Déjà vu in the Capitol: independent nursing bill introduced – Physician advocacy needed

When Governor Tony Evers vetoed legislation in April 2022 that would have allowed broad independent nursing practices in the state, his veto message included his disappointment that the bill “[did] not address some of the issues raised by parties in the medical profession that went unremedied during the legislative process.” Those issues included ensuring nurses would first be required to gain significant “real world” experience working in a physician-led health care team, creating special safety guardrails for nurses who wished to open pain medicine practices, and establishing “truth in advertising” provisions in state statute that would ensure terms referring to physicians and physician specialties can only be issued by physicians.

After the November 2022 general election, which returned Gov. Evers to the Capitol’s East Wing for a second four-year term, the Wisconsin Medical Society (WisMed) and the Wisconsin Nurses Association have had productive conversations regarding those and other issues related to any Advanced Practice Registered Nurses (APRN). When Gov. Evers introduced his 2023-25 biennial budget proposal, he included elements regarding potential independent APRN practices that fit quite well with what WisMed and WNA had been discussing. WisMed has been keeping legislators in the loop on those discussions and had asked legislators to hold off on any APRN bill introduction until the talks resulted in an agreement.

Unfortunately, Sen. Pat Testin (R-Stevens Point) on Wednesday announced that he is introducing an APRN independence bill that is a déjà vu moment for physician advocates, as the bill fails to include the important patient safety safeguards and compromise positions that the physician community has been requesting, or that Gov. Evers put in his budget.

The Basics

To recap, Gov. Evers put these elements in his budget proposal:

• Require four years of “real world” nursing experience (and at least two of those years in an APRN role) before an APRN is allowed to practice independently.
• Require truly independent CRNA doing pain management to work in collaboration with a physician who has pain medicine expertise/training/education.
• Include “Truth in Advertising” protections for various physician-specialty terms, reserving those terms only for physicians.
• Require a hospital offering emergency services to have an emergency physician on site.
• Include truly independent APRNs – other than certified nurse midwives – in the Injured Patients and Families Compensation Fund (IPFCF).

To compare, Sen. Testin’s bill:

• Requires only two years of APRN experience before being allowed full independent practice.
• Reverts back to allowing CRNAs to practice in collaboration with a physician, with no specifics on that physician’s pain medicine training/experience/etc.  
• Does not include any Truth in Advertising language (there is an attempt by a different GOP senator to introduce that language as a separate bill, but there is no guarantee that bill would ever make it to the Governor’s desk).
• Does not have a hospital ED provision.
• Does include the IPFCF language.

In WisMed’s talks with WNA on the Governor’s five provisions, we were in broad agreement on the first three elements and were continuing to discuss other aspects of an APRN bill. We have been keeping key legislators informed about the progress of our talks with WNA and asked them to hold off introducing an APRN bill until it could better reflect the tenor of those discussions. Sen. Testin unfortunately chose otherwise.

What you can do

The proposal is now circulating for other legislative cosponsors. Physicians across the state can help in this effort by contacting their members of the State Assembly and State Senate, asking them not to sign on to Senator Testin’s APRN proposal (which currently in the process is called “LRB 0589”). Instead, they could wait until further discussions between the physician and nursing groups lead to a better proposal.

You can find the contact information for your legislators on the State Legislature website: enter your home address into the “Who Are My Legislators?” box on that page.

Contact WisMed Chief Policy and Advocacy Officer Mark Grapentine, JD with any questions.  

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WisMed, other major health care groups support school vaccination recommendations

The Wisconsin Medical Society (WisMed) joined with other leading physician and public health organizations March 7 in supporting a proposal to update Wisconsin’s student and child care center immunization regulations. The proposal from the Wisconsin Department of Health Services (DHS) – an administrative rule update – would bring Wisconsin into agreement with federal recommendations from the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP). Specifically, the rule proposal includes:

• Adding the meningococcal vaccine to the list of required vaccine for students entering 7th grade and a booster dose for students entering 12th grade.
• Moving the current Tdap requirement from 6th to 7th grade.
• Requiring a health care practitioner to verify a history of varicella when a parent requests a vaccination exception (current rule allows for only parental notification).
• Updating the definition of “substantial outbreaks” for some vaccine-preventable diseases.

The rule update did not propose altering the current medical, religious or “personal conviction” exceptions parents or students can request. These exceptions are among the broadest in the nation. You can read more about the overall proposal on this DHS-created webpage.  

The state Legislature’s Joint Committee for Review of Administrative Rules (JCRAR) can object to rules proposed by executive branch agencies. If there is a possible objection, JCRAR holds a public hearing – which it did for the DHS rule update proposal on March 7, allowing WisMed and other groups to provide this testimony. The hearing was a hotbed of anti-vax activity, with many from a group called “Wisconsin United for Freedom” filling the State Capitol’s largest hearing room. The hearing itself lasted deep into the evening hours, with those supporting the rule update put at the end of the queue to testify.

JCRAR quickly scheduled a vote on whether to object to the rule. An odd quirk in legislative procedures allows certain votes to be held by paper ballot rather than in a public forum. Ballots on the DHS proposal were due by late this morning and resulted in a 6-4 party-line vote to suspend the rule. That suspension will last until the end of the current legislative biennium.

Contact WisMed Chief Advocacy and Policy Officer Mark Grapentine, JD with any questions.

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Health equity in practice, maternal and infant health, physician leadership – Health & Harmony CME

Health & Harmony, the Wisconsin Medical Society’s medical education, Foundation fundraiser and annual business meeting, will be held April 14 and 15 at the Monona Terrace in Madison. The education conference will focus on justice, equity, diversity and inclusion in health care and the Foundation event will celebrate outstanding health professionals. There will be food, drinks, a wine pull, raffle and dueling pianos. 

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.

Farah Kaiksow, MD, MPP, FHM

Farah Kaiksow, MD, MPP, FHM, will present The Real World: How Does Health Equity Show Up in Practice? Dr. Kaiksow is a faculty member in the Division of Hospital Medicine within the Department of Medicine at the UW School of Medicine and Public Health. She teaches "The Intersection of Incarceration and Health," an elective course for medical students that includes topics such as conducting research with the correctional system, infection control, addiction and mental health, and caring for chronic conditions after release.

Jesse Ehrenfeld, MD, MPH

Jesse Ehrenfeld, MD, MPH, American Medical Association President-elect, senior associate dean, tenured professor of anesthesiology and director of the “Advancing a Healthier Wisconsin Endowment” at the Medical College of Wisconsin, will present Physician Leadership in Advancing Equity in Health Innovation.

Karen Watson, MD, FACOG; Kalifa Wright

The panel about Maternal and Infant Health Inequity will be moderated by Roanne Osborne, MD, MBA, FAAFP, FASAM, CHCQM, CPE, President, Dane County Medical Society, Medical Management Vice President, Quartz. Panelists will include the Foundation’s 2023 Superhero of Medicine honoree, Karen Watson, MD, FACOG, OB-GYN at Ascension, Jeff Huebner, MD, FAAFP, Lead Medical Officer, Division of Medicaid Services – WI Department of Health Services and Kalifa Wright, M1 at UW Madison School of Medicine and Public Health.

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.

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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Win Packers tickets at Health & Harmony – our annual event!

We hope that you can join us 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, host a raffle with amazing prizes.

Items such as Packers tickets, a kayak, a massage and more will be raffled off at the evening Foundation event of Health and Harmony. Medical students will be competing to see who can sell the most tickets. Proceeds from this event support health initiatives across the state and our well-trained and dedicated physician workforce in Wisconsin. To purchase individual tickets, click here.

In addition to the raffle, the evening will include an awards ceremony, dinner, a wine pull, dueling pianos and great company. We hope to see you there – you must be present to win a raffle prize! If you are unable to attend or already have your tickets, please help us spread the word by sharing this article or this Facebook post.

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.

Additionally, we are excited to announce 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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Get to know the WisMed Assure Team – Chris Noffke

WisMed Assure provides employee benefits to clinics and health care groups throughout Wisconsin. Chris Noffke, CSFS, GBDS, VP of Employee Benefits, works with Tara Julien, Account Director, to ensure their clients have the best employee benefits for their employees and owners.

What products/services does your WisMed Assure team provide?

Services:

• Employee handbooks
• Employee benefit books
• Open enrollment materials
• Claims assistance
• Contribution review
• HRA/H.S.A. assessments
• Quoting
• Strategies
• And much more!

Insurances:

• Dental
• Health
• Vision
• Life
• Disability
• And more

Why is it important for physicians/groups to have this coverage or these services in place?

In today’s market, employees are weighing benefits as heavily as incomes. If your organization does not have an insurance plan needed by a potential employee, you may lose high quality employees and medical professionals. It’s also always a good way to let your employees know you appreciate them via a Total Compensation review.

If you want to expand on your insurance options available to employees and partners, you can add voluntary benefits at no cost to the business or you can choose to pay for a portion of the insurance premiums (e.g.: 10, 25, or even 50%). You can also make flat dollar contributions and your employees can then determine which benefits are most important to them and apply these “cafeteria benefit dollars” towards the cost. These additional benefits could include life, disability, dental, vision and wellness options. Our team can help you determine the best possible selection of voluntary benefits to offer your staff.

Who should reach out to your team for coverage (what stage of life, what age, etc.)?

Practice owners or managers, HR persons, anyone who is helping make the decision regarding which benefits and which agency to work with should reach out to us to compare plans, explore additional benefits or get a quote.

I have 17 years of experience in insurance – all focused on Employee Benefits. I’m dedicated to helping people find insurance solutions because I’ve seen the importance of having good coverage through my sister’s Leukemia cancer journey and via my brother-in-law’s sickle cell anemia and death. I also love working with physicians because my sister’s and her husband’s physicians all came to their wedding, some of whom had been treating them since they were five.

What’s different about WisMed Assure? 

My role here has always been to help create and maintain the best employee benefits insurance solutions and services for the health care companies of Wisconsin. Since I began, we have added multiple services and solutions that many of our clients have embraced and benefited from premium savings with increased benefits.

We are the only agency exclusively serving health care companies and physician practices. Additionally, profits earned by WisMed Assure support the mission of the Wisconsin Medical Society.

What is your favorite client story?

I had a client who had issues getting services for their son. I was able to use our relationships to not only get a referral, but also medications approved within 24 hours.

Another client experienced a massive rate increase. Their existing insurance agent showed them lots of insurance quotes but no strategies. We were able to save this group of 12 nearly $100,000 and still offer rich benefits!

To explore employee benefits options, please contact Chris Noffke at chris.noffke@wismedassure.org or 608.442.3734.

WisMed Assure, the Wisconsin Medical Society’s insurance agency, offers members discounts and exclusive access to insurance products including medical malpractice insurance, business owners’ insurance, WPS Medicare Supplement program, dental, health, disability and life insurance. 

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Board Chair Jerry Halverson, MD, opens Wisconsin Health News legislative roundtable

    

Wisconsin Medical Society (WisMed) Board of Directors Chair Jerry Halverson, MD, welcomed attendees to a Wisconsin Health News state legislative roundtable program at Madison’s Monona Terrace on March 7. WisMed was the lead sponsor of the event, which featured Senate Health Committee Chair Rachel Cabral-Guevara (R-Appleton), Joint Committee on Finance member Sen. LaTonya Johnson (D-Milwaukee), Assembly Health Committee member Rep. Dora Drake (D-Milwaukee) and Assembly Health Committee Chair Rep. Clint Moses (R-Menomonie).  

WisMed is one of the original supporters of Wisconsin Health News, an online subscription service covering state health care policy happenings in Wisconsin government. Dr. Halverson’s introduction emphasized how important it is for policymakers in the Capitol to hear from their physician constituents about the real-world effect government actions – or inaction – can have on physicians’ ability to effectively and efficiently take care of their patients.

Contact WisMed Chief Policy & Advocacy Officer Mark Grapentine, JD for more information.

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Last chance: vote for WisMed Offices via WisMed Mobile

President-elect Nominee - Cynthia Hart, MD, FAAFP

Today is the last day Wisconsin Medical Society (WisMed) Members can vote for WisMed President-elect and Treasurer via the WisMed Mobile app.* According to WisMed’s Constitution, Article V, the President-elect and Treasurer will be elected by the general membership.

The Nominating Committee of the Wisconsin Medical Society prepared a slate of nominees for WisMed offices during its January 20 meeting. The nominees, including those for American Medical Association (AMA) Delegates are as follows:

• President-elect: Cynthia M. Hart, MD, FAAFP
• AMA Delegate 2024 and 2025: George Lange, MD, FACP
• AMA Delegate 2024 and 2025: Don S. Lee, MD, MPH, FACP, SFHM
• AMA Delegate 2024 and 2025: Kieran McAvoy, MD
• AMA Alternate Delegate 2024: Corey M. Cronrath, DO, MPH, MBA
• AMA Alternate Delegate 2024: Tony Thrasher, DO, MBA, DFAPA
• AMA Alternate Delegate 2024 and 2025: Thomas I. Joles, MD
• AMA Alternate Delegate 2024 and 2025: Roger Kapoor, MD, MBA

Treasurer Nominee - John Cook, CPA

The Wisconsin Medical Society Board of Directors, as directed by WisMed’s Bylaws, selected its nominee for Treasurer on January 21, 2023:

• Treasurer: Mr. John Cook, CPA

The ballot for President-elect and Treasurer will be available until the close of business March 10. All Wisconsin Medical Society members are eligible to vote via WisMed Mobile.* The candidate materials are available for review on the ballot as well.

The Board of Directors will consider nominees for the AMA Delegates, Board of Directors and Nominating Committee members at its meeting in April.

*If you haven’t downloaded WisMed Mobile app, you can do so here. For assistance, please contact membership@wismed.org or 800.762.8975.

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