January 9, 2015
Volume 58, Issue 1


New WHA President Eric Borgerding Tackles Hospital Reimbursement

As of January 1, Eric Borgerding is the president and chief executive officer of the Wisconsin Hospital Association (WHA). Borgerding succeeds Steve Brenton, who will now hold the position of WHA senior policy advisor.

Borgerding brings more than 25 years of experience in government relations and advocacy to the top WHA post, including the past 13 years leading WHA’s advocacy efforts. He was named director of legislative affairs for WHA in 1992 and became the chief state lobbyist for the University of Wisconsin-Madison in 1994. In 1997 he was named director of legislative relations at Wisconsin Manufacturers and Commerce where he directed the business group’s lobbying efforts in the areas of energy, transportation and health care. When Brenton was named president of WHA in 2002, he recruited Borgerding back to the organization as vice president of government affairs. Borgerding was named senior vice president in 2003 and executive vice president in June 2007.

In an interview with Milwaukee Journal Sentinel reporter Guy Boulton published January 5, Borgerding said his top priority is hospital reimbursement.

"We have to do something about reimbursement in Medicaid. We have to. It is so low that we have to start making progress," Borgerding told the Journal Sentinel. "I’m going to focus on hospital reimbursement, even though physician reimbursement is equally poor if not worse. On average, hospitals are getting reimbursed 65 cents for every dollar they spend taking care of a Medicaid patient. Every time we spend a dollar, we have to recoup 35 cents from someone else."

Borgerding told the Journal Sentinel he is also concerned about the cost shift that occurs when government does not cover what it costs to care for patients in their programs.

"We have a Medicaid program that is expanding coverage. That’s a positive thing," according to Borgerding. "But on the flip side, the amount we have to shift to employers in this state continues to grow. It is almost like another corporate income tax."

Established in 1920, WHA’s mission is to advocate for the ability of its members to lead in the provision of high quality, affordable, and accessible health care services, resulting in healthier Wisconsin communities. WHA is committed to serving member needs, keeping members informed of important local and national legislative issues, interpreting clinical and quality issues for members, providing up-to-date educational information and encouraging member participation in Association activities.

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Medicaid In The Spotlight

Wisconsin’s Medicaid program, otherwise known as "BadgerCare," is one of the poorest payers in the nation for hospitals and physicians. That’s according to the American Hospital Association’s analysis of reimbursement rates across the country. Right now, Wisconsin’s BadgerCare program pays hospitals roughly 65 percent of the actual costs (not charges) of providing care to a BadgerCare patient. This is 27 percent less than the national average. When government pays only 65 percent of its cost for a service, that means the remaining 35 percent of costs must be shifted onto others like employers across the state. This cost shift is called the "Hidden Health Care Tax."

Stay tuned for WHA’s next "Medicaid In The Spotlight" to learn more about Wisconsin’s hidden health care tax.

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2015 Advocacy Day – WHA’s Premiere Event – Set April 28
WHA expects nearly 1,000 hospital supporters at April 28 event in Madison

WHA’s annual Advocacy Day is the Association’s premiere event of the year. This year the goal is to top the previous record-setting attendance by bringing even more hospital supporters to Madison and increasing the number of legislative visits.

It is not too early to mark your calendar for the WHA 2015 Advocacy Day scheduled April 28 in Madison. It is one of the best ways your hospital employees, trustees and volunteers can make an important, visible impact in the State Capitol.

Advocacy Day 2015 will again feature an impressive lineup of speakers along with the popular legislative panel discussion. Governor Scott Walker has been invited to speak as well.

The highlight of Advocacy Day is the hundreds of attendees who take what they’ve learned during the day and meet with their legislators in the State Capitol in the afternoon. WHA schedules all meetings, provides transportation to the Capitol and prepares attendees for their visits. In addition to an issue briefing at Advocacy Day, WHA offers an optional webinar on legislative visits prior to Advocacy Day.

In previous years, Advocacy Day drew up to 900 hospital advocates to Madison. This year the goal is to reach 1,000 for the first time in the event’s history. Watch for more information on the day’s events in upcoming issues of The Valued Voice.

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Guest Column: Parting Comments
By Edward Harding, WHA 2014 Board Chair

I gained so much by serving on the board of this excellent organization. It was a great experience, both as a board member and as chair in 2014. Collectively, we accomplished a lot in 2014, and I am very proud of our achievements.

During my tenure as chair, I learned a lot about WHA as an organization and as an advocate for our hospitals. One realization was that WHA is a bi-partisan organization and works well with both sides of the aisle, in Madison and Washington, D.C. Policymakers respect WHA and know that we stand together on the issues. We get to know our legislators, we make it a point to help them understand our issues, and we make our voices heard when it counts.

The second observation I would make is to emphasize the importance of the Rural Conference, which is made possible in large part by the hard work of WHA staff and the WHA Rural Health Council. Year after year, this conference surpasses expectations. I’ve spent most of my career in rural health care, and this conference provides not only excellent education, but also offers great networking opportunities. This year, the Rural Health Conference will be June 17-19 in Wisconsin Dells.

And lastly, the WHA Advocacy Day, with more than 800 attendees in 2014, speaks to the clout that WHA has in Madison. Not only is the program itself excellent, but the highlight is seeing hundreds of our members and hospital volunteers walk down to the State Capitol to meet face-to-face with their legislator. That makes a powerful statement to our elected officials.

On a personal note, I’d like to express my appreciation to the board and to WHA staff. You have all provided me support and made my term as chair easy and very rewarding. I encourage all WHA members to rise to the occasion and, when asked, serve. It is a great experience.

I look forward to working with Therese (Pandl) as she starts her term in 2015, and I wish her, and all of you, another successful year.

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Wisconsin Hospital Association CEO Talks Priorities for 2015
By Guy Boulton, Milwaukee Journal Sentinel

This article was published in the Milwaukee Journal Sentinel January 5, 2015.

Eric Borgerding became president and chief executive officer of the Wisconsin Hospital Association January 1, succeeding Steve Brenton, who will become the organization’s senior policy adviser.

Borgerding, whose first job after college was as a staffer for a representative in the Assembly, has spent almost 25 years in government relations and advocacy. He has been with the Hospital Association since 2002, when Brenton recruited him from Wisconsin Manufacturers & Commerce to become vice president of government affairs. Borgerding was promoted to senior vice president in 2003 and executive vice president in June 2007.

Borgerding and his wife, Dana, have been married 26 years and have three children, ages 23, 20 and 16. One of his interests is musky fishing in Wisconsin, and he has written for Muskie, Historic Madison and Hunting & Fishing Collectibles magazines.

Borgerding recently talked with the Milwaukee Journal Sentinel about the Wisconsin Hospital Association, the industry and other topics. Here’s an edited version of that interview:

Q. What will be some of your initial goals as president and chief executive of the Wisconsin Hospital Association?

A. Maintaining and growing WHA’s position as a leading advocate and leading voice for our members—and not just for hospitals, because I think our name increasingly is a misnomer. The fact is the evolution of our membership is beyond the walls of the hospital. It really is regional and local integrated health systems, something that Wisconsin is known for.

Advocacy, lobbying, government relations—being our members’ voice for sound health care policy is their No. 1 expectation. We have built a brand, if you will, in the advocacy area over the last 10 to 12 years. Maintaining that and growing that in an evolving health care delivery system will be our top job going forward.

Q. Is the focus on hospitals outdated?

A. It varies geographically. But there clearly is a trend that has been going on for quite some time away from inpatient, even though there will be always be a role for acute care and inpatient care. But the fact is our members are health systems.

The majority of physicians in the state are employed by health systems. It’s estimated that 75 to 85 percent of physicians are employed by health systems. It really does dictate for us a broader scope of issues that we weigh in on.

Q. What are some of the challenges facing hospitals and health systems?

A. There are several, but first and foremost is pressure on reimbursements. The bottom line is people realize that there are not pots of gold at the end of the health care rainbow, whether from government payers or from commercial payers. Health care dollars are tight. They are getting tighter.

Q. How are health systems responding?

A. One of the very positive things about being in Wisconsin is we are blessed with very forward-looking health systems and leaders of those health systems who understand that health care is changing, reimbursement is changing, and they are taking steps to get their costs in order to be in a position where they can remain healthy in an era when dollars are certainly not growing at the pace they have grown in the past.

Another thing they are doing is focusing on delivering better care. That is something that WHA has played a strong role in over the past several years. And ultimately, if we are indeed moving toward a payment system that’s away from fee-for-service—that’s away from volume and more toward value and outcomes—the forces are aligned to deliver better quality and better outcomes for patients. That’s a real strength in Wisconsin. We have been focusing on this well before the Affordable Care Act and before a lot of these payment changes were taking place.

There are a lot of challenges going forward. But I’m very proud of where our state is and the commitment of hospitals and health systems across the state to quality and outcome improvement. We have just as much engagement from our smallest, 25-bed, critical-access hospitals to our quality improvement programs as we do from our largest hospitals. That’s really a testament to Wisconsin. You don’t see that in other states.

Q. What are some other challenges?

A. Workforce continues to be a challenge. Where the demand is tends to be a reflection of how health care is changing. There is a lot more focus on primary care and prevention. We are making investments in keeping people healthy and out of hospitals.

Q. How has the Affordable Care Act affected hospitals?

A. It’s hard to say. We believe it has had a positive effect in terms of coverage. But it is hard to know what the net gain has been in coverage. We worked very hard and continue to work very, very hard on outreach, connecting people with both Medicaid and subsidized coverage on the marketplaces.

At this point in the game, I’d say it’s been a positive for coverage. It is affecting the marketplace in ways yet to be determined. There is a move to narrower and narrower networks, which was happening anyway. Some would say that’s being accelerated by the ACA and the marketplaces.

It is important that as this moves forward we make sure, particularly in rural areas of the state, that access is protected. The ACA is attempting to do that through rules and regulations around network adequacy.

My sense is today’s consumer is increasingly willing to accept limiting choice if it means a lower premium because they are increasingly responsible for more of the cost of their care.

Q. What are the some of the changes you foresee in the next decade?

A. The future is all about population health and prevention and producing better outcomes. But one of the most important things to sustain that pace is to change the way we pay for health care. I’m concerned that Wisconsin is a leader state when it comes to refocusing on what should be the priority in health care, but the payment system is not keeping pace.

You can’t have delivery reform without payment reform, and they have to keep pace with each another. That is going to be one of the biggest challenges over the next 10 years.

Q. What are some of the Wisconsin Hospital Associations legislative goals?

A. We have to do something about reimbursement in Medicaid. We have to. It is so low that we have to start making progress. I’m just going to focus on hospital reimbursement, even though physician reimbursement is equally poor, if not worse. On average, hospitals are getting reimbursed 65 cents for every dollar they spend taking care of a Medicaid patient. Every time we spend a dollar, we have to recoup 35 cents from someone else.

I am not talking about generating a margin here. I’m talking about minimizing loss so that we can minimize the amount of costs that we have to shift to everyone else. We have a Medicaid program that is expanding coverage. That’s a positive thing. But on the flip side, the amount we have to shift to employers in this state continues to grow. It is almost like another corporate income tax.

Q. What’s the Wisconsin Hospital Association’s position on the states accepting the additional federal dollars available through the Affordable Care Act for Medicaid expansion?

A. WHA has supported and continues to support accepting the federal dollars. We’ve focused on implementing the path Wisconsin chose. The path we took is positive in terms of coverage expansion, more positive than in other states that rejected the federal dollars.

But the manner in which Wisconsin expanded coverage costs this state a lot of money. And because of that, it has the potential to crowd out other important priorities within Medicaid, such as minimizing cost shifting to employers. Rejecting federal dollars is the path Wisconsin chose, but now we have to recognize that path has a price tag to it.

Q. What do you like about your job?

A. One of the reasons that WHA that has been so successful and one of the absolute best parts of this job is working with some leaders in Wisconsin who really are national leaders. They are committed to improvement and they are committed to the notion of value. This is going to sound corny but it’s true. It makes representing Wisconsin’s health systems very rewarding. It’s that sort of the pro-active embrace of change and reform in health care that allows us to be out front as an advocacy organization.

Find at: www.wha.org/Data/Sites/1/pdf/borgerding1-5-15mjs.pdf

Milwaukee Journal Sentinel by JOURNAL/SENTINEL, INC.. Reproduced with permission of JOURNAL/SENTINEL, INC. in the format Post on the Internet via Copyright Clearance Center.

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Walker Inaugurated for Second Term as Wisconsin’s Governor
New lawmakers in Senate and Assembly take oath of office

Governor Scott Walker took the oath of office at a ceremony in the State Capitol Rotunda on Monday, January 5. Walker won re-election in November 2014 and began his second term as Wisconsin’s 45th Governor.

In his inauguration remarks, Walker stated his vision for his second term includes addressing Wisconsin’s workforce skills gap, providing a "quality education" for every child, investing in the state’s transportation infrastructure, providing additional broadband internet access, and reducing the size and scope of government.

Nearly a quarter of the entire state Legislature turned over this past election cycle, with 24 new state representatives and seven new state senators. These new lawmakers, along with all re-elected legislators in the Assembly and Senate took their oath of office on January 5 as well.

Senate Majority Leader Scott Fitzgerald (R-Juneau) called on his Senate colleagues to bring a bipartisan spirit back to his chamber, stating that 97 percent of laws enacted last year received bipartisan support throughout the legislative process. Fitzgerald said the Senate will renew commitments to job creation and workforce development, while striving to "reform our education system, defend public safety, invest in infrastructure, and prove that we are responsible stewards of Wisconsin’s finances."

Speaker Robin Vos (R-Rochester), during his inaugural address, called on the Assembly to "think of ways to reduce the size of government by consolidating agencies and eliminating programs to make government more efficient and effective."

Shortly after his inauguration, Walker announced that his Cabinet officials would remain the same during his second term. Secretary Kitty Rhoades will continue to serve as the head of Wisconsin’s Department of Health Services.

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Be Involved, Join a WHA Council or Committee

WHA is currently soliciting appointment requests from WHA members to participate in WHA councils and subcommittees. Now is your opportunity to participate on the councils that are at the forefront of identifying key policy issues for the membership and making recommendations on positions to the WHA Board.

There are six councils and one committee that are seeking member participation:

Additional information including council responsibilities and current member information is located at http://events.SignUp4.net/2015councilDescriptions. You may direct questions to Sherry Collins at scollins@wha.org or (608) 274-1820.

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Grassroots Spotlight: Hospital Leaders Meet With Sen. Darling, Sen. Gudex
State budget, DSH and Medicaid reimbursement topics for discussion

Over the last several weeks, hospital leaders have been meeting with legislators to discuss the Medicaid disproportionate share hospital (DSH) program and new ways to increase Medicaid reimbursement for crucial primary care services at Wisconsin hospitals.

Ten hospital leaders from Southeastern Wisconsin met with Sen. Alberta Darling (R-River Hills) at Columbia St. Mary’s (Ozaukee Campus) in December. Darling is the co-chair of the Legislature’s powerful budget-writing committee, the Joint Finance Committee, which will focus its attention on the budget over the next few months. Columbia St. Mary’s President/CEO Travis Andersen kicked off the meeting with Darling and discussed the need to reauthorize the state’s Medicaid DSH program in the upcoming state budget bill. Representatives from Columbia St. Mary’s, Aurora Health Care, Froedtert Health, Ministry Health Care, ProHealth Care, Wheaton Franciscan Healthcare and the Wisconsin Hospital Association also attended the meeting. They discussed the impact of DSH and Wisconsin’s low Medicaid reimbursement to their organizations.

Attendees told Darling that, in 2013 alone, the state Medicaid program’s reimbursement caused $960 million in hospital costs to go unreimbursed by the state. These costs must be shifted over to other payers, resulting in a "hidden health care tax" on Wisconsin businesses. The group told Darling that Wisconsin’s $960 million "hidden health care tax" rivals what is paid by Wisconsin businesses and families for motor vehicle fuel taxes and corporate income taxes.

The DSH program was enacted two years ago to mitigate concerns resulting from Medicaid eligibility changes that affected thousands of individuals who were transitioning off of the program. Nearly half of those who were disenrolled from the state Medicaid program did not pick up exchange coverage or now have unknown coverage status. The state Department of Health Services projected that 93 percent of Medicaid enrollees would purchase coverage on the federal health insurance exchange.

In addition, the DSH program is aimed at addressing historically low Medicaid reimbursements in Wisconsin by targeting dollars at hospitals based on their Medicaid volumes. If the Governor and Legislature do not reauthorize the Medicaid DSH program, hospitals will face a $75 million cut in reimbursement during the next budget cycle. The group also discussed ways to improve primary care and behavioral health payments for increased access to vital services.

Also in December, Ministry Mercy Medical Center in Oshkosh hosted Sen. Rick Gudex (R-Fond du Lac) for a tour and meeting. Jeremy Normington-Slay hosted Gudex and provided insight into how Medicaid under-funding impacts his hospital. Normington also discussed the Wisconsin’s high value worker’s compensation program and that a "fee schedule" or rate setting in that program, as proposed by some in 2014, would negatively impact hospitals, physicians and other providers all across the state.

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Green Bay Chamber Asks for Increased Medicaid Reimbursement
Northeastern Wisconsin chamber calls on Legislature to reduce cost-shifting

The Greater Green Bay Chamber recently released their agenda for the 2015-2017 legislative session, highlighting increased Medicaid reimbursement for health care providers. This agenda included several proposals related to health care in Wisconsin and cited the impact of cost shifting from Wisconsin’s Medicaid reimbursement on employers.

Their agenda is calling on the Legislature to "improve reimbursement to providers for BadgerCare recipients in order to reduce or eliminate cost shifting." The Chamber included this action item as a way to "have an affordable health care system that allows businesses to be more competitive in the marketplace and attract a high quality workforce."

Wisconsin’s Medicaid reimbursement leaves $960 million in hospital costs unpaid, relying on private payers to make up the difference. This "cost-shift" has been dubbed the "hidden health care tax" by Wisconsin Manufacturers and Commerce and costs nearly as much as what employers statewide pay for unemployment insurance. This "hidden health care tax" costs nearly as much as the state’s motor fuel tax and corporate income tax.

The Chamber also called on the Legislature to enact policies that are consistent with WHA positions, including the continuation of Wisconsin’s highly successful graduate medical education grant program to attract and retain physicians in this state. To date, this program has added 60 additional residency slots statewide and has created seven brand new residency programs throughout Wisconsin.

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WHA Staff News

WHA President Eric Borgerding is pleased to announce the following WHA staff title changes as of January 1:

     Jenny Boese will be Vice President, Federal Affairs & Advocacy

     Steve Brenton will be Senior Policy Advisor

     Kyle O’Brien will be Senior Vice President, Government Relations

     Brian Potter will add Chief Operating Officer to his current position of Senior Vice President

     Matthew Stanford will be General Counsel

 “One of WHA’s greatest strengths is the caliber of our team,” said Borgerding. “These promotions and changes reflect that ongoing excellence.”

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WHA Searching for Vice President of Workforce and Clinical Practice 

This position is a key part of our advocacy team, leading our proactive workforce efforts and serving as our in-house and public expert on clinical care-related policy development and advocacy. 

The ideal candidate would have experience in a clinical leadership role in a health care facility, have worked with policy, and be a confident writer and public speaker. This candidate would be very self-directed and seek support and advice when needed from a team of experts.

This position works closely with WHA members, policymakers and many community institutions and groups. It offers the opportunity to impact health and health policy in Wisconsin.

If you or someone you know might be a good fit for our highly collaborative, results-oriented, impactful and proactive team, contact Mandy Ayers at 608-274-1820 or mayers@wha.org.

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WHA Education: Medical Gas System Management Focus of Jan. 22 Hospital Engineering Webinar

As part of WHA’s 12-part series focused on the latest technical topics related to hospital engineering, the January 22 webinar will focus on helping facility managers understand the use of and how to develop a medical gas management plan for improved testing, maintenance and inspection processes for medical gas systems in their facilities. This session will also identify The Joint Commission expectations for medical gas management, as well as the location of inspection timelines in codes and standards.

Health care facility managers, plant engineers, operations directors, clinical engineering staff, telecommunications staff, safety managers, health care administrators, nurse leaders, and facility planners should plan to participate.

For a complete list of the 12 sessions, their descriptions and learning objectives, visit http://events.SignUp4.net/2015HospEngineerWebinar. Registration options exist for individual sessions or a discounted fee for the series of 12 webinars, and recordings of past sessions can be provided to those who would still like to participate in the full series.

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WHA Education: Labor & Employment Webinar Series Approved for HR Continuing Education

Each session in WHA’s three-part webinar series focused on important labor and employment issues has been approved through the HR Certification Institute for 1.5 HR general recertification credit hours toward PHR, SPHR and GPHR recertification.

The first webinar session, scheduled January 23 and presented by attorneys from the labor and employment practice of Reinhart Boerner Van Deuren s.c., will focus on wage and hour litigation, current issues in labor law, and tips to ensure compliance with ADA and FMLA regulations. Additional webinars focusing on other labor and employment issues will be offered February 20 and March 20. Webinars can be taken as a full series or individually. Full descriptions of each session, as well as online registration, can be found at: http://events.SignUp4.net/2015LaborEmployWebSeries.

Health care human resources professionals, hospital and health system in-house counsel and others interested in learning more about these important labor and employment issues should plan to participate. Attendees are encouraged to participate in this webinar series as a team, to gather and learn together through one, low-cost registration. While attendees are encouraged to attend all three sessions, the option exists to register for individual sessions as well.

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WHA Education: Early Bird Discount for WHA’s Physician Leadership Conference Ends Jan. 15

Take advantage of the early bird discount by registering today for WHA’s tenth annual Physician Leadership Development Conference, scheduled March 13-14, 2015, at The American Club in Kohler. Registration is now open at http://events.SignUp4.net/15PLD, and the rate increases for both physicians and hosts after January 15, so register today.

As a reminder, the special room rate at The American Club is only available until the room block fills or until February 19 (whichever occurs first), so plan to register and make your hotel reservations today.

A "host" registration option is available for senior-level hospital representatives (non-physicians) who accompany one or more of their physicians to the conference but do not need CME credit. The American Association for Physician Leadership (AAPL) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. AAPL designates this live activity for a maximum of 11 AMA PRA Category 1 Credits.TM Physicians should only claim credit commensurate with the extent of their participation in the activity.

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Member News: Turkal Named Chairman-Elect to AHA Section

The American Hospital Association named Nick Turkal, MD, president and CEO of Aurora Health Care in Milwaukee, as chairman-elect of the AHA constituency section for Health Care Systems Governing Council. Turkal will assume the role of chairman in 2016. Turkal served on the council from 2012-2014. His chair officer term runs from 2015-2017.

The Health Care Systems Governing Council includes leaders who represent some of the country’s premier health systems. Members of the council govern the AHA’s health care systems activities through its Section for Health Care Systems Governing Council. This council actively advises AHA from a systems perspective during decision-making phases on advocacy positions, public policy issues and member service strategies.

As chairman-elect, Turkal will bring to the council the perspective of Aurora’s 30,000 caregivers, including 1,500 employed physicians, who provide care across the continuum in two tertiary-care centers, 12 community hospitals, one mental health inpatient facility, 159 clinics, 70 retail pharmacies, the Aurora Visiting Nurse Association and Aurora Family Service.

Turkal has been very engaged with the Wisconsin Hospital Association. He served on the WHA Board from 2006-2011 and became WHA Chair in 2011. He has served on numerous WHA councils and committees, including the Council on Medical and Professional Affairs, which he chaired from 2004-2006. Turkal also served on and has chaired the WHA Executive Committee, the Advocacy Committee and the Nominating and Awards Committee.

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Member News: Janavitz Named Integrated Health Network CEO

Integrated Health Network of Wisconsin announced Kurt Janavitz will be the organization’s new chief executive officer.

Integrated Health Network, a Brookfield-based network of independent health systems, hospitals and physicians, includes Agnesian HealthCare, Columbia St. Mary’s, Froedtert Health, Hospital Sisters Health System, the Medical College of Wisconsin, Ministry Health Care, Wheaton Franciscan Healthcare and many independent physician partners.

Janavitz succeeds Peter Pruessing, who was Integrated Health Network’s CEO. Pruessing will continue in a transitional role until his retirement later this year.

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