State Controlled Substances Board tells Legislature: don’t de-schedule kratom

The Wisconsin State Controlled Substances Board (CSB) voted March 10 to recommend that the state legislature keep the substance kratom in the state’s Controlled Substances Act. Kratom comes from the leaf of a southeast Asia evergreen tree and has opioid-like properties, including links to addiction and kratom-caused fatalities. The Wisconsin State Legislature acted in the 2013-14 legislative session to classify harmful substances found in kratom (mitragynine and 7-hydroxymitragynine) as a Schedule I drug in the state’s Uniform Controlled Substances Act, making Wisconsin one of six states to ban the substance. In recent years the American Kratom Association (AKA) has pushed to legalize the product in Wisconsin, first by unsuccessfully lobbying the state’s Medical Examining Board and the CSB to weigh in on the 2013 Act, then by introducing legislation in the 2021-22 legislative session that failed in part due to strong Wisconsin Medical Society (WisMed) and law enforcement opposition (see this Medigram article from February 24, 2022).

The AKA’s latest effort involved convincing a small group of state legislators to make a request (essentially on AKA’s behalf) that the CSB examine certain statutory elements referenced when considering whether to schedule a drug. Utilizing a faulty premise, the AKA termed this list of eight considerations an “eight-factor test,” opining that any CSB finding on kratom falling short of all eight factors would prove that there was no merit to scheduling kratom. WisMed has helped counter the AKA’s erroneous logic, pointing out how federal agencies and numerous medical entities have warned the public that kratom is unsafe, addictive and ineffective. You can read WisMed’s latest memo to the CSB on kratom here.

At its meeting March 10, the CSB made two motions: first, that kratom did not at this time satisfy all eight statutory elements related to scheduling decisions. But fearing that such a motion standing alone would be “misleading” to the state legislature, the CSB approved a second motion:

Although the Board voted that all eight factors were not met, the Board’s investigation raised significant concerns on some factors; therefore, the Board does not recommend any action to de-schedule kratom (mitragynine and 7-hydroxymitagynine [7-HMG]).

Despite this setback, the AKA will undoubtedly push for legislation this session that would de-list kratom and allow the addictive substance to be sold in Wisconsin. WisMed will continue to work with other health care partners and law enforcement groups to educate legislators about kratom and ask that they continue to support the unanimous action the legislature took in the 2013-14 session. Contact WisMed Chief Policy and Advocacy Officer Mark Grapentine, JD for more information.

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Don’t miss the dueling pianos at Health & Harmony!

We’re looking forward to seeing you on the evening of Friday, April 14, 2023 at Health & Harmony, where the Wisconsin Medical Society Foundation will raise awareness for health equity in Wisconsin and host a raffle with amazing items including Packers tickets and a massage.

Piano Fondue will be taking the stage at our Foundation evening event. Dueling Pianos is an exciting performance of singing and playing of grand pianos. Guests will have the opportunity make a donation and request a song. Click here to get a sneak peek of the performance. Beyond the dueling pianos, the evening will include an award ceremony, dinner, wine pull, raffle and great company.

Plan your weekend for Health & Harmony, the WisMed Annual Event:

• Medical Education Conference - April 14, 9 a.m.
• Foundation Fundraising Event - April 14, 5 p.m.
• Annual Business Meeting - April 15, 9 a.m. 

Register here for part or all of the weekend.

The education conference has been approved for AMA PRA Category 1 Credit™ and will help learners define social determinants of health inequity and identify strategies to apply Justice, Equity, Diversity and Inclusion into clinical practice encounters and medical decision-making.

We hope you can join us! Purchase an education conference ticket for just $149 and get one Foundation event ticket for free. Additionally, WisMed members get discounted CME registration! Contact education@wismed.org to get your coupon code. Register here for part or all of the Annual Event. Please help us spread the word by sharing this article or this Facebook post.

We are excited to offer sponsorship and exhibitor opportunities for Health & Harmony! Exhibitors will spend the day connecting with Health & Harmony attendees from across the state. In addition to the booth, you will have the opportunity to have a table at our evening event allowing for the connection (and fun!) to continue.

Learn more here or contact Mikaela Powers. 

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Set your DVR for a debate between Supreme Court candidates Kelly and Protasiewicz on March 21

On Tuesday, March 21, the Supreme Court candidates, former Justice Dan Kelly and Milwaukee Circuit Court Judge Janet Protasiewicz will debate in a traditional format hosted by the State Bar of Wisconsin. This debate will be taped early in the day (if you’re interested in attending the debate live in Madison, contact the State Bar at 800.728.7788) and shown at 4 p.m. via WISC-TV in Madison, WKBT in La Crosse or on Channel 3000.com.

This is the only debate between the candidates who are vying for the open Supreme Court seat. This statewide election is April 4. The debate is sponsored by the State Bar of Wisconsin, WISC-TV and WisPolitics.com.

If you have any questions, call the State Bar of Wisconsin at 800.728.7788 and be sure to vote on April 4! 

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Can saving too much be bad?

Contributing too much too early into your 401(k) or 403(b) retirement plan could mean missing employer matching contributions.

Employer matching formula

Employer matching contributions are typically based on a percentage of the employee's contributions, up to a certain limit. For example, an employer may match 50% of an employee's contributions, up to a maximum of 6% of the employee's salary. So, if an employee earns $200,000 per year and contributes 6% ($12,000) to their 401(k), the employer will match $6,000.

Reaching the limit

However, if an employee reaches the maximum employee contribution limit of $22,500 for 2023 (or $30,000 if age 50+) before the end of the year, they may miss out on employer matching contributions for the remainder of the year. This can be a significant loss, especially for employees who contribute a large portion of their salary to their retirement plan early in the year.

Tip 1. Timing contributions

One solution is to adjust your deferral rate so you have an employee contribution, and therefore employer match, on each paycheck. To be savvy, make heavy contribution early in the year so you benefit from that year’s investment gains then reduce your contribution for the later pay periods to still get the maximum employer match.

Tip 2. True-up contributions

Another option is an employer true-up contribution. This allows employers to make up for any missed matching contributions at the end of the year. Not all employers offer true-up contributions, so it's important to check with your payroll or your plan documents to see if this is an option for you. Similarly, some employers make matching contributions at the end of the year instead of each pay period. Like the true-up, this makes the timing of the employee’s contributions irrelevant.

Today’s Extras

• WisMed Financial and WisMed Assure are offering complimentary tickets for this year’s Wisconsin Medical Society Annual Event on April 14-15. First come, first served while they last. Request your complimentary tickets here.
• Investing in real estate learning event is this Friday at noon via Zoom. Click here for details and to register. Replays are provided to all registrants. We look forward to seeing you there!
  

For personalized help eliminating debt, investing smart and securing retirement, please contact Mark Ziety, CFP®, AIF® 608.442.3750.

Mark Ziety, CFP®, AIF®
WisMed Financial, Inc. part of the Wisconsin Medical Society. 

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WMJ seeking Deputy Editor – apply by March 31

The Wisconsin Medical Journal (WMJ) is seeking candidates to serve as Deputy Editor. The WMJ is an indexed, peer-reviewed journal published since 1903 that is owned and operated through a collaboration between the Medical College of Wisconsin (MCW) and the University of Wisconsin School of Medicine and Public Health (SMPH). Click here to learn more and download the position description.

The Deputy Editor will report to the WMJ Editor in Chief and assists in guiding the WMJ to consistent high quality and fulfillment of its mission: to provide an opportunity to publish original research, case reports, review articles and essays about current medical and public health issues.

This volunteer position averages 2 to 4 hours per week and requires a three-year term, with the potential for renewal.

The successful candidate will:

• Be a faculty member at MCW or UW-Madison with MD, DO or clinically oriented PhD
• Have a record of successful previous publications in peer-reviewed journal(s)
• Possess a broad medical vantage point
• Have extensive knowledge of research methods
• Possess excellent writing and editing skills

Previous experience as an editor or associate editor is strongly preferred, as is prior editorial board experience.

Interested candidates should submit the following by March 31, 2023 to wmj@med.wisc.edu with the subject “Deputy Editor Search”:

• A current curriculum vitae
• A one-page letter summarizing why you are interested in and qualified for the role
• A current conflict of interest form (download here)

Email wmj@med.wisc.edu with any questions.

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WisMed joins AMA, physician organizations urging Congress to pass legislation providing for an annual inflation-based Medicare payment update

On March 15, the Medicare Payment Advisory Commission (MedPAC) for the first time called for a physician payment update tied to the Medicare Economic Index (MEI). The Wisconsin Medical Society (WisMed) and American Medical Association (AMA) have long championed this move and appreciate MedPAC’s acknowledgement that the current Medicare physician payment system is inadequate – a critical first step toward the larger, necessary work of reforming Medicare to make it more rational and serve patients better.

In the face of inflation, the COVID-19 pandemic and growing costs of running a medical practice, physicians have struggled to keep their doors open, jeopardizing access to care, particularly in rural and underserved areas. Not only have Medicare payments failed to respond adequately, but physicians saw a 2% payment reduction for 2023, creating an additional challenge at a perilous moment. 

“Having surveyed the health care landscape, MedPAC recognized that physician pay has not kept up with the cost of practicing medicine," said AMA President Jack Resneck Jr., MD. "Yet, we feel strongly that an update tied to just 50% of MEI will cause physician payment to chronically fall even further behind increases in the cost of providing care. Congress should adopt a 2024 Medicare payment update that recognizes the full inflationary growth in health care costs,” Doctor Resneck said.

As one of the only Medicare providers without an inflationary payment update, physicians have waited a long time for this change. When adjusted for inflation, Medicare physician payment has effectively declined 26% from 2001 to 2023. These increasingly thin or negative operating margins disproportionately affect small, independent, and rural physician practices, as well as those treating low-income or other historically minoritized or marginalized patient communities. Our workforce is at risk just when the health of the nation depends on preserving access to care.

The AMA, WisMed and more than 130 other health organizations – representing 900,000 physicians and tens of millions of Medicare patients – wrote congressional leaders, telling them that a full inflation-based update is “the principal legislative solution to the ongoing problems plaguing the Medicare Physician Fee Schedule.”

The letter notes that Congress has passed stopgap measures in the past few years to mitigate threats to Medicare physician payments. Yet, practice costs have outpaced those efforts. The gap between frozen physician payment rates and rising medical practice costs due to inflation will continue to widen. A permanent solution is needed to avoid this annual panic and legislative chaos.

The letter points out the real-life impact of the eroding value of Medicare payments. According to MedPAC, among those looking for a new primary care physician, half of Medicare patients had difficulty in finding one. And among Medicare patients looking for a new specialist, one-third struggled to find one. Finding specialists in rural and historically underserved areas is particularly difficult, and the payment system is creating even bigger barriers for patients in those communities.

The full letter can be found here.

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