WISCA works closely with our national association partner – the Ambulatory Surgery Center Association (ASCA) – on advocacy and other issues important to our members. In fact, the WISCA Government Affairs Team joins a national ASCA state chapter call twice a month for a federal regulatory and legislative briefing and closely follows their published Government Affairs Updates. Here is the latest federal government affairs news from ASCA:

·        IV Shortages: ASCA recently sent a brief letter to US Department of Health and Human Services (HHS) Secretary Xavier Becerra regarding intravenous (IV) solutions shortages arising in the aftermath of Hurricane Helene. Much of this is due to damage done to Baxter’s manufacturing site in North Cove, North Carolina, from the rain and storm surge that resulted in water permeating the facility.

o   This Baxter facility supplies approximately 60 percent of the IV solutions used every day in the US. Baxter’s website is being updated as new information is released. Baxter has stated, “Supporting our employees in the impacted communities, bringing the North Cove facility back online and helping to ensure ongoing supply to patients are our top priorities.”

o   As such, ASCA requests that a national public health emergency be declared to allow for waivers of the Centers for Medicare & Medicaid Services (CMS) rules and regulations that would help alleviate the growing problems associated with sterile IV shortages throughout the US. In addition to declaring a national public health emergency, HHS should continue to work with and encourage the US Food & Drug Administration (FDA) to declare a shortage of sterile IV solutions to allow certain flexibilities not otherwise available to healthcare providers.

o   ASCA has created a webpage with links to the most recent developments in Baxter’s hurricane response and additional resources. Contact Kara Newbury at knewbury@ascassociation.org with any questions.

·        CMS Final Rule: On September 9, ASCA submitted formal comments in response to the Centers for Medicare & Medicaid Services (CMS) 2025 proposed payment rule for ASCs and hospital outpatient departments (HOPD). ASCA expects the final rule to be released around November 1 and will provide more information to its members as soon as it becomes available. Contact Kara Newbury at knewbury@ascassociation.org with any questions.

·        OAS CAHPS: As a reminder, the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey was finalized as a new measure, ASC-15a-e, in Medicare’s ASC Quality Reporting (ASCQR) Program in the CY 2022 OPPS/ASC final rule. Voluntary reporting for the measure began in 2024, with mandatory reporting beginning in 2025.

o   The survey has specific administration modes and requires ASCs to work with an approved OAS CAHPS Survey vendor to fulfill the reporting requirements. There are more than 6,300 Medicare-certified ASCs, but as of this week, only about a third of facilities (2,188) have authorized a vendor to submit data on their behalf.

o   In a recent episode of ASCA’s Advancing Surgical Care Podcast, “OAS CAHPS Keys to Success,” ASCA Immediate Past President Mandy Hawkins, RN, CASC, CAIP, leads a discussion with Press Ganey Emerging Markets President Bob McSweeney and Director of Health Policy Eme Augustine. The three talk about the challenges and opportunities confronting ASCs administering the OAS CAHPS Survey and provide practical advice that can help ASCs succeed with the new survey.

o   To ensure your facility is ready when the survey becomes mandatory, ASCA strongly encourages all ASCs to start the vendor selection process as soon as possible. Those with experience conducting the survey say setup alone can easily take three months or more. Surgery centers that fail to comply with the reporting requirement will be subject to a reduction in their Medicare reimbursement rates in 2027 and beyond. Learn more about the OAS CAHPS Survey. Contact Kara Newbury at knewbury@ascassociation.org with any questions.

With the November election only days away, most people are focused on the race for the White House, but there will be many interesting races to watch that will shape the future political make-up of the Wisconsin Legislature – especially after the implementation of new legislative maps. The implementation of new maps will perhaps have the most immediate impact to the State Assembly where Republicans have maintained large comfortable majorities for the past decade. That cushion will not be the case for the next several cycles and instead we will likely see tightening of the margins and potentially a flip from GOP to Dem.

Currently out of the 99 seats, the GOP holds 64 seats to the Dems 34 (with one vacancy). While elections almost always yield surprises, if Trump v Harris ends up as close as polling says it will, the below twelve seats will be the most impactful toward the new makeup of the Assembly. While Republicans are expected to return with a majority, the tighter margins will likely lead to a new dynamic in the Assembly and potentially a need for more bipartisan compromise on more issues than what has been the norm. 

We are starting with the assumption that safe and likely seats in both houses provide for a 46-41 Republican majority, leaving the below 12 seats to define the final margin.  Republicans can go 4-8 and still maintain the majority, democrats would have to go 9-3 to take it. 

Incumbents Face Challenges in New Districts

·        Assembly District 21

Incumbent Rep. and Joint Finance Committee member Jessie Rodriguez is running for re-election in south Milwaukee, where redistricting has shifted her seat to the left, making the race highly competitive. Her challenger, Democrat David Marstellar, a floriculturist and grassroots advocate, aims to capitalize on the district's new 54% Democratic lean in hopes of securing a win.

·        Assembly District 26

Freshman Republican Rep. Amy Binsfield is playing defense to maintain her new Assembly seat in what is now a 52% Democratic-lean Sheboygan area seat. Challenging Binsfield is Democratic Joe Sheehan, a former school superintendent and economic development executive.

·        Assembly District 30

Representative Shannon Zimmerman is seeking to maintain his Western Wisconsin district, which includes Hudson and River Falls. The new district moved 5 points to the left, and it now is just at 51% lean Republican in a fast-changing part of the state. Zimmerman, a seasoned Finance Committee member and businessman, is being challenged by Democratic Alison Page, a nurse and health care administrator.

·        Assembly District 51

Seasoned Republican Rep. Todd Novak has demonstrated in past races he can prevail in his southwestern Wisconsin left-leaning seat. However, his previously purple district shifted 5 points to the left now tracking at 55% Democratic. Facing off against Novak is Elizabeth Grabe, a farmer and realtor from Mount Horeb.

·        Assembly District 61

Freshman Republican Rep. Bob Donovan, who is former Milwaukee County Council member, moved into this district after seeing his current district turn solid blue. Donovan, who hails from Greenfield, is now running in the AD 61^st which includes Hales Corners and Greendale. Challenging Donovan in this 50/50 seat is LuAnn Bird, a caregiver, school board member and former Executive Director of the League of Women Voters of Wisconsin.

·        Assembly District 85

After redistricting, Republican Rep. Pat Snyder also faced a decision – stay or move into what is largely his former district that surrounds Wausau. Synder decided to take his chances in the new 85^th, which has shifted 2 points to the left, to a 51% lean GOP district. Snyder, who has outperformed in previous elections, is facing off against Democratic Yee Leng Xiong, a local official and non-profit executive. 

·        Assembly District 91

If there is a parallel Dem redistricting version to Rep. Moses and the 92^nd, current Democratic Rep. Jodi Emerson would be it. Emerson’s Eau Claire area seat now consists of 60% of new territory, which shifted her solid blue seat to a 54% lean Dem seat. Current Rep. Karen Hurd was drawn into this district but decided to take a pass and instead move to a solid red open seat in the 69^th. Challenging Emerson now is Michele Skinner, a member of the Eau Claire County Board of Supervisors and Altoona Lake District.

·        Assembly District 92

This is border-line lean 53% GOP district just makes it into the competitive category. Current Republican Rep. and practicing chiropractor, Clint Moses is hoping to hold onto his seat in a district where roughly sixty percent of the constituency is new to him. On the Democratic side, Joe Plouff, a former Assembly representative himself, is hoping his previous political experience gives him some leverage in the new 92^nd.

·        Assembly District 94

In all the changes with redistricting, some things never change- as is the case in AD 94. Rep. Steve Doyle is once again facing challenger Ryan Huebsch. Doyle has won his largely unchanged district six times since 2012, including winning in 2022 over Huebsch by 756 votes. This one will once again be a toss-up come November.

Open Seats (No Current Legislator Running)

·        Assembly District 53

Spanning from Neenah up to Menasha, the 53^rd is deemed highly competitive by most metrics. The district leans very slightly to the left – at about 53% lean Dem, but the GOP is running a candidate, Dean Kaufert with significant name ID which could help them in pick this up in November. Kaufert represented the area as an Assembly Rep from 1991 to 2015, followed by a stint as Neenah mayor from 2014 to 2022. Challenging Kaufert is Duane Shukoski, also a Neenah resident and longtime Kimberly Clark employee.

·        Assembly District 88

The new AD 88th is a 50/50 seat, with redistricting shifting the former red district around De Pere, Allouez, and Bellevue 5 points to the left. The district is now open, with two new candidates vying for the position. Republican small business owner Ben Franklin of De Pere emerged victorious in the primary against challenger Phil Collins. On the Democratic side, former business systems officer and Brown County Democratic Party chair Christy Welch, also of De Pere, did not face a primary challenge, potentially giving her a bit more runway than Franklin. However, in this 50/50 seat, it’s anyone’s guess what November will bring.

·        Assembly District 89

Like the 88th, AD 89th is also a 50/50 open seat that includes Ashwaubenon and eastern Green Bay. Democrat and Assistant District Attorney Ryan Spaude is running against Brown County Board Chairman and Republican Patrick Buckley. Both candidates are from Green Bay and have a background in local government, making this new seat an interesting one to follow.

The November general election, which will determine who controls the Wisconsin Legislature, is less than two weeks away. Before you know it, we will be rolling in to the new year – and the 2025-26 legislative session. And to align with state lawmakers reconvening in 2025, WISCA is in the process of developing and finalizing our legislative priorities and our advocacy roadmap for the next two years.

As you know, WISCA invites all members to attend a monthly state legislative update meeting led by our Advocacy Team, which reviews and discusses state legislative issues of importance to surgery centers, the latest political news, federal regulatory matters, and grassroots advocacy efforts and opportunities. However, it is extremely important for members to participate in next month’s meeting – which will be held on Thursday, November 7 at 12:00 PM. This one-hour meeting will focus on building WISCA’s 2025-26 Advocacy Plan and provide members with an opportunity to provide their input on what legislative and regulatory issues the Association should tackle over the next two years. Register online for the Update.

If you cannot attend next month’s meeting, please share your thoughts online on what state legislative issues you believe WISCA should prioritize during the 2025-26 Wisconsin Legislative Session.

The WISCA Leadership Summit held earlier this month in Wausau, WI, featured a tour of the Wausau Surgery Center. The tour provided Summit participants with a peek behind the curtain of WSC’s new, state-of-the-art facility, which opened in September 2022. WISCA invited and was thrilled to be joined by two state lawmakers from the Wausau area – Sen. Cory Tomczyk (R-Mosinee) and Rep. Pat Snyder (R-Schofield).

The tour allowed WISCA to show both legislators firsthand the benefits of the Ambulatory Surgery Center (ASC) model of care, how ASCs have transformed the outpatient experience, and how surgery centers offer patients a more convenient and safer alternative to hospital-based outpatient procedures at a lower cost. The tour also afforded WISCA members the opportunity to ask the lawmakers questions and to express their concerns over the regulatory challenges ASCs face and potential solutions to those challenges. 

August is National ASC Month, a time to raise awareness and celebrate the invaluable contributions of Ambulatory Surgery Centers (ASCs).

In 2022, 30 Medicare-certified ASCs in Wisconsin saved Medicare more than $52 million. If you need outpatient surgery or one of the many lifesaving health screenings that surgery centers provide, talk to your doctor about getting the care you need in an ASC.

https://bit.ly/3Y6Jv88

Bloomberg Law | BY Justin Wise | June 14, 2024

A Texas federal judge said she will decide a challenge to the Federal Trade Commission’s near-total ban on worker noncompetes without a hearing.

A hearing on the “requested injunctive relief is not necessary,” said Ada E. Brown of the US District Court for the Northern District of Texas in a brief order submitted late Thursday.

Brown has said she will make a decision by July 3 on a motion for a preliminary injunction seeking to block the regulation, which is set to go into effect in September. A ruling will carry significant weight, as noncompete provisions are utilized across the economy, including in industries such as tech and finance.

A Texas tax firm, Ryan LLC, filed a lawsuit mere hours after the rule was finalized in April seeking an injunction preventing it from becoming law. Ryan LLC, the Chamber of Commerce and other business groups claim the FTC stepped beyond its authority with the rule and that the regulation does not account for certain non-competes that have been rendered lawful in the past.

The FTC in April passed the new regulation in a 3-2 commission vote. The rule, if it goes into effect, will prohibit virtually all noncompete provisions that keep employees from making job moves in a certain industry for a period of time.

The FTC has said the rule falls within its mandate to regulate unfair methods of competition. Some states, including California, a hub for jobs in the tech industry, already have restrictions on the use of noncompete provisions.

Ryan LLC is represented by Gibson Dunn & Crutcher and The Fillmore Law Firm.

The case is Ryan LLC v. Federal Trade Commission, N.D. Tex., No. 24-cv-00986, 6/13/24.

WISCA NOTE: The Ambulatory Surgery Center Association submitted formal comments opposing the proposed rule, but did not take a position on the appropriateness of noncompete agreements specifically. In the comments, ASCA noted, “Under this proposal, surgery centers and other tax-paying healthcare providers would be subject to restrictions that tax-exempt systems would not. Hospitals are more likely to employ physicians currently, and this rule would allow nonprofit providers to more aggressively engage in noncompetitive behavior that would impede a physician’s ability to eventually move to an ASC or other healthcare provider.”

The 2023-24 legislative has come to an end, and legislators have shifted their focus to the upcoming election season and the need to connect with voters. With that in mind, it is more important than ever for WISCA members to strengthen their relationships with their state lawmakers (and new legislative candidates) to educate them on the ASC model of care, the regulatory challenges we face, and the legislative solutions we need to increase access to affordable, quality care provided in the ASC setting. Remember, decisions state legislators make in the Capitol can have a significant impact on the ASC industry, your organization, and your profession.

One of the best ways you as a WISCA member can engage your local legislators is to invite them to tour your ASCs to illustrate firsthand the many benefits of surgery center care. These visits provide a tremendous advocacy opportunity, which is why WISCA members across the state have already hosted numerous successful legislative tours. But we need to maintain the enthusiasm for this critical grassroots advocacy program, and WISCA is excited and ready to set-up additional tours today.

If you would like to host a legislative tour at your site, please contact the WISCA office at WISCA@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.   

WISCA needs your help...  Please share your thoughts on what state legislative issues you believe WISCA should prioritize during the 2025-26 Wisconsin Legislative Session. We are in the process of identifying challenges faced by Wisconsin ASCs that have a potential legislative solution, and your input is critical. If you have ideas or thoughts, please email the WISCA office at WISCA@badgerbay.co. The earlier we have these discussions, the more prepared we will be to impact change in the 2025-26 legislative session. Thank you!

It’s official... The election field is set for state legislative races in Wisconsin, and we now know which incumbent legislators will be running for reelection and which ones will face primary challenges. While the Presidential race at the top of the ticket will garner most of the attention and play a large role in voter turnout, down ticket races in the state Senate and state Assembly will be very interesting this cycle. 

Of course, this election cycle is unique, as lawmakers will be running in new legislative districts after the State Supreme Court required new maps to be drawn. And with the new maps comes some political uncertainties. First, while Senate Republicans will return in the majority, the key question is how many seats Democrats can pick up, and whether it will be enough to give them a shot to win the majority in 2026.  State Senators run on staggered four-year terms, meaning half of the seats are up in 2024 and the other half are up in 2026.  Democrats have four pick-up opportunities this cycle and need to hit most of them to have a shot at the majority in 2026. 

While Assembly Republicans can’t guarantee they will return in the majority, the odds are heavily in their favor.  New maps will lead to gains for Assembly Democrats, but they would have to essentially run the table to get to a majority. Their pathway could be greatly impacted by top of the ticket dynamics. 

Maybe the most interesting development to come out of the Assembly is that Speaker Robin Vos, who is the longest tenured Speaker in the country has avoided a primary this fall. Though he is still facing recall attempts, those efforts will not deny him a return to office next January. While a primary opponent did turn in signatures, that opponent has since dropped out of the race, eliminating any real potential challenge. 

Here are some interesting primary races to watch in both houses of the Wisconsin Legislature:

 

·        Senate

o   District 4 – This seat will see a July special election in Milwaukee, pitting two current Democratic representatives against each other. Reps. Dora Drake and LaKeshia Myers face off in what used to be Sen. Lena Taylor’s seat.  Sen. Taylor held the seat for nearly 20 years.  Whoever wins the primary will win the seat, as there is no Republican running in the general election.

o   District 16 – This seat became open when Senator Melissa Agard decided to run for Dane County Executive. There is a crowded primary on the Democratic side featuring three current state representatives.  They were all required to give up their Assembly seat to run.  Reps. Jimmy Anderson, Samba Baldeh, and Melissa Ratcliffe will square off in August for the opportunity to replace Agard.  No Republican has filed to run in the seat, so similar to the 4^th Senate District, this is a winner take all primary. 

o   District 20 – This seat features Republican incumbent Senator Dan Feyen, who is being challenged by former GOP State Representative Tim Ramthun.  Feyen is a member of Senate leadership and is the perceived favorite against Ramthun who unsuccessfully ran for Governor in 2022 (garnering 6% of the primary vote).

 

·        Assembly

o   AD 6 – In this northeastern Wisconsin seat, two GOP incumbents – Reps. Peter Schmidt and Behnke – will square off for the opportunity to remain in the Assembly. Behnke moved into the 6^th Assembly District to challenge Schmidt after he was drawn out of his current district.   

o   AD 24 – This Germantown/Menomoniee Falls area seat may be the most interesting primary of the election season, as it pits Republican legislators Janel Brandtjen and Dan Knodl against each other. Brandtjen has been an outspoken critic of Speaker Vos and Knodl is a sitting Senator who lost his seat due to the new maps. He is moving into AD 24 to run for this safe GOP seat. 

o   AD 55 – In this Oshkosh area seat, veteran GOP lawmaker Mike Schraa will face-off against Republican freshmen legislator Nate Gustafson. Political insiders thought Schraa (63) might retire from the legislature and were somewhat surprised when he decided to run for reelection. However, they were more surprised when Gustafson announced he would challenge Schraa. The winner of this primary is positioned to win the general election.

o   AD 86 – This seat has a similar set-up to AD 55, as the new district has two sitting GOP legislators drawn into it.  Reps. John Spiros and Donna Rozar are two accomplished veteran legislators who will face each other in the race for this Marshfield area seat. 

The 2023-24 legislative has come to an end, and legislators have shifted their focus to the upcoming election season and the need to connect with voters. With that in mind, it is more important than ever for WISCA members to strengthen their relationships with their state lawmakers (and new legislative candidates) to educate them on the ASC model of care, the regulatory challenges we face, and the legislative solutions we need to increase access to affordable, quality care provided in the ASC setting. Remember, decisions state legislators make in the Capitol can have a significant impact on the ASC industry, your organization, and your profession.

One of the best ways you as a WISCA member can engage your local legislators is to invite them to tour your ASCs to illustrate firsthand the many benefits of surgery center care. These visits provide a tremendous advocacy opportunity, which is why WISCA members across the state have already hosted numerous successful legislative tours. But we need to maintain the enthusiasm for this critical grassroots advocacy program, and WISCA is excited and ready to set-up additional tours today.

If you would like to host a legislative tour at your site, please contact the WISCA office at WISCA@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.