Amid dozens of friends and supporters of rural health care, Governor Jim Doyle signed the Rural Healthcare Access Act (AB 770) into law on April 19 at a location most fitting—a small rural hospital.

The new law (Act 190) creates an assessment on Critical Access Hospitals (CAHs) similar to that already in place for non-CAH hospitals. The revenue generated by the assessment will be matched with federal Medicaid funds and restore a 10 percent Medicaid cut to rural hospitals that took effect January 1. Act 190 also strengthens the rural healthcare safety net by increasing Medicaid payments for most CAHs and providing funding to boost efforts to bring much-needed doctors, nurses and other health care professionals into rural areas.

Ed Harding, the president and CEO of Columbus Community Hospital and chair of the joint WHA/RWHC task force that crafted AB 770, hosted the bill signing ceremony.

"What a great day for rural health care," said Harding before introducing Governor Doyle. "Our fine democratic process has allowed the 59 CAHs across the state to make a positive change via the very backbone of our country—our legislative process."

Fellow CAH CEOs Cindy Eichman of Stanley and Bob Van Meeteren of Reedsburg joined Harding at the bill signing. Physicians, community leaders, volunteers and other supporters of rural health care also came to watch Governor Doyle sign AB 770 into law.

"The Critical Access Hospitals Bill is a win for rural hospitals and taxpayers," Governor Doyle said before the bill signing. "Additional federal funds will help these hospitals avoid payment reductions and damaging cuts to jobs and services. And it will actually increase payments to rural hospitals that serve a lot of Medicaid patients. This is a good bill and it represents what we can do—even in these really tough national economic times—when we work together to support Wisconsin’s rural communities and hospitals."

The signing of Act 190 on April 19 culminates an intensive policy development and lobbying effort that began last year with the September 1 convening of the WHA/RWHC Task Force on Critical Access Hospital Payment Reform. The group, comprised of CAH CEOs from across the state, developed both the proposal that became AB 770 and the legislative strategy that helped gain relatively swift passage of the legislation in the State Capitol.

"This is a tremendous accomplishment for our rural hospitals and a great example of how early on-the-ground grassroots, coordinated with diligent lobbying in the Capitol, can build bipartisan support and move a good bill swiftly and smoothly through the process," said WHA Executive Vice President Eric Borgerding. "Our members embraced a strategy early on and rose to the challenge to get this done. The entire effort will serve us well as we prepare to take on the challenges we know are on the horizon for our hospitals and doctors."

The budget bill introduced by Governor Doyle early last year included hundreds of millions in cuts to Medicaid in an effort to address the state’s burgeoning budget deficit. The final version of the budget adopted by the Legislature included $635 million in cuts to the Wisconsin Medicaid program, but the budget did not specify how the Department of Health Services was to implement the cuts. Shortly after the budget bill was enacted, DHS developed a plan to implement the cuts, which included the 10 percent cut to CAHs, one of the few providers to take an across-the-board payment cut in DHS’s Medicaid reduction plan. Among other important provisions referenced above and detailed in previous editions of Valued Voice, Act 190 will restore those cuts beginning on July 1, 2010.

While AB 770 is now law, the work of implementing the new assessment is not over. Like the current PPS hospital assessment, the federal Centers for Medicare and Medicaid Services (CMS) must approve the CAH assessment. Watch for future WHA member communications on implementation of the CAH assessment and other key elements of the just-completed 2009-10 legislative session.

The 2009-10 legislative session began back in January of last year. Sixteen months and hundreds of individual pieces of legislation later, the session came to a close today (April 23) at 4:15 a.m. after the Assembly pulled another all-night session. While there are limited business floor periods scheduled in May, this morning’s action effectively brings to a close one of the most challenging legislative sessions in recent memory, characterized by a single overriding fact—an ever-tightening fiscal environment.

Driven by the worst recession in decades, fiscal decisions across the state often became matters of survival, and policy proposals reflected the reality that even the soundest ideas could be handcuffed by funding shortfalls. Despite these challenges, the 2009-10 Legislative Session provided WHA with opportunities to preserve, and in many ways enhance, the ability of its members to continue providing the highest quality in the nation to every patient that walks through their doors.

"It was a tough session from start to finish, but hospitals emerged quite well," said WHA Executive Vice President Eric Borgerding. "Our members really got involved this year, particularly on the grassroots side of things, and that made a huge difference. We also have a top-notch team at WHA, some of whom literally spent more time in the Capitol than at home the past few weeks. But that commitment to advocacy is not just in the government affairs department, it’s across the entire WHA staff."

According to the Wisconsin Government Accountability Board, WHA was officially registered to lobby on nearly 60 individual pieces of legislation and dozens of other specific budget issues and administrative rules. Below is a summary of some of the major legislative issues WHA engaged in throughout the session:

Legislation WHA Supported

PPS Hospital Assessment: Two years after it was first proposed, and with hospitals facing mounting losses from skyrocketing charity care and bad debt due to the expanding recession, the PPS hospital assessment was signed into law on February 19, 2009 by Governor Doyle.

The reworked assessment, which took months of work by WHA and state staff to craft in a package that finally met all of WHA’s board-adopted principles for supporting a hospital assessment, captured millions of dollars in increased federal Medicaid funding and improved hospital MA reimbursement rates for the first time in nearly 14 years.

With a portion of the assessment dollars going to fund childless adults’ coverage across the state in the BadgerCare Plus program. A year later, the hospital assessment continues to demonstrate it is a win for hospitals, their patients and Wisconsin.

CAH Assessment: See related CAH Assessment story.

Improvements to Physician Licensure, Nurse Survey: Included in the state budget, and in a very tight fiscal environment, 17 positions were added to the Medical Examining Board (MEB) to support regulatory and licensing functions. These positions are for the purpose of granting licenses and completing investigations in a more timely manner. Temporary staff for peak application times was also approved. The additions were in response to concerns expressed by WHA about turnaround times for investigations and licensure and improvements have been seen.

Also included in the budget was a motion to create and support a biennial survey of the nurse workforce. Funding for the survey comes from a $4 surcharge on nursing licenses. The first survey has already gone out and results will help greatly increase the accuracy and timeliness of nurse workforce planning efforts.

BadgerCare Basic: SB 484, Governor Doyle’s bare bones, low-cost health plan proposal for those on the waiting list for BadgerCare Core passed both houses of the Legislature. WHA secured several important amendments which will help ensure the intent of Basic as a safety-net health care program for low-income individuals who have no other options include and allow the public and the Legislature to monitor the performance of Basic and ensure that it functions as intended. These amendments include:

• Verifying monthly that individuals with coverage under Basic meet eligibility criteria.
• Requiring a quarterly report to the Joint Committee on Finance that includes information on claims paid, premiums collected, a description of any changes to benefits or premiums, demographic information on applicants and enrollees, and a description of the Department’s process for verifying eligibility.
• Ensuring that Basic applicants receive information about other coverage options they may qualify for and that may provide superior coverage:
• The Health Insurance Risk-Sharing Plan (HIRSP)
• Availability of dependant coverage under his or her parent’s health care plan if the applicant is under age 27
• The right to purchase continuation coverage under certain situations as provided by COBRA and any state or federal premium tax credits or other premium subsidies that might be available for that coverage.
• Preserving access to services by requiring payments to providers be no less than payments under Medicaid (however, deductibles will apply that are not required under Medicaid).
• Requiring an audit of program performance by the Legislative Audit Bureau.
• Ending the program on December 31, 2013

The proposal is now available for Governor Doyle’s signature.

Health Information Exchange: Legislation (AB 779) that authorizes the creation of a private-public entity to coordinate planning and implementation of a statewide health information exchange (HIE) system was approved by both houses of the Legislature. Under the terms of a $9.4 million federal grant to the Wisconsin Department of Health Services, the state must select a state-designated entity (SDE) to carry out these functions.

In testimony supporting the measure, WHA noted that hospitals in Wisconsin have invested tens of millions of dollars in recent years to advance their health information technology capabilities to provide safer, more cost-efficient and higher quality care to their patients. The bill is now available for Governor Doyle’s signature.

Transparency: AB 614 was signed into law as 2009 Wisconsin Act 146: www.legis.state.wi.us/2009/data/acts/09Act146.pdf. This new law will increase the amount of information health care providers and insurers disclose to health care consumers.

WHA worked closely with the bills’ authors to ensure the new law acknowledged hospitals’ continuous proactive transparency efforts and recognized their unique position to take advantage of existing infrastructure (including the electronic submission and collection of hospital data that is mandated under Wis. Stats Ch. 153), and transparency technology.

Due to amendments secured by WHA, hospitals will be able to comply with requirements in the proposals through both PricePoint and CheckPoint. The new law takes effect on January 1, 2011.

Criminal Prosecution for Unintentional Errors: In testimony supporting SB 657, a bill relating to the abuse and neglect of patients and residents, WHA noted that the proposal struck an important balance between protecting patients from egregious misconduct and not making a criminal out of a well meaning nurse or physician who makes a medical error. Importantly, the bill did not change current law regarding when criminal charges can be brought against a health care provider who acted recklessly or intentionally harmed someone.

While WHA also believed the bill removed a disincentive to become a health care provider and recognized that good faith errors in judgment do occur, but did not put patients at increased risk. SB 657 received a hearing in the Senate, but no further legislative action was scheduled.

Legislation WHA Opposed

Mandatory Overtime (MOT): Proposals banning mandatory overtime (AB 152 / SB 108) failed to advance by the end of the legislative session. Throughout the process, Wisconsin hospitals maintained that MOT is not a routine staffing measure, but remains a critical last resort to maintaining the highest in safety and quality for patients. On April 1, 2009, more than a dozen hospital leaders signed up to testify and close to 100 hospital advocates registered their opposition to AB 152 at a public hearing in Madison.

The only hospitals where MOT is documented as a serious issue are state facilities, and the fiscal impact to the state’s budget is over $5 million annually. Wisconsin hospitals continue to stand by their long-standing offer to sit down with all interested parties to discuss the larger issue of worker fatigue.

Loss of Society and Companionship: Citing the need to protect Wisconsin’s well-balanced medical liability system and the growing economic strain on the Injured Patients and Families Compensation Fund (IPFCF), WHA opposed SB 203 / AB 291. The proposal would have increased the number of medical malpractice claims by permitting adult children and the parents of adult children to make claims for loss of society and companionship in medical malpractice actions when the adult child’s parent or the parent’s adult child is injured.

WHA worked with the Wisconsin Medical Society, the Wisconsin Civil Justice Council, the Wisconsin Academy of Family Physicians, the National Federation of Independent Business and others to educate legislators on the issue. SB 203 passed the Senate, but was not taken up for a vote in the Assembly.

Medical Record Copy Fees: A last-minute provision added to the budget by the Joint Finance Committee last year set permanent limits on the fees that can be charged for copies of medical records. This issue has been contentious over many legislative sessions, and health care providers and medical record copying firms have for years complained that the amount they are allowed to charge does not cover the cost of making copies.

WHA spearheaded a major effort that sought a veto of all language relating to medical records access and copy fees, including a veto letter to Governor Doyle ultimately signed by 30 Democratic legislators.

In his veto message, Governor Doyle indicated that because the impact of some of the changes made in the budget requires further study, he directed DHS to work in collaboration with the Wisconsin eHealth Care Quality and Patient Safety Board to evaluate alternatives and to make recommendations that can be adopted in future legislation.

While the new law sets the allowable per-page fee that health care providers can charge for copies of medical records below the cost of making the copies and includes no provision for future price increases. But language that would have drastically limited fees for electronic copies of records and language that conflicted with HIPAA timetables and penalties was removed.

Discrimination Relating to Employer-sponsored Meetings: SB 585 prohibits discrimination against an employee who declines to attend an employer-sponsored meeting or to participate in communication with the employer around specific topics including religion, politics and union activity. WHA joined other employer groups in opposition to the measure on the grounds that employees would not be given the opportunity to learn the employer’s perspective on union activities and that the proposal potentially violates federal law.

SB 585 passed both houses of the Legislature and is now available for consideration by Governor Doyle.

School Conference/Activities Leave: AB 116 / SB 86 would have allowed any employee of an employer employing at least 50 individuals on a permanent basis, including the state, to take up to 16 hours of school conference and activities leave in a 12-month period. In discussing concerns with lawmakers, WHA noted the difficulties hospitals would have maintaining safe patient staffing levels should the bill become law, and highlighted the flexible staffing options already offered by hospitals.

AB 116 passed the Assembly, and SB 86 received a hearing in the Senate, but neither proposal was scheduled for any further legislative action.

Hospital Outpatient Clinic Charges: AB 207 related to patient notification of hospital clinic charges. As amended, the bill would have required a health care facility or health care provider to orally notify a patient, if an appointment is made over the phone, that they may receive a charge for clinic services in addition to a charge for provider services, which may be on a separate bill. If a patient makes an appointment electronically, the same notification would have to have been provided in writing or electronically within 24 hours of receiving the appointment request.

The bill required a health care facility or health care provider, upon request of a patient and before the end of the second business day after the request is made, to provide a good faith estimate of the charge for clinic services. Under the bill, insurers were required to disclose coverage information on charges for clinic services.

AB 207 passed out of committee in the Assembly, but outstanding questions remained relating to notification requirements and how to best address repeat or follow up appointments and no further legislative action was scheduled.

Radiation Technicians: 2009 WI Act 106 (www.legis.state.wi.us/2009/data/acts/09Act106.pdf) relating to the practice of radiography was signed into law by Governor Doyle. Among other provisions, Act 106 defines the practice of radiography, creates a Radiography Exam Board and defines their duties, creates licensure requirements, defines the types of radiography that can be performed with a license and defines who can practice radiography without a license.

At the hearings on this proposal, WHA expressed concern that the sheer volume of individuals requiring licensure, when added to the work surrounding creation of a new board and rules, would negatively impact the length of time now required to license other professionals and could affect the Department of Regulation and Licensing’s (DRL) ability to conduct and complete complaint investigations. Estimates are the new law will involve licensing more than 7,000 radiographers that are currently certified in Wisconsin, with a potential of licensing more than 10,000 individuals. This will make radiographers the third largest licensed group in DRL, just behind registered nurses and physicians in number.

Surgical Techs: AB 744 relating to qualification requirements for performing surgical technology for a hospital or ambulatory surgery center passed out of committee in the Assembly, but was scheduled for no further legislative action.

The proposal required that all surgical technicians be certified. Certification required that an individual graduated from an accredited program in surgical technology and passed a written exam. The bill also required 60 hours of continuing education every four years, and that proof of completion be submitted to the hospital or ambulatory surgery center. The certification requirement did not apply to individuals currently performing surgical technology.

WHA successfully lobbied for amendments to the bill that that ensured the requirements applied only to surgical technicians and that the technicians themselves would have tracked their continuing education requirements.

Emergency Volunteers: 2009 Wisconsin Act 140 (www.legis.state.wi.us/2009/data/acts/09Act140.pdf) is a new law that permits employees who are volunteer emergency responders to be late or absent from work if that lateness or absence is due to responding to an emergency. WHA worked with the bill’s authors to amend the proposal to not apply to employees that provide direct patient care in emergency rooms and intensive care units.

The annual Wisconsin Rural Health Conference is the forum for examining the issues that impact small and rural hospitals. This year, learn from the presenting experts and from each other as health care providers work find the courage to reinvent rural health care.

Scheduled June 23-25 at the Kalahari Resort in Wisconsin Dells, the conference will feature keynote speaker Maureen Swan, a nationally-known expert in identifying health care and consumer trends. She will focus on the long-term direction of health care in the U.S., the seismic industry shifts that will affect health care, and the top "must do’s" every health care organization should implement in order to thrive in the new era of health care.

In addition, this year’s conference will again offer the popular governance education track, offering board of trustee members and their CEOs sessions focused on health care reform, a board’s role in quality and patient safety, strategic planning and the changing role of boards.

The annual Wisconsin Rural Health Conference is a great way for hospital executives, leadership staff and trustees to take advantage of high-quality education, right in your backyard, at a fraction of the travel and registration costs of out-of-state events. Register before May 15 to take advantage of the early bird discount, and reserve a hotel room now to ensure the special Rural Health Conference group rate.

The conference agenda and registration are available online now at www.wha.org. Printed brochures will be included with the April 30 issue of The Valued Voice.

Dana Richardson, WHA’s vice president of quality for the past seven years, announced she will be leaving the Association and joining the staff of the American Medical Association (AMA) in Chicago. Her last day at WHA is May 21.

Richardson has been responsible for implementing WHA’s hospital quality program, a key component of which was the creation of CheckPoint (www.wiCheckPoint.org) in 2004. CheckPoint was the first voluntary hospital public reporting program in the country, starting with 15 measures and expanding to more than 90 measures today. Richardson helped facilitate and foster improvement in the quality of care provided by Wisconsin hospitals by encouraging member hospitals to participate in quality improvement collaboratives and through WHA’s participation in the Robert Wood Johnson Foundation’s "Aligning Forces for Quality" statewide grant.

In her new position at the AMA, Richardson will be the director of the Physician Consortium for Performance Improvement (PCPI) program. The PCPI provides performance measurement sets and other resources to help physicians in their efforts to improve the quality and safety of patient care. The PCPI is comprised of more than 170 national medical specialty societies, state medical societies, the American Board of Medical Specialties and member boards, Council of Medical Specialty Societies, health care professional organizations, federal agencies and individual members.

"While we are sad to see Dana go, we are at the same time happy to see that she will be taking on new and exciting challenges in health care quality improvement on a national scale," said WHA President Steve Brenton. "Dana has been instrumental in advancing Wisconsin leadership on clinical performance improvement, and I’m certain that she will be equally successful in her new position at the AMA."

On April 19, the Centers for Medicare & Medicaid Services (CMS) issued a hospital inpatient and long-term care prospective payment system proposed rule (IPPS) for FY 2011, which begins on October 1, 2010. The 1,296 page proposed rule covers a broad range of issues. Details on three major issues—the 2011 update factor, treatment of provider taxes for CAHs, and the 2011 proposed quality measures used for pay-for-performance—are provided below:

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The State Senate has confirmed Governor Jim Doyle’s re-appointment of WHA Information Center Vice President Joe Kachelski to the Health Insurance Risk-Sharing Plan (HIRSP) Authority Board of Directors. Kachelski’s new term will run through April 30, 2013.

HIRSP is the state’s health insurance program for medically uninsurable individuals who do not have access to employer-sponsored health insurance. The program currently covers 17,000 people. It is expected that the federal government will contract with HIRSP to administer the federal high-risk pool provisions of the recently-enacted health care reform law.

Kachelski joined the HIRSP Board of Governors in 2004 when the program was run by the Department of Health Services (DHS). In 2006, the program was converted to a quasi-governmental Authority and divorced from DHS oversight. At that time, Kachelski was named Vice Chair of the HIRSP Board and Chair of the HIRSP Finance and Audit Committee and continues in those roles.

On April 21, 2010, Governor Jim Doyle signed into law Assembly Bill 659 (2010 Wisconsin Act 209) that updates state statutes related to HIV and AIDS. This law eliminates the requirement for written informed consent for HIV testing by replacing it with an opt-out testing model consistent with the Centers for Disease Control and Prevention (CDC) recommendations. A letter that highlights the legislative changes regarding HIV testing consent procedures and the impact on providers when they perform HIV testing in clinical settings was sent to Wisconsin health care providers on April 22 (link below).

The Wisconsin Division of Public Health has added a Web page for clinicians to the AIDS/HIV Program’s website. This web page has links to the provider letter mentioned above, as well as a HIV testing fact sheet that can be used with patients and a sample script on how to offer opt-out consent. The web page will be updated over the coming weeks with more information regarding implementation of HIV testing under the new law, and is located at: http://dhs.wi.gov/aids-hiv/ClinicianResources/index.htm.

Direct questions to Wisconsin Department of Health Services staff Christopher Bering, HIV Screening Consultant: (608) 266-3073 or Kathleen Krchnavek, HIV Testing Technology and Policy Specialist:  (608) 267-3583.

The Wisconsin State Health Plan identifies the primary risks associated with unprotected sexual behaviors as unintended pregnancies and sexually transmitted diseases. These health conditions significantly affect the health of the public as well as the social and economic well-being of individuals, families and communities. Hospitals reach out to at-risk mothers to help them have safe, healthy pregnancies and a successful transition to parenthood. Education classes supported by hospitals focus on maternal and child health issues and help connect women to the social, emotional, and health resources they need to ensure good outcomes for mother and baby.

Meriter’s Prenatal Care Coordination Program teaches moms "to fish." Just as teaching someone to fish, rather than just giving them a fish, will help them feed themselves for a long time, this program helps pregnant women at high risk for early deliveries access and utilize the support and services they need to have healthy babies.

"We teach women how to advocate for themselves," says Krystal Wages, who along with Susan Lee, coordinate care for over 100 women a year. "Our goal is to foster independence."

In addition to health issues, many women served by this program have lives complicated by unstable home, economic and social concerns. Wages and Lee walk the women through the steps of exploring the housing, transportation, parenting and other resources available, helping them make the vital connections and filling out the necessary applications to ensure a more stable life for their babies. Moms also are encouraged to develop healthy habits by earning incentives for baby supplies through the Angelica’s Child program.

As an indication of the success of Meriter’s program, a recent state study highlighted the low rate of low-birth weight babies in Dane County and research is underway to duplicate the results here to other parts of the state.

"We are proud of our moms and the steps they take to give their babies a healthy start," says Wages.

We serve many young women through the Blanket of Love prenatal education and support program. Increasingly, the young women who participate are from long-term poverty and often have learning disabilities. Cherry was one such 19- year-old who came to us with little family support. Her mother died two years ago, and she had no contact with her own father. The father of her baby was involved with her and promised to be supportive.

Because of her learning disability and low literacy level, we needed to connect her to an especially attentive physician and had to accompany her to many appointments. She was helped with WIC nutrition eligibility and housing and was given much emotional support from me and the pregnant girls who are also helped by the Blanket of Love.

One day, Cherry called and told me that she and her boyfriend were moving to be with his family in Mississippi. I told her I thought that was a bad idea since she had everything well set-up for the completion of her prenatal care with a good MD in Milwaukee. The pull of love was too strong, however, and she left with him for the South.

A week later, I received a call from her from a shelter in Mississippi. She had been beaten by her boyfriend and sought refuge in a domestic violence shelter. She wanted my help to return home. I was able to contact her county case worker who was still active on the case and arranged for train fare. I met Cherry at the train station and helped her to get home. At our next meeting, the other girls in Blanket of Love were very forgiving and welcomed her back to the group with open arms. Their love and support is a real service to Cherry and her soon-to-be-born baby.

The Western Racine County Health Department, which is part of Aurora Memorial Hospital of Burlington, recently developed a new program called Club ABC to help address a growing health care need in the community.

According to Cheryl Mazmanian, director, Western Racine County Health Department, the area is seeing a higher incidence of teen pregnancy after years of decline. She said the trend reflects national numbers that show increases in teen pregnancy.

Club ABC is a group of pregnant or parenting teen girls, age 18 and under. The purpose of the group, which meets monthly, is to discuss parenting issues, provide support, and help build brighter futures for moms and their children. Currently, the program serves between 10 and 15 girls in western Racine County. Partial funding for the program comes from the United Way of Racine County.

"This is a high risk group and we share information critical to their overall health and well being, including immunization, nutrition, and developing parenting skills,’’ Mazmanian said. "Other focus areas include making sure they do not get pregnant again and stay in school."

Mazmanian said without this program, there would be no way to provide the type of high intensity interventions necessary in these cases. She said it’s difficult to connect with the teen moms because they are in school or working at jobs.

Alison Krings was pregnant with her first child. She had been diagnosed with a high-risk pregnancy and put on bed rest. Then, at seven and a half months, she lost her job as a restaurant manager, which also cost the mother-to-be her health insurance, and the chance to continue seeing her primary obstetrician.

"All I could think was, ‘I’ve never done this before. Who do I call, where do I go, what do I do?’" recalls Alison.

When Allison relayed her predicament to her high risk pregnancy specialist at Wheaton Franciscan, she was immediately connected with a financial counselor. By the end of the day, Alison and her baby had coverage once again. Wheaton financial counselors are experts at helping individuals and families navigate and interpret the numerous coverage options available to them. In Alison’s case, she qualified for BadgerCare, Wisconsin’s Title 19 program. They also connected her with the team at the St. Joseph Women’s Outpatient Center, which provides prenatal care and other women’s services.

"To have insurance available to you and to have people supporting you through that time is unbelievable," says Alison. "It makes you reassured to know there is someone out there helping you."

Milwaukee’s high teen pregnancy rate carries with it numerous problems, including premature births and high infant mortality rates. Recognizing the risks, and in an attempt to empower the mothers as well as focus on birth outcomes, the Aurora Midwifery and Wellness Center and a pediatric nurse practitioner from Aurora’s School-Based Health program joined to bring a unique program to pregnant teens at North Division High School.

The Centering Pregnancy® Group Prenatal Care program is the only one of its kind in the area, and possibly the state. Teens meet for two hours at the end of the school day, every other week for 10 weeks, to learn in detail about pregnancy, nutrition and childbirth, and to receive support from each other as well as from trained health care workers. To encourage bonding, the teens also perform minor health checks such as blood pressure and weight readings on each other.

While they meet in the school’s basement, the atmosphere is one of peace and sharing. Lights are low and music plays quietly. The floor is covered with a soft rug, and the air is diffused with the scent of essential oils. Healthy snacks, from juice to granola bars, are provided. The program’s creators, Midwife Eileen Nyholt, BSN, CNM, and Nurse Practitioner Vikky Carlson-Oehlers, MSN, RN, CPNP, hope to expand it to other schools.

"We want these young women to become the best moms they can be, to advocate for their babies and to get the best health care possible for themselves," Eileen said.

"Kids from urban settings, where there’s a lot of poverty, want to be cared for," Vikky said. "For some of them, this may be the first time in their lives they get this kind of one-on-one attention. They don’t know there’s a healthier way to live."

Outside speakers are brought in through the assistance of Susan Belanger, a community health worker with Aurora’s School Based Health program who also assists with activities and creates the peaceful atmosphere.

In addition to talks about labor, nutrition, exercising safely, newborn care and safety issues, the program includes information on birth control and domestic abuse.

"The idea is, take control of your body and your life. We can celebrate this pregnancy, but let’s plan for the future," Eileen said. "We hope they can start making informed decisions, become empowered and become better mothers."

As any new parent can attest, the first few weeks of parenthood can quickly turn from excitement and joy to stress, fatigue and exhaustion when babies cry. The stress of hearing a baby continually cry can drive some exhausted new parents to behave irrationally. Sadly, according to estimates from the National Center on Shaken Baby Syndrome, an estimated 1,300 infants in the United States are hospitalized or die from shaken baby syndrome each year. One in four babies die as a result of their injuries, and among those who survive, approximately 80 percent suffer brain injury, blindness and deafness, fractures, paralysis, cognitive and learning disabilities, or cerebral palsy.

Statistics from Walworth County Health and Human Services show that Walworth County recorded six cases of shaken baby syndrome between October 2007-January 2009. Deborah McDaniel, a county social worker, said the number of shaken baby cases in Walworth County is disturbing and added that it can occur in any family, regardless of income or education levels. She said the difficult economy is one of the primary factors driving these cases in Walworth County.

"Job losses and concerns about the economy add another level of stress to new families who may be struggling,’’ she said. "What we hope to do is provide these parents with the information and education they need to cope. There is no reason for shaking a baby. Six cases are six cases too many.’’

In response, Aurora Lakeland Medical Center is partnering with Walworth County Health and Human Services to provide information and education to address this issue. Now, all families who deliver a baby at Aurora Lakeland Medical Center –regardless of their financial status – receive information developed by the National Center on Shaken Baby Syndrome called "The Period of Purple Crying." The educational materials, which include a DVD and brochure, were made possible by funds donated by Aurora Lakeland Medical Center caregivers.

Dawn Haxton, registered nurse and manager of women and infant care services at Aurora Lakeland Medical Center, explains: "The program helps parents and caregivers understand the aspects of crying that can trigger the kind of irrationality that can lead to shaking or abuse. If new parents better understand this normal early crying period and know the strategies they need to employ to keep their poise and composure, they are less likely to feel stressed to the point where they shake their baby out of frustration or anger. ’’

"The Period of Purple Crying," which is also available in Spanish, is approved by pediatricians, public health nurses, child development experts and parents. It also provides suggestions for what to do for inconsolable crying.

Addressing community challenges associated with teen pregnancy is best achieved when the capacity of multiple community stakeholders working together is supported and strengthened.

For three years Aurora Health Care has sponsored a physician recital to raise money for the Adolescent Parenting Coalition, Inc. This nonprofit organization consists of a group of citizens, benefactors, legislators, service providers and businesspersons whose mission is to prevent teen pregnancy through education and awareness, but also to enhance the ability of teen parents to successfully raise their children and serve as a voice for educating the community on issues of teen pregnancy and parenting.

The physician recital featured solo performances by Aurora physicians and raised more than $20,000 in 2008 alone, bringing Aurora’s three-year fundraising total to more than $50,000.

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