Two years after it was first proposed, on February 19 Governor Doyle signed the hospital assessment into law. The assessment was one of several proposals included in the bill aimed at shoring up the state’s finances for the remainder of the 2007-09 biennium and taking the first steps toward stimulating the economy and heading off a projected $5.7 billion deficit in the coming 2009-11 biennium.

"This is an example of what we can accomplish when we sit down and work through our differences," Doyle said to the media-packed room. "I want to acknowledge the willingness of the Wisconsin Hospital Association and hospitals across the state to get this done."

The reworked hospital assessment is a marked improvement over the previous version debated during the past two years. It took months of work by WHA and state staff to craft the package that meets all of WHA’s board-adopted principles for supporting a hospital assessment.

"The proposal signed into law today is a win for hospitals, our patients and the state," said WHA President Steve Brenton. "Not only will it result in a significant and much needed Medicaid payment increase for hospitals—the first in over a decade—it will help capture our fair share of federal health care dollars and allow the state to provide insurance coverage for uninsured, low-income childless adults statewide."

"Our members are being squeezed hard by increases in the number of uninsured patients coming to their doors," Brenton continued. "Charity care and bad debt increased by $85 million (20 percent) just last year. The increased payments from the assessment will help fill this deficit and the extended coverage for childless adults will mean more people will have health insurance."

The assessment is slated to take effect retroactively back to July 1, 2008. Steps for implementation are underway, with a net $200 million in higher Medicaid payments FY09 expected to start flowing next month and ahead of assessment payments. The first full year of implementation will begin July 1, 2009.

As it has throughout the past two years, WHA will be scheduling member conference calls in the near future to discuss next steps in implementation of the new hospital assessment.

Department of Health Services Secretary Karen Timberlake gratefully acknowledged the cooperation and assistance of the Wisconsin Hospital Association and its members in her remarks at the WHA Board of Directors meeting February 19 in Madison.

"The hospital assessment could not have happened without the cooperation between my Department and WHA…over many, many weeks," according to Timberlake.

Timberlake continued, "The hospital assessment is an absolutely critical part of the solution to the Medicaid program. I don’t know where we would be with the Medicaid program if it had not passed. I can’t thank you enough for your willingness to take some risk and ultimately be committed to where we need to go to ensure low-income families and individuals have access to health care," she said.

Timberlake said expanded coverage for low-income, uninsured childless adults would not have been possible without hospital support for an assessment. She said they are "working hard" to ensure access and provide coverage. One in ten Wisconsin residents are covered by the Medicaid program.

Referring to the number of people who are estimated to qualify for the childless adult coverage, Timberlake said, "There are 40,000-50,000 people in Wisconsin who should appreciate the work you have done on their behalf."

During the Governor’s Budget Address February 17, Timberlake said she was struck by the very somber mood in legislative chambers. She described the 2010-11 Biennial Budget as tougher than those in the past and as one that is affecting everyone in the state in unique and challenging ways. The Governor will continue to "fight hard," according to Timberlake, to maintain the gains that have been made in health care and education, and he will make "smart use" of the federal stimulus money and attempt to not create a deeper future budget hole.

The Governor’s priorities are to cut state spending and use the federal stimulus money to get people back to work so economic growth can occur naturally. Timberlake said the Governor is acutely aware that the one-time tobacco settlement money was used to plug a hole in the 2003-2005 Biennial Budget, which only created more problems downstream.

While there are an abundant number of reasons for concern with the state budget, the news is not all bad. Timberlake said the expansion to cover childless adults is certainly a bright spot in the Governor’s budget, and DHS is committed to continue to reform and modernize the Medicaid program.

The Governor included both a statewide smoking ban and an increase in the cigarette tax, which if approved, will mean a total tax of $3.52 on cigarettes. Timberlake said when Wisconsin raised the cigarette tax in 2008 by one dollar, 45 million fewer packs of cigarette were sold—a move that Timberlake called a "good public health investment."

An increase in nursing home rates of 2 percent, funded by a higher bed tax, is also in the Governor’s budget.

Timberlake said DHS remains interested in talking to health care providers to develop a way to better align incentives for how the State purchases health care. She believes that, for instance, when providers do a good job managing chronic disease, dollars should follow appropriately.

In conclusion, she thanked WHA members for helping move Wisconsin forward in a difficult budget environment and invited them to share their thoughts with the Department.

Brenton Outlines 2009 Association Goals

WHA President Steve Brenton presented the 2009 WHA goals to the Board. Historically, the Board received a very detailed document, but following member input, this year the goals were more broadly stated in an executive summary that outlined eight specific themes that relate to high-level goals. Each theme, according to Brenton, is backed with "a lot of specificity generated from work plans developed by WHA staff."

The goals reflect a series of proactive program priorities that advance key issues of concern to Wisconsin hospitals, health systems, and health care stakeholders who will influence and shape the future.

Eight themes frame WHA’s work priorities in 2009. They include: the hospital assessment, health reform, economic and social impact of hospitals, quality and safety performance, physician workforce challenges, health care workforce, government program reimbursement issues, and behavioral health.

The Board approved the goals as presented. Brenton told the Board they can expect to receive a specific set of outcomes for each goal at the end of the year.

Federal Stimulus Package Helps Fund IT Investments, Blocks IME Payment Cuts

The American Recovery and Reinvestment Act (H.R. 1), signed by President Barrack Obama on February 17, contains over $100 billion for health care. The Act provides $87 billion over 27 months through the Federal Medical Assistance Percentages (FMAPs). FMAPS are used to determine the amount of federal matching funds for state Medicaid expenditures. Wisconsin is in line to receive $1.3 billion through the 6.2 percent FMAP increase. In addition, the scheduled Indirect Medical Expenditure capital payment cuts have been blocked for FY2009, which means $5 million for Wisconsin, according to Brenton.

In addition, the Act provides:

• COBRA subsidies of 65 percent for those who are recently unemployed, which amounts to about $25 billion;
• Community health clinic modernization - $1.5 billion;
• Physician and nurse training grants in underserved areas - $500 million;
• $19 billion in hospital and physician "bonus" payments from 2011-2015;
• 2009 and 2010 tax incentives for banks and individuals to purchase hospital bonds (raises bank-specific limits from $10-30 million); and,
• $1.1 billion to NIH, AHRQ and HSS to develop and disseminate "comparative effectiveness" research that will be broadly disseminated.

Brenton said the Act also brings with it a "mountain of unnecessary and potentially expensive privacy regulation." For more detail on H.R. 1, see the Federal Spotlight article in this newsletter.

State Advocacy Overview

Brenton reminded the Board that just two years ago at the February WHA Board meeting a considerable amount of time was devoted to the Governor’s hospital tax proposal. "When we look at the journey between then and now, it has been significant," Brenton said. He thanked members for being a part of the process for the past 24 months. "I believe the Board handled this issue from an advocacy, technical and membership perspective extremely well. When I think of governance, I consider this process to be an example of governance done well," he added.

Brenton said WHA staff worked to align the development of the hospital assessment closely with the specific principles identified by the membership in determining what could and what could not be supported. He recognized WHA General Counsel Laura Leitch for her oversight and direct involvement on the myriad of technical details associated with the assessment and the bill.

Brenton provided the WHA Board an overview of the hospital assessment that was passed in both the Senate and Assembly on February 18. Governor Doyle signed the bill into law February 20, 2009.

Brenton walked the Board through some of the details of the assessment, emphasizing that it meets the WHA Board-approved principles, which include:

Safeguards are in place on the revenue

• The bill specifies the total assessment amount and includes a separate appropriation for assessment revenue.
• The statute will include a separate segregated fund for the hospital assessment revenue and will specify the uses.
• The statute will provide for hospital rate increases based on an explicit formula amount.
• The bill calls for depositing the difference between the assessment amount and the amount paid to hospitals as rate increases—also known as the "skim"—into the Medicaid Trust Fund.
• If CMS does not approve the assessment plan, the revenue that DHS cannot use for increased reimbursement and a proportional amount of the "skim" must be returned to the hospitals.

• The Administration included assurances in non-statutory language that it will continue to request General Purpose Revenue (GPR) sufficient to support existing Medicaid rates for hospitals (adjusted upwards to reflect intensity and caseload). A meeting with the Governor’s staff on this point is pending.
• HMOs are required to pass through 100 percent of their cap rates that are paid using hospital assessment revenue. HMOs are required to provide DHS with information that will ensure hospital payments are correct. Hospitals can appeal payments from HMOs.

• Critical Access and psychiatric hospitals are exempt from the assessment.
• DHS will base the amount of the assessment exclusively on gross patient revenues generated by the hospital.
• The bill requires quarterly assessment (except in the first year, which will be two).
• The assessments follow the payments, maintaining a positive cash flow.
• The bill permits DHS to approve delayed assessment payments for financially-challenged hospitals.

Brenton explained that the current assessment has major differences from what was proposed in 2008. The biggest difference, he said, is that the bill increases the reimbursement amount to hospitals by over $50 million annually and it specifies the reimbursement and "skim" through a formula. A portion of the "skim" will fund the new Medicaid childless adults program.

Budget Repair Bill and the 2009-2011 Biennial Budget

WHA Executive Vice President Eric Borgerding reported that the Budget Repair bill, which included a hospital assessment, passed out of the Senate and Assembly February 18 and was signed into law on February 19.

If this past week weren’t busy enough, on February 17 Governor Doyle introduced his 2009-11 state budget bill. Borgerding said the biennial budget is more than 1,000 pages long and WHA staff is still reviewing it. He said there is a reduction in the Medicaid budget, but the cuts are not specified and may be implemented administratively. The cost to continue the Medicaid program is going up, and staff is optimistic that DHS has done a good job estimating the impact the economy will have on Medicaid enrollment. DHS did build some savings into the Medicaid program, attributing a total of $1.2 million all funds savings to the statewide smoking ban.

Borgerding said WHA will continue analyzing the Governor’s Biennial Budget, but added the Legislative Fiscal Bureau does a thorough analysis of it as well.

The Governor’s Budget includes a new bureau and 15 FTEs within the Department of Regulation and Licensing (DRL) that will regulate those professions that currently are within the scope of responsibility of the Medical Examining Board. Borgerding said WHA views this as positive and hopes it will result in quicker licensure of physicians. The budget also includes a small amount of money for hiring LTEs at DRL during peak licensure times (May and December). WHA staff is hopeful this will reduce delays in licensing important, non-MD health professionals, including nurses. WHA will support keeping both initiatives in the state budget.

2008 WHA and WHAIC Financial Statements

WHA Senior Vice President George Quinn presented the December 2008 financial statements. He indicated that the statements reflect the combined results of both WHA and the WHA Information Center. Combining the two reflects the fact that the organizations operate closely together, and that the WHA auditors consider them as one in reviewing financial operations.

Commenting on the balance sheet, Quinn said that total assets and liabilities decreased by $637,000 from 2007 to 2008. Current assets were $317,000 lower primarily due to lower receivables and the timing of money being put into longer term investments. Current liabilities were lower by $251,000 due to the timing of deferred revenues. Equity was $237,000 less than 2007 due to investment losses in WHA. Fixed assets decreased by $103,000 due to the depreciation of new items purchased at the time of the WHA office move, and other assets decreased by $217,000, which includes investment losses.

Relative to the income statement, Quinn stated that operating income was $134,000 greater than budget, with WHAIC revenue and expense positive variances making significant contributions. WHAIC had a positive $41,000 variance due to sales of the PricePoint Web site (www.wiPricePoint.org) to other states.

Task Force and Council Reports

Behavioral Health Task Force: Task Force Chair George Kerwin said the group identified the most problematic issues at their first meeting. These were identified as: access, payments, workforce shortage, Chapter 51 deficiencies, emergency detention, health records and confidentiality. Access, workforce and payment issues surfaced as the highest priorities.

Quinn presented an overview of the Task Force’s charge, including developing recommendations on how to break down the barriers to care. The key to addressing that problem may well hinge on improving the relationships between the private and public sectors that are involved in behavioral health issues.

Council on Rural Health: Quinn said the Council on Rural Health spent their last meeting working on the agenda and identifying speakers and topics for the Rural Health Conference June 17-19. WHA’s Jennifer Frank said the Rural Health Conference is one of the only Wisconsin venues that provide governance education, and she encouraged members to register their trustees.

Council on Medical and Professional Affairs: Dana Richardson, WHA vice president, quality initiatives, presented an overview and update on WHA’s quality and safety initiatives. They were:

• Color-coded alerts: More than 100 Wisconsin hospitals have now standardized to the same colors for patient alerts prior to the March 1 deadline. Richardson said WHA will issue a news release around March 1.
• Wisconsin Pressure Ulcer Project: WHA is a member of the Wisconsin Pressure Ulcer Coalition, which now has a project manager. The project is modeled after a successful effort on the east coast. At the first learning session, more than 400 representatives from 23 hospitals, 85 nursing homes and eight home health and hospices were in attendance. It is, according to Richardson, the biggest cooperative effort of its kind in Wisconsin.
• Rural Health Stroke Improvement Project: In its second year, 29 rural hospitals participate in this project funded by the Wisconsin Office of Rural Health. Richardson co-leads the group with a representative from the American Stroke Association. This project is funded through June.
• Peer Review: Dr. Mark Edwards spoke at the last MPA meeting on peer review. Edwards found that there is no research on whether peer review is effective or appropriately structured. WHA Senior Medical Advisor Chuck Shabino, MD, said there are three takeaways from Edward’s research: 40 percent of those who completed a recent national survey on peer review said physicians were not engaged in the process. Second, regardless of the size of the hospitals only one percent of the cases reviewed are sent out for outside review. Third, Wisconsin and nationally, hospitals spend 0.2 of 1 percent of their operating budgets, which equates to one FTE per 100 beds, on support of hospital medical staff peer review activities.
• Stop BSI: This new initiative will include 30 states and will focus on eliminating central line infections associated with BSI in the intensive care unit. Richardson said information on this project will be distributed to hospitals soon. She said some hospitals have achieved zero infections in central lines, but it is still an opportunity that offers value to hospitals by creating an affinity group focused on hospital-acquired infections.

Richardson said the success that Wisconsin has had with statewide standardization projects, and the fact that the feedback from hospitals is extremely positive as it relates to these initiatives, sets the stage for perhaps tackling another statewide project. The Board directed WHA to form a task force to evaluate the need to standardize overhead pages in Wisconsin’s hospitals.

Beyond the somber tone related to proposed deep cuts in spending that will affect citizens all across Wisconsin, Governor Doyle’s budget plan includes several measures seeking to modify health-related services in the state.

Among the health care items included in his budget plan—in addition to an increase in the cigarette tax, increases in nursing home rates and in the nursing home bed tax, and the new regulatory bureau at the Department of Regulation and Licensing focused on professions that currently are within the scope of the Medical Examining Board (also mentioned in this week’s Valued Voice)—are proposals to:

• Change the funding mechanism for counties to encourage community-based treatment rather than institution-based treatment for mental health services.
• Allow enrollees in the BadgerCare Plus Benchmark Plan for Childless Adults to be eligible for the HIV/AIDS assistance program. Enrollees would have the option of enrolling in HIRSP in order to give them the opportunity to choose the program that best fits their needs.
• Establish a domestic partner registry maintained by local Registers of Deeds to allow for the registration of domestic partner relationships. Registered domestic partners would be extended certain dependent of survivor benefits for employee benefits, health and mental health and after-death decision making, probate matters, and motor vehicle titles.
• Increase the fee for birth certificates and other vital records by $2 to provide funding for a foster care public information campaign at the Department of Children and Families and to reduce disparities in birth outcomes.
• Expand access to the Wisconsin Cancer Reporting System (WCRS) data to certain qualified researchers and allow the department to charge fees for access. Fee revenue would be used to improve cancer data collection and reporting.

The non-partisan Legislative Fiscal Bureau’s thorough analysis of the Governor’s budget proposal should be completed in the next few weeks. The budget will then be debated by the Joint Finance Committee, which has tentatively planned public hearings for across the state. From there, each house of the Legislature will need to pass identical versions of the budget before it is forwarded back to Governor Doyle for his review and signature. The entire process is expected to be completed over the next several months.

WHA staff continues their ongoing in-depth review of the document.

Take advantage of nationally-recognized, CME-qualifying education offered in-state for your new or seasoned physician leaders—great education at a fraction of the travel and registration costs of out-of-state events.

Reminder:  Today, February 20, is the deadline for the group rate at The American Club.

Many are debating the merits of the American Recovery and Reinvestment Act. Is it stimulus or porkulus? Will it lead to economic rebound or stagflation? Is it "transformational" or an abomination? Setting aside that ongoing debate, what is not debatable is the fact that the significant HIT provisions within the package are seriously flawed. And that’s disappointing given the fact that proponents rightly tout digital health records as a necessary precursor for systemic Health Reform, especially delivery reform.

WHA’s health reform principles call for the rapid diffusion of information technology that should be encouraged, coordinated and funded by providers, government and payers as a way to improve quality, patient safety and cost efficiency. The good news is that the Reinvestment Act places a high priority on fast-tracking funding of hospital and clinic "meaningful" digital health records. Eligible Wisconsin hospitals may see as much as a quarter billion dollars in bonus payments beginning in late 2010 for capital investments. The Act also signals a national commitment to attain seamless digital data interchange between organizations using different vendor systems—a serious existing flaw and an impediment to achieving the sharing of information across systems of care.

The bad news is that Critical Access Hospitals (CAHs) are not considered "hospitals" by Congressional architects of the HIT Reinvestment Act provisions. Specifically, Congressional Conferees acquiesced to the demands of Ways and Means Committee powerhouse Pete Stark (D-CA) and rejected Senate language that provided CAHs with incentive payment funding parity. The rationale was that the rural hospitals are "already cost-based" and such funding would be akin to "double dipping." That argument was vigorously refuted by WHA, the Rural Wisconsin Health Cooperative (RWHC), AHA and others. Instead, the final legislation expedites up-front depreciation of HIT systems. The compromise will cost Wisconsin CAHs, especially early adaptors, tens of millions of dollars compared to the Senate version.

The other bad news is that the initiative is rife with unnecessary and expensive "privacy regulations." Again, efforts in the Senate to modify the onerous provisions were partially successful (Senator Kohl was particularly helpful and Gundersen Lutheran representatives did yeoman work). But the privacy zealots prevailed, apparently with Representative Stark as their benefactor. One early Wisconsin adaptor has closely examined the provisions related to establishing an "accounting of disclosures" of data requirement to and determined that associated compliance costs may be as much as $5 million, not including increased operating costs of 10-30 percent. If that estimate is accurate, the costs of regulatory compliance will significantly dilute the positive impact of new funding.

The serious flaws within the HIT provisions of the Reinvestment Act are disappointing. The rush to get the bill passed created an environment that just wasn’t conducive to getting it done right the first time. Now we need to redress the legislative shortcomings as quickly as possible.

Steve Brenton
President

Over the past month WHA has advocated diligently with our Members of Congress on key health information technology (HIT) provisions of the American Reinvestment and Recovery Act of 2009 (ARRA). Those provisions include HIT incentive payments for Critical Access Hospitals (CAHs) and onerous privacy provisions. President Obama enacted the ARRA into law on Tuesday, February 17.

Roughly $19 billion dollars in the AARA is provided to encourage the adoption of HIT primarily through incentive payments to providers. Initially only Prospective Payment System (PPS) hospitals would have been able to access the hospital incentive payments, which prompted WHA to aggressively advocate for "CAH parity." Details emerged after The Valued Voice went to press last week on what the conference committee ultimately decided to do.

Unfortunately, conference committee negotiators created a whole new approach for CAHs to access HIT dollars. Under the approach signed into law, CAHs will receive a type of "bonus" payment, whereas PPS hospitals will receive straight incentive payments via a standardized formula ($2 million x a Medicare share calculation x transition factor) for being a "meaningful electronic medical records user."

CAHs will essentially be able to expense the cost of their HIT investments in a single year and not have to depreciate that out for cost reporting purposes. The portion of their HIT cost that may be expensed will be determined using a Medicare Share calculation (similar to the PPS calculation mentioned in the preceding paragraph) PLUS an additional 20 percent (not to exceed 100 percent). While this provides a modest HIT incentive payment for CAHs, WHA is disappointed that these small, rural hospitals were not provided parity.

The ARRA also makes several significant changes to the federal HIPAA privacy laws, including:

• New accounting requirements for disclosures for payment, treatment and health care operations;
• Creating new notification requirements for breaches of privacy or security of protected patient information;
• Refining "minimum necessary" standards;
• Limitations on use of patient health information for marketing purposes;
• Requiring that patients have an opportunity to opt out of fundraising communications;
• Expanding HIPAA provisions and penalties to business associates of health care providers;
• New prohibitions on certain sales of patient health information;
• Higher penalties for HIPAA violations;
• Allowing persons harmed by a HIPAA violation to share in a portion of a monetary penalty or settlement; and
• Allowing state attorney generals to enforce HIPAA.

Hospitals are particularly concerned that the new accounting requirement would be an expensive new barrier to broader adoption of electronic health records without providing significantly new benefit to patients. The bill adds a new requirement for HIPAA covered entities to provide upon a patient’s request an accounting of disclosures of the patient’s health care information made through an electronic health record for purposes of treatment, payment and health care operations during the three years prior to the request.

Unless delayed by the Secretary of HHS, the accounting requirement will begin to apply on January 1, 2014, to disclosures from an electronic health record acquired before January 1, 2009, and on January 1, 2011 to disclosures from an electronic health record acquired after January 1, 2009. Additionally, many of the HIPAA changes require HHS to promulgate new regulations or guidelines during the next two to 18 months to fully implement the new requirements. WHA will join the American Hospital Association and others in advocating during that process on these provisions.

Watch for additional information in the coming months as details emerge.

The American Reinvestment and Recovery Act (ARRA) includes substantial funding to enhance the health care workforce. In all, the final plan contains $11.46 billion for this purpose. This includes $500 million in health workforce investments: $300 million for the National Health Service Corps and $200 million for primary care and other health care professions trained through Titles VII and VIII of the Public Health Service Act. All three components provide funding for primary care health professionals, which includes as primary care physicians, dentists and nurses; public health, and preventive medicine programs.

Learn about the major health care and hospital issues in line to be tackled by the new administration firsthand from keynote speaker Rick Pollack of AHA.

Worker fatigue is an issue that crosses many sectors, including health care, utilities, airline and transportation. In the health care industry, concern has centered on both patient and employee safety when very long hours or very many hours are worked.

An increasing amount of study and research has expanded what is understood about the role fatigue can play on outcomes due to shift length and/or number of days worked. There is evidence that long hours and fatigue can impair judgment, put employees at risk for injury and patients at risk for errors. Hospitals are working with employees to address the issue through appropriate, evidence-based strategies.

The Wisconsin Hospital Association Board of Directors has endorsed a document that outlines the Association’s position on worker fatigue and long work hours. In addition to the position paper, the Association sponsored a webinar in February that featured two member hospitals’ progress in addressing the issue. The notes from that webinar, along with many other resources on the issue of worker fatigue, are now in the WHA Toolkit at www.wha.org/toolkit/fatigue.pdf.

"Our members are engaging their staff in discussions and developing policy on how work is scheduled, discussing the importance of arriving at work rested, taking time off between shifts and taking scheduled breaks and time off between shifts," according to Judy Warmuth, WHA vice president of workforce. "All are important strategies to address the issue of fatigue," she added.

If you have questions about this subject or other workforce-related questions, contact Warmuth at jwarmuth@wha.org or 608-274-1820.

Six Western Technical College (WTC) nursing students completed a seven-week clinical experience at Black River Memorial Hospital last spring. This was the second class of nursing students from WTC to complete their medical rotation at Black River Memorial Hospital.

The students were guided by their instructor Ramona Yehle, RN, MS who has been teaching nursing students for 16 years. The students learned how to care for patients with an acute or chronic illness and worked with nursing and medical staff in the Medical-Surgical and Emergency Departments.

Ramona Yehle says the staff was extremely friendly, helpful and resourceful in making this a positive learning experience for the students. "WTC is looking forward to having students attend clinical sessions like these every semester," she says.

The students were in their third semester of a four-semester nursing program at WTC. They will graduate with an Associate degree and will be eligible to take the national/state N-CLEX exam, which when passed, they will become registered nurses.

Comments from the students:

"My experience at Black River Memorial Hospital was very educational and rewarding. I feel that I have gained much more knowledge in the medical-surgical area not only with the patient experiences that were great, but also with the staff experience. I was treated with respect and trust in my abilities to care for patients. I was very impressed with this hospital and all that it has to offer." - Stefanie Clements

"I was thrilled when I heard BRMH was allowing clinical groups to utilize their facility. Being from BFF, it is nice to see our great community expand not only in enlightening education, but in the hospitality of each and every staff member."  - Jenny Fisher

"I will admit that living 65 miles from Black River Falls, I wasn’t very excited to drive the distance. However, after the first day here my mind was changed. From the time Chipper (Wyss) pulled me out of my truck at 6:40 a.m. to sneak me in the side entrance and walk me to the med-surg floor so I didn’t get lost, I knew it would be a great experience. Everyone here was very helpful, friendly and willing to answer questions. Thank you all for the great learning opportunity." - Jason Augenstein

"I enjoyed my clinical experience at BRMH. It’s a great place to learn. We were able to work with the same nursing staff who were helpful and supportive. The hospital has the latest technology and safety equipment so it was safe for the students and the patients. The equipment is the top of the line and the nurses were very helpful. They also have electronic medical records which is much more efficient than paper charts." - Jen Jostad

"I really enjoyed my clinical experience at BRMH. There were so many opportunities for us here. I was proud of my hospital and I believe my clinical group could see the pride. Staff in med-surg and ER were especially diligent about keeping our learning experiences to a maximum. Thank you to everyone at BRMH for allowing us to learn and grow in your facility." - Kathy Guenther

"I really enjoyed being able to take part in a clinical that is in a rural area. It is a smaller hospital, but it offers a lot. I was amazed at how many services are offered – you get pretty much here as you get in a large medical center. I think working here would be a great experience and I think it makes you a "well-rounded" nurse. The staff was easy to work with and offered help when asked. They are all so knowledgeable in what they do. Thank you." - Jodi Soto

Aurora Sheboygan Memorial Medical Center sponsors the Go Girl Go program. Go Girl Go ensures that girls ages 9-14 who are not confident in their sports ability can participate comfortably in fun and healthy "girls only" activities. This sponsorship makes it possible for young girls to explore healthy eating options, learn high and low impact exercise, and address topics of interest and concern to adolescent females in a safe and secure environment.

The program is vital to adolescent girls in that it provides insight into their lives and thoughts much more than a young girl can get by confiding in a school counselor, teacher or parent. The girls are made to feel secure and comfortable in discussing their issues and asking questions of a knowledgeable professional or familiar staff member.

Aurora Sheboygan Medical Center has been a sponsor of this important program for three years. Approximately 18 girls attend each session. Three to four sessions are offered throughout the year. Pre- and post-testing demonstrates significant improvement in areas of personal growth and development and health and fitness.

For more than 34 years, Luther Midelfort Northland - Mayo Health System has been assisting the Barron County Elderly Nutrition Program with meal service to homebound residents on special diets. While the county reimburses the medical center a portion of the costs, the 3,041 meals were an additional $13,684.50 expense to the organization in 2007 due to additional staff time and food costs to prepare meals for those with diet restrictions. The facility also provides meals on the weekends for several homebound individuals that have no family in the area. With the help of the United Methodist Church Men’s Group, the meals are delivered to those who have no other means for a warm meal.

"The commitment of the hospital has made it possible for us (Office on Aging) to avoid waiting lists that exist in many parts of the country and to keep the meals affordable for the program participants," says Charlene Oftedahl, director, Barron County Office on Aging. "Partnering with the hospital to provide home-delivered meals has helped us serve more folks in the community...individuals who might otherwise continue to struggle at home and eventually end up in a health crisis."

Getting one’s life back on track from welfare to work can be an overwhelming task, but women who turn to Madison’s YWCA for help find they have access to many community resources that can make that transition more viable.

One of the newer services is Smiles for Success, a program run through Meriter’s Max Pohle Dental Clinic. Meriter and the YWCA collaborate on Smiles for Success to help women with dental and oral health problems who cannot afford the cost of dental care.

The impetus for the program came last year when Stanley Brysh, DMD, head of the Max Pohle Dental Clinic at Meriter, was picking up some dry cleaning and noticed a flyer for the YWCA’s Suits for Success program advertised in the window.

Dr. Brysh’s first thought was "How about a Smiles for Success program?"

Soon after, he and Meriter’s Community Relations Director Mary Carr Lee met to discuss the idea with Eileen Mershart, Executive Director of the Dane County YWCA. Eileen loved the possibilities that such a program could provide women in this region

The program is for motivated women who have the skills to be successful, but are being held back because they lack confidence due to missing, broken or decayed teeth. Smiles for Success offers free dental care to repair their teeth. Doing so helps address the embarrassment, pain or self-consciousness they may feel as they try to hide a smile. And, it makes them more likely to successfully re-enter the workforce and smile for success!

First announced at YWCA Circle of Women event in February, the program expects to serve 8-10 people each year. The program will also benefit Max Pohle Dental Clinic residents, as they will have an opportunity to get experience in a different aspect of dentistry.

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