August 2, Wisconsin Health News

The University of Wisconsin and UW Health are offering a new hotline allowing primary care doctors and other providers in the state to consult with addiction experts to treat patients.

The Department of Health Services awarded a $500,000 grant for the hotline, which can be renewed for an additional year. The service, which UW believes is the first of its kind in the nation, will provide counsel about a range of addictions during weekdays.

Seventy percent of Wisconsin’s rural counties lack a provider who is certified to provide medication-assisted treatment for opioid use disorders, according to Dr. Randall Brown, who oversees the program team for the services.

“The goal of this project is to offer real-time support and expertise from specialists in addiction medicine, addiction psychiatry, psychology and AODA counseling,” he said in a statement last week. “I am confident that we can reduce the enormous suffering substance abuse produces in this state.”

July 17, Wisconsin Health News

A nonprofit policy and research organization released more recommendations last week for improving Wisconsin's substance use disorder treatment services.

Pew Charitable Trusts has spent the last year studying the state’s treatment system. The Governor’s Task Force on Opioid Abuse adopted a series of recommendations from the organization in January, with lawmakers enacting some through executive order and others through new laws.

Andrew Whitacre, senior associate for the Substance Use Prevention and Treatment Initiative at the Pew Charitable Trusts, presented more recommendations at a task force meeting in Madison Friday. He said lawmakers could accomplish them by April.

Whitacre said the recommendations aim to ensure the state is getting its “biggest bang for the buck” and building a treatment infrastructure that can address future drug epidemics. Pew tried to strike a balance between innovation and evidence-based approaches.

“There’s a lot of opportunity for states to be innovative and push the envelope,” he said. “The bottom line is an effective treatment system gets people into treatment sooner, so that people can get back to work and lead productive lives.”

Pew’s recommendations were:

• Expand opioid treatment programs. Whitacre said that Wisconsin does not have enough providers offering methadone, a medication used to treat opioid use disorder. Pew suggested allowing sites that deliver medical services to operate as methadone treatment programs. That could improve access to physical and mental health services for people with opioid use disorder.
  
• Develop a legal definition for recovery housing that would bar discrimination against those using medication-assisted treatment. Whitacre said that Pew’s interviews and focus groups in the state have confirmed that substance use disorder patients on medication-assisted treatment have been barred from some recovery housing in Wisconsin. 
  
• Ensure patients receiving medication-assisted treatment are placed in the right setting through a standardized patient placement tool. Patients seeking treatment aren’t often referred to the right care setting, leading to administrative waste and burdens on those who want help and providers, according to Whitacre. The tool could reduce costs and standardize care.
  
• Fund an expansion of buprenorphine training for providers during training programs for doctors, nurse practitioners and physician assistants, as many patients have difficulty accessing medication for opioid dependence.
  
• Use the Behavioral Health Review Committee established under recent state law to ensure that Wisconsin’s substance abuse counselor certification and licensure process align with best practices and that the number of counselors meets the state’s needs. Whitacre suggested the committee could find ways to evaluate and meet the need for counselors across the state. That could include a look at training requirements, scope of practicing, continuing education requirements and regulatory barriers.
  
• Direct the Department of Health Services to develop a plan with the Department of Corrections to pilot the availability of medication-assisted treatment in at least one prison or one jail. Part of the plan should include a review of prisons and jails to document the current availability of treatment. Whitacre suggested Rhode Island as a model, which has a correctional medication-assisted treatment program that led to a 61 percent decrease in overdose deaths among recently incarcerated people and a 12 percent decrease in overdose deaths statewide.
  
• Direct DHS to promote best practices of care for pregnant women with substance use disorder by requiring programs receiving Medicaid reimbursement and other public funding to follow guidelines that call for screening of patients and medication-assisted treatment. About 12.5 percent of treatment facilities in the state offer programs tailored to pregnant women, compared to 20.7 percent nationally.
  
• Direct DHS to incentivize healthcare providers to either offer or partner on postpartum care programs for women with substance use disorder.
  
• Direct the Medical Examining Board to establish guidelines on neonatal abstinence syndrome, a group of problems that newborns face if they're exposed to drugs in the womb. The rate of babies diagnosed with neonatal abstinence syndrome in Wisconsin more than doubled between 2009 and 2014, and treatment isn’t uniform across the state, according to Pew.
  

Whitacre said Pew is planning to wind down its work in Wisconsin, but it will help support recommendations if the state moves forward.

They’re also planning to release a final report soon, with other recommendations that could take longer than nine months. They'll include proposals targeting medication-assisted treatment in emergency rooms

The Wisconsin Department of Health Services is sponsoring an online training program on how to help behavioral health patients quit smoking. The program offers 6 hours of complimentary CE credits, and is being held in partnership with the University of Wisconsin Center for Tobacco Research and Intervention, and the Wisconsin Nicotine Treatment Integration Project. Learn more.

The annual Wisconsin Health News CEO Roundtable is August 14 in Madison. A panel of the state’s leading health system and hospital leaders will discuss the most pressing issues facing their industry. Panelists include: 

• Dr. Sue Turney, CEO, Marshfield Clinic Health System 
  
• Robert Van Meeteren, CEO, Reedsburg Area Medical Center 
  
• Dr. Alan Kaplan, CEO, UW Health 
  

Register now (link).

July 12, Wisconsin Health News

Workers’ compensation premiums for businesses are set to decline by 6.03 percent this October, according to a statement from the Department of Workforce Development.  

That could result in an estimated $134 million in annual savings for businesses, the Tuesday statement noted. It’s the third year that workers’ compensation rates have declined, following an 8.46 percent decrease last year and a 3.19 percent decline in 2016. 

“A safe workplace results in a more productive and profitable one for employers,” Ted Nickel, insurance commissioner, said in a statement. "Employers are recognizing the relation between their employees' safety and the savings that ensue as premiums continue to decline." 

Mark Grapentine, senior vice president of government relations for the Wisconsin Medical Society, said the report shows that “good news keeps coming” for the state’s workers’ compensation program. 

“We’re already a national model, with faster return to work, fantastic patient satisfaction and ready access to the highest-quality healthcare in the nation – all at a cost per claim that is below the national average,” he wrote in an email. “Another significant insurance rate reduction is just more evidence that Wisconsin’s system is win-win for both businesses and their employees.” 

Grapentine added that there’s room for improvement, pointing to a need for the state’s on-the-job injury rate drop below the national average. He added that healthcare providers are “always striving to find better ways to improve care.” 

Chris Reader, director of health and human resources policy, also lauded the announcement. He said the reduction follows a national trend as employers and workers have invested in and focused on safety. But he noted that costs for medical treatment for workplace injuries are on the rise. 

“Had Wisconsin enacted a medical fee schedule like almost every other state, medical costs also would have been kept in check and the insurance reduction today would have been even greater," he wrote in an email. 

Reader also argued that the rate reduction doesn’t mean much to fully-insured employers who don’t pay insurance costs and are left footing “incredibly high medical bills.” 

Proposals to establish a fee schedule haven't gained traction with lawmakers.

The Wisconsin Supreme Court issued its ruling today in the Ascaris Mayo v. Wisconsin Injured Patients and Families Compensation Fund case to uphold the $750,000 cap on noneconomic damages, thus restoring medical malpractice caps in Wisconsin.

In January, a coalition of medical specialty organizations jointly filed an amicus brief with the Supreme Court in support of the cap. The collaborative efforts of Wisconsin’s medical community resulted in a major victory for physicians and helped preserve access to healthcare across Wisconsin.

The case centers around Ascaris Mayo, who lost her limbs after a Milwaukee emergency room failed to identify an untreated infection. A court awarded her economic damages as well as $15 million intended to compensate for pain and suffering.

The state’s Injured Patients and Families Compensation Fund, which covers large medical malpractice claims in the state, moved to reduce the $15 million to $750,000. An appeals court backed the award and ruled the law unconstitutional.

Chief Justice Patience Roggensack wrote the majority opinion upholding the law, in part because she said the Legislature acted rationally when creating the law.

“We conclude that the Legislature's comprehensive plan that guarantees payment while controlling liability for medical malpractice through the use of insurance, contributions to the fund and a cap on noneconomic damages has a rational basis,” she wrote. “Therefore, it is not facially unconstitutional.”

Dear WISAM Members,

Our next teleconference is this Thursday June 28 at 7:00 pm. This will be our one and only teleconference of the summer so join us! Along with the always-lively dialogue among colleagues, some issues we will be discussing include updates on ongoing projects such as the conference and webinars (see below) as well as the State expansion of prescribing of buprenorphine by NPs and PAs and the requirement for MD supervisors for these prescribers. If you have a topic idea to submit for this or future teleconference calls, please send your ideas to WISAM@badgerbay.co. 

Our Annual Conference is September 27-29, 2018 at the UW Pyle Center. CME wil be provided as well as credit for the MEB Opioid Prescribing educational requirement. Register here for the main conference (Thursday/Friday). On Saturday, September 29, we will be offering clinical training workshops for those who are prescribing (or considering prescribing) ORT. Primary Care providers will find these workshops very useful. For information and to register for the Saturday workshops, click this link.

Our 2018 Webinar Series is underway! The first of the four part series began on June 20th and was led by Drs. Bhatnagar and John Ewing. There are nearly 50 providers currentlyi registered to take part in some or all of the sessions. The next session will be presented live on Wednesday, July 18 at Meriter Hospital in Madison. It's not too late to register to access the recordings for any of the sessions, or attend the live presentations of the upcoming sessions. Learn more. 

Happy summer to all! 

Matthew Felgus, MD FASAM
President

In competitive elections for council seats, seven delegates were selected by their peers at the AMA House of Delegates to serve. Included was longtime WISAM member and leader, Michael M. Miller, MD, an addiction psychiatrist with Rogers Behavioral Health, who was elected to serve on the AMA Council on Science and Public Health. 

Doctor Miller is a nationally recognized addiction psychiatrist and addiction medicine physician. He has effectively integrated addiction care into the various psychiatric subspecialty services at Rogers Behavioral Health.

His work with the Division of Mental Health and Substance Abuse Services of the Wisconsin Department of Health Services, and his work on prevention with respect to opioid overdose and accidental deaths, is well known and ongoing in the state of Wisconsin, and nationally.  

Dr. Miller has served as Vice Speaker of the Wisconsin Medical Society House of Delegates and has been a member of the WMS delegation to the AMA HOD since 2000. Prior, he served as a specialty society delegate to the AMA HOD from ASAM.  He has been a member of three AMA HOD Reference Committees, including serving as chair of the Reference Committee on Advocacy Related to Medical Education and Science and Public Health.  A Past President of the Dane County Medical Society, Dr. Miller has chaired or served on numerous committees and task forces of the WMS, the WPA, AAAP, ASAM, ABAM, and the ABAM Foundation. Notably, he chaired the WMS Council on Addictive Diseases and served a dozen years on the Managing Committee of Wisconsin’s Statewide Physician Health Program.  

Dear WISAM Members,

It's been an interesting month. For those of you who were not able to make it to the Annual ASAM conference in San Diego, we hope you'll consider attending the 2019 conference. Mark your calendars now for April 4-7, 2019 in Orlando, Florida.

While in San Diego, several WISAM officers and members were interviewed by Ashley Luthern, a reporter for the Milwaukee Journal Sentinel, who showed a real interest for, and an understanding of, the issues we face in treating the disease of addiction. View article.

Also at the conference, we connected with our counterparts from Illinois (ISAM). Dr Raymond Bertino, ISAM President, plans to distribute our Wisconsin Chapter Annual Conference information to Illinois Chapter members, so we are hoping for a good turnout from colleagues to the south.

The WISAM 2018 Annual Conference, Road to Recovery: The Science of Addiction and Practical Applications, is September 27-29 at the Pyle Center in Madison. Our conference committee has put together an exciting program, and registration is now open! The detailed registration brochure will be available soon.

In other news, I’d like to express my thanks to WISAM member Britni Bolduc, who has volunteered to get our WISAM Facebook page up and running. Stay tuned for details on connecting with us on Facebook.

WISAM is launching its four-part webinar series, Treatment of Substance Use Disorders in Primary Care, funded through a WMS Foundation educational grant. The topics and speakers are confirmed, and sessions are scheduled to begin June 20th. Each session in the series will be presented as a live educational activity at Meriter Hospital in Madison, and will be recorded for members to view on-demand for up to one year following the recorded presentation. 

And finally, after an April break, our monthly teleconference series will resume on Thursday May 24th from 7:00 to 8:00 pm. Dr. David Galbis-Reig, WISAM President-Elect, will lead the discussion. Stay tuned for more information.

Enjoy your spring!

Matt Felgus, MD, FASAM
President

Aleksandra Zgierska, MD

Approximately 65 people from Wisconsin attended the American Society of Addiction Medicine's Annual Conference in San Diego. Many of them were WISAM members but quite a few were not, and we welcome them to consider membership.Approximately 30 people attended the Wisconsin Chapter annual business meeting, which took place during the ASAM conference.

ASAM has developed a toolkit that offers suggestions on how you can make most out of Addiction Treatment Week. Please spread the word through social media, as well as engagement with the community and the media. See below for more information!

WISAM President Matt Felgus, MD and Immediate Past President Aleksandra Zgierska, MD holding the certificate signed by Governor Walker proclaiming the week of Apr 23-29 as Addiction Treatment Week.