Earlier this month, Gov. Tony Evers signed the $99 billion state budget bill sent to him by the GOP-controlled Legislature, but not before using his powerful veto pen to make 51 vetoes to the two-year spending plan for the state.

One of the Governor’s vetoes eliminated $3.3 billion in income tax cuts approved by lawmakers. Primarily because of this veto, the state of Wisconsin is projected to have a balance of more than $4 billion at the end of the 2024-25 fiscal year. Prior to Evers vetoes, the projected balance was $588 million.

Republican lawmakers are expected to send another tax cut to the Governor via a stand-alone bill prior to the end of the 2023-24 legislative session.

Republican Paul Melotik (R-Grafton) defeated Democrat Bob Tatterson (D-Mequon) in a special election held on July 18 to fill the vacant 24th Assembly District –which includes portions of Ozaukee, Washington, and Waukesha Counties.

Melotik won the historically Republican-leaning district with 53.7% of the vote, compared to Tatterson’s 46.3% vote total. The Melotik victory gives the GOP a 64-35 majority in the 99-member Assembly.

Melotik, an accountant, small business owner, and former local official who has served on the Ozaukee County Board and Town of Grafton Board, will replace Dan Knodl (R-Germantown) in the Assembly. Knodl was elected to the state Senate (8th Senate District) in an April 4 special election.

On July 13, the Centers for Medicare & Medicaid Services (CMS) released the 2024 proposed payment rule for Ambulatory Surgery Centers (ASC) and hospital outpatient departments (HOPD), which aims to update Medicare payment rates and policies under the Outpatient Prospective Payment System (OPPS) and ASC Payment System.

In the proposed Rule, CMS recommends updating the OPPS conversion factor by 2.8 percent, which includes a market basket increase of 3.0 percent and a productivity adjustment of negative 0.2 percent. CMS also proposes applying the 2.8 percent update to ASC payments in 2024. However, it is important to note that CMS does not consider sequestration in its proposed rule. This statutory 2.0 percent reduction remains in effect unless Congress acts.

CMS also issued the proposed 2024 update to the Medicare Physician Fee Schedule. Under the proposed rule, clinicians would see a 3.36% decrease to the physician conversion factor. The proposed conversion factor for 2024 is $32.75, which is a reduction compared to the 2023 conversion factor of $33.89.

WAO Action Alert - Contact NGS Today and Tell them Not to Restrict Access to Sight-Saving Glaucoma Surgeries

Action Requested by August 5

Recently, National Government Services (NGS) published a proposed local coverage determination policy on micro-invasive glaucoma surgery (MIGS) that considers some procedures, including adult goniotomy and canaloplasty, to be “investigational.” Medicare typically does not pay for investigational or experimental treatments.

The Wisconsin Academy of Ophthalmology is concerned that NGS’ proposed policy states that the MIGS procedures below are considered investigational in patients over age 18 for glaucoma management:

• Goniotomy or ab interno trabecular bypass surgery
• Viscocanaloplasty
• Canaloplasty in combination with trabeculotomy ab interno
• Gonioscopy-assisted transluminal trabeculotomy
• Ab Interno Canaloplasty
• Cyclophotocoagulation

WAO is submitting comments to NGS, and also invites members to submit personal comments directly to NGS. Comments should  be sent to NGSDraftLCDComments@anthem.com by August 5, 2023. Be sure to include “Public Comment for Proposed LCD - Micro-Invasive Glaucoma Surgery (MIGS) (DL37244)” in the subject line.  Please note, that due to online security requirements, NGS is unable to accept encrypted emails, compressed attachments, and links. Comment letters are accepted as MS Word and/or Adobe PDF attachments.           

 Key points that you may choose to include are:

• There is extensive published data and clinical experience over more than 10 years using MIGS, including goniotomy and canaloplasty to treat glaucoma.
• Patients with glaucoma, which disproportionately affects Black and Hispanic patients, need access to a range of surgical procedures.
• Trabecular meshwork stents have an important role in treating patients with glaucoma and coverage for standalone trabecular stents under CPT code 0671T is appreciated.
• There are some patients for whom treatment with medications is inadequate and their glaucoma is not at a stage requiring more invasive procedures such as trabeculectomy and tube shunts. For these patients, MIGS help preserve quality of life and reduce total costs to the healthcare system.
• Cyclophotocoagulation can be vision-saving in patients with no other options and decades of literature evidence support its efficacy, thus it should not be considered investigational.
• To ensure that Medicare beneficiaries with glaucoma have meaningful access to these transformative procedures, the draft LCD should be revised to include coverage for:

WAO Letter

Consistent and focused advocacy is critical to the long-term viability of ophthalmology and the delivery of quality medical eye care in Wisconsin. And the WAO is an active force in the State Capitol working on health care issues that impact the practice of ophthalmology. Our comprehensive advocacy program aims to:

1. Strengthen the image of the practice of ophthalmology and educate policymakers on the importance of medical eye care; and
2. Provide public policy leadership to enhance the practice of ophthalmology and ensure high standards for medical eye care are maintained in Wisconsin.

Of course, our most effective advocacy efforts actively engage WAO members in their strategy and execution – aiming to capitalize on the expertise of our physician members. Member participation in WAO’s advocacy programs is increasingly important, as we are facing two highly concerning policy challenges in the 2023-24 legislative session: 1.) The APRN bill currently is under consideration by lawmakers that would authorize broad independent nursing practices in Wisconsin; and 2.) Efforts by optometrists to expand their permissible scope of services to include laser surgeries.

Thankfully, WAO is well-positioned to act on these issues. In addition to our direct lobbying efforts through our professional lobbying firm (HZW), we have several grassroots advocacy programs in place to influence public policy at the state level. If are not already involved, WAO encourages you to participate in the following two key programs to strengthen our influence in the Wisconsin Legislature and ultimately help us meet our legislative/regulatory goals:

•  Participate in the WAO Capitol Connection Program

In WAO’s ongoing effort to raise the profile of ophthalmology and our organization in the State Capitol, we have established our Capitol Connection program to encourage WAO members to invite their local legislators to visit their clinics and facilities.

The program is designed to help WAO members build and strengthen working relationships with legislators and offers a unique face-to-face opportunity to educate them about the importance of ophthalmology and medical eye care. Through the Capitol Connection program, lawmakers can learn firsthand what is important to the ophthalmology community. In many cases, just a single meeting or contact can have a significant impact on a legislator's view or position on a legislative issue.

To date, we have held multiple successful legislative tours and have several more being planned for the near future. Hosting a legislator at your site is easy, enjoyable, and can make a significant advocacy impact, so we would encourage all WAO members to participate in this highly effective advocacy program.

If you would like to host a legislative tour at your site, please contact the WAO office at wao@badgerbay.co. We will work with you and your legislators to coordinate the meetings and will provide participating members with full support, including legislator bios, advocacy tips, issue briefings, and supporting documents. 

• Contribute to the WAO Political Action Committee

One of the most effective advocacy tools the WAO has as its disposal is the Ophthalmologists for Better Government Political Action Committee (PAC). The PAC allows WAO to collect contributions from members into a single account to support candidates for state legislative office who understand and support issues important to ophthalmologists, the practice of ophthalmology, and Wisconsin’s House of Medicine.

As mentioned above, the WAO PAC is funded through contributions from ophthalmologists across the state and is only effective as a political tool if members participate in the program. With that in mind, please take a few moments and contribute online TODAY to the Ophthalmologists for Better Government PAC. Every dollar helps, as the risk of non-involvement in the political process is getting too high to ignore.

Health Care in the News

Assembly Speaker Robin Vos: Medicaid expansion will never happen, but medical marijuana might

Wisconsin Public Radio - By Anya van Wagtendonk

Medicaid expansion will never happen under the leadership of Wisconsin Assembly Speaker Robin Vos, but a Republican proposal on medical marijuana could be unveiled later this summer, the lawmaker pledged on Tuesday.

Vos, R-Rochester, made the remarks at a luncheon hosted by Wisconsin Health News at the Madison Club. He spoke about his health care priorities, including his overarching philosophy that American health care is accessible and high-quality — and therefore costs more.

"That is the challenge that I think we have, because it can't simply be a role of state government to subsidize the system. But I think it can make sure that we have access for those who are the most poor in partnership with the federal government," he said.

Earlier this month, the Wisconsin Legislature passed legislation (Assembly Bill 245), which was subsequently signed by Gov. Tony Evers, to eliminate the state’s personal property tax. Elimination of the personal property tax was a top legislative priority for the business community –  including those in the health care sector – as the antiquated tax was an unnecessary financial and administrative burden for businesses across Wisconsin.

The personal property tax was initially implemented in the 1830’s, before Wisconsin was a state, to fund the territorial government. At the time, Wisconsin did not have an income or sales tax. Lawmakers have been chipping away at the personal property tax for decades, and the passage of AB 245 – a sweeping bipartisan bill that also provides an increase in state funding to local governments – finally completes the job in abolishing the tax.

Senator Dan Knodl (R-Germantown), who spearheaded efforts to eliminate the tax, said, “With this legislation signed into law, the personal property tax has been finally eliminated. I have been working towards this moment throughout my time in the legislature and it is such a relief knowing this tax will no longer burden our small business owners.”

Previously, when a business purchased an item (i.e., personal property), not only did they have to pay sales tax on it, but they also had to pay personal property taxes on the item for as long as they owned it. Under the new law, Wisconsin businesses will receive long-overdue tax relief.

As was reported in the May edition of the WAO Advocacy Newsletter, on May 24, the Wisconsin Senate Health Committee held a public hearing on two critical bills being lobbied on by the Wisconsin Academy of Ophthalmology (WAO): Senate Bill 145, the Advanced Practice Registered Nurse (APRN) bill, and Senate Bill 143, the physician Truth-In-Advertising bill.

The APRN bill, which the WAO and other physician groups oppose in its current form, would implement extensive independent nursing powers for APRNs, including the authority to prescribe medications and the ability to practice independently without physician collaboration. The Truth-In-Advertising bill, which the WAO supports, would provide practical patent safety measures by restricting non-physicians from using certain words, terms, letters, or abbreviations that would characterize them as a physician.

Since the May public hearing, no official action – in either the Senate or Assembly – has been taken on the bills. However, negotiations continue behind the scenes between the physician community and nursing interest groups. The Wisconsin “House of Medicine” continues to believe there is a path to a compromise on the APRN bill with nursing stakeholders, but remains steadfast that any agreement must include the following provisions:

• Require four years of real-world, team-based care experience before an APRN can advance to practice independently. Current law does not allow for independent practice.
• Include “Truth in Advertising” title protection language in the bill to help ensure patients better understand who is providing the care they need.
• Ensure that a physician specializing in pain medicine collaborates with independent APRN clinics (those not directly connected to a hospital or health care system) so that complex pain medicine for patients can be provided more safely.

The WAO will continue to provide members with updates on the status of both bills as the legislative process unfolds.

The Wisconsin Legislature’s budget-writing committee – the Joint Finance Committee (JFC) – recently concluded its work on the 2023-25 state budget bill, essentially rewriting Gov. Tony Evers’ $104 billion two-year spending plan for the state. The committee has sent the budget to the full Legislature, which will take-up and ultimately pass (with no significant changes) the bill this week.

The budget bill includes numerous health care-related provisions that may be of interest to WAO members. Please find below the budget items approved by JFC related to the Wisconsin Department of Health Services:

• Funds Medicaid cost to continue.
• Increases hospital reimbursement rates.
• Increases primary care provider reimbursement rates for certain codes to 70 percent of Medicare rates.
• Increases the maximum allocation for Disproportionate Share Hospital payments to $71.6 million.
• Requires DHS to establish new reporting requirements for long-term care Managed Care Organizations.
• Prohibits Medicaid payments for puberty-blocking drugs or gender reassignment surgery.

Once approved by lawmakers, the budget will be sent to Evers for veto review and approval. The next edition of the WAO Advocacy Newsletter will provide a full recap of the budget bill.

Thank you to Roxana Godiwalla, MD and Steven Seto, MD for attending the AAO Mid-Year Forum and representing Wisconsin as Resident Ambassadors. We asked them both to provide a brief summary of their experience attending the event, see below:

Dr. Godiwalla: Excellent! Felt so humbled to have the opportunity to speak with government officials, and so proud of our Ophthalmologists across the country! Looking forward to being part of advocacy again!

Dr. Seto: Overall an excellent and important experience that brought light onto the legislative side of medicine and ophthalmology. I think this experience was not only worth attending but was important enough that I would suggest all residents be required to attend it at least once in their training. I would personally be interested in attending future MYFs from my experience this year, both as a resident and in my future practice.

Review a full overview of the Mid-Year Forum from AAO here.