what her Life Insurance policy can and cannot do for her and her family.

This was the lowest premium… and it is, indeed, a cheap policy…

  1. She has 5 years left on her 20-year level term. Then you know what happens at the end of the level term? It becomes very expensive—onerously expensive—and increases in premium every year. So, with a tight budget, it quickly becomes unaffordable… at just the wrong time.
  2. She is now uninsurable and cannot get a new policy.
  3. Her policy could have been convertible to a longer term, but only during the first 10 years.

Talk about stress... At a time when one is emotionally vulnerable, now there is additional stress.

So, how could this have been avoided?

There could have been a longer “conversion” period put on the original policy. This would have allowed for the policy to be stretched to a longer term. A conversion to a “permanent” policy is no bargain at this point; it has a much higher premium; it is around $1,000 per month; $12,000 per year. But, at least one would have had the option. Please Note: longer conversion periods cost pennies more per month… but need to be applied for and put on the original policy at inception.

Could a better decision have been made back when the policy was originally purchased? The answer is yes. There could have been a “Waiver Of Premium” Rider on the policy.

Waivers differ with each Insurer, but “strong” waivers waive premiums when one is totally disabled… and continue to waive them past the “level” term period… Many will waive it all the way until one passes… no matter how long they live.

Disability waivers typically cost about $12 – $15 per million per month. If this had been part of the policy, the contract would have stayed in force free of charge. The result could have been less stress, knowing that one’s family would be getting that $1,000,000 no matter how long or how short one’s life would have been.

Could decisions have been made that would have been even better than this? The answer is yes. This could have been a contract with the ability to both “waive” the premium and then convert it to a permanent contract, which, if one is totally disabled, not only waives premiums, but it funds itself—that is, the Insurer pays the premium.

Now that same $1,000 per month is deposited into the contract by the Insurer and would have been building a cash reserve for the insured that could have been accessed later in life.  

At age 65, the cash would have probably been in excess of $500,000… and, of course, there’s the Life Insurance.

Now, instead of stress, there is the emotional comfort of knowing that one’s family is financially sound no matter if one lives a long time or dies prematurely.

There’s a little bit more to this story…

A “20” year level term is, by far, the most common “term” chosen by young Physicians … and, with me having been around for 24 years, many of those 20-year terms are coming to an end.

As mentioned before, once the “level” term ends, these contracts get incredibly expensive. No one ever keeps them.

The thing is, many—now at age fifty-something—still want some life Insurance. “The kids are still in college… Not quite enough yet in the Retirement plan… Just want the extra million for another 10 – 15 years or so...” are commonly heard reasons.

Well, back at age 30, that 20-year term for $25 per month could have been a 30-year term for $44, but it was decided back then that was just a little too “pricey”. Now at age 50, if one is healthy, a new 10-year level term is $75 per month and a new 20 year term is $119 per month. Again, that is assuming one is still in good health.

In closing, if you want the cheapest Life Insurance, anyone can shop for you. But as a young physician, if you want “inexpensive” insurance with the appropriate protections for you and your loved ones, our promise is to watch out for you and provide the right kind of guidance.

Dave Serena

Dave Serena is in his 25th year as an Agent with the Wisconsin Medical Society’s Insurance Group Wismed Assure. He has physician clients in 36 states and continues to provide them with life-long counsel and guidance. His position is that physicians are free to practice high quality medicine and enjoy their families when they are confident about their personal financial security. He can be contacted at dave.serena@wismedassure.org  or 414.238.6105.

Term life insurance

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La Follette School of Public Affairs to host inaugural policy forum

La Follette Forum logo - Health policy - March 2, 2020

With generous support from Herb Kohl Philanthropies, the La Follette School of Public Affairs at the University of Wisconsin–Madison is pleased to announce its inaugural La Follette Forum. The first conference will focus on health policy.

On March 2, the La Follette School will bring together more than 250 researchers, policymakers, practitioners and community leaders to engage in conversation about innovative solutions to health policy challenges to improve the lives of Wisconsin’s residents.

The daylong conference will be at the Monona Terrace Community & Convention Center in Madison. Drew Altman, president & CEO of the Henry J. Kaiser Family Foundation, will give the opening keynote.

In addition, participants will have the opportunity to attend panel discussions on the following topics:

  • Healthcare Coverage and Access: Medicaid, the Affordable Care Act, and Patient Awareness
  • Caring for an Aging Population: Quality, Workforce, and the Patient Experience
  • Consumer-Driven Healthcare: Impacts and Engaging Patients and Families
  • Personalized Medicine: Innovation, Implications, and Access
  • Societal Determinants of Health: New Models of Partnerships in Housing
  • Strategies for Rural Communities: Collaborations to Strengthen Health

Mia Keeys, Director of Health Equity Policy & Advocacy in the American Medical Association’s Center for Health Equity, will give the closing keynote at 3 p.m.

Throughout the day, participants will have several networking opportunities, including lunch and a closing reception at 4 p.m.

For more information and to register, visit www.lafollette.wisc.edu/health-policy-forum. Registration for the La Follette Forum is free. Click here to register

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