December 22, 2011
Volume 55, Issue 49
WHA Joins National Quality Improvement Initiative
The Wisconsin Hospital Association will start work early next year on a national project aimed at preventing avoidable hospital-acquired conditions (HAC) and reducing unnecessary hospital readmissions.
"Partnership for Patients" is a national initiative supported by the Centers for Medicare and Medicaid Services (CMS). CMS awarded $218 million to organizations that will develop a "hospital engagement network." The American Hospital Association, who has been designated as a CMS primary contractor, has sub-contracted the quality and safety improvement work in Wisconsin hospitals to WHA. It is a good fit for the Association.
"WHA has been successful in fostering collaboration among our state’s hospitals that has helped Wisconsin gain a national reputation for sharing practices that lead to safer, higher quality patient care," according to WHA President Steve Brenton.
"Wisconsin’s hospitals are known for providing care that is ranked as being among the best in the nation. This project will expand our improvement activities and lead to even higher performance and better care for patients in our communities."
The ambitious goals of the Partnership for Patients initiative are to reduce inpatient harm by 40 percent and readmissions by 20 percent over a three-year period on ten key areas for improvement:
WHA will engage up to 80 hospitals. Through the new project, hospitals will have access to evidence-based practices, staff training and opportunities for sharing practices, as well as continued direct engagement with WHA staff.
"Our selection as a sub-contractor is largely based on the fact that WHA staff has been highly successful in working with our member hospitals to form quality collaboratives that have driven measurable results in the area of infection prevention," according to Kelly Court, WHA chief quality officer. "The federal funding will enable us to expand our already proven results even further."
Launched in April 2011, Partnership for Patients seeks to prevent 1.8 million injuries to patients in the hospital, saving more than 60,000 lives over three years. It also seeks to make care less costly. Funding is being channeled through the CMS Innovation Center, which was created by the Affordable Care Act.
"Partnership for Patients is helping the nation’s finest health systems share their knowledge and resources to make sure every hospital knows how to provide all of its patients with the highest quality care," Health and Human Services Secretary Kathleen Sebelius said in an HHS news release.
For more information on the Wisconsin Hospital Association, visit: www.wha.org. For more information on the Partnership for Patients, visit www.healthcare.gov/partnershipforpatients.
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The Wisconsin Hospital Association this week commented on a regulatory reform proposal from the Centers for Medicare and Medicaid Services that would ease the regulatory burden for hospitals. CMS’s proposal is the first comprehensive review and revision of the Medicare Conditions of Participation (CoP) in more than 25 years.
In the proposed reform, CMS removes several antiquated regulatory burdens, which will allow hospitals to deliver more efficient and better care. The amended CoP would allow a single governing body over multiple hospitals within a health system, a change from CMS’s previous position that each hospital within a health system must have its own board; CAHs to provide certain services, such as diagnostic, therapeutic, laboratory, radiology and emergency services, under service arrangements; and advanced practice practitioners to serve in an expanded role among other changes.
WHA Executive Vice President Eric Borgerding noted, "Regulatory reform is a key element of health care reform in the true sense of that phrase. Hospitals must be allowed to provide higher quality, better coordinated care efficiently. The CMS proposal is a good first step, and we appreciate their efforts."
Borgerding emphasized that regulatory reform is not solely a federal issue. "Wisconsin’s state hospital regulations have not been updated in several decades. They are becoming increasingly inconsistent with federal and industry standards. In short, they are obsolete and perpetuate redundant, unnecessary red tape."
WHA has been discussing hospital state-level regulatory reform with the Wisconsin Department of Health Services for years. "We urge Wisconsin to follow CMS’s lead, and embrace the exact type of hospital regulatory streamlining we are seeing in other states like Minnesota and Ohio," Borgerding said.
A copy of WHA comments on CMS’s proposed changes to the CoP is available on the WHA website at www.wha.org/Data/Sites/1/reimbursement/WHAcommentsCAH-CoPReforms12-22-11.pdf.
CMS’ proposal is available at: www.gpo.gov/fdsys/pkg/FR-2011-10-24/html/2011-27175.htm.
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Aspirus health system and the Wisconsin College of Osteopathic Medicine announced Nov. 30 that we are exploring the development of what would be the state’s third medical school.
The statement came on the heels of the Wisconsin Hospital Association report, "100 New Physicians a Year: An Imperative for Wisconsin," which called for big changes in our state’s system of educating, recruiting and retaining doctors to ensure there are enough providers to serve future demand for health care. The report identified options for addressing this growing physician workforce shortage, including establishing a new, independent medical school.
The need: The WHA report certainly didn’t shock the health care industry, as Aspirus and other health systems have been working on this problem for years. But it did highlight the issue and provide an opportunity to marshal support for efforts such as ours.
Aspirus, like other health systems in northern Wisconsin, is located in a rural service area, where people rely on primary care—family medicine, internal medicine, pediatric and obstetrics/gynecology—physicians for health services.
It’s hard to recruit physicians to small towns. And although Aspirus and other systems in our region provide world-class care, doctors-in-training rarely think of northern Wisconsin as a hotbed for medical distinction. This new college could change
Train them, keep them: We have discovered something interesting: If physicians train in Wausau, they often stay here. Since 1978, Aspirus has partnered with the University of Wisconsin School of Medicine and Public Health to offer a residency program in Wausau. Since that time:
About two-thirds of residency graduates have established practices in the state.
Sixty-five percent of the family doctors on staff at Aspirus Wausau Hospital graduated from the Wausau residency program.
Osteopathic physicians have been an important part of the UW-Wausau Family Medicine Residency, and of Aspirus Wausau Hospital:
A long process: One of the reasons the WHA issued a strong plea for action is that there is no quick solution to the growing physician shortage. Wisconsin can’t simply flip a switch and start cranking out new providers.
If we are successful in establishing a medical college in Wausau and enroll the first class in 2013, it will take seven years until the first physicians graduate and complete their residencies. That means the actions we take now would not be a part of the solution until 2020 at the earliest.
A big project: Throughout 2011 we have worked with the Wisconsin College of Osteopathic Medicine and others, including the City of Wausau, to evaluate the prospects for a new medical school. Our feasibility study should be complete in February. If that report is favorable and we gather enough support, we would build a school enrolling 100 students a year, with its first class graduating in 2017.
The physician shortage is a statewide challenge, so we have been in discussions with health systems and organizations throughout Wisconsin to join us in this project. Establishing a third medical school will not solve Wisconsin’s growing physician shortage, but it would be a big step in the right direction.
Duane Erwin is president and chief executive officer of Aspirus, a six-hospital system serving north central Wisconsin and the Upper Peninsula of Michigan.
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WHA Delivers Exchange Presentation for WMC Government Affairs Council
On December 20, WHA’s Vice President of Payment Policy and Reform, Joanne Alig, delivered a presentation on consumer and employer incentives around private coverage in 2014 when health insurance exchanges come online.
The presentation took place at Wisconsin Manufacturers and Commerce (WMC) headquarters in Madison and was attended by more than 50 government relations and advocacy staff of WMC members and state trade associations.
The presentation included background information about the health insurance exchange, as well as information about the subsidies, tax credits and penalties included in the health care reform law. A copy of the presentation can be found at: www.wha.org/Data/Sites/1/finance/healthReform/HER12-20-11.pdf.
Similar to the discussion at a recent WHA Board meeting, Alig provided a comprehensive overview of how an insurance exchange could work in Wisconsin, and a view on how consumers and employers might respond in this new environment (see www.wha.org/pubArchive/valued_voice/vv12-16-11.htm#2). However, she reminded the group there is still much uncertainty at the federal level surrounding health care reform, including an expected Supreme Court decision next year on aspects of the health care reform law. (See www.wha.org/pubArchive/valued_voice/vv11-18-11.htm#2.)
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Late last week, the federal Department of Health and Human Services released long-awaited guidance on the Essential Health Benefits, a key provision of the Patient Protection and Affordable Care Act (PPACA). The HHS guidance avoids pitting states and advocates against HHS and against each other by "benchmarking" benefits to existing plan options.
Under PPACA, all health benefit plans in the individual and small group markets will have to offer a minimum set of benefits. PPACA identified ten coverage categories that must be included in the essential health benefits, and left it up to the Secretary of the federal Department of Health and Human Services to determine specifics about what must be included.
The general thought was that HHS would identify specific services – like hearing aids, for example – that would have to be included in the essential benefits package. Instead, they strategically chose not to do that, under the guise of state flexibility.
The new guidance requires states to select one of the following existing plans to set the benchmark for what gets included in the essential health benefits:
One question that arises is, what does this mean for state mandates? Under PPACA, states that wanted to require mandates over and above the essential health benefits would have had to pay certain costs associated with those mandates. In allowing states to benchmark to a small business plan, state mandates can be included without the states having to pay for them.
More importantly, however, is what this might mean for costs. Some that had hoped for a "skinny" plan option will be disappointed, meaning that plan costs could be higher than anticipated in 2014.
WHA staff will be analyzing the guidance in more detail. Comments on the Essential Health Benefits are due to HHS by January 31, 2012 and can be sent to: EssentialHealthBenefits@cms.hhs.gov.
To access the HHS bulletin, go to: http://cciio.cms.gov/resources/files/Files2/12162011/essential_health_benefits_bulletin.pdf.
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The term "bipartisan agreement" is an oxymoron, especially as it relates to any kind of consensus in Washington D.C. where partisan rancor has a very comfortable home.
But we should shed disbelief for just a moment and recognize two members of Congress—Senator Ron Wyden (D-Oregon) and Representative Paul Ryan (R-Wisconsin) for catching the holiday spirit and proposing a promising long-term concept that can help protect Medicare while reigning in unsustainable costs. Their unique act of bipartisan accord has already prompted scathing criticism from the "usual suspects"—members of their own caucuses who’d rather demagogue Medicare for partisan advantage than save it.
Both Ryan and Wyden are known in Washington as two of the smartest policy wonks in Congress. And neither has been accused as being either a RINO (Republican in Name Only) or a DINO (Democrat in Name Only). So the fact that they are proposing systemic and transformative Medicare reform is remarkable on many fronts.
The broad framework of the Wyden/Ryan proposal would, beginning in 2022, give people turning 65 the option to choose between the current Medicare program where government pays hospitals and physicians fee-for-service rates set by fiat (how’s that working?), or an alternative system paid via "premium support" (government vouchers that would allow beneficiaries to choose a private health plan). Presumably, one of the plan options would allow provider-led delivery networks—accountable care type organizations—to contract directly with Medicare beneficiaries, thus minimizing the traditional commercial insurance component. Under such a scenario, perhaps high performing organizations might have the opportunity to see value actually rewarded!
While the "devil" certainly looms in the details, the bipartisan nature of this proposal should pave the way for a rational debate over altering an unsustainable status quo.
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Register now for WHA’s seventh annual "Physician Leadership Development Conference," scheduled Friday, March 9 and Saturday, March 10. The conference will be held at The American Club in Kohler. The full conference brochure with registration and resort information as well as online registration is available at http://events.SignUp4.com/12PLD.
A discounted "early bird" registration fee is available to those registering by January 20. Additionally, a "host" registration option is available to hospital leaders who would like to accompany their physicians to the conference but do not need CME credit. This popular conference offers nationally-recognized faculty to assist in developing physician leadership skills and facilitating the transition of physicians from clinicians to physician leaders. ACPE is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. ACPE designates this live activity for a maximum of 12 AMA PRA Category 1 Credits.TM
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This past week U.S. Rep. Sean Duffy (R-7th District) introduced legislation named the Patient Centered Healthcare Savings Act, HR 3682. His bill fully repeals the health care reform law, known as the Patient Protection & Affordable Care Act, and replaces it with other health care reforms.
"The Wisconsin Hospital Association is pleased that Cong. Duffy has teed up for consideration a number of important initiatives that seek to address coverage, access and performance improvement goals," said WHA President Steve Brenton.
Among the major provisions in the legislation are:
Access details on HR 3682 at http://duffy.house.gov/issue/health and http://thomas.loc.gov.
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This week the U.S. Department of Health & Human Services (HHS) named 32 organizations as Pioneer Accountable Care Organizations (ACOs). HHS received 80 applications and ultimately chose 32 to become Pioneer ACOs. Bellin-ThedaCare Healthcare Partners and Allina Hospitals & Clinics (MN), which includes Wisconsin’s River Falls Area Hospital, are among those named.
"Pioneer ACOs are leaders in our work to provide better care and reduce health care costs," said Secretary Kathleen Sebelius in making the Pioneer ACO announcement. "We are excited that so many innovative systems are participating in this exciting initiative…."
The Pioneer ACO Model is an initiative run by the CMS Innovation Center and is designed to support organizations in their efforts to achieve better care for Medicare beneficiaries at lower costs. It is one of several payment models being tested by the CMS.
The CMS indicated these 32 organizations were selected due to their demonstrated experience of providing coordinated care in an ACO-like arrangement already. Because of these characteristics, Pioneer ACOs are expected to move in a parallel but quicker track than others in the Medicare Shared Savings Program.
Brief details on all 32 Pioneer ACOs was provided with this week’s announcement, including the following on Wisconsin’s Pioneer ACOs:
The 32 Pioneer ACOs represent 18 states and some 860,000 Medicare beneficiaries. The first performance period will begin January 1, 2012. To read the full list of Pioneer ACOs and other program information, log onto: http://innovations.cms.gov/initiatives/aco/pioneer.
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Recently State Senator Jen Shilling spent the day meeting and shadowing with Prairie du Chien Memorial Hospital (PDCMH) leadership. As Sen. Shilling was newly-elected to represent the 32nd Senate District and had not previously represented Prairie du Chien during her tenure in the State Assembly, the hospital felt it was important to have her visit and meet with hospital leaders.
During her time there, Sen. Shilling met with hospital CEO Bill Sexton and other members of the senior leadership team and board, including: Skip Gjolberg, Dave Breitbach, Ellen Zwirlein, Julia Nelson, Sasha Dull, Board Chair Paul Ginkel, and Board Vice-chair Charlie Connell. The group discussed health care issues in general, issues specific to Critical Access Hospitals like PDCMH, support for the "I’m Sorry" legislation currently pending in the State Senate, and the economic impact of PDCMH in the larger community.
Sen. Shilling also joined the Lean Steering Committee meeting where various Lean project chairs provided updates on current projects, discussed potential new projects and other issues. Sen. Shilling was intrigued by the hospital’s use of Lean and was able to hear how it had positively changed processes at the hospital. Chief Administrative Officer Skip Gjolberg and others discussed plans for a new hospital building and then the Senator was able to round/tour the hospital with Ellen Zwirlein, chief nursing officer.
As a member of the Prairie du Chien economic development board, Gjolberg also arranged for Sen. Shilling to meet with that group in the afternoon, providing another example of the role PDCMH plays in the larger economy and community.
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With a project as big as the ICD-10 transition, virtually no provider is undertaking the transition without an external partner. And no transition plan is complete without a thorough assessment of the ICD-10 readiness of current vendors and payers. Choosing the right partner or having an existing partner not be ready in time can be the difference between success and failure, and knowing how to leverage these partnerships may prove to be invaluable to the success of a hospital’s transition plan.
On February 15, WHA is offering a webinar focused on asking the right questions and knowing the right facts about current vendors and in selecting any new vendors.
Attendees will learn which vendors are needed for a successful ICD-10 transition; how to choose the right vendors for the right risks; how to leverage your relationship for maximum return; and when to outsource and when not to outsource.
This webinar is part of a four-part webinar series focused on helping hospital executives and their ICD-10 team leaders understand the magnitude of the ICD-10 implementation, the financial and clinical impact of the transition on your organization, and be better prepared for on-time implementation.
The four sessions include:
A team can register for the full four-part webinar series (for a discounted fee) or for individual sessions. An audio recording of each presentation is available to registered attendees at no extra cost to share at a more convenient time with ICD-10 transition team members who are unable to participate on the scheduled dates. A full brochure describing the four sessions and online registration are available at: http://events.SignUp4.com/ICD10Impact11-12.
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Although there are many areas of preparation important to a successful transition to ICD-10, ensuring detailed physician documentation may be the most vital of them all. Proper physician documentation is critically important because of its direct bearing on a hospital or clinic’s revenue cycle and ability to report quality outcomes appropriately.
When WHA members were surveyed in early 2011 regarding their ICD-10 readiness and needs, 74 percent of hospital members indicated their medical staff was not aware of the final rule related to ICD-10 transition by October 1, 2013, and 74 percent indicated physician education on documentation improvement was their number one need.
Based on this member feedback, in March 2012, WHA is offering five regional, one-day seminars focused on physician documentation improvement for ICD-10, presented by Lynn Kuehn, a Certified Coding Specialist for Physicians (CCS-P) and an AHIMA Certified ICD-10-CM/PCS trainer. Hospital leaders should encourage their physician leaders, physician liaisons, clinic managers, coding supervisors and managers, clinical documentation specialists and other ICD-10 implementation team members to attend one of these regional sessions.
While appropriate documentation is currently an issue with ICD-9 coding, it will only be intensified with the detail required for proper ICD-10 coding. One key to compliance is to have physicians familiar with the new documentation requirements of the ICD-10 code set, particularly the significant differences between the current ICD-9 and ICD-10 code sets. Physicians need to understand that there are significantly more codes in ICD-10 than in ICD-9, and the codes that are used are significantly more detailed and granular, requiring additional and more specific documentation to support. In addition, the ICD-10-CM codes are organized differently.
Attendees will learn how the ICD-10 regulation will affect physicians and their practices and discuss specific examples of how physician documentation impacts ICD-10 coding accuracy. In addition, Kuehn will share the information needed from the various physician specialties and why this information is vital to code assignment. Most importantly, tools for physician leaders and others on the ICD-10 team to use in supporting the physician community with the ICD-10 transition will be identified, and each attendee will receive a packet of documentation quick references developed by Kuehn for AHIMA. One quick reference document per specialty and body system will be provided.
The seminar will be offered in five regional locations across Wisconsin:
All seminars will be identical, so attendees can choose the date and location most convenient for them.
A full brochure is included in this week’s packet and on-line registration is available at:http://events.SignUp4.com/UnlockICD10.
Wisconsin Hospitals Community Benefits: Charity Care
Fear of a bill should never prevent a patient from seeking care at a Wisconsin hospital. Wisconsin hospital charity care programs provided $232 million to more than 700 patients each day in 2010. The stories that follow illustrate the deep commitment and continuing concern that hospitals have to their patients to ensure they receive the care they need regardless of their ability to pay.
"I am so very grateful."
The costs related to just one serious illness can be enough to rock any family’s finances. After a series of medical crises in recent years and subsequent bankruptcy, a local couple is grateful for the financial help and bill payment options they received from Froedtert Health and Froedtert Health St. Joseph’s Hospital.
"It’s been a series of things," said John*, who is in his late 60s. He was treated several years ago for cancer and has heart problems. "Two years ago my wife hurt her leg pretty badly and had to be transported to the hospital. Then last year, I had to go to the emergency department and ICU. Fortunately, the financial assistance we had applied for earlier was still in effect."
John had been on disability for the last several years of his career and his wife, Mary, has had difficulty finding a job because of her own health problems. About four years ago, their mounting stack of bills was more than their insurance or income could cover. They were happy to learn that Froedtert Health could help.
"We got good counseling all the way along," John said. "I’d also like to mention that the care the nurses, assistants and doctors provided, we found to be very, very good. They made sure we had what we needed."
The Froedtert Health Financial Assistance Program assists patients who are unable to pay their hospital bills. Patients who qualify receive care with no obligation, or discounted obligation, to pay for services.
"We understand that billing and collection for health care services can often be confusing. And we know that, especially in these economic times, many families struggle to keep up with their bills," according to Amy Ciriacks, supervisor of admissions for St. Joseph’s Hospital. "Our financial counselors work with patients to answer their questions and to educate them about the options and programs that are available to people who are uninsured or underinsured. We also guide them through the application process."
"There are many options for bill payment that we want patients to know about, and we work to find the best solutions for them, even before they come to the hospital," she added.
Now that John is on Medicare, and with some help from other sources, the family is in better financial health. John said he wanted to share his experience with others who may also need help.
"I am happy to do it, because I am so very grateful," he said.
*Names used are not patients’ actual names.
Froedtert Health St. Joseph’s Hospital, West Bend
Preventing a potentially fatal outcome
Cholecystitis is a condition that occurs when the gallbladder becomes inflamed as the result of infection, gallstones, tumors or injury. If cholecystitis is not treated, the gallbladder may rupture or perforate. A ruptured gallbladder is an emergency and can be fatal if not treated aggressively.
Severe abdominal pain, caused by gallbladder infection, brought a 20 year-old woman into the Emergency Department at Aurora Memorial Hospital of Burlington. She was unemployed, uninsured and lived at home. Financial counselor Diane Mantey met with the young woman to let her know about the Aurora Helping Hand program and its benefits. The patient left to collect the few documents needed for processing the application.
Diane explained, "The patient came back within hours with all her documents ready for me to process." When Diane was able to tell the patient that she was eligible for the program and could undergo her surgery the next day, the patient was overcome with appreciation.
"I needed this gall bladder surgery so desperately and, with your assistance, I will be able to live without this pain," the patient said, through grateful tears, as she anticipated the care she would be receiving at the hospital.
Aurora Memorial Hospital of Burlington
Peter was going through a difficult time in his life. His wife left him, he was recently laid off, and he had just started a new job. With the stress of an upcoming divorce and a new job with an uncertain future, he moved in with his parents for support. At their suggestion, he was admitted to Aurora Psychiatric Hospital for the help he needed during this difficult transition.
Karen, lead financial counselor, was alerted to his admission when his case manager was unable to obtain authorization; the insurance carrier could not identify his coverage. You see, he elected not to take out the COBRA coverage offered by his former employer because he believed he was still covered by his wife’s insurance. However, during the separation, his estranged wife had removed him from her policy.
Peter was ineligible for insurance offered by his new employer for several months. Karen quickly reassured Peter that Aurora understands difficult situations like this, and she would find a program to help him. Because his estranged spouse would not provide any information, Karen worked primarily with Pete’s mother to obtain the necessary information.
After providing Peter and his mother with information regarding various prescription and Veteran’s assistance programs, Karen guided Peter’s mother through Aurora’s Helping Hand financial assistance application process. He received a discount and an interest-free payment plan for the remaining balance through Aurora’s Helping Hand program.
Peter’s mother sent an email to Karen’s manager to thank her. "Karen was very kind and empathetic to Peter’s situation. She told us of several alternatives for paying his bill. Would you let her know for me how much my husband and I appreciate her help?"
Aurora Psychiatric Hospital, Wauwatosa
Near the end of 99 weeks
Becky is a single female in her late 50s who became unemployed near the end of 2009. Becky went from a good-paying job to trying to make ends meet on unemployment benefits. Becky tried to keep a small health insurance plan with a large deductible and out-of-pocket coinsurance; however, the premiums became too high for her to manage when her savings was exhausted and she only had her unemployment income. To make matters worse, Becky was coming close to her maximum unemployment eligibility of 99 weeks, after which she would have no income. While still covered by her health insurance, Becky found herself in need of a total knee replacement. Her health insurance paid a good portion of her surgery and therapy but also left her with an unmanageable patient balance. Holy Family Memorial was able to assist Becky with a portion of her balance through their Community Care Program and reduce her expected payments to a more affordable amount monthly.
Holy Family Memorial, Inc., Manitowoc
Man grateful charity care gives grandson fresh start
An elderly gentleman came in requesting to speak to a financial counselor. He had recently lost his wife, his only income was from social security and his grandson was living with him. His grandson was unemployed, had no insurance, and had previous medical bills with St. Mary’s. He spoke with one of our financial counselors requesting to pay for his grandson’s bill in small monthly increments. After reviewing his situation, it was determined that they would not qualify for a monthly payment plan, so our financial counselor suggested that he have his grandson complete a charity application. At first the gentleman strongly objected that they were not a charity case and that we should reserve that for others that truly need it. It took a somewhat lengthy discussion, some counseling and reassurance to convince him that it would be OK if all they did was complete the application and return with the required documents.
He left and returned a few days later with all of the paperwork in hand. The financial counselor reviewed the information and brought it to her manager for an immediate approval. We were able to approve the case at 100% that day while the grandfather waited in our Atrium. When he was informed of our decision he began to sob and remarked "Why is the Lord being so good to me?" He thanked us over and over again for resolving his grandson of his medical debt and allowing him a fresh start. As he left he emphatically stated that they would not forget what we did for his family and would definitely be sharing his story with others.
St. Mary’s Hospital Medical Center, Green Bay
Submit community benefit stories to Mary Kay Grasmick, editor, at
Read more about hospitals connecting with their communities at www.WiServePoint.org.
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