March 13 marked the end of the 2007-2008 general legislative session in Wisconsin—a long and controversial law-making period complicated by a several-month delay in approval of the state budget and strong partisan differences.

As the 13-month regular session ends, a new, open-ended, "special session" begins, triggered by a projected $600+ million deficit. The budget situation required Governor Doyle to call the Legislature back into special session and introduce his version of a "budget repair bill," which he did this week. The Governor’s budget balancing proposal again includes the improved hospital assessment supported by WHA (see related story).

Once again, WHA ranked as one of the busiest lobbying organizations in the state. Based on data filed with the Government Accountability Board (formerly the Wisconsin Ethics Board) through December 2007, WHA logged 5,031 hours lobbying during the regular session, including 3,164 on the Medicaid issues in the state budget—the most of any lobbying organization in the state.

So what was WHA lobbying on? WHA registered lobbying activity on dozens of bills, in addition to a host of issue topics, bill drafts and state budget issue areas. As in years past, staff was instrumental and successful in supporting important legislation benefiting hospitals and opposing proposals that would be harmful. Here are some highlights:

Supported Legislation

AB 321, relating to state agency status for certain health care facilities, passed both houses of the Legislature and was signed by Gov. Doyle. While current law granted hold harmless protections to volunteers who offer assistance in times of a declared emergency, AB 321 extends state agent status protection to hospitals acting in the same declared emergency situation.

SB 310 gives more priority to an organ or tissue donor’s wishes, codifies some federal regulations regarding donation, makes other changes to make Wisconsin law consistent with the Revised Uniform Anatomical Gift Act, and provides DHFS with authority to create a donor registry. This bill passed the Senate and Assembly and is expected to be signed by Gov. Doyle.

SB 409 allows a pharmacist to dispense from a location that is not a licensed pharmacy. In the past, dispensing from clinics, offices and smaller locations that did not have a pharmacy license had only been allowed under a physician’s authority. This bill passed both houses of the Legislature and is expected to be signed by Gov. Doyle.

SB 487 is a first step in removing statutory barriers that impede the implementation of interoperable electronic medical records in Wisconsin. The bill removes some restrictions on the re-disclosure of medical records, disclosures of mental health and substance abuse records and disclosures to family and friends, and also removes some documentation requirements. This bill passed the Senate and Assembly and is expected to be signed by Governor Doyle.

SB 490 created a hospital assessment and Medicaid payment increase plan for hospitals, was passed by the Senate Health Committee, but was referred to the Joint Committee on Finance and not considered by the full Senate. As previously mentioned, language relating to an assessment and increased Medicaid payments for hospitals was included in Gov. Doyle’s budget repair bill.

The "Quality Improvement Act" related to strengthening protections against the use of quality improvement and regulatory investigations and reports in civil and criminal proceedings and maintaining medical malpractice as a matter for the civil, not criminal, courts. AB 863 was supported by WHA and 36 other health care and business organizations. It passed the Assembly on a voice vote, but disappointingly was not taken up by the Senate. The only organization that opposed the Quality Improvement Act, and which continues to stand in the way of these important reforms is…The Wisconsin Academy of Trial Lawyers.

AB 440 would have created a loan program for students in a Wisconsin Pharmacy school (currently there is only one school at UW-Madison) who agreed to practice in a professional shortage area of Wisconsin after graduation. This bill received a hearing before the Assembly Committee on Public Health, but did not receive committee vote.

AB 90 would have created a loan program for students in either of Wisconsin’s Medical Schools who agreed to practice in an underserved area of Wisconsin after graduation. This bill passed the Assembly Committee on Public Health, but did not receive a vote in either house.

SB 430 relates to certain changes to the Workers Compensation program. As part of the biennial "agreed to" bill process used in the Workers Compensation program, WHA staff—with staff from the Medical Society and the Wisconsin Chiropractic Association—stopped what would have been dramatic rate cuts for health care providers who treat injured workers. Without the rate cuts, WHA did not oppose the legislation. The bill passed both houses and the Governor is expected to sign the bill within the next two weeks.

Opposed Legislation

SB 512 would have prevented health care facilities from requiring (mandating) that individuals providing direct patient care work beyond an agreed upon shift or more than 40 hours in a week. Fiscal estimates related to the bill indicated a very high cost for state and county facilities to implement and confirmed what WHA has known for some time—to the extent there is a problem with mandatory overtime in Wisconsin, it is clearly a problem in state government facilities, not hospitals. This bill passed the Senate Labor Committee but was referred to the Joint Committee on Finance and did not receive a vote in either house.

Relating to the duties of coroners and expanding the requirements for reporting deaths to coroners to include, among other things, deaths of individuals receiving emergency care at a hospital or other medical facility and deaths associated with medical error. WHA opposed this proposal as requiring, in effect, mandatory adverse events reporting that would be operationally difficult, did not have adequate definitions, and did not include necessary protections. AB 783 narrowly passed by the Assembly Health Committee, but failed consideration by the full Assembly.

Other Legislation and Activities

Relating to adding to current immunity protections from civil and criminal liability for good faith reporting of possible law violations or standard of care violations. A WHA-proposed amendment was included that added immunity protections for reporting information to any prospective employer of an employee or former employee of a health care provider or facility relating to allegations of violations of clinical or ethical standards. AB 224 passed the Assembly and was approved by the Senate Judiciary committee, but did not receive a final vote in the Senate.

"Transparency" legislation, this bill would have required health care providers to respond to patient requests by providing (non-binding) price estimates for any of their services "within a reasonable period of time" and to disclose median charge information for a specified list of 25 procedures or services immediately upon a patient’s request. WHA testified for information only and worked extensively with the bill’s author to make changes to the legislation that made this a bill hospitals could implement via WHA’s PricePoint Web site. AB 729 was unanimously approved by the Assembly Small Business Committee, but was not taken up by the full Assembly.

Another transparency bill, AB 872 would have required multiple health care providers to be jointly responsible for delivering pricing estimates for the entire course of treatment of a patient’s care, within 10 business days of the time a physician first recommends a course of treatment. WHA testified for information only and again worked extensively with the bill’s authors to make changes to the legislation that made this a bill hospitals could implement via WHA’s PricePoint Web site. AB 872 passed the Assembly Health Committee and the full Assembly but did not receive a hearing in the Senate.

Relating to requiring health care providers to provide price estimates, similar to AB 729, but also requiring providers to provide MA payment rates for the provider’s 25 most frequently performed health care services. WHA worked with the bill’s author to improve the legislation and make it more workable, but SB 337 did not receive a hearing in the Senate.

Efforts turn to budget repair bill

The focus is now on the budget repair bill as Gov. Doyle and legislators grapple with a projected $650 million shortfall in the state’s general fund by the end of the current biennium (June 30, 2009). Among other ideas to address the deficit, the Governor has again included a hospital assessment as a vehicle to draw down additional federal dollars while at the same time providing much-needed Medicaid payment improvements for Wisconsin hospitals (see related story).

Earlier this week, Assembly Republicans countered with a budget repair proposal of their own that does not include a hospital assessment, but instead relies heavily on across-the-board agency spending cuts. Senate Democrats, who support the hospital assessment, have not yet acted on the budget repair bill. There is a vast philosophical divide between the two houses that suggests another protracted debate that could run well into the year. Stay tuned.

When Governor Doyle introduced his budget repair legislation this week, he included the much improved version of the hospital assessment. The proposal, which would result in dramatic and long overdue increases in hospital payments for treating Medicaid patients, is again supported by WHA (see statement below), but they are not alone. The Governor’s latest assessment proposal is also drawing the support of the state’s largest business organizations – the Metropolitan Milwaukee Association of Commerce (MMAC) and the Wisconsin Manufacturers & Commerce (WMC).

"We welcome and appreciate the support of the hospital assessment by the MMAC and WMC, two of the state’s most active and respected business organizations," said WHA President Steve Brenton. "They are moving beyond the notion that this is a ‘tax’ and recognize that simply talking about Medicaid cost shifting is no longer enough. The hospital assessment is a viable means of finally delivering much needed MA payment increases to hospitals, and we look forward to working with them as part of a growing and diverse group supporting the assessment."

WHA Statement Supporting the Hospital Assessment

The Wisconsin Hospital Association applauds Governor Doyle and Minority Leader Kreuser for continuing to pursue the hospital assessment as a means of improving historically abysmal Medicaid payments to Wisconsin hospitals and preserving access to safety net health care programs for our most vulnerable patients and their families. Additionally, the assessment will gain millions of dollars in federal funding that has been left on the table far too long, making this a "win win" proposition for lawmakers, service providers and patients.

Wisconsin’s budget situation, unless addressed, could jeopardize access to important health care programs while worsening the "hidden tax" which already raises the cost of health insurance because of cost shifting due to inadequate Medicaid payments.

The Wisconsin Hospital Association is committed to working with Governor Doyle and the Legislature to advance the best solutions to these immediate and ongoing challenges. We are working with Administration officials on important details of the proposal and believe that a well-crafted hospital assessment can and should be a component of a bipartisan budget solution.

Make plans now to join the more than 600 health care professionals, trustees and volunteers from across the state at WHA’s Advocacy Day on May 15 in Madison.

As always, Advocacy Day is a free event, so register your hospital contingent today. You can register today by visiting www.wha.org to view the brochure and registration information. Printed copies of the Advocacy Day brochure and registration form are also included in this week’s packet. For questions, contact Jenny Boese at 608-274-1820, or email jboese@wha.org. For more information about registration, contact Lisa Geishirt at 608-274-1820 or email lgeishirt@wha.org.

To schedule your appointment to meet with your legislator on the afternoon of May 15, contact Angela Miloszewicz directly at 608-268-1801.

George Quinn and Laura Leitch, WHA, and Tim Size, Rural Wisconsin Health Cooperative (RWHC), met with the Division of Quality Assurance (DQA) staff this week in the most recent quarterly "Hospital Forum." Otis Woods, Jane Walters, Cremear Mims, and their staff provided updates and new information:

• DQA staff provided the most recent quarterly hospital state and federal citation report. The reports provide valuable information concerning the number and types of citations DQA issued during the quarter. In an effort to educate hospitals concerning the compliance issues identified by DQA staff, the reports provide a brief description of the basis for the most common citations. The reports can be viewed on the WHA Web site under legal and regulatory.
• The meeting participants discussed the current CMS position concerning when CMS would be willing to waive the 25-bed limitation for critical access hospitals that are in an area experiencing unusually high demand related to a public health emergency or some other occurrence. A number of hospitals are working to meet the needs of their communities during the current flu epidemic. DQA will continue its discussions with CMS concerning this important issue.
• DQA is piloting a second location to intake hospital construction plans submitted to DQA for review. The pilot location is in Milwaukee.
• DQA advised that Rural Health Centers are now priority level 3 for the DQA survey staff, moving up from priority level 4.
• DQA provided a number of memos and publications from CMS that are available for review on the WHA Web site.
• Woods described the process DHFS is using for updating HFS 124, the state’s hospital regulation. DQA has requested comments on their proposed amendments to the rule from a number of stakeholders and will consider changes to their proposal based on comments they receive. The amended draft will be circulated for comments prior to DQA starting the formal promulgation process.

DQA also provided the results of their post construction inspection questionnaire. After discussing with DQA a number of complaints about the post construction surveys conducted by DQA, WHA and the RWHC requested that DQA ask hospitals for feedback on the survey process. To date, 16 hospitals have returned the questionnaire and the comments have been uniformly positive. A copy of the results is available on the WHA Web site at www.wha.org/legalAndRegulatory/PostConstructionSurveyResults.pdf. WHA and RWHC asked that DQA continue to solicit comments concerning the process.

The Wisconsin Department of Health and Family Services (DHFS) intends to seek a further delay in the federal requirement that state Medicaid agencies collect National Drug Codes (NDCs) on Medicaid claims.

The requirement was originally set to become effective on January 1, but DHFS was successful in obtaining a three-month delay from the Centers for Medicare and Medicaid Services (CMS). The current Medicaid claims system is unable to accept NDCs, and a new system will not be implemented until October 1. DHFS will now attempt to convince CMS to delay the NDC reporting requirement until October 1.

Wisconsin hospitals have expressed concerns about numerous implementation details. It appears that most if not all hospital outpatient claims may be exempt from the NDC reporting requirement because Wisconsin Medicaid pays outpatient claims at a daily rate irrespective of the items or billed charges on the claim.

WHA is encouraging DHFS to issue definitive compliance instructions as soon as possible.

The public overwhelmingly says that the cost of health care is the central issue that makes "health care reform" so important to them. While much of the political debate is aimed at providing universal coverage, voters are far more concerned about their own coverage (which they rate highly) and whether or not they (and/or their employer) will be able to afford that coverage in the future.

If the central issue is cost then the prevention and management of chronic disease should be the focus of driving down those costs in a workable and sustainable reform scenario.

A new national organization, led by Emory University Professor Ken Thorpe, has been organized to make chronic disease the central health care issue in the 2008 presidential election. Thorpe was in La Crosse recently, appearing with former Governor Tommy Thompson to announce the formation of a Wisconsin chapter of the Partnership to Fight Chronic Disease. The group is designed to be a non-partisan, multi-stakeholder coalition of organizations committed to making chronic disease management the central strategy for dampening rising costs in the future.

Actually doing something meaningful about chronic disease prevention and management means getting serious about addressing personal responsibility (including penalizing individuals who continue to make unhealthy lifestyle decisions) and altering the current delivery system culture which rewards hospitals and physicians for "doing more stuff…not less." As Dr. Robert Nesse, Franciscan Skemp (La Crosse) CEO noted at the press conference, "The hospitalization of an asthma patient is a failure in the management of a chronic illness." But the current payment system, for the most part, fails to pay providers for managing asthma, or hypertension, or obesity.

Necessary delivery system reforms essential for managing chronic disease include: paying primary care physicians (and perhaps non-physician extenders) for effectively overseeing chronic disease; supporting claims-based data repositories that collect a full continuum of claims data that can then generate benchmarkable episodes of care data; the rapid diffusion of seamless EMR systems that will enable practitioners to better manage a chronic disease focused delivery system; and greater transparency that focuses on chronic disease measurements.

For some, a health reform platform founded on fighting chronic disease may not be as immediately appealing as promising universal access to LEXUS coverage that is somehow less expensive than the status quo. But if we are after results in the necessary struggle to control health care costs, that’s where our focus must be.

Steve Brenton
President

The Pharmacy Examining Board has been in discussions on the question of whether pharmacy technicians should be credentialed. The Board has invited a number of groups as well as some individuals to present their positions at the Board’s next meeting April 9. WHA has been invited to provide input.

Currently, Wisconsin Statutes do not require technicians to obtain a credential prior to employment. If that were to change, credentialing could be done in a variety of ways ranging from requiring an educational component, to testing, certification and possibly even licensure.

WHA will raise the following questions/concerns at the April 9 meeting:

• What would be the cost of credentialing to the pharmacy technicians, hospitals and the health care delivery system?
• Is there a risk of limited access to the required education or testing, especially in non-urban settings?
• What would be the impact on response times from the Department of Regulation and Licensing if the department were to become responsible for the credentialing process?
• Could there be a potential workforce shortage if barriers are created for individuals entering the workforce as pharmacy technicians?

The Pharmacy Society of Wisconsin is conducting an electronic survey of its members on the topic. WHA encourages hospital pharmacists and pharmacy managers to participate in the survey and invites hospital leaders to contact WHA with their comments and/or concerns.

New or enhanced regulation of occupational groups within health care has been a popular topic in this recently completed legislative session. Audiologists, radiologic technologists, physical therapists, and dietitians have all sought credentialing changes.

Judy Warmuth, WHA vice president, workforce, said, "Hospitals’ number one priority is patient safety. WHA is unclear if these changes would achieve any higher level of patient or public protection. The impact of more regulation, higher costs, and increases in the workload at the Department of Regulation and Licensing all must be taken into account before making a final decision regarding credentialing of pharmacy technicians."

Assembly Bill 321 was recently passed by both houses of the Legislature and signed into law by Gov. Doyle on March 12, 2008. This piece of legislation was a work product of the Joint Legislative Council’s Special Committee on Disaster Preparedness, of which WHA played a prominent role.

The piece of the legislation that is applicable to health care expands the current state law that provides for state agent status for specified types of volunteers at health care facilities during declared emergencies. The new law now provides state agency status for the health care facility itself.

"This hold harmless provision in the new law is exactly what was needed in light of the multitude of demands that will be placed on hospitals, especially during a time of crisis," says Dennis Tomczyk, state director of the Wisconsin Hospital Emergency Preparedness Program. "In addition to the volunteers themselves, the hospital now will be covered with state agency status that will provide important risk management cover in case of potential lawsuits. On behalf of all our communities here in Wisconsin, I want to thank WHA for its leadership in helping to draft the legislation, as well as with its efforts to guide it through the legislative process."

Several Wisconsin hospitals are among the hospitals that have reached a settlement in a long-running Medicare reimbursement dispute with the Centers for Medicare and Medicaid Services (CMS). The settlement was filed with the Federal District Court in Washington, DC on March 12, 2008. The dispute centered on the calculation of disproportionate share hospital (DSH) payments the hospitals were entitled to receive for services rendered in fiscal years that dated back to the early 1990s. Many hospitals, including four Wisconsin hospitals represented by Daniel Miller of Whyte Hirschboeck Dudek S.C., sued CMS and challenged its refusal to recalculate their DSH adjustments in light of the Agency’s 1997 acknowledgment that it had improperly excluded from the hospital’s DSH calculations, patients who were Medicaid eligible, but for whom the Medicaid Program did not pay for the services the patients received. According to Miller, the Federal District Court and Court of Appeals rejected CMS’s argument that it did not have to recalculate the DSH payments for the earlier years, and the Supreme Court refused to hear the Agency’s final appeal in 2006. The parties then conducted negotiations for two years aimed at a global settlement. The total amount CMS paid in settlement is more than $666 million.

The Wisconsin Department of Health and Family Services (DHFS) will soon issue an update to providers outlining changes in Medicaid and BadgerCare coverage for bariatric surgery.

The update will provide new instructions on the documentation of comorbidities and will add laparoscopic adjustable gastric banding to Medicaid’s list of covered procedures. Transverse gastroplasty will no longer be covered.

In addition, Medicaid and BadgerCare will cover bariatric surgeries only at facilities accredited as a level 1 facility by the American College of Surgeons or certified as a "Center of Excellence" by the American Society for Metabolic and Bariatric Surgery.

DHFS expects the update to be issued around April 1. The coverage changes will be effective upon the publication of the update.

On March 18, WHA is offering a webinar, "Preparing for the Recovery Audit Contractor (RAC) Program: An Overview - What Every Hospital Needs to Know," scheduled from 12 - 1 p.m. For one fee of $295 per phone line, you can educate your hospital staff on this important topic.

The webinar will be led by Kathy Reep, vice president of financial services at the Florida Hospital Association. Reep is integrally involved with the RAC program in Florida and has years of RAC experience under her belt. She will share their experience as a demonstration state, discuss the key differences between the demonstration and permanent program, and discuss how to prepare your facility for the RAC audits during this one-hour program.

"The experiences of the three demonstration states reveal the importance of the hospital association in educating members on this issue," said WHA President Steve Brenton. "This webinar presented by faculty who experienced it first-hand in Florida is one of the many means WHA will use to make certain our members are well informed as this comes to Wisconsin," he added.

Hospitals and health systems approach physician relationships from various perspectives based upon their respective needs and various operational, financial and regulatory concerns. The intensity of this integration may vary from a less intensive model (such as a medical staff relationship) to a more intensive model (such as direct employment).

On March 24 and 28, WHA is offering a two-part audionconference series, "Physician Integration: Options for Hospitals and Health Systems." These sessions will describe the various regulatory, financial, operational and practical issues faced by hospitals and health systems in aligning their interests with physicians. Part one of the series will discuss full integration and physician employment, as well as practice management models. The second part will discuss partial integration alternatives through partnerships, joint ventures, contractual relationships and other less-intensive alternatives. Each audioconference session is scheduled from 9 - 10 a.m. A discounted fee is available to those registering for both sessions.

The Wisconsin Healthcare Public Relations and Marketing Society (WHPRMS) is offering a professional development session for public relations, marketing and communications health care professionals May 15.

The program will be led by Anthony Cirillo, FACHE, ABC, and will focus on measuring return on investment. Determining and aligning your priorities with the C-suite; constructing marketing plans that set you up for ROI and on marketing audits that determine if you have the right skill sets to get it done will all be discussed. Building ROI mechanisms into your campaign, ROI formulas to follow and a case study will also be discussed.

The WHPRMS event coincides with WHA’s Advocacy Day, which will also be held May 15, at Monona Terrace in Madison. The WHPRMS seminar will be in the afternoon, which will allow registrants to attend the WHA Advocacy Day program and luncheon in the morning and the WHPRMS seminar in the afternoon. A separate registration and fee are required to attend the WHPRMS event.

Registration information for the WHPRMS professional development day event is available at www.whprms.org. For more information, contact Julie Wieser at julie.wieser@uwmf.wisc.edu or 608-265-1664. For information on WHA’s Advocacy Day, a free event that includes lunch, go to www.wha.org. You can register for both events on the WHPRMS registration form.

The Wisconsin Society for Healthcare Human Resource Administration (WSHHRA) will host its annual conference for human resource professionals May 7-9 in Wisconsin Dells. The conference will open with a keynote session focused on creating and sustaining a lean culture, presented by Cindy Mand of the BloodCenter of Wisconsin. A variety of timely concurrent session topics will be offered, as well as the annual legislative, legal and ASHHRA updates.

The convention will be held at the Kalahari Resort in Wisconsin Dells. Anyone who has human resource responsibilities in a health care organization will benefit from the educational agenda and is welcome to attend. Attendance is not limited to current WSHHRA members.

The Great Jeans Giveaway was held in 2006 to promote healthy attitudes about body image.

The event was launched with a free seminar, "Be Comfortable in Your Genes," led by an Aurora psychotherapist and conducted in the evening to accommodate more people. Throughout the week in Fond du Lac, Neenah and Oshkosh, community members cast their gently used "skinny jeans" into containers at local Aurora Health Center facilities and in return received encouragement to "change the size of their jeans to fit their genes." They also received educational materials about the health risks of eating disorders and invitations to free, confidential eating-disorder screenings offered at Aurora Behavioral Health offices in Oshkosh. Individuals identified at-risk were directed to appropriate behavioral health services.

In a culture that puts pressure on people to be thin, as many as 10 million females and one million males struggle with the devastating and life-threatening effects of eating disorders, anorexia and bulimia. Another 25 million battle binge-eating disorder. Their health risks include high blood pressure, Type II diabetes mellitus and high cholesterol.

The event sparked the interest of local schools and the Fond du Lac Department of Social Services, each of which asked Aurora Behavioral Health Services to provide educational programs in their venues on eating disorders. Jeans collected were donated to the Christine Ann Domestic Abuse Center and Salvation Army.

Elmbrook Memorial Hospital has joined forces with several key community organizations in a combined effort to put "Brookfield in Motion." The Brookfield in Motion initiative is a unique partnership between the hospital and several government, school and business organizations. The group’s common goal is to reduce chronic disease in the community through promoting healthy living, encouraging regular exercise, and raising awareness to the health and wellness services available throughout the community.

Collaborating groups include: Elmbrook Memorial; City of Brookfield Parks and Recreation, Police and Fire departments; Village of Elm Grove Parks and Recreation, Police and Fire departments; the Elmbrook School District, and Elmbrook Senior Center.

Whether is it encouraging community members to utilize the area’s numerous bike and walking paths, play with their family at one of several parks, listen to a health professional speak on a wellness issue or get up and exercise at the senior center, the Brookfield in Motion collaboration is committed to offering a variety of opportunities for exercise, improving the quality of life or becoming educated on wellness.

The collaboration allows for the coordination of promotional materials to provide wellness and healthy living tips through articles, fact sheets and web pages. Additionally, the group is able to combine resources for programs for both the senior population and school-aged children. This includes speakers on health-related information, community activities/opportunities during summer months and developing a calendar promoting wellness activities. Each year, an activity calendar is distributed to all elementary school students in the district which offers a daily suggestion for getting out and getting active.

To celebrate the start of its second year of the Brookfield in Motion campaign, the collaboration coordinated the "Brookfield in Motion Play Day," a free event for all local students on the first day of summer vacation. Play Day 2006 had over 300 in attendance and 2007 grew to over 500. Activities included free healthy activities for elementary and middle school students, mini massages for moms and dads, a Tai Chi demonstration, games and life skills activities and a bike safety course. Health-related information and handouts were available to all attendees.

Elmbrook Memorial is pleased to be a founding and active member of the Brookfield in Motion collaboration. Together with other local agencies, we hope to make a lasting difference in the health and wellness of the community we serve.

The American Society for Healthcare Engineering (ASHE) announced the recipients of its 2008 Vista Awards for health care building and design. The award is presented in three categories: new construction, renovation and infrastructure. Luther Midelfort Central Energy Plant, Luther Midelfort Mayo Health Systems in Eau Claire, Wis., received the infrastructure award. ASHE President Leo Gehring commended all the award applicants, adding, "Each entry represents a ‘win’ for the communities and patients served by these outstanding facilities." ASHE is an AHA personal membership group.

Global markets are currently experiencing heightened volatility. It is important to remember that capital markets are driven not only by underlying economic fundamentals, but by investor behavior and perception. We are coming out of one of the longest periods of strong economic growth, which has resulted in an annualized return of over 17 percent for the global equity markets over the last five year period. The current slowdown is rooted in concerns over today’s issues such as sub-prime investments, housing, and slowing corporate profits. Historically, however, market cycles like these are common. While negative market returns certainly do not "feel good" to the average investor, a long-term outlook coupled with appropriate managers and monitoring should help investors meet their objectives.

Measures such as tracking error and up/down capture are used to illuminate that managers have, and still are, adhering to a sound management process in negative returning environments. In market cycle slowdowns, these measures may assist in reducing risk while maximizing return, which will benefit investors who stay put over the long-term. Over a full market cycle, investors can benefit from a manager’s ability in both the up and down markets.

Are we in a bear market? Only time will tell. As of mid-January, markets are off as much as 15 percent from their peak last October, which by some definitions suggest we have experienced a "correction." With regard to a recession, we will only know if one has happened with the benefit of hindsight (two negative quarters of GDP growth), and markets may recover well beforehand (remember, markets are "forward-looking"). Our situation today, however, is not without some good news. The U.S. unemployment rate is below 5 percent, which is lower than its historical average (5.6 percent since 1950). Additionally, the global economy is stronger than ever and the Fed’s recent rate reductions will help buffer the economy as investor uncertainty persists. WHA Financial Solutions will continue to quantitatively evaluate and monitor those managers best positioned to maximize relative returns, while limiting volatility and risk. Focusing on the process, and not the ups and downs of the market, should help create long-term success.

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