March 4, 2011
Volume 55, Issue 9
2011-2013 Biennial Budget Introduced
Governor Walker says efficiencies necessary to maintain Medicaid safety net; Budget adjustment bill remains in limbo
In his budget address this week, Governor Scott Walker described Wisconsin as "broke" and outlined his plan for balancing the state’s budget for the next two years, which includes efforts aimed at maintaining safety net health care programs.
As previously reported, Wisconsin’s fiscal situation is dire as the state faces a nearly $140 million shortfall for the fiscal year ending June 30 and a looming $3.6 billion dollar deficit heading into the next biennium.
Walker described his plan as reducing all funds spending by $4.2 billion, or 6.7 percent, and said that reduction will decrease Wisconsin’s structural budget deficit by 90 percent from $2.5 billion to $250 million, noting that will be the lowest structural deficit in recent history.
Walker’s budget proposal calls for significant reductions in funding for Medicaid ($500 million), local governments, the UW and schools.
Governor Walker addressed Medicaid directly in his budget address.
"The state’s Medicaid program represents the area of fastest growth," Walker said. "Medicaid costs continue to outstrip growth in general fund revenues. Long-term care expenditures, in particular, are growing much faster than other areas of the budget. Coupled with the use of $1.3 billion in one-time federal funding – the state is facing an unsustainable budget challenge."
"While maintaining services for our most vulnerable, we must also refocus those services and find efficiencies where possible," Walker added. "That will mean asking some individuals to pay modest co-pays and premiums as they transition from the safety net that these programs provide to gainful employment. This will allow those individuals to begin to transition to a time in the future when they will no longer need government support, while protecting those who need these services the most."
WHA continues to analyze Walker’s budget, but initial findings include:
Walker administration budget documents also discuss the rate of growth in the Medicaid program as unsustainable and indicate that the proposed changes will "bend the cost curve" and, as noted above, reduce program expenditures by $500 million over the biennium.
A significant part of Walker’s plan, however, remains held up in the Senate, due to Senate Democrats remaining out-of-state, effectively preventing a vote on the Governor’s Budget Adjustment Bill (BAB) in that house.
Among the provisions included in the BAB are full funding of the Medicaid program for the remainder of the current biennium, and a process whereby the Department of Health Services will find savings over the coming year through studying key elements of the Medicaid program, develop a plan for changes and reforms, and implement that plan via administrative rules, rather than legislation. (See previous Valued Voice articles.) This process will be the primary vehicle for identifying portions of the $500 million in unspecified savings.
In a statement released after the budget address, WHA Executive Vice President Eric Borgerding confirmed WHA’s commitment to finding solutions to the challenges facing Medicaid.
"In the face of unprecedented budget challenges, including a nearly $140 million deficit in Medicaid this year (FY2011) and a projected $1.8 billion deficit in the 2011-13 biennium, Medicaid must adapt and evolve via a process that involves key stakeholders, including hospitals and hospital systems that increasingly serve as the health care safety net for so many in Wisconsin," Borgerding said. "WHA is committed to finding solutions that will: (1) maintain a fully-funded and operating Medicaid program in FY2011; (2) preserve Medicaid for our most vulnerable citizens; and, (3) minimize cost shifting to employers and employees from unreimbursed Medicaid costs and uncompensated care."
Immediately following introduction of the budget, WHA staff began their in-depth analysis of its provisions, which continues. Over the next few weeks, the non-partisan Legislative Fiscal Bureau will prepare their budget analysis, which will be completed prior to the start of public hearings before the Joint Committee on Finance.
Review by the full Legislature will follow before a final version of the budget is forwarded back to Governor Walker for his review, possible line-item veto, and signature. Historically, the entire budget approval process has lasted for several months.
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Representatives Erik Severson (R-Star Prairie) and John Nygren (R-Marinette) and Senator Pam Galloway (R-Wausau), are circulating the "apology bill" among their colleagues seeking co-sponsors for the legislation. The bill would protect statements of apology, condolence, compassion, sympathy, among other expressions by a health care provider to his or her patient.
In addition to being new members of the Wisconsin Legislature, both Severson and Galloway are physicians.
The Wisconsin Hospital Association strongly supports the bill. This week, Paul Merline, WHA vice president of government relations, sent a memo to all members of the Senate and Assembly encouraging their support and co-sponsorship of the proposal. Merline emphasized, "WHA believes that open and honest communication between a provider and his or her patient results in the best health care environment and strengthens the provider-patient relationship," which is helpful to all parties involved.
A similar bill passed both houses of the Legislature in the 2005-2007 legislative session, but was ultimately vetoed by then-Governor Doyle. WHA expects the bill to be introduced soon.
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The final deadline to complete the WHA membership survey is Wednesday, March 9. If you received the survey link but have not yet shared your feedback, please take the time to do so. The survey will only take 10-15 minutes to complete.
To date, we have a 45 percent response rate. Thank you to those who have shared their feedback already, but please know that significant member participation is critical to the success of this effort. Feedback from a majority of our members is essential to tee up the future priorities of the Association.
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Central line-associated bloodstream infections (CLABSIs) declined by 58 percent in U.S. hospital intensive care units between 2001 and 2009, according to a report released this week by the Centers for Disease Control and Prevention (CDC). The report estimates the finding represents up to 27,000 lives saved and $1.8 billion in health care costs avoided. CDC Director Thomas Frieden, MD, called the public-private partnership to reduce CLABSIs "a model for improving health care." Among other efforts, the report cites the "highly successful" On the CUSP: Stop BSI campaign.
The Agency for Healthcare Research and Quality has contracted with the AHA’s Health Research & Educational Trust (HRET) affiliate to implement the CUSP model nationwide. In Wisconsin, WHA has led the "On the CUSP: Stop BSI" campaign since June, 2009. Wisconsin hospitals have been recognized by HRET as being among the top states in terms of participation in and support for improvement collaboratives. WHA has provided implementation guidance and the tools necessary for hospitals in the current collaborative to succeed. In addition, teams have had the unique opportunity to share best practices among their peers.
AHA President and CEO Rich Umbdenstock applauded the work of hospitals, doctors, nurses and other hospital staff in making hospitals safer than ever before. He added, "We’ve learned that success comes from collaboration and promotion of best practices rather than through counterproductive policies such as recent congressional action that would penalize 25 percent of all hospitals each year—those that report the highest proportion of hospital-associated conditions, no matter how small that number may be—regardless of improvement."
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Retail pharmacies and hospital-based pharmacists are experiencing an unprecedented amount of drug shortages in practice. Hospitals that have faced drug shortages may have been forced to pay higher-than-usual prices to keep the pharmaceuticals in supply. These shortages impact patient care on a daily basis. The Pharmacy Society of Wisconsin has shared resources with WHA, including this link to an article that will be published in the March/April issue of the Journal of the Pharmacy Society of Wisconsin: www.pswi.org/communications/journal/2011/drug_shortages_MA11.pdf.
The American Society of Health-System Pharmacists (ASHP) has developed a comprehensive Web site resource on drug shortages: www.ashp.org. This Web site includes information about current shortages, resolved shortages and a place to report shortages. In addition, pharmacists frequently use the guidelines and suggestions for addressing drug shortages that can be found on this page: www.ashp.org/shortages?WT.ac=hp%5FPopLinks%5FDrug%5FShortages.
The American Hospital Association (AHA), along with other medical groups, has written a letter in support of S. 296, which Senator Amy Klobuchar (D-Minn.) introduced to address the ongoing problem of prescription drug shortages. AHA and the other groups wrote, "The number of drugs in critically short supply is increasing at an alarming rate and threatens quality of care in hospitals and clinics nationwide...In many cases, therapeutic alternatives are not available, or carry increased risk of severe side effects and drug-to-drug interactions." S. 296 enables the FDA to work more effectively with supply chain entities to ensure drug availability, and enhances the Agency’s ability to monitor drugs that are vulnerable to shortages in the future.
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The Wisconsin Payment Reform Initiative (WPRI) was initiated nearly one year ago under the sponsorship of the Wisconsin Health Information Organization (WHIO). WHIO is a public-private, voluntary, multi-stakeholder, nonprofit organization whose primary purpose is to aggregate, analyze, and disseminate health care data in a manner that supports the ongoing transition toward value-based health care purchase and delivery decisions. The Wisconsin Hospital Association is a founding member of WHIO.
Recognizing that advancing the goal of better health care at lower cost requires the engagement of health care providers, payers, employers, and consumers, WHIO convened a meeting in early 2010 of more than 170 health care providers, payers, employers, and state officials. This meeting launched three large work groups that are developing payment reform pilot projects, designed to build on Wisconsin’s impressive track record of advancing quality and transparency in health care.
Providers and purchasers alike are motivated to conserve scarce health care resources. Similar to the Medicare bundled payment projects under development, the WPRI will pilot new payment models for certain acute, chronic and preventive care services. These pilots are designed to test how bundling of payments and other strategies will work, how changes in reimbursement methods can be complemented by changes in physician, health system, employer and consumer decision making, and how best to facilitate widespread transition from volume-based reimbursement to value-based reimbursement.
What is WPRI working to accomplish?
For nearly 12 months, more than 100 WPRI work group participants from across Wisconsin have been engaged in designing pilot projects in acute, chronic and preventive care. The Acute Care work group will pilot a bundled payment for total knee replacement, modeled after a similar project underway under the direction of the Integrated Healthcare Association in California. The Chronic Care workgroup is focusing on care for adults with diabetes for its first pilot project and proposes using a shared savings model that transitions over time to a global payment. The Preventive Care workgroup is assessing the feasibility of modifying reimbursement methodologies to increase rates of screening for breast cancer, cervical cancer, and colorectal cancer.
These pilots are experiments. The intention is to test ideas and processes; to find out what works and what needs adjustment. The final product is intended to be scalable to include other medical conditions and places of service as well as expanded geographic regions.
WPRI work groups include more than 100 clinicians, health care administrators, insurance company leaders, and employers. The work of the WPRI is sponsored by WHIO. A complete list of WHIO members is available at www.wisconsinhealthinfo.org/index.html. The WPRI effort is supported by a Steering Committee comprised of the volunteer chairs of the workgroups and subgroups, as well as a number of WHIO Board members.
Organizations represented on the WPRI Steering Committee include:
Wisconsin Hospital Association
Wisconsin Medical Society
Wisconsin Academy of Family Physicians
Wisconsin Collaborative for Healthcare Quality
Greater Milwaukee Business Foundation on Health
WPS Health Insurance
Gundersen Lutheran Health System
Anthem Blue Cross Blue Shield of Wisconsin
Holy Family Memorial
Wisconsin Department of Health Services
In addition, the WPRI Council includes individuals and organizations interested in following the work of the Wisconsin Payment Reform Initiative. Council members receive periodic updates on the progress of the payment reform pilot programs and will be invited to participate in future events as they are planned. To join the WPRI Council, please contact Tim Higgins, WPRI project manager, at Tim.Higgins@chirhoservices.com.
The Wisconsin Hospital Association and the Wisconsin Medical Society recently sent a letter to health care provider organizations inviting organizations interested in serving as a pilot site to express their interest. A copy of that letter is available at www.wha.org/WPRI1-28-10.pdf. The work groups are finalizing the design of their projects. Pilots will begin mid-2011.
If your organization is interested in learning more about participating in one or more of the pilots, please contact Karen Timberlake, director, WPRI, at KTimberlake1@gmail.com.
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Licensed practical nurses (LPNs) in Wisconsin renewing their licenses from March 4 - April 30, 2011 will be required to complete a confidential survey. The state will use the data from the survey to identify areas of need in the nursing profession.
The nearly 18,000 LPNs in Wisconsin can expect to receive a postcard early in March with information on how to renew their licenses and complete the required workforce survey online. The online survey will be the most efficient way to meet the requirement and receive a license.
LPNs can complete the survey from their home computers, at DWD Job Centers across the state, or at public libraries. All information is kept strictly confidential and is not identifiable. Many health care employers are also providing access to computers at their work sites. Renewed licenses won’t be issued until the survey is completed.
The workforce information obtained from the nursing licensees will be sent to the Wisconsin Department of Workforce Development (DWD) to analyze the data. Once the survey responses are analyzed, a statewide nursing center will collaborate with health care and nursing organizations to develop a statewide strategic plan to address workforce needs in Wisconsin.
More information, including answers to Frequently Asked Questions (FAQs) about the 2011 LPN renewal, is available at www.drl.wi.gov.
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Since 2002, the Wisconsin Hospital Association has sponsored the Health Care Employee Pride Program to recognize the dedication of Wisconsin’s health care workforce. The program encourages WHA member hospitals to invite their employees to express themselves in an essay and tell others why they chose a health occupation. The Pride Program gives employees the opportunity to share why they love their career of service to others, while giving the Association an opportunity to honor their contributions to their hospital, community and profession.
A designated leader from administration, human resources, public relations or patient care from WHA member hospitals is asked to coordinate the program. Employees are encouraged to submit to the hospital a one-page essay, poem or story that explains why they chose to work in health care. From those essays, a committee at the hospital will pick one employee to represent their hospital and forward that person’s essay to WHA. WHA will send the hospital representative a certificate and pin to present to their honoree in May, and will also post the essays on the WHA Web site at that time. Like last year, WHA will not be hosting a banquet for all honorees.
Pride Program materials are available on WHA’s Web site at www.wha.org/workforce/pride_2011.aspx. For more information contact Shannon Nelson at firstname.lastname@example.org or Mary Kay Grasmick at email@example.com, or call 608-274-1820.
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On March 16, Wisconsin hospitals have the rare opportunity to hear one of the most notable experts on patient safety, Atul Gawande, MD, MPH, without leaving the hospital. Dr. Gawande is speaking at the South Carolina Hospital Association’s Patient Safety Symposium, and WHA members have the unique opportunity to hear his presentation via a live webcast.
Dr. Gawande is the author of New York Times bestsellers Complications: A Surgeon’s Notes On An Imperfect Science and Better: A Surgeon’s Notes On Performance. His most recent book, The Checklist Manifesto, is a current New York Times bestseller. He is a surgeon and staff member at Brigham and Women’s Hospital and the Dana Farber Cancer Institute, and has been a staff writer for the New Yorker magazine since 1998. He won the 2010 National Magazine Award for Public Interest writing for his New Yorker article, "The Cost Conundrum."
Dr. Gawande will be discussing the next phase of the surgical checklist implementation on a national scale—Safe Surgery 2015—and the initial logistics of this initiative. He will discuss South Carolina’s role as a pilot state for the first year, and how the intent is to create a program that a can be used by any state to implement and sustain on a large scale.
In addition to Dr. Gawande, the webcast will include presentations from Maureen Bisognano, president/CEO of the Institute for Healthcare Improvement (IHI) and Dr. Robert Wachter of the University of California, San Francisco Medical Center. A full agenda and online registration can be found at: http://events.SignUp4.com/Gawande.
As with other webinars offered by WHA, there is a webcast site fee per connection, which includes the ability to view all four of the sessions included on the day’s agenda. You are encouraged to gather your team together to view the webcast from one location. Please note that due to limited connections, this opportunity is available only to the first 20 Wisconsin hospital registrants. Also, before registering, be sure you can meet the technical requirements of the webcast, which can be found at this link also:http://events.SignUp4.com/Gawande.
Register Today for WHA Advocacy Day, April 27
Advocacy Day is one of the best ways your hospital employees, trustees and volunteers can make an impact in Madison. Plan to attend this year’s WHA Advocacy Day event, scheduled for April 27, and register your hospital team today, including your senior leaders, trustees and volunteers, for this important event. Advocacy Day is free of charge and takes place at the Monona Terrace in Madison.
As always, WHA has a great lineup of speakers, including morning keynote Jim VandeHei, luncheon keynote Governor Scott Walker (invited) and the perennially-popular legislator panel discussion.
The highlight of Advocacy Day is always the hundreds of attendees who take what they’ve learned during the day and put that into action by meeting with their legislators in the State Capitol in the afternoon. With the State Capitol only a scant two blocks away (transportation will be available), you can speak up on behalf of your hospital by meeting with your legislators or their staffs. In these difficult budget times, hospital representatives need to meet with their legislators and make sure they are telling them about the value they provide to their communities and how program changes, like to the Medicaid program, will impact Wisconsin hospitals.
Join more than 650 of your peers from across the state at Advocacy Day 2011 on April 27. Register today. A complete program and online registration are available at http://events.SignUp4.com/AdvocacyDay. A printed copy of the Advocacy Day 2011 brochure is included in this week’s Friday Packet. For Advocacy Day questions, contact Jenny Boese at 608-268-1816 or firstname.lastname@example.org. For registration questions, contact Lisa Littel at email@example.com or 608-274-1820.
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Aurora Memorial Hospital of Burlington has reached an 80 percent employee flu vaccination rate consistently since the 2007-2008 flu season. Colleen Goetzke, RN, and employee health specialist at the hospital, says there are multiple factors that contribute to this success.
When the flu season starts, the hospital is prepared to administer the vaccination. For starters, each department—even the major units—has a flu champion, a person responsible for administering flu shots. These flu champions are equipped with to-go boxes that contain all the necessary tools to vaccinate employees.
For the first two weeks of the flu vaccination program, Goetzke’s department is open 10 hours a day, which helps reduce scheduling barriers. When Goetzke is not in her office, other staff members maintain the walk-in atmosphere. House supervisors make the vaccination available to all employees who work nights and weekends.
Goetzke also has a traveling flu cart that goes to all the departments in the hospitals, including the parking lot. After employees receive their vaccination, they are given a treat, which is a great incentive.
"One of our biggest successes is the mobile cart," Goetzke said. "Especially our sweet treats at the end. It’s a small gesture that works well with our employees."
Aurora’s facility in Burlington is a smaller hospital, which is another big advantage. They are able to create a more personalized atmosphere for their employees. This facilitates an easy vaccination process, especially if employees are hesitant about receiving it. Out of all the reasons for not getting vaccinated, Goetzke said that misperceptions about the flu shot are the most common.
"The misconceptions about the flu shot, that the vaccine can cause the flu, is the biggest obstacle we face," Goetzke said.
To combat such obstacles, Goetzke calls the employee personally, which often is the extra encouragement the employee needs to decide to be immunized. Frequently asked questions and common misperceptions also are addressed in the flu champion packet given to employees.
The most important thing of all is that Goetzke reminds the employees who get the vaccine that they are not the only ones who benefit.
"The shot is not just for them," Goetzke said. "They need to remember they are protecting their family, patients and other employees by receiving the vaccination. Everyone has an obligation to get it."
An obligation caregivers take seriously. Aurora Memorial Hospital of Burlington has had a consistent flu vaccination rate of 80 percent for three years in a row.
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A teen arrives in the emergency department by ambulance following a terrible car accident. A child receives head injuries while bicycling without a helmet. A woman walks into the emergency department with injuries inflicted by an abusive spouse. These are stories of pain and tragedy that hospital personnel see all too often. Injury is the most under recognized major public health problem facing the country and it is the leading cause of death in people ages 1 to 44 in Wisconsin. Wisconsin hospitals devote significant resources to reduce the number of intentional and unintentional injuries that occur in the communities they serve.
Car seat safety: nothing to take lightly
You are a proud parent, devoted to the safety and well being of your baby or child. You follow all the rules – particularly about car seats – and you faithfully strap your child in even when you’re only driving a few blocks, secure in the knowledge that you’ve done all you can to protect your child.
But when was the last time you checked the expiration date of the car seat?
Expiration dates are just one in a series of items Randy Reimer covers with parents when he is out in the community providing car seat safety checks. Randy advises parents to keep in mind that there is only a six-year "life expectancy" for car seats, which can be gauged by looking up the make and model on the manufacturer’s Web site.
Randy is a paramedic who works in the emergency room at Aurora Medical Center in Two Rivers. Because he sees what can happen when seats aren’t properly installed or they don’t fit the child, Randy became a certified car-seat safety technician.
Randy reports that when he inspects car seats, 90 percent of the time the seat is not tight enough and that the seat belts, safety bars and other features aren’t always used correctly. The instructions may be difficult to understand, or, if car seats were purchased at rummage sales or acquired as hand-me-downs, the instructions may be missing. For those on tight budgets who rely on used car seats, it may be possible to get the directions through the manufacturer’s Web site.
Other concerns as car seats age involve disintegrating cushioning and safety straps that have been weakened from stretching. Additionally, a car seat that is too big or too small will not work as intended.
To avoid the problematic situations listed above, Randy points out that you can’t judge a car-seat’s safety by its price. Researching the options, reading the instructions and consulting with a certified car-seat safety technician ahead of time are best practices – along with attending any of the inspections that are offered free throughout the year as part of Safe Kids Manitowoc County.
Randy and others who volunteer this service keep updated by attending a class every two years. Randy also teaches car seat safety to prenatal classes at the hospital.
Aurora Medical Center in Two Rivers
Teaching safety and health to more underserved families
Families were slipping through the cracks. Many who had no idea that, of the 67,000 bike-related head injuries emergency room physicians treat each year, most can be prevented just by wearing a helmet.
Appleton Medical Center and Theda Clark Medical Center, along with its parent organization, wanted to change that. In addition to hosting bike and in-line safety clinics throughout various communities each year, it became a sponsor of YMCA’s Healthy Kids Day event, the nation’s largest health day for children and families. ThedaCare hosts the Fox Cities bike safety clinics at Healthy Kids Day every other year, and this year helped YMCA reach more underserved families in the Fox Cities.
"We know the quality of health care in a community is more than just not being sick and not coming to the hospital," said Paul Jenson, community involvement specialist with ThedaCare. "It has to do with the whole person and having opportunities to grown and learn, and be part of groups and teams and activities."
This year YMCA contacted families through local schools, direct mail, various community programs and social services. More than 4,000 attended Healthy Kids Day. At the event, families got to play games, attend demonstrations, receive educational resources and learn about healthy treats in addition to participating in ThedaCare’s bike clinic.
"It’s an eye-opening event," said Sue Pawlowski, community relations director with YMCA of the Fox Cities. "We have to get these kids mobile and keep them moving, and ThedaCare has the same goal in mind."
During the bike clinic, children ages 5 to 12 learned safety tips and the importance of always wearing a proper-fitting helmet when riding a bike. They also took home a fitted Bell helmet, which families may not otherwise have been able to afford. Since 1994, ThedaCare has provided more than 35,000 Bell helmets to children at various clinics held in the community. That includes more than 1,500 helmets worth over $50,000 handed out at events hosted at area YMCAs.
Child Health & Safety Fair
More than 200 children and parents attended the annual Back to School Health & Safety Fair co-sponsored by Memorial Health Center and Allied Health Wildberg Chiropractic. This free event is held each year in an effort to teach area children how to be safe, healthy, and happy.
Highlights of the fair included interactive hand washing and eye health activities; teeth plaque checks; a bicycle safety course that included assessments of children’s bike riding skills; car seat safety checks; karate, gymnastics, and dance student demonstrations; and nutrition information.
All children attending the event received a free bike helmet, and free booster seats were available for parents with children meeting the proper height and weight requirements.
Memorial Health Center – An Aspirus Partner, Medford
Community Memorial Hospital shows students the impact of dangerous driving
In April 2010, Community Memorial Hospital participated in the Every 15 Minutes program, coordinated by Germantown High School and Germantown Police Department.
The program teaches high school students about the dangers of drunken driving and texting while driving through a series of staged events, including a simulated traffic accident. The events bring home the fact that every 15 minutes someone in the U.S. dies of an alcohol-related traffic collision.
During the event, two student actors involved in the mock crash were taken to Community Memorial, where Emergency Department personnel worked on them to simulate what would actually happen to people involved in a serious traffic accident. One student was flown to the hospital by Flight for Life. Youth videographers filmed the events for a video which was presented at Germantown High School during an all-student assembly.
During the assembly, Joel Farren, principal of Germantown High School, addressed the student body:
"If this program helps one person to make a different or better decision, makes one person think twice about drinking and driving, using drugs and/or texting while driving, motivates someone to take away the keys of a friend who is impaired and should not drive, prevents someone from getting into a vehicle of a person that is impaired, or saves even one life, then we have accomplished our mission," he said.
The program utilized the time and talents of physicians and many hospital staff.
"The feedback from students, staff, parents, community members, participants and media were overwhelmingly positive," Farren said. "In the debriefing that staff did with students, many noted that the program’s impact included re-thinking decisions they would make in the future."
Community Memorial Hospital, Menomonee Falls
Submit community benefit stories to Mary Kay Grasmick, editor, at firstname.lastname@example.org.
Read more about hospitals connecting with their communities at www.WiServePoint.org.
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