Governor Jim Doyle will be the keynote speaker at WHA’s 2009 Advocacy Day luncheon April 1 at Monona Terrace in Madison. The deadline is fast approaching, so register soon.

"WHA is pleased that Governor Doyle will speak at our Advocacy Day program again this year," said WHA President Steve Brenton. "The Administration’s leadership in advancing coverage improvements and protecting health care in the face of the worsening state budget picture are noteworthy, and we look forward to hearing of future Administration priorities."

The seemingly recession-proof health care industry is reeling in today’s economy. Wisconsin’s community hospitals are treating an unprecedented number of patients who are either uninsured, receiving Medicaid benefits, or are unable to meet their deductibles. The symptoms are disturbing.

Today, the Wisconsin Hospital Association released a special report on the impact the economy is having on Wisconsin hospitals. Included in this week’s packet, a limited number of hard copies of the Special Report are available to member hospitals. The report is available for download at: www.wha.org/pubArchive/special_reports/WisHospitalsandEconomy2-2009.pdf, and it is in the WHA Toolkit under "Economy," at www.wha.org/toolkit/recession.pdf.

The report details the impact that the recession is having on the hospital workforce, finances and charity care. The rise in unemployment has been accompanied by the loss of employer-sponsored health insurance. In turn, more people are relying upon safety-net programs, such as Medicaid or on hospitals’ charity care programs for their health care.

Hospital margins continue to fall as hospitals take action to cope with the economic recession. In a recent survey, WHA member hospitals indicated they are reducing or freezing staffing levels, modifying, delaying or cancelling capital projects, and considering cutting back existing programs or services.

In spite of the considerable challenges facing them, community hospitals continue to provide free health screenings, support free medical clinics, and subsidize important services, such as nursing homes. WHA President Steve Brenton said all these services become even more urgent in tough economic times.

"While the nation weathers one of the worst economic downturns that most Americans have ever experienced, Wisconsin hospitals continue to be positioned to serve the health needs of their communities," Brenton said.

For information about the Special Report, contact Brian Potter, WHA, bpotter@wha.org, 608-274-1820. To request copies contact Liz Schumann at eschumann@wha.org.

In a recent survey, 98 percent of members rated WHA’s overall performance as ‘excellent’ or ‘good,’ with a 12 percent increase in the ‘excellent’ rating over the 2006 membership survey results. The overall survey results confirm that members continue to highly value WHA as a strategic partner.

Of the most challenging issues noted by members, reimbursement rated number one, yet had decreased by 10 percent from the 2006 survey results. The issue making the largest jump from 2006 to 2008 (an increase of 29 percent), and ranked as the number two most challenging issue overall, is physician workforce. This issue first surfaced in 2006, with significant time spent at that year’s Board strategic planning session on how to engage the membership in this issue. Physician workforce issues will once again be a focus, if not the focus, of the 2009 strategic planning session. Of special interest are the issues of the economy and access to capital. The access to capital issue nearly doubled in its ranking as one of the top issues in the 2008 survey. The economy, which was not even mentioned by members in the 2006 survey, registered with a 23 percent ranking in 2008.

"My guess is that if we conducted the membership survey today, we’d find the economy moving up on the ‘most challenging issues’ list," Brenton added.

Once again, advocacy was identified as the top expected benefit of WHA members, and 96 percent of the members ranked it being done ‘extremely well’ or ‘well.’ In addition, 97 percent of the membership ranked their WHA membership as an ‘excellent’ or ‘good’ value, which includes a 10 percent increase in the ‘excellent’ rating over the 2006 survey.

Brenton shared highlights of the WHA membership survey with the WHA Board at its February 19 meeting in Madison.

The WHA Board has been a big supporter of regular member surveys that identify the critical issues facing our community hospital members, assess member perception as to WHA’s potential role in managing those issues, and provide important feedback as to the Association’s performance. As mentioned and described in the Valued Voice article above, our most recent survey results were reviewed by the Board last week and will certainly be an important resource that shapes Association programming in 2009 and beyond.

Here are a few takeaways from the 2009 Member Survey:

• The economy, including access to capital issues, came out of nowhere and is now a top five issue. The economic environment wasn’t on the radar screen for the 2003 and 2006 surveys. And it probably would have hardly registered as a priority concern as recently as last summer.

• The physician workforce remains the top consensus concern of members. Survey results, combined with a pile of anecdotal evidence, confirm that the field is worried about how to best address the question…"Who will take care of our patients?"… in the not too distant future. The recent physician workforce report (www.wha.org/pubArchive/special_reports/2008PhysicianReport.pdf) from the multi-stakeholder Wisconsin Council on Medical Education and Workforce (WCMEW) provides clarity as to why those concerns persist. It’s also a good blue print for action.

• WHA’s diverse membership continues to view the Association as a valued strategic partner. Over the past two decades, WHA has evolved from an affinity organization to a trade association. That new reality means that members now make calculated decisions relative to their ongoing investment in their statewide advocacy umbrella. The evidence is clear that perceived value remains extremely high—at least as of December 2008.

• As an organization of diverse member opinion, WHA "survived" the hospital assessment debate. Survey results show no fallout from what has been (and will continue to be) an issue that engenders lively and legitimate member discussion and debate. The WHA Board’s strong leadership on the assessment issue was a case study in effective governance and leadership. More will be necessary in the future.

Steve Brenton
President

This week President Obama released an overview of his first budget bill. While specific details are not yet available, it is known that the plan creates a 10-year reserve fund of $630 billion to finance health reform efforts, with half of that amount coming from new revenues such as higher taxes on wealthier Americans, and the other half from Medicare program savings including:

• Bundling payments for hospital care and post-acute care
• Cutting payments to Medicare Advantage plans
• Paying hospitals with certain readmission rates less for patients readmitted within 30 days
• Linking a portion of inpatient hospital payment to performance on specific quality measures

In terms of how health care can be reformed in the future, President Obama also indicated in order to achieve the common goals of constraining health care costs, expanding access, and improving quality, he will work with Congress over the next year using the following set of eight principles:

Protect Families’ Financial Health. The plan must reduce the growing premiums and other costs American citizens and businesses pay for health care. People must be protected from bankruptcy due to catastrophic illness.

Make Health Coverage Affordable. The plan must reduce high administrative costs, unnecessary tests and services, waste, and other inefficiencies that consume money with no added health benefits.

Aim for Universality. The plan must put the United States on a clear path to cover all Americans.

Provide Portability of Coverage. People should not be locked into their job just to secure health coverage, and no American should be denied coverage because of preexisting conditions.

Guarantee Choice. The plan should provide Americans a choice of health plans and physicians. They should have the option of keeping their employer-based health plan.

Invest in Prevention and Wellness. The plan must invest in public health measures proven to reduce cost drivers in our system—such as obesity, sedentary lifestyles, and smoking—as well as guarantee access to proven preventive treatments.

Improve Patient Safety and Quality Care. The plan must ensure the implementation of proven patient safety measures and provide incentives for changes in the delivery system to reduce unnecessary variability in patient care. It must support the widespread use of health information technology and the development of data on the effectiveness of medical interventions to improve the quality of care delivered.

Maintain Long-Term Fiscal Sustainability. The plan must pay for itself by reducing the level of cost growth, improving productivity, and dedicating additional sources of revenue.

There are many important issues in play nationally and more will arise over the coming months. WHA will continue to partner with the American Hospital Association in advocating for changes consistent with WHA’s health reform principles (www.wha.org/financeAndData/pdf/accessprinciples.pdf).

Additionally, WHA will take the voice of Wisconsin hospitals straight to Capitol Hill during our yearly trip to Washington, DC. This event runs concurrent with the AHA Annual Meeting held April 26-29. If you plan to attend, please let WHA know.

Contact Jenny Boese at 608-268-1816 or jboese@wha.org on any of the above items.

Approximately 20 hospital employees, volunteers and Advisory Council members met with Rep. Kristen Dexter and her Chief of Staff Ilsa Peterson at St. Joseph’s Hospital.

Chief Executive Officer David Fish publicly thanked Rep. Dexter for her support of the hospital assessment proposal and being part of the team that quickly enacted this proposal into law.

Rep Dexter provided attendees with her perspective on Governor Doyle’s stimulus proposal and discussed various health care reform issues that could come up this year.

During the two hour meeting, the group discussed federal efforts on health care reform, including the American Hospital Association’s "Health For Life" platform.

The group provided insight on several state nursing workforce issues, including a proposal to ban the use of mandatory overtime and potential legislation that would mandate nurse-to-patient staffing ratios. With respect to the latter, the group provided Dexter with a recent study showing how mandating ratios in California (the only state to have adopted this) has been shown not to work. Additionally, the group discussed transparency and quality improvement initiatives, such as the Wisconsin Hospital Association’s CheckPoint program.

In closing, the group encouraged Rep. Dexter and her staff to attend WHA’s Advocacy Day event coming up on April 1.

Senator Cowles gets closer look at ThedaCare’s quality improvement

ThedaCare has opened the doors of its Friday morning "Report Outs" to state and legislative officials to increase understanding of the ThedaCare Improvement System among policymakers. A Report Out is a public reporting of all Rapid Improvement Events, or other lean-related activities, that happened during that week. By joining in these Report Outs, legislators can experience the steps that dozens of ThedaCare employees go through every week to improve patient care.

State Sen. Robert Cowles, a Republican who represents the Second Senate District which includes parts of Brown, Oconto, Shawano, Outagamie and Waupaca counties, says he was amazed by what he saw at a January report out.

"I wanted to see for myself how ThedaCare is becoming more efficient and improving care for patients," Cowles said. "There was a lot of enthusiasm and excitement in that room. I recommend it as something everyone should go through. I think people can learn a lot from it."

Sen. Cowles was the first of several Wisconsin legislators and state officials, including Department of Health Services Secretary Karen Timberlake, expected to attend Report Outs sessions in 2009.

By inviting policymakers to these gatherings, ThedaCare seeks to raise awareness about how its efforts to reduce waste have improved patient care while keeping costs down, said Jeff Hunter, ThedaCare’s senior vice president of planning and marketing.

"The marketplace currently doesn’t reward measurably better value," Hunter explained. "In their book ‘Redefining Health Care,’ Michael Porter and Elizabeth Olmstead Teisberg suggested consumers and payers should be able to compare health care providers on the relative value they produce for treating a medical condition. As a result of this form of competition, quality would increase and cost would decrease, continuously improving value. However, public policy is not moving the market toward these principles," he said. "We need the relative performance of providers to be available to consumers and payers, and for those providers who drive better value (like us) to be rewarded. This is why we engage policymakers in the conversation."

ThedaCare began to apply the principles and tools of the Toyota lean production system to its work in health care back in 2003. What emerged was their system-wide, continuous improvement initiative, ThedaCare Improvement System. The TIS reduces waste, eliminates errors, increases productivity and provides better value and outcomes to patients.

As for Sen. Cowles, he now has greater appreciation for how ThedaCare does business. "I came away with an understanding of why ThedaCare is No. 1 in so many areas. It was impressive to see employees talking and giving input," Cowles said.

Worker fatigue is an issue that crosses many industry sectors, including health care, utilities, airline and transportation. In the health care industry, concern centers on patient and employee safety when employees work very long hours or very many hours.

Wisconsin hospitals are working closely with their employees to develop evidence-based strategies to address the issue of fatigue. There is a growing amount of research on the topic which shows long hours and fatigue can impair judgment, put employees at risk of injury and patients at risk for errors.

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

The issue of fatigue, whether the cause is "mandatory" or voluntary hours (including long hours resulting from multiple jobs at different employers) demands an open conversation and creative solutions from all stakeholders, not narrowly-focused legislation or mandates, according to Warmuth. WHA supports constructive dialogue aimed at finding evidence-based strategies that ensure patients are cared for by staff that have not worked long hours, have had adequate time between shifts/jobs and can come to work rested, alert and safe.

WHA is concerned because a bill to ban mandatory—often unavoidable—overtime is now being circulated and will likely be introduced in the Legislature. If passed, this bill will restrict hospitals’ ability to care for patients in circumstances of very high census or acuity, or unexpected/unanticipated staff absences, while failing to address the underlying concerns of employee fatigue. WHA has sent a memo to Wisconsin legislators on this issue. A copy of the memo is available at www.wha.org/workforce/pdf/MOTlegMemo2-26-09.pdf.

WHA does not believe mandatory overtime is an appropriate, or frequently used routine staffing strategy. However, in order to protect patients it must remain an option in 24/7/365 health care settings.

"Hospitals must have the tools to respond to unanticipated/unexpected patient care situations—our patients deserve nothing less. This legislation will make it more difficult to manage their care," according to Warmuth.

WHA is a member of the Wisconsin Safety Partnership, a cooperative group of agencies and organizations, including OSHA, insurers, employers and the Department of Workforce Development, focused on worker safety. The partnership is working to educate employers and to develop strategies for a safer workplace for patients and employees.

The WHA Board of Directors has endorsed a position that outlines the responsibilities of both employers and employees relative to fatigue (www.wha.org/toolKit/fatigue.pdf). WHA has provided and will continue to provide education for its members on this topic.

The American Hospital Association’s free service to help tax-exempt hospitals field test the Internal Revenue Service’s new Schedule H for community benefit reporting has been extended to April 1. Through April 1, hospitals can confidentially submit a mock Schedule H to Ernst & Young tax specialists retained by AHA and receive feedback to help them clarify and improve their responses. Participating hospitals also can see aggregated information on how other similar hospitals completed the form, with identifying information removed.

Hospitals can complete the mock Schedule H online at https://survey.ey.com/ScheduleHProject/ or download a copy to mail or fax to the consultant. Hospitals must file Part V of Schedule H with the IRS for tax year 2008 and begin filing the full schedule for tax year 2009.

As of March 1, 2009, 78 percent of Wisconsin hospitals have met the goal to voluntarily standardize their color-coded alerts. Standardization of these alerts improves communication across the state and reduces the risk of an error when patients are transferred from one hospital to another, or physicians and staff work in more than one hospital. The WHA color-coded alert guidelines specify that hospitals should use red to signify allergies, yellow for fall risk and purple for do-not-resuscitate preferences. The standard colors apply to wristbands, as well as other visual communication tools that hospitals use to alert physicians and staff to patients unique needs and wishes.

In June, 2008, the Wisconsin Hospital Association Board of Directors recommended that Wisconsin hospitals standardize wristband and other color alerts used in their facilities. The goal is to achieve 100 percent voluntary use of the standard colors by March 1, 2009.

"Although we did not meet the 100 percent goal of statewide standardization by March 1, we are thrilled to be so close to the goal and are aware of additional hospitals that will have this process in place very soon," according to Dana Richardson, WHA vice president of quality initiatives. "This voluntary, statewide standardization project is yet another example of our hospitals’ commitment to work together to improve the safety of the care they provide to their patients," she added.

For more information about the Color Coded Alert Standardization project, contact Dana Richardson at drichardson@wha.org or 608-274-1820.

The list of hospitals that are already compliant is below:

Agnesian HealthCare/St. Agnes Hospital, Fond du Lac
Amery Regional Medical Center, Amery
Aspirus Wausau Hospital, Wausau
Aurora BayCare Medical Center, Green Bay
Aurora Lakeland Medical Center, Elkhorn
Aurora Med. Ctr. of Manitowoc Co., Inc., Two Rivers
Aurora Med. Ctr. of Washington Co., Inc., Hartford
Aurora Medical Center, Oshkosh
Aurora Medical Center-Kenosha, Kenosha
Aurora Memorial Hospital of Burlington, Burlington
Aurora Psychiatric Hospital, Wauwatosa
Aurora Sheboygan Memorial Medical Center, Sheboygan
Aurora Sinai Medical Center, Milwaukee
Aurora St. Luke’s Medical Center, Milwaukee
Baldwin Area Medical Center, Baldwin
Bay Area Medical Center, Marinette
Beaver Dam Community Hospitals, Inc., Beaver Dam
Bellin Hospital, Green Bay
Bellin Psychiatric Center, Green Bay
Beloit Memorial Hospital, Beloit
Berlin Memorial Hospital, Berlin
Black River Memorial Hospital, Black River Falls
Boscobel Area Health Care, Boscobel
Burnett Medical Center, Grantsburg
Calumet Medical Center, Chilton
Children’s Hospital of Wisconsin-Fox Valley, Neenah
Chippewa Valley Hospital, Durand
Clement J. Zablocki VA Medical Center, Milwaukee
Columbus Community Hospital, Columbus
Community Memorial Hospital, Menomonee Falls
Cumberland Memorial Hospital, Inc., Cumberland
Curative Care Network, Milwaukee
Fort HealthCare, Fort Atkinson
Franciscan Skemp Healthcare-Mayo Health System, Arcadia
Franciscan Skemp Healthcare-Mayo Health System, La Crosse
Franciscan Skemp Healthcare-Mayo Health System, Sparta
Froedtert Memorial Lutheran Hospital, Milwaukee
Grant Regional Health Center, Lancaster
Hayward Area Memorial Hospital, Hayward
Holy Family Memorial, Inc., Manitowoc
Hudson Hospital, Hudson
Indianhead Medical Center/Shell Lake, Shell Lake
Kindred Hospital Milwaukee, Greenfield
Lakeview Medical Center, Rice Lake
Lakeview Specialty Hospital and Rehab, Waterford
Langlade Hospital - An Aspirus Partner, Antigo
Luther Midelfort, Eau Claire
Luther Midelfort Chippewa Valley, Bloomer
Luther Midelfort Northland, Barron
Luther Midelfort Oakridge, Osseo
Memorial Health Center, Medford
Memorial Hospital of Lafayette Co., Darlington
Memorial Medical Center, Ashland
Mercy Health System Corporation, Janesville
Mercy Medical Center, Oshkosh
Mercy Walworth Hospital and Medical Center, Lake Geneva
Meriter Hospital, Madison
Ministry Health Care - Door County Memorial Hospital, Sturgeon Bay
Ministry Health Care - Eagle River Memorial Hospital, Eagle River
Ministry Health Care - Good Samaritan Health Center, Merrill
Ministry Health Care - Howard Young Medical Center, Woodruff
Ministry Health Care - Our Lady of Victory Hospital, Stanley
Ministry Health Care - Sacred Heart Hospital, Tomahawk
Ministry Health Care - Saint Clare’s Hospital, Weston
Ministry Health Care - Saint Joseph’s Hospital, Marshfield
Ministry Health Care - Saint Mary’s Hospital, Rhinelander
Ministry Health Care - Saint Michael’s Hospital, Stevens Point
Monroe Clinic, Monroe
Moundview Memorial Hospital & Clinics, Inc., Friendship
Osceola Medical Center, Osceola
Prairie du Chien Memorial Hospital, Prairie du Chien
Reedsburg Area Medical Center, Reedsburg
Riverview Hospital Association, Wisconsin Rapids
Rusk County Memorial Hospital and Nursing Home, Ladysmith
Sacred Heart Hospital, Eau Claire
Sauk Prairie Memorial Hospital, Prairie du Sac
Southwest Health Center, Platteville
Spooner Health System, Spooner
St. Clare Hospital & Health Services, Baraboo
St. Croix Regional Medical Center, St. Croix Falls
St. Elizabeth Hospital, Appleton
St. Joseph’s Hospital, Chippewa Falls
St. Joseph’s Hospital, West Bend
St. Mary’s Hospital Medical Center, Green Bay
St. Nicholas Hospital, Sheboygan
St. Vincent Hospital, Green Bay
Stoughton Hospital Association, Stoughton
Tomah Memorial Hospital, Tomah
Upland Hills Health, Inc., Dodgeville
UW Health Partners Watertown Regional Medical Center, Watertown
Westfields Hospital, New Richmond
Wheaton Franciscan Healthcare-All Saints, Racine
Wheaton Franciscan Healthcare-Elmbrook Memorial, Brookfield
Wheaton Franciscan Healthcare-Franklin, Franklin
Wheaton Franciscan Healthcare-St. Francis Hospital, Milwaukee
Wheaton Franciscan Healthcare-St. Joseph, Milwaukee
Wheaton Franciscan Healthcare-The Wisconsin Heart Hospital, Wauwatosa
Wild Rose Community Memorial Hospital, Wild Rose
Waukesha Memorial Hospital, Waukesha

The physician shortage is a complex issue, but the Wisconsin Council on Medical Education and Workforce (WCMEW) continues to face it head on to ensure that physician supply meets the future demand for care. WCMEW Chair Carl Getto, MD, senior vice president of medical affairs and associate dean for hospital affairs at the University of Wisconsin Hospitals and Clinics, presided at the February 25 meeting in Madison. The group reviewed the considerable amount of progress they have made in the last couple of years as they determined their focus for 2009.

WCMEW set the following priorities for 2009:

• Increase access to medical care in urban-underserved areas by attracting and retaining physicians. Programs are in the planning stages at both of Wisconsin’s medical schools aimed at addressing the shortage of physicians entering urban medicine, according to WCMEW member Byron Crouse, MD, and Ken Simon, MD, Medical College of Wisconsin. One successful model aimed at increasing the number of physicians practicing in rural areas, endorsed by WCMEW, was the creation of the Wisconsin Academy of Rural Medicine (WARM). The WARM program created a "school within a school" at the University of Wisconsin School of Medicine and Public Health (UWSMPH), admitting students who expressed a desire to practice medicine in a rural setting. The hope is that the two medical schools will be successful in attracting students to medical school who have an interest in practicing in urban-underserved areas.

• Expand the number of family medicine residency slots in Wisconsin. It is well-documented that physicians tend to set up their medical practice in the community where they complete their residency. Given the addition of medical students graduating from Wisconsin medical schools (i.e., UWSMPH class size will increase by 17 percent with implementation of WARM) more primary care residency positions (OB, pediatrics, internal medicine and family practice) are necessary to keep these students in Wisconsin for their post graduate training.

• Integrate the medical curriculum where practical between physicians and advanced practice professionals to assist in the early development of care models where health care professionals can have experiences together that help facilitate the development of a team approach to delivering health care.

• Retain physicians who are now practicing and attract physicians from other states to Wisconsin. Efforts will be ongoing to attract physicians to Wisconsin, while additional data is needed to determine why physicians leave practice. WCMEW will work with the Wisconsin Medical Society to develop questions that can be included in their regular survey of physicians that will help WCMEW develop strategies to address physician retention.

The lack of good data on the physician workforce continues to hinder WCMEW’s progress on several key issues related to retention and answering the question of why physicians leave Wisconsin when they complete their residencies. Wisconsin only retains 38 percent of the physicians who attend medical school here.

"We need better data regarding where, when and how physicians practice in our state in order to further develop recruitment and retention strategies," according to Chuck Shabino, MD, WHA senior medical advisor.

Efforts will continue to market the physician career Web site, www.WisconsinPhysicianCareers.org, launched last fall, aimed at keeping physicians in Wisconsin who train here, and bringing physicians back to Wisconsin. WHA Education Vice President Jennifer Frank said the statistics gathered to date on the site indicate that physicians from other states are visiting it with more than 6,000 visits made to the "job search," and more than 600 visits directed to "apply for this job." The Wisconsin Hospital Association, which created the site for WCMEW, has heard from several member hospitals that they have hired physicians who found their position through the Web site.

Frank, who is leading the marketing efforts of the Web site, thanked the alumni associations at UWSMPH and MCW for their assistance in building awareness of the Web site through email and postcards to their alumni. She said based on the data, the post cards and emails did boost the number of hits to the site, and plans are in place to continue those efforts with each new class of residents in late summer.

Members are encouraged to contact George Quinn with comments or suggestions for WCMEW, at gquinn@wha.org or 608-274-1820.

During the 20th Annual Institute for Healthcare Improvement (IHI) Forum, President and CEO Donald L. Berwick, MD, announced the continuation of their improvement campaigns with a new phase called the "Improvement Map."

One of the new interventions in the Improvement Map is the use of the World Health Organization (WHO) Surgical Safety Checklist. The checklist outlines essential standards of surgical care and is designed to be simple, widely applicable and capable of addressing common and potentially disastrous lapses. In order to jump-start the use of the Surgical Safety Checklist, Berwick threw down a challenge for the Checklist to be adopted and used in a least one operating room in every hospital by April 1, 2009.

The Wisconsin IHI Node, of which WHA is a member, has accepted the Surgical Safety Checklist Sprint challenge and is now challenging hospitals to join in and make Wisconsin one of the states where all hospitals have used the checklist by April 1. Hospitals that have not participated in previous IHI campaigns are welcome and encouraged to enroll in this challenge.

The Wisconsin Node is providing a ‘toolkit’ to assist hospitals in using the checklist. The toolkit is available at www.wha.org/qualityAndPatientSafety/ihi.aspx.

Wisconsin is a low-incidence tuberculosis state, meaning it has fewer than 100 cases of active disease per year. Most physicians will never see a case of active tuberculosis (TB). But what if you do suspect TB? Who can you call, what tests should you do, and what help can your local public health department give? What about multi-drug resistant TB?

From March 31 through April 1, The State of Wisconsin TB Program will provide a three-day training session on case management of tuberculosis infection and disease, followed by a half day intensive session on MDR TB identification, management, and ethical issues. National speakers will provide information on diagnosis and treatment of latent TB infection and TB disease, evaluation of chest radiographs, medications, new and existing laboratory tests, and more. Wisconsin speakers will discuss TB epidemiology and clarify what the risk factors are for TB in Wisconsin.

Physicians and nurses who are interested in learning more about TB can simultaneously learn the basics, question the experts, and get to know the public health nurses who will follow their patients in the community.

The conference will be held at the Country Springs Hotel in Waukesha, at a cost of $25 per day. Deadline for registration is Monday, March 9, 2009. The conference brochure is available on the Division of Public Health Web site at http://dhs.wisconsin.gov/tb/pdf/TBTrainingMarApr09-1.pdf. The conference will also be webcast live, and will be available free during and after the conference at http://media1.wi.gov/dhfs/catalog. 

If you have any questions, call Lorna Will, DHS, at 608-261-6387.

Joe started smoking when he was 12 years old. Building up to more than two packs a-day, he talked about quitting from time to time, but never seriously tried. Plenty of time for that, he figured. Older people get cancer. Not people in their 30s, not people who are in fairly good health. He was more worried about his mother, 57, who had smoked since she was 25.

Joe was 36 when he found out he had small cell cancer. He did not live to be 37.

Above is the radio ad The Richland Hospital used to promote the FREE Smoking Cessation classes that were held in 2007. Connie Dunn and Ceil Simonson coordinated and ran the free classes weekly for the general public in response to the hospital and clinic campus becoming smoke free.

The two worked with Greater Richland Area Cancer Elimination to provide a wide range of support materials to participants. The community rallied together hoping to provide the motivation, support and encouragement that people needed to quit smoking. The class is still running free of charge.

The Family Health Expo was created as a venue for Memorial Medical Center to do something significant in addressing the issue of access to primary and preventive health services, a priority of Healthiest Wisconsin 2010. Of the State’s four objectives for this priority, the Family Health Expo addresses three: increasing provider screening for chronic diseases and other improvements in system capacity for prevention; reducing barriers to health care access; and increasing access to oral health services.

Anyone is eligible to attend the Family Health Expo, as even people with health insurance are delinquent on health screenings, tests, etc. Our target population, however, is anyone who is uninsured or under-insured. This population has a far higher rate of utilizing Urgent Care or Emergency Room care, which is often more expensive – especially when accompanied by an ambulance transport.

The Expo provides free full physical screenings (including pap smear and vaginal exam for women) and free targeted health screenings (including prostate, colon cancer, breast, skin, hearing, blood pressure, oral health, and vision). For only $50, people receive comprehensive lab tests, including PSA, thyroid function, kidney & liver function, cholesterol, and blood sugar, which typically cost hundreds of dollars. Finally, we schedule qualifying women for a reduced-cost screening mammogram. The cost is $100, but for women who cannot afford this, we utilize funds donated by a local business, specifically targeting women who need mammograms, but are deterred due to cost.

Outside our facility, we set up tents with informational and interactive booths on medical services such as general and orthopedic surgery, sports medicine, physical therapy, cardiovascular disease prevention, diabetes education, health information privacy, obstetrics, health risk assessments, and more.

We have no geographical restrictions; however, our primary target includes residents of Clark, Wood, Jackson, Marathon and Eau Claire counties. We host the Expo on a Saturday, trying to lessen the conflicts with work schedules.

The Family Expo Team begins planning the event six months prior to the event, with bi-weekly meetings and additional independent work "on the clock." This equates to well over $50,000 of time in salaries and wages.

Membership includes: Scott Polenz - CEO, Dr. Shoaib Sheikh, Dr. Tim Meyer, Dr. Dean Funk, Tina Opelt – Nurse Practitioner, Lori Gregorich - RN, Chris Miller - RN, Liza Bourget - Medical Assistant, Sharon Struensee - Medical Assistant, Lora Wagner - Director of Public Relations & Development, and Audrey Borcherding - Communications & Development Specialist.

The higher level of medical expertise and variety of quality services offered to Expo participants is made possible through partnerships:

• A local dental office provides a dental hygienist to screen people’s mouths for oral cancer, gingivitis, and decay. The hygienist also provides oral health education materials and coaching.
• Two local optometrists will provide vision screening and "signs and symptoms" education.
• Clark County Community Services will provide a mental health doctor to have an interactive booth to discuss adult and youth behavior health, "signs and symptoms" of depression, etc.
• As mentioned earlier, a local business donated funds to target women who need screening or diagnostic mammograms but who do not have either of these due to cost.

To keep costs low, Memorial Medical Center’s administration, medical staff, and employees (approximately 115 individuals in total) all volunteer their time on the day of the Expo. We also ask vendors to donate supplies such as gloves, gowns, paper, envelopes, display boards, etc.

The success of the Expo is measured in a variety of ways, including:

• Abnormal test results detected at the Expo in 2007 included possible cervical cancer, enlarged prostate, hypertension, skin melanoma, suspicious skin lesions, and more. We communicate these results to patients, and help them to understand their options for treatment and prevention of future problems.
• Number of follow-up appointments made, resulting from an irregular screening or lab result received at the Expo. This is significant because it means that people (1) are now aware of a health risk/problem that they were not prior to Expo, and (2) they are being proactive in managing their problem, rather than letting problems persist and worsen. Last year, 48 patients registered scheduled follow-up appointments. This figure does not include patients who scheduled appointments at other medical facilities, which was equally encouraged.
• Of those who have registered for this year’s event, several attended last year. (We will have final numbers by August 16th.) These people will have health screenings two consecutive years, meaning access is possible and their mindset places their health as a priority.
• Hopefully, we will find increased community awareness and referrals from community organizations. As people register, we track how they heard about the Expo.
• Overall event attendance. In 2007, approximately 130 people attended. We are scheduling at a pace to exceed this number in 2008.
• Number of community organizations that ask to be part of the Expo, by reserving booth space. We had three businesses set up booths and one table of area not-for-profit organizations.

The repetitive message from Expo participants is summarized in the words of Ken and Patti Mitchell, participants of the 2007 Expo: "Dear Committee, My husband (Kenneth Mitchell) took part in your 8/18/07 Health Expo. We’d like to thank all of you for this affordable health check. Without health insurance, this was very, very helpful for us, and worth the drive."

Submit hospital community benefit stories to Mary Kay Grasmick, editor, at mgrasmick@wha.org.

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