WisMed joins in Fed effort to reform prior auth

Joining with more than 300 other health care groups across the country, the Wisconsin Medical Society (WisMed) is enthusiastically supporting the reintroduction of the federal Improving Seniors’ Timely Access to Care Act, which would streamline the prior authorization (PA) process under Medicare Advantage (MA). While PA is theoretically a useful tool to guard against unnecessarily expensive or duplicative health care, recent nonpartisan federal agency analyses show that some insurance plans grossly overutilize PA delays. Both the Office of the Inspector General and the U.S. Department of Health and Human services have raised concerns over an audit showing that Medicare Advantage plans have approved 75% of requests that were previously denied. Both entities have also released a report showing that MA plans wrongly denied patients’ access to some services despite satisfying Medicare coverage rules.

A section-by-section of the summary of the bill is here. Specially, the bipartisan, bicameral bill would:

• Establish an electronic PA process for MA plans including a standardization for transactions and clinical attachments.
• Increase transparency around MA PA requirements and its use.
• Clarify CMS’ authority to establish timeframes for e-PA requests including expedited determinations, real-time decisions for routinely approved items and services, and other PA requests.
• Expand beneficiary protections to improve enrollee experiences and outcomes.
• Require HHS and other agencies to report to Congress on program integrity efforts and other ways to further improve the e-PA process.

As a physician constituent, you have the power to share real-world stories about how prior authorization has slowed down your practice and hindered patient access to necessary care. Contact your members of Congress and ask them to sign on to the Improving Seniors’ Timely Access to Care Act, authored by U.S. Senators Roger Marshall, MD (R-KS), Kyrsten Sinema (I-AZ), John Thune (R-SD), Sherrod Brown (D-OH), and U.S. Representatives Mike Kelly (R-PA), Suzan DelBene (D-WA), Larry Bucshon, MD (R-IN), and Ami Bera, MD (D-CA). Contact information for U.S. Senators Tammy Baldwin (D-WI) and Ron Johnson (R-WI) is here. You can find out how to contact your member of the House of Representatives here.

Contact WisMed’s Mark Grapentine, JD with any questions.

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June Referendum Town Hall recording, materials now available to members

Wisconsin Medical Society (WisMed) leaders held a Town Hall on June 5, 2024 to share information related to the August 2020 decision by the WisMed House of Delegates (HOD) to eliminate itself as the organization’s ultimate policymaking body. That action also scheduled a member-wide referendum for June 2024 to ask whether WisMed should resurrect its HOD – that referendum is scheduled for June 24 through June 30.

A recording of the Town Hall and other pertinent materials are now available for WisMed members here.* Along with the information related to the 2020 action, the panel also shared facts and data on WisMed staffing and policymaking-expenses over the last decade, how many other state medical societies have similarly evolved their policymaking process away from a once-per-year, in-person HOD, and answered questions that had been previously submitted. The panel also took questions from attendees, allowing for a lively discussion on WisMed’s policymaking experiences, advocacy efforts overall and frank descriptions of what a reversion to the old system might portend.

For more information, contact WisMed Chief Policy & Advocacy Officer Mark Grapentine, JD.

*This page requires your WisMed username and password. Click here to retrieve your username or password, or call 866.442.3800 or email [email protected] for assistance.

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Buprenorphine (suboxone) potential for opioid overdose treatment

The opioid epidemic is currently a leading health crisis in the United States, and evidence supports Medication for Opioid Use Disorder (MOUD) as the most effective treatment. As part of Wisconsin Medical Foundation’s ongoing effort to connect with local agencies, staff attended the Ending Death from Despair Task Force quarterly meeting and obtained information on the pre-hospital availability of buprenorphine (suboxone) to help paramedics combat overdose mortality.

With the increased availability of naloxone (NARCAN), more overdose patients can be treated, but the naloxone frequently sets them up for increased withdrawal symptoms. Prehospital initiation of buprenorphine for Opioid Use Disorder (OUD) by paramedics is an emerging potential intervention. Many patients at high risk for overdose deaths never engage in treatment because they often refuse transport. Recent data have demonstrated a significant increase in both short- and long-term mortality following an opioid overdose.

Treatment with buprenorphine lessens the desire for a high, helping with withdrawal, and has shown to significantly reduce both all-cause and overdose mortality among individuals with opioid use disorder. Offering buprenorphine treatment to individuals who experience a nonfatal opioid overdose represents an opportunity to reduce opioid overdose fatalities. Although some emergency departments (ED) initiate buprenorphine treatment, many individuals who experience an overdose either refuse transport to the ED or are transported to an ED that does not offer buprenorphine. Emergency medical services (EMS) professionals can help address this treatment gap. 

EMS are observing an ever-increasing number of patients who, due to refusing transport after naloxone rescue, represent a treatment void at the point of overdose. A new protocol utilizes frontline EMS paramedics to administer high dose buprenorphine to treat withdrawal symptoms and offer a next day bridge to additional care.

A recent case study looked at patients revived from opioid overdose with naloxone who were then treated with 16 mg of buprenorphine to relieve and prevent withdrawal symptoms. Patients were provided outpatient follow up irrespective of ED transport. This innovative program provides EMS with education and tools to promote patient engagement. While still in its infancy, this approach utilizes existing EMS resources to bring MOUD to the prehospital setting, offering a new avenue to long-term treatment.

Click here to learn about overdose deaths in Dane County. Find opioid prescribing education, including a DEA MATE Act training course and How to Decrease Prescription Drug Abuse from the Wisconsin Medical Society here.

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Resident, fellow and med student meet ups in Madison, Milwaukee

Madison area medical students, residents, and fellows are invited to enjoy a meet-up with free drinks and snacks provided by WisMed Assure and WisMed Financial! Café Hollander, 701 Hilldale Way, Madison on Monday, June 24, from 5:30 – 7:30 p.m. Click here to RSVP.

Join us for complimentary wine, beer or soda along with appetizers in the private indoor/outdoor atrium at Café Hollander located in the Hilldale area near campus.

Hear from Wisconsin Medical Society representatives about the benefits of being involved in organized medicine in Wisconsin. Members of the WisMed Assure and WisMed Financial teams will also be there for anyone interested in learning about how their physician-focused insurance and financial planning can help support you and give voice to the future of medicine.

Monday, June 24
5:30 – 7:30 p.m.
Café Hollander
701 Hilldale Way
Madison, WI 53705
Click here to RSVP!

Milwaukee area residents, fellows, and medical students are invited to join us for the third annual Wisconsin Medical Society Resident & Fellow Section welcome event on Tuesday, June 25, from 6:30 – 8:30 p.m. at Camp Bar in Wauwatosa! Register now to attend!

Discover the benefits of being involved in organized medicine in Wisconsin while enjoying appetizers and drinks provided by the Medical Society of Milwaukee County, WisMed Assure and WisMed Financial. 

Tuesday, June 25
6:30 – 8:30 p.m.
Camp Bar Tosa
6600 W North Avenue
Wauwatosa, WI 53213
Register now to attend!

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Avoid these five common financial mistakes

Navigating the world of personal finance can be daunting, even for the savviest individuals. Mistakes can be costly and may hinder long-term financial goals. To help you stay on the right track, here are five common financial missteps I regularly see and how to avoid them.

The temptation to time the market often leads to poor investment decisions. Market timing is notoriously difficult and can result in missing out on significant gains. Instead of trying to predict market movements, adopt a disciplined investment strategy. Dollar-cost averaging (regular, systematic investments of a fixed dollar amount) can reduce the impact of volatility and build wealth over time.

Maxing out your 401(k) or other retirement plans early in the year might seem like a good idea, but it can cause you to miss out on employer matching contributions. Many employers match contributions on a per-pay-period basis. By contributing too much too soon, you might not get the full match for the remaining pay periods. To optimize your retirement savings, spread your contributions evenly throughout the year to maximize employer matching benefits.

While having a cash reserve is important, holding too much cash when you have auto loans and other consumer debt can be counterproductive. Consider using excess cash to pay down debt, especially high-interest liabilities. This approach can save you significant amounts in interest payments and improve your financial position.

Many investors tend to favor domestic stocks over international ones, a phenomenon known as home bias. This can limit diversification and expose your portfolio to country-specific risks. In fact, foreign stocks comprise 41% of the global stock market yet most US investors are well under this percentage. To mitigate this, diversify your investments geographically. Including international stocks in your portfolio can enhance diversification and potentially improve returns.

Roth IRAs offer significant tax advantages due to their tax-free access in retirement. However, investing too conservatively in Roth IRAs can limit growth potential. Consider a more aggressive allocation to stocks within your Roth IRA to maximize the tax-free growth. If needed, offset the aggressive allocation with additional conservative investments in tax deferred accounts. This approach can maximize the net returns of your retirement accounts.

Avoiding these common financial mistakes can significantly enhance your financial health and help you achieve your long-term goals. Stay informed, make strategic decisions, and seek professional advice when needed. By doing so, you'll be better positioned to navigate the complexities of personal finance and secure a prosperous future.

For personalized help with your financial plan, please contact Mark Ziety, CFP®, AIF® 608.442.3750. 

Note: This article is for informational purposes only and should not be considered as financial or tax advice. Please consult with a qualified financial advisor or tax professional before making any financial decisions.

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Talent recruitment services - WisMed member benefit

Wisconsin Medical Society (WisMed) members benefit from a partnership with Titus Talent Strategies.

This member benefit gives your practice or health care organization discounted rates for talent strategy services from the experts at Titus Talent Strategies. Titus Talent Strategies can help health care facilities of any size looking to hire a physician – from large systems looking for multiple physicians to private practices searching for one physician.

In addition, this partnership also provides individual WisMed physician members seeking a position in Wisconsin free access to confidential job search services through Titus Talent Services.

Click here to see the Titus Talent Strategies benefit details for member physicians and here for details for employers seeking to hire. Click here to learn more about Titus Talent Services or here to get started!

If you have questions about this new partnership or any of the benefits of your Wisconsin Medical Society membership, please contact Jim Lorence.

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