Earlier this month, a group of state lawmakers led by Sen. Patrick Testin (R-Stevens Point) and Rep. Gae Magnafici  (R-Dresser), announced plans to reintroduce the Advanced Practice Registered Nurse (APRN) bill. The proposal, which is opposed by the WAO, the Wisconsin Medical Society, and other physician specialty groups, is similar to legislation vetoed by Gov. Tony Evers last session that would have authorized broad independent nursing practices in Wisconsin.

More specifically, the legislation would authorize APRNs to prescribe medication and generally practice an expanded scope of care without direct physician supervision. The bill in its current form largely ignores months of negotiations between stakeholders to find a workable agreement and does not include any of the "compromise" language Gov. Evers proposed in his 2023-25 Biennial Budget bill. The legislation lacks common sense patient safety protections, including:

• Physician title protection that would prevent the use of specific words and terms in titles, advertising, and descriptions of services by medical professionals who are not physicians;

• An appropriate level of education and clinical experience required of APRNs prior to independent practice; and

• Requiring proper physician oversight of nurses who are providing pain management services.

In addition to the APRN bill,  Sen. Rachel Cabral-Guevara, who supports the ARPR proposal, has unveiled a separate physician title protection bill. The legislation would restrict individuals, except licensed physicians, from using certain words, terms, letters, or abbreviations that represent a person as a physician – and specifically applies those restrictions to a person's title, advertising, or description of services.

While the title protection bill – better known as truth in advertising legislation – is important and supported by the physician community, it is concerning that it was not included in the APRP bill as part of a greater compromise. The fear is that the Legislature could pass the APRN bill first and ultimately fail to approve the title protection bill.   

To best protect our members from potential political gamesmanship that could hang the physician community out to dry, the WAO is working closely with the Wisconsin Medical Society and other physician groups to oppose the APRN bill its current form and continue to work with lawmakers and other stakeholders on a workable compromise that includes robust physician title protection and other critical patient safety provisions.

From the Desk of WAO President David Nash, MD

For patients who need eye care, they quickly find out there are several different types of specials who work together to provide eye care, most notably ophthalmologists and optometrists. As you know, the difference between ophthalmology and optometry is a common source of patient confusion. That same confusion is also common among policymakers. A key reason for their confusion stems from the fact that optometrists are often referred to as eye doctors although they do not have medical degrees.

While we know ophthalmologists and optometrists frequently work together to effectively manage the long-term eye health and vision of patients, it is important for the public to recognize the difference in education and training between these eye care specialists. Education of both patients and policymakers is more important than ever as optometrists in Wisconsin and across the country continue efforts to expand their scope of practice to include laser eye surgery.

When it comes to tissues in the eye, we are talking about micrometers from one important tissue to the next. Ophthalmologists understand the room for error is small, and surgery on the eye is a specialized field of ophthalmology that requires years of advanced medical training and specialized equipment to perform. We also need policymakers in Madison to understand the concept of allowing an unqualified provider to shoot a laser in the eye is extremely troubling.

While optometrists are well-educated and critical to the collaborative eye care team, they are not trained to perform delicate surgical procedures, including laser surgeries. Optometrists can work alongside ophthalmologists to provide comprehensive eye care, including pre- and post-operative care for patients undergoing laser surgery, but they should not perform the procedure themselves.

As we watch other states across the country expand their optometric scope of practice laws to specifically include certain office-based laser procedures for glaucoma and post-cataract care, I am thankful the WAO has a robust government affairs program committed to securing policies at the state level that preserve patient safety and encourage the delivery of high-quality medical care.

The optometrist “scope creep” challenge we currently face is not likely to go away anytime soon, but the WAO is highly focused on the issue, and we will keep members update on any new developments.

Ophthalmologists are board certified medical doctors and surgeons who provide the highest quality of medical and surgical eye care for military veterans, and who are committed to maintaining the highest possible safety standards.

The Wisconsin Chapter of the Foundation for Fighting Blindness is holding the annual VisionWalk on May 21.  The event is located at Veteran’s Park at the Lagoon.  Registration opens at 9am and the walk begins at 10:30am.  Since its inception in the Spring of 2006, Vision Walk has raised over $63 million to fund sight-saving research.  Join the Wisconsin VisionWalk community; together we step closer to fighting blinding diseases.  Visit the event page for more information.

WAO is looking for experts in their fields to submit presentations to educate and inspire our attendees. Presentations will be accepted until Saturday, April 8. We estimate that all applicants will be notified of the status of their applications before the end of April.

Proposal selection is based on the following criteria:

• Originality of material
• Topic alignment with membership interest
• Timeliness of information
• Ease of implementing ideas presented
• Level of sophistication
• Specific learning objectives
• Practical application of materials
• Speaker qualifications

Learning Objectives:

Each abstract will need to include two to three concise and complete learning objectives that describe what the learner will be able to do at the conclusion of the session.

Please send questions to WAO@badgerbay.co.

SUBMIT HERE

With Wisconsin ophthalmologists facing a potential scope battle during the 2023-24 legislative session – as optometrists appear committed to expand their scope of services to include laser surgery – the WAO Government Affairs Team is keeping a close eye on Ophthalmology vs Optometry scope battles playing out in other states.

There are numerous states that have already expanded their optometric scope of practice laws to specifically include certain office-based laser procedures for glaucoma and post-cataract care. In addition, there are efforts currently underway in other states to pass similar optometric “scope creep” laws. Please find below a brief snapshot of what is happening with this growing threat to medical eye care across the country:

• South Dakota – The South Dakota Senate recently passed legislation (SB 87) – on a 26-9 vote – that would expand the  optometry practice scope in the state. More specifically, the legislation would authorize optometrists to perform laser surgery, including capsulotomy, peripheral iridotomy, selective laser trabeculoplasty, and corneal crosslinking. It would also allow ODs to administer injections around the eye, remove lid lesions, use a local anesthetic for lesion removal, and prescribe pharmaceutical agents. The bill is now under further consideration in the South Dakota House.
• Washington – In the state of Washington, a key senate committee recently passed legislation (SB 5389) that would authorize ODs to remove lumps and bumps from the eyelids, prescribe oral steroids, administer injections around the eye, and perform laser surgeries such as YAG capsulotomy and selective laser trabeculoplasty.
• Nebraska – A bill (LB 216) has been introduced and heard by a key committee in the Nebraska Legislature that would allow optometrists to perform selective laser trabeculoplasty (SLT) for the treatment of glaucoma.

In the closely watched Feb. 21 primary for the Wisconsin Supreme Court – which centered on the issue of abortion after the U.S. Supreme Court overturned Roe v. Wade in 2022 – liberal-leaning Milwaukee County Judge Janet Protasiewicz and conservative former Supreme Court Justice Daniel Kelly captured the most votes in the four-way race and will face-off in the April 4 general election. Protasiewicz took 46% of total votes cast, with Kelly coming in a distant second, capturing 24% of the votes. The winner of the general election will decide the ideological direction of the 7-seat high court, which is currently controlled 4-3 by conservative-leaning justices.

The other high-profile primary race saw Republican state Rep. Dan Knodl (R-Germantown) defeat fellow state Rep. Janel Brandtjen in the GOP primary for the 8th WI Senate District. Knodl will face Democrat Jodi Habush Sinykin in the April 4 spring election for the chance to replace former Republican Sen. Alberta Darling, who left office in Dec. 2022 after holding the senate seat for three decades. If Knodl ultimately wins the seat, Republicans will hold a veto-proof majority in the senate.

Earlier this month, Gov. Tony Evers announced his appointment of Kirsten Johnson as the next secretary of the Wisconsin Department of Health Services (DHS). Johnson, who begins her new role on Feb. 27, will replace former Secretary Karen Timberlake’s who left the state agency at the end of 2022. 

According to a press release issued by the governor’s office, Johnson has over 20 years of experience as a public health leader in local, state, national, and international organizations. Most recently, she served as the health commissioner for the city of Milwaukee following her appointment in January 2021. Prior to serving the city of Milwaukee, Johnson led the Washington-Ozaukee Public Health Department for more than a decade as the director and health officer. Johnson also served as a health policy fellow and advisor for U.S. Congressman Ron Kind and helped develop policy for the House Committee on Ways and Means. 

“Over the past 20 years of my career in public health, I have worked to address the challenges and health disparities facing Wisconsin’s rural, urban, and suburban communities alike—disparities that were laid bare by the pandemic,” said Johnson. “I am excited and honored to join Gov. Evers’ administration to lead DHS, where I look forward to using my expertise and knowledge to continue this important work.” 

Johnson has her master’s degree in public health from Tulane University of Public Health and Tropical Medicine and holds certifications as a public health professional and certified education specialist.

Gov. Tony Evers Unveils 2023-25 State Budget Proposal
The spending bill includes healthcare workforce Initiatives; Medicaid expansion

Earlier this month, Governor Tony Evers introduced his 2023-25 Biennial Budget proposal – the state’s two-year spending plan – before a Joint Session of the Wisconsin Legislature. The Legislature’s Joint Finance Committee met shortly afterwards to formally introduce the bill.

As was the case with the governor’s previous budget proposals, the Republican-controlled Legislature is expected to essentially scrap most of the Evers budget and craft their own version by working off current spending levels. However, it is likely the Legislature will adopt some of the governor’s initiatives.

According to Evers, his budget includes proposals that would increase access to affordable healthcare coverage, improve the quality of healthcare services in the state, and expand the scope of benefits available through Medicaid. Please find below a brief overview of items included in governor’s budget proposal that may be of interest to WAO members and the greater healthcare community:

• Expand Medicaid eligibility for parents and adults from 100% of the federal poverty line ($27,750 annually in 2022 for a family of four) to 138% of the federal poverty line ($38,300 annually in 2022 for a family of four). According to the Evers Administration, this expansion would result in 89,700 low-income individuals becoming eligible for Medicaid, of which approximately 30,300 are uninsured. Under this proposal, the state would realize a savings of over $1.6 billion and draw down an additional $2.2 billion in federal funding over the two-year budget cycle. Republicans who control the Legislature are firmly opposed to this proposal.

• Provide $200 million in additional funding for Wisconsin Innovation Grants, a current program previously funded with federal dollars to design and implement plans to address workforce challenges. This proposal includes a $100 million allocation to specifically focus on fortifying the state’s healthcare workforce by providing grants to healthcare employers and related organizations.

• Provide $10 million to expand the state’s nurse educators program.

• Provide over $900,000 to the Department of Workforce Development to support healthcare profession apprenticeship curriculum development and to advance new collaborations related to healthcare workforce.

• Provide nearly $4 million and increased staffing to the Department of Safety and Professional Services to streamline the state’s credentialling process for licensed professionals and provide more efficient processing of license applications.

The Legislature will take roughly a month to review the bill before the formal budget process begins. In late March or early April, the Joint Finance Committee (JFC) will hold informational hearings on the bill with testimony from state agencies. This will be followed by a series of public hearings on the budget around the state. Beginning in May, JFC will begin meeting two or three times per week to take up and vote on individual budget provisions, with the goal of completing their work in early June. The legislation will then be considered and voted on by the full Legislature, with lawmakers aiming to pass it and send it to Gov. Evers before the end of the current fiscal year on June 30.

Below you will find links to Gov. Evers’ Budget Address, a “Budget in Brief” Summary Document, the full Executive Budget Document, and a copy of the actual legislation:

• Governor Evers’ Budget Address
• Budget in Brief Summary
• Executive Budget Document
• Statutory Language of AB 43/SB 70

The WAO Government Affairs Team continues to fully analyze the recently introduced budget bill and will keep the membership updated throughout the budget process.

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 Madison working on issues of importance to WAO members that impact the practice 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 aim to engage WAO members to capitalize on their medical expertise and experience– including creating opportunities for our physician members to meet with their local lawmakers.

In fact, now is the time for you to build relationships with your state lawmakers ahead of scope battles that are likely to unfold during the 2023-24 session of the Wisconsin Legislature. Optometrists could very well pursue legislation to expand their permissible scope of services in Wisconsin, as they have in several other states. In fact, there are now ten states – with Virginia and Colorado being the latest—that have expanded their optometric scope of practice laws to specifically include certain office-based laser procedures for glaucoma and post-cataract care. There are also current efforts underway in Nebraska and Washington state to pass similar optometric “scope creep” laws. Wisconsin could be the next target…

In addition, nursing special interests will almost certainly reintroduce their “APRN bill” – a proposal to create a new advanced practice nurse practitioner (APRN) license and authorize APRNs to prescribe medication and generally practice an expanded scope of care without direct physician supervision. A similar proposal introduced last session ignored the need for critical title protection for physicians. 

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.

With potential scope of practice legislative battles on the horizon, it’s more important than ever for WAO members to connect with their state lawmakers to discuss the critical role of ophthalmology, as well as the level of education, training, and knowledge required of ophthalmologists.

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 meeting and will provide full support, including legislator bios, advocacy tips, issue briefings, and supporting documents.