April 18, 2014
Volume 58, Issue 16
WHA Advocacy Day Attracts over 800 Hospital Supporters
Even with winter trying to keep its snowy fingers on northern Wisconsin, some 800 hospital leaders, employees, trustees and volunteers traveled to Madison for the Wisconsin Hospital Association (WHA) 2014 Advocacy Day event April 16. Roughly 450 attendees made their way to the State Capitol later in the afternoon to visit with their legislators.
WHA Board Chair Ed Harding, President/CEO of Bay Area Medical Center in Marinette, kicked off the event by welcoming the dedicated audience.
"This is an impressive view!" Harding said as he took a "selfie" with the massive crowd. "You have a passion for your hospital and for our health care legislative issues," Harding said. "More than half of you will visit with your legislator later today. Thanks for your continued efforts to communicate our important legislative issues to your legislators."
Attendees heard a preview of the 2014 elections and 2016 presidential contenders by morning keynote Larry Sabato, professor of politics and director of the University of Virginia’s Center for Politics and nationally known for website and weekly e-newsletter, "Sabato’s Crystal Ball."
Sabato said that right now, republicans are favored to pick up seats in the congressional elections, but that "toss up" states will change as new issues arise and gaps are created. He also listed the potential nominees for the next presidential race, including two Wisconsin leaders, Governor Scott Walker and U.S. Rep. Paul Ryan.
Sabato also discussed the polarization in national politics and how that same pattern is being repeated in state legislature elections. He said that this level of polarization is seen in many states across the country—red and blue—without consideration of the individual candidate’s leadership abilities. In the last presidential race, the candidates bypassed many states where the "vote had already been decided" far in advance of the actual election.
"We need to find a way to change that…it is destructive when we don’t talk and don’t listen to each other because it tends to reinforce bias," Sabato said.
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Gov. Scott Walker was clearly impressed by the number of hospital supporters gathered at Monona Terrace to attend the WHA Advocacy Day event in Madison April 16.
"As I look around this room and see all these volunteer leaders from your respective communities…making positive things happen in the state of Wisconsin…I want you to know how much I appreciate your good work," Walker said.
In his introduction of the governor, WHA President Steve Brenton noted that Gov. Walker and his staff have been "strong partners" with WHA and its member hospitals to advance policies that lead to higher-quality, higher-value health care.
"Governor Walker has been a strong champion for Wisconsin’s high-value health care as an economic engine for growing private sector jobs in our state," Brenton said.
Recognizing health care as a critical component of Wisconsin’s infrastructure has been a theme that the governor has refined—and repeated—throughout his first term.
"All too often we talk about health care in terms of the ‘jobs’ it creates or we talk about cost. There is quality and cost, and we have to balance those two out, but we also need to talk about the value that health care adds for our Wisconsin employers," Walker said. "The fact that we have some of the highest quality health care in the world right here in Wisconsin is a tremendous asset. We get employers to expand and locate here from all over the world. Health care is an asset, especially in our rural areas where we can compete with anyone in the world for jobs."
The governor never fails to include "health care" when he lists the factors that site locators consider when evaluating a community. All across Wisconsin employers can access high quality health care, an asset and an advantage other states can’t always boast, and should be a key factor in economic development, according to Walker.
Citing a report released by WHA that identified a shortage of physicians, Walker reminded the group that he included funding in the state budget aimed at supporting the medical schools and creating more in-state residency positions.
"Expanding the Medical College of Wisconsin campus to Green Bay is incredibly important," Walker said. "If we put resources into training physicians in those areas and put more money into graduate medical education and residency programs, we can supplement the supply of physicians in the rest of the state, too."
In closing, the governor again touted health care as an important factor in economic development.
"I appreciate the work you do to ensure that health care is an asset in our state, not just a cost, and that it is an important factor in attracting and retaining employers in all areas of the state," he said. "I look forward to continuing to work with WHA in the capitol on behalf of your shared interest, to make sure that not only when it comes to health care, but also to our quality of life, we are all moving Wisconsin forward."
Walker: "Top-Tier" Health Care Communities Attract, Retain, Add Jobs
The Medical College of Wisconsin recently presented Gov. Scott Walker the first-ever "Hands of Humanity" award. In the most recent state budget, Walker invested more than $7 million to partner with MCW on its new medical school campus in Green Bay. That school will welcome its first students July 2015. Walker also provided for new and expanded family medicine residencies to help train and retain physicians in areas of the state in which doctors are critically needed.
"Governor Walker shows great vision in his commitment to help the medical community enhance and transform health care in this state. It is the true spirit of the Hands of Humanity," said John R. Raymond, MD, president and CEO of MCW.
Here is an excerpt from the governor’s acceptance speech:
"If you are going to (attract an employer) you have to have a skilled workforce, you’ve got to have cost effective reliable sources of power. You’ve got to have some sort of transportation links. But one of the other key assets that you have to have is quality health care. Access to quality health care is one of those things that’s a make or break not just for health care but for employers. If you’ve got a top tier community when it comes to health care, you’re going to be able to attract and retain and add even more jobs going forward. So it’s not just about the health care system and the help it provides to us and our families here, it’s about the ability to build a healthy economy based on the strength of your quality of health care."
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A bipartisan group of state lawmakers joined over 800 hospital advocates on April 16 at WHA’s Advocacy Day to debate issues facing Wisconsin hospitals. The panel of state lawmakers included the co-chairs of the state’s powerful budget-writing Joint Finance Committee, Sen. Alberta Darling (R-River Hills) and Rep. John Nygren (R-Marinette). Democratic members of the panel included Joint Finance Committee member Rep. Cory Mason (D-Racine) and Minority Caucus Chairperson Sen. Julie Lassa (D-Stevens Point).
WHA Executive Vice President Eric Borgerding moderated the panel and asked both prepared and audience-submitted questions. It was a wide-ranging, 75-minute conversation that covered a number of timely topics, including Medicaid and exchange coverage, Medicaid reimbursement, behavioral health and recent legislation related to Wisconsin’s Worker’s Compensation system.
Panelists were asked about the challenges they see with the federal insurance exchange, the transition of coverage for individuals moving off of Medicaid onto the exchange and the major impacts of the Affordable Care Act (ACA) on Wisconsin’s health insurance marketplace.
Rep. Nygren, a health insurance agent, said Wisconsin faces a lot of unanswered questions when it comes to coverage, including how many individuals have actually paid their premium. "Getting people covered is something I support," said Nygren. "We covered more citizens than we have seen in the past" and "more people having coverage will be a positive end result, even if we disagree on how we got here."
Rep. Mason said that expanding Medicaid coverage instead of leaning on the exchange would have been a wiser choice for the state. Mason called it a "missed opportunity" for Wisconsin and said that it "will be continued to be discussed in the years ahead."
Darling said Wisconsin needs to see the data first before it judges the success of the Affordable Care Act. "I am approached by people who tell me, around the district, that they are shocked at what happened to them. They say ‘my new insurance is more expensive’ or ‘I can’t figure out how that will be better than what I had before." In gauging the positive or negative impacts of the ACA, Darling said she will look at how Wisconsin fared in 2011 and 2012, prior to the ACA, because Wisconsin already had a health care system that is "one of the best in the nation, with high insured rates and a competitive insurance environment."
While there are different viewpoints on the ACA and Medicaid coverage, one thing is certain—Wisconsin’s hospitals are the backbone of their local communities. "We have hospitals in my district that really are a true source of employment for their communities," said Lassa. "Hospitals in these communities play a key role not only in care but also as employers."
During a discussion of the Disproportionate Share Hospital (DSH) program, the panelists were fairly united in saying that overall Medicaid reimbursement needed to be improved in Wisconsin. Mason talked about the experience of his local hospital in Racine.
"Wheaton All Saints is really the only hospital in town. It is much different than other hospitals. It has a huge Medicaid population," said Mason, responding to a question about reauthorizing Wisconsin’s DSH program for hospitals that serve a high number of Medicaid and uninsured patients. "The last number I heard from them was $19 million a year in uncompensated care. It’s a big number. It matters."
Darling said that Wisconsin needs to get serious about Medicaid reimbursement rates. "The delivery system for Medicaid patients has to be refocused, and the rates have to be increased. This is a huge issue," said Darling.
The panel wrapped up with a question on legislation last session to establish government price-setting in Wisconsin’s Worker’s Compensation program. The panel was asked whether or not they support government-imposed fee schedules in the successful program—a dramatic change from the current program.
Darling responded first by saying that Wisconsin has "one of the best systems in the country." Darling said she opposed the bill because she was opposed to a fee schedule in the statutes and believed the state needs to focus on worker safety and wellness in the workplace. Lassa said a fee schedule "presents a concern because of what we have seen from states that have gone in this direction." Lassa stated that business’s main goal in the Worker’s Compensation program is to "get employees back to work as quickly as possible" and that there are "other hidden costs of having an employee off longer."
Nygren said that he hears mostly from constituents who are frustrated with fraud within the Worker’s Compensation system. "Anytime I talk to a business person, the issues that come up deal with fraud over anything else," said Nygren. "For me, that is what the business community is looking for. Let’s talk about issues that are really bothering industry."
Borgerding closed the panel by telling attendees that the "appetite for bipartisanship" in Wisconsin is much more apparent with hospital and health care policy than most other areas of public policy. He said that the state legislative panel discussion illustrates that point.
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As patients assume greater financial responsibility for their health care needs, they need to have meaningful and transparent price information.
The Wisconsin Hospital Association (WHA) and the Healthcare Financial Management Association – Wisconsin Chapter concurred with the findings published in a national report released April 16 that recommends all health care industry stakeholders—hospitals, insurers, physicians and employers—work together to provide consumers the cost and quality information they need to make informed health care decisions. The report is available at www.hfma.org/Content.aspx?id=22275.
A task force convened by the national Healthcare Financial Management Association recommended several different price transparency platforms to address the needs of different types of health care purchasing groups. The task force recommended the following:
"We have been very proactive in Wisconsin. Our hospitals and health systems have voluntarily provided information about cost and quality of care since 2006, and we are committed to continuously improving this information to make it even more accessible and relevant. Our patients are our partners, and health care is better when patients are informed and consumers are engaged," said WHA Executive Vice President Eric Borgerding. "But more needs to be done. As noted by the HFMA, health plans have a primary role in providing consumers with information about deductibles, co-pays and out-of-pocket expenses associated with their insurance coverage."
The WHA Information Center website, www.WiPricePoint.org, posts prices for every Wisconsin hospital and hospital-based surgery center for inpatient services, outpatient surgical and diagnostic services, emergency and urgent care services, and other non-surgical services provided on an outpatient basis (such as radiological procedures). WHA publishes quality-related information on www.WiCheckPoint.org.
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Hospital advocate meetings in the State Capitol with their legislators are the most important aspect of Advocacy Day.
Following the Governor’s speech, hospital supporters gathered for an issue briefing by WHA Executive Vice President Eric Borgerding. Borgerding reviewed the key issues that the hospital groups would later discuss with their legislators. Legislative meetings were scheduled for close to 450 attendees at Advocacy Day.
Borgerding was quick to credit WHA’s success in the last legislative session to the grassroots efforts of the thousands of hospital supporters across the state.
"YOU are the reason why we were so successful in the last legislative session," Borgerding said. "Your emails, personal visits, town hall meetings, phone calls and engagement on our key issues are outstanding. You are extremely effective in communicating with and educating your legislators on local health care issues."
Borgerding outlined three key issues for the advocates to discuss during the legislative meetings. Those issues included:
"Wisconsin has done a good job of cutting personal income taxes, cutting corporate taxes and property taxes. It’s now time to cut Wisconsin’s hidden health care tax," Borgerding said.
"It was great hearing the Governor talk about how excellent health care is essential to attracting and retaining employers and to a healthy workforce," Borgerding said. "Our high-quality care helps workers get back to work and the activities they enjoy faster. It is a big reason why we enjoy the quality of life we do in this state, and why employers want to locate here."
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Sen. Leah Vukmir (R-Wauwatosa) received the Wisconsin Hospital Association (WHA) Health Care Advocate of the Year Award April 16 at WHA’s Advocacy Day in Madison. WHA presented this year’s award to Vukmir in recognition of her collaborative efforts with hospitals and health care providers on several key issues during the 2013-2014 Legislative session.
"Senator Vukmir has championed several of WHA’s priority issues, including helping us pass legislation to address the Supreme Court’s Jandre decision; enacting long-overdue legislation that modernizes hospital regulation in our state; and securing crucial changes that will lead to better care for those with mental illness," said WHA Executive Vice President Eric Borgerding in presenting the award. "Most notably, these bills all had broad bipartisan support."
Borgerding also recognized Vukmir’s support for tort reform legislation and sound approaches to health care price transparency. He also noted her long-term involvement in health care workforce issues and consistent opposition to "innovation stifling overregulation in health care."
A registered nurse and certified pediatric nurse practitioner, the senator received a bachelor of science degree in nursing from Marquette University and a master’s degree in nursing from the University of Wisconsin-Madison where she specialized in child development and primary care treatment of children. She is a nationally-certified pediatric nurse practitioner with more than 25 years of nursing and teaching experience.
"It is an honor for me to accept this award," Vukmir said. "When I am asked the question, how did you make the transition from nurse to legislator, the answer is easy. As a nurse we advocate for our patients. As a legislator we advocate for our constituents. It is easy to apply those same principals to my work in the Legislature."
Vukmir is serving in her first term in the Wisconsin Senate. She previously served four terms in the Wisconsin Assembly. She chairs the Senate’s Committee on Health and Human Services and co-chairs the Legislature’s Joint Committee for Review of Administrative Rules.
This is the second year in a row that WHA's Advocate of the Year Award has been given to a legislator who is also a nurse. In 2013, Rep. Sandy Pasch (D-Shorewood), a psychiatric nurse and former assistant professor of psychiatric nursing, received the WHA honor.
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Prairie du Chien Memorial Hospital was presented with the Wisconsin Hospital Association (WHA) 2014 Advocacy All-Star Award at the Association’s annual Advocacy Day April 16. Hospital CEO Bill Sexton accepted the award before some 800 hospital supporters. The award is presented to one hospital that exemplifies dedication to grassroots advocacy.
Sexton said he was honored to accept the award on behalf of the hospital’s Board of Directors and the physicians, nurses, volunteers and Prairie du Chien Memorial employees.
"This award really recognizes our entire team—employees, board members and volunteers—and the advocacy work we do on behalf of not just our hospitals, but for all the hospitals in Wisconsin," Sexton said. "The sheer number of advocates gathered here today demonstrates the importance that our hospitals have in our communities. We know individually and collectively that we are making a difference."
Over the past year, the hospital’s advocates have regularly contacted or met with their elected officials to discuss important health care issues. In addition, they have traveled to Washington, DC with WHA to make certain their federal legislators are aware of how federal issues impact the hospital and local community.
"Prairie du Chien Memorial has shown exemplary grassroots commitment this past year," said Jenny Boese, WHA vice president, external relations & member advocacy. "From advocacy training to regularly meeting with legislators and attending Advocacy Day, their efforts on behalf of their patients and community are to be saluted."
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If you count the number of WHA-supported bills that Gov. Scott Walker has signed over the past few weeks, it comes as no surprise that WHA’s Legislative Score Card is "nearly all As." WHA Executive Vice President Eric Borgerding called the last legislative session one of the Association’s most successful in terms of advancing WHA-supported legislation. In total, the Governor signed seven bills into law, including:
"As divided as the current Legislature is sometimes portrayed in the press, it is important to point out that the bills WHA lobbied on and supported received bipartisan support," Borgerding said. "Our success this past session is a credit to the WHA team, our member hospitals, and the incredible amount of participation that we receive from our grassroots supporters. Just yesterday, more than 450 of our attendees at Advocacy Day went to the State Capitol and visited with their legislators. There were over 900 contacts to legislative offices opposing a fee schedule in worker’s comp. Those personal contacts make a huge difference in our ability to educate and motivate legislators."
Borgerding said a few issues remained at the end of the session, including worker’s compensation and a couple of behavioral health-related bills. Preparation has already started for the 2015 session. Borgerding said WHA will advocate for additional medical residency funding and boosting Medicaid reimbursement, to name just a few.
WHA continues to build out its lead advocacy message, which is to promote Wisconsin’s high-quality, high-value health care as an economic development asset. Dean Halvorsen, Leede Research, shared some preliminary results of an employer survey with the Board that WHA has in the field. The survey is aimed at assessing employer perspectives on health care.
SGR Fix: It’s the 17th Time Around this Block
WHA President Steve Brenton pointed out that Congress just passed the SGR fix, for the 17th time. The good news is that physicians avoided a 24 percent cut in reimbursement, the rural extenders stayed in place, there is another delay on the "two midnight’s" rule, and there were no major cuts to hospitals. However, it was not without its thorns. The ICD-10 delay in the bill will cost Wisconsin hospitals millions as many are "double coding" in both ICD-9 and ICD-10, and it did not address the recovery audit contractors (RAC) or Critical Access Hospital "96 hour" rule.
Brenton said advocacy efforts in Washington will continue as he recounted the nearly half dozen meetings that WHA member hospitals have hosted with members of Congress so far in 2014.
"The latest SGR ‘patch’ is a mixed bag," Brenton said. "And the ICD-10 delay illustrates just how difficult the D.C. environment has become for consideration of sound public policy."
ACA Implementation: The Numbers are Slowly Coming in
With the data slowly trickling in, it is difficult to get a handle on the full extent of coverage transitions over the past six months. While official reports from the federal government and from the Wisconsin Department of Health Services are expected soon, Joanne Alig, senior vice president, policy and research, said in measuring the impact of the changes, we must recognize where Wisconsin was prior to the implementation of the Affordable Care Act (ACA).
The latest numbers—now a month old, show that 68,655 people who enrolled in the exchange were found eligible for Medicaid, and an additional 71,443 selected a qualified health plan through the exchange. However, little is known about the extent to which the newly enrolled are coming from the uninsured population.
Alig showed the results from a recent Rand survey which suggests a reduction in the uninsured nationally of just over nine million, mostly as a result of a significant increase in employer-sponsored coverage which could be good news. However, Congressional Budget Office’s (CBO) April 2014 report shows no increase in employer-sponsored coverage, but an overall reduction in the uninsured of 12 million. The estimates of the reduction in the uninsured in both reports are still significantly lower than the 21 million uninsured reduction originally projected by the CBO in 2011.
"As we continue to evaluate the impacts on coverage, it will be important to understand all of the component parts including changes in Medicaid, in the individual market inside and outside of the exchange, as well as employer-sponsored coverage, not just nationally but here in Wisconsin," Alig said. And it may take a while before we have good data to do that. "
Other Board Action
Council on Rural Health – Chair Robert Van Meeteren said the agenda and registration materials for the Rural Health Conference will be out soon. The conference is now one of WHA’s largest and features a broad range of topics, including a governance track.
Public Policy Council – Chair Mike Wallace reported that DHS Deputy Secretary Kevin Moore was the guest at the last meeting, which provided a good forum for discussing issues related to DHS-124, behavioral health and Medicaid.
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An innovative and collaborative approach to delivering care is making cancer treatment more accessible in northwestern Wisconsin. During an April 11 visit to the New Richmond area, Gov. Scott Walker had an opportunity to tour the center. The Cancer Center is a joint effort among area hospitals who partnered to offer the best possible patient care for people battling cancer.
"The Cancer Center of Western Wisconsin is an example of an incredible partnership between the six hospitals in the area," said Walker. "This collaboration is an innovative approach, which affords cancer patients the convenience of the location that works best for them. I enjoyed the experience of touring the facilities, speaking with staff and seeing all they have to offer."
The co-op was formed in 2006 with the vision of "ensuring all community members receive the most effective and specialized cancer prevention, treatment and recovery possible within the healing comfort and familiarity of their hometowns." The collaboration includes the Amery Regional Medical Center, Baldwin Area Medical Center, Hudson Hospital & Clinics, Osceola Medical Center, St. Croix Regional Medical Center of St. Croix Falls, and Westfields Hospital of New Richmond.
The Cancer Center’s state-of-the-art facility in New Richmond opened in 2011 and is home to the Radiation Therapy Center of Western Wisconsin. Through a partnership with Minneapolis Radiation Oncology, PA, patients receive radiation therapy treatments at this facility. Chemotherapy services are provided at all six hospitals.
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The IRS recently released the final employer shared responsibility rules under the Patient Protection and Affordable Care Act (also called the "Pay or Play" rules). Now that final regulations are out, it is time for employers to take action.
WHA is offering a member forum on this topic April 23. This webinar will focus on the new changes included in the final regulations, including guidance on on-call employees; transition rules providing additional time for full compliance; and on new rules handling employee hour decreases. In addition, this webinar will cover the critical steps that must be taken by employers, including how to determine, and document, which employees are "full time" under the new guidance; how to count on-call hours; and required and optional plan amendments.
Hospital HR professionals, CEOs, COOs, and CFOs will benefit most from participation in this webinar. There is no cost to participate in this WHA Member Forum, but pre-registration is required. Register by April 21 at http://events.SignUp4.net/14PayOrPlay0423.
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The Fox Valley Family Medicine Residency Program will transition from the University of Wisconsin School of Medicine and Public Health (UWSMPH) to a consortium of health care institutions consisting of ThedaCare, Ministry Health Care (which includes Affinity Health System) and the Medical College of Wisconsin.
"We have an active, vibrant and supportive health care community," said Daniel E. Neufelder, senior vice president and chief operating officer of Ministry Health Care. "This residency program closely aligns with our commitment to enhance the community’s overall health and well-being, and we look forward to playing an even larger role in the training and development of future physicians."
"The Residency Program has had a strong and successful history, but it was governed by leadership in Madison," said Dean Gruner, MD, President and CEO of ThedaCare. "We will be able to expand the number of resident slots in the program, which will meet increasing demands and looming primary care doctor shortages. We could add other opportunities at ThedaCare and Ministry Health Care including rural training options. The local leadership will better serve the needs of the program and the patients we care for in the Fox Cities."
Adding in-state residency positions has been a WHA priority since the release of its workforce report that found that 70 percent of the physicians who attend both medical school and complete a residency in Wisconsin stay here to practice medicine.
"With the expansion of both medical schools it is imperative that we have corresponding strong Wisconsin-based residencies so we can maximize the retention of newly-trained primary care physicians in Wisconsin," said Chuck Shabino, MD.
As of July 1, 2015, the consortium will assume responsibility for both the educational mission of the Fox Valley Medicine Residency Program and its clinic at 229 S. Morrison St. in Appleton. The program is accredited to train both osteopathic and allopathic (D.O. and M.D.) physicians. There are 18 residents in the program; six graduate each year.
"We at the Medical College of Wisconsin are honored and enthused to join ThedaCare and Ministry Health Care in a consortium directing the Fox Valley Family Medicine Residency Program," said Kenneth Simons, MD, Medical College of Wisconsin’s senior associate dean for graduate medical education and accreditation. "This opportunity emphasizes the importance of community-academic partnerships that address the specific needs of the local health care programs. As a new member of the Medical College of Wisconsin Affiliated Hospitals, the Fox Valley Family Medicine Residency Program also will draw on the resources and expertise of 10 eastern Wisconsin health systems and organizations providing training to more than 800 physicians in residency and fellowship training."
The Fox Valley Family Medicine Residency is a program of the University of Wisconsin Department of Family Medicine, established in 1980 as a joint educational effort with the local health and business communities for the purpose of training family physicians for the rapidly-growing Fox Cities communities. St. Elizabeth Hospital and Appleton Medical Center serve as sponsoring teaching hospitals for the residency program. In 2013 the program graduated its 31st class of residents and its 180th resident. More than 60 of the residency graduates are currently or have practiced in the Fox Valley and rural communities.
"It is critically important to the future health of our state that Wisconsin strengthen and expand residency programs in primary care," added Robert Golden, MD, dean of the UW School of Medicine and Public Health. "Strong programs, such as the Fox Valley Family Medicine Residency Program, should be embedded in and supported by their communities. Local control of health care programs by the communities they serve is a great model, and we support the transition of the administration of this program to ThedaCare and Ministry Health Care, together with their new partner, Medical College of Wisconsin."
Lee Vogel, MD, residency campus director and faculty with the program for 24 years, said she looks forward to the new administrative structure. "Partnership with our local health systems will commit us to focusing even more on the health of our community and our region in ways that will better serve our physician trainees and patients," Vogel said. "Having a more diversified portfolio of collaborators will be the key to success for the residency in the midst of a changing health care landscape."
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