May 20, 2011
Volume 55, Issue 20


JFC Approves WHA-Backed Budget Amendments
Medical record copy fees increased; Language on newborn screening fees clarified

An omnibus motion with a number of public health-related items, including provisions relating to the fees that can be charged for copies of medical records and the process for setting newborn screening fees, was approved this week by the Republican-controlled Joint Finance Committee (JFC) on a party-line 12-4 vote.

The motion was put forth by JFC Co-Chair Sen. Alberta Darling (R-River Hills), Sen. Sheila Harsdorf (R-River Falls) and Rep. Pat Strachota (R-West Bend).

Last session, an amendment supported by plaintiff’s attorneys was inserted into budget that set the per-page fee health care providers can charge at 35 cents per page for copies of medical records, well below the cost of making the copies, and provided no index to inflation.

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.

In his budget proposal, Governor Walker called for the repeal of the statute governing medical record copy fees and to instead have those fees set by administrative rule. WHA supported this provision.

WHA worked with major copy service provider IOD, Inc., the Wisconsin Insurance Alliance and the Wisconsin Defense Counsel on a compromise to set in statute fees that are closer to the cost of making the copies.

Among other provisions, the following maximum fees for copies of patient records were set: $1.00 per page for pages 1 through 25; $0.75 per page for pages 26 through 50; $0.50 per page for pages 51 through 100; $0.30 per page for pages 101 and over; $20 for retrieval of copies; $8 for certification of copies; $10 for a print of an X-ray; $1.50 per page for microfiche or microfilm; actual shipping costs; and any applicable taxes.

Newborn screening fee language clarified

Currently, the Wisconsin State Lab of Hygiene (WSLH) and DHS establish the fees for testing newborns for congenital disorders and its related program without legislative oversight. Last year DHS and the WSLH dramatically increased the fees without a vote by the Legislature, adequate public notice or comment, or input by affected organizations. WHA strongly objected to this action. (See previous Valued Voice articles at www.wha.org/pubArchive/valued_voice/vv8-20-10.htm#1 and www.wha.org/pubArchive/valued_voice/vv8-6-10.htm#4)

The Governor’s proposed budget included a WHA-supported provision to move the fee-setting process into administrative rules, which would allow for additional analysis, input and legislative oversight. The Joint Finance Committee voted to clarify the proposed language to ensure that both the WSLH and DHS fees would be subject to the administrative rule process.

The Joint Finance Committee is expected to wrap up its work on the budget, including major provisions on MA, in the next few weeks. Identical versions of the bill will need to pass both houses of the Legislature and then be returned to Governor Walker for approval and possible line-item veto.

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Register Today for the 2011 Wisconsin Rural Health Conference
The Osthoff Resort, Elkhart Lake *** June 15-17, 2011

Reminder… Osthoff Resort Room Reservation Cut-Off: Monday, May 23

Due to other large events in the area, it is very likely there will be no hotel rooms available after the May 23 cut-off date, so make your reservations ASAP.

More information and online registration is available at http://events.signUp4.com/Rural

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WHA Medicaid Reform Group Discusses Care Coordination

On May 12, the WHA Medicaid Reengineering Group (MRG) met to take on the challenging topic of care coordination in the Medicaid program. A series of guest speakers provided members an overview of possible challenges and opportunities to better manage care in the Medicaid program.

Guests included Curtis Cunningham and Marlia Moore Mattke from the Department of Health Services. As hospitals seek to improve care for all Medicaid patients—both fee-for-service and HMO enrollees—Cunningham was asked to provide an overview of Medicaid HMO performance requirements and care management activities. Mattke informed the MRG of a new project being undertaken by the Department to pilot health homes for fee-for-service SSI patients who have moderate or severe behavioral health conditions.

George Kerwin, President of Bellin Health System, along with Rebecca Ramsey from CareOregon, discussed ways that providers and managed care organizations can work better together to identify care coordination opportunities and improve care for patients. "When all parties come to the table to share information and identify common goals, the patient wins," Kerwin noted.

The MRG also hosted Larry Pheifer, executive director of the Wisconsin Academy of Family Physicians. Pheifer gave several examples of health home models that were successful at reducing costs and improving quality outcomes. He emphasized the importance of changing the payment structure and supports a blended payment consisting of care management and the usual fee-for-service payment. Pheifer also noted the startup and infrastructure costs that need to be part of the payment mechanism.

At its next meeting, the MRG will identify specific recommendations for improvements in care management in the Medicaid program. "We all agree that significant health care costs result from uncoordinated care," said Nick Desien, CEO of Ministry Health and Chair of the MRG. "It is going to take the combined effort of the state, managed care organizations and providers working together to overcome the challenges we’ve identified in order to implement effective care management strategies for all patients."

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New Quality Improvement Steering Committee Seeks to Align Improvement Activities

The Wisconsin Healthcare Improvement Coordinating Committee, created by the Wisconsin Hospital Association and the Wisconsin Collaborative for Healthcare Quality (WCHQ), held its first meeting in Madison May 16. The committee will monitor national and state level initiatives to help ensure the improvement agenda for Wisconsin is aligned to promote the best care possible for Wisconsin residents.

The multi-stakeholder committee is comprised of health care providers, members of the business community, and organizations whose mission includes health care quality improvement. The group will develop a catalog of current improvement initiatives across the state and then use that information to identify opportunities for collaboration.

"A primary goal for our group is to identify synergies, minimize duplication of efforts and approach improvement as broader communities," according to Kelly Court, WHA/WCHQ chief quality officer.

Organizations participating in the new committee include:

Wisconsin Hospital Association

Wisconsin Collaborative for Healthcare Quality

Aspirus System

Baldwin Area Medical Center

Holy Family Memorial Medical Center

Marshfield Clinic

MetaStar

Ministry Saint Joseph’s

Rural Wisconsin Health Cooperative

The Alliance

ThedaCare

University of Wisconsin Medical Foundation

University of Wisconsin Population Health Institute

Wisconsin Association of Health Plans

Wisconsin Manufacturers and Commerce

Wisconsin Medical Society

Wisconsin Primary Health Care Association

For more information contact Kelly Court at kcourt@wha.org or call 608-274-1820.

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WHA Information Center Welcomes New Employee: Dan Nagle

Dan Nagle recently accepted the software developer position with the WHA Information Center. Nagle will provide technical support and develop enhancements for a variety of web applications, such as PricePoint and WIPOP.

Nagle has 17 years of computer technology experience along with a background in health care. Prior to this role, he worked as a software engineer with Physicians Plus and Dean Health Plan. He holds a bachelor’s degree from the University of Wisconsin in history and a MBA from the University of Tennessee.

"We are fortunate to have Dan with us," said Geoff McAlister, senior director of information systems. "His experience will be a great asset for WHA Information Center as we look to expand and improve our products."

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President’s Column: WHA Member Survey Results Identify Top Priorities

Earlier this year, WHA commissioned a member survey in order to 1) Identify member needs and expectations; 2) Measure WHA performance; and 3) Assess the value that WHA members believe they are receiving.

Because WHA undertakes a members survey every couple of years, we have also been able to mark trends in the Association’s performance and benchmark WHA performance to that of other peer state hospital associations.

Over the next few weeks, this column will discuss results of the 2011 WHA leadership survey.

This week will look at members’ most challenging issues and the Association’s relevance as it relates to helping address those issues.

The top three member issues this year are: Reimbursement, Physician Workforce, and Health Reform Implementation. No surprises there.

Compared to member challenges as identified in 2008, there has been an uptick in all three categories, especially health reform implementation given the timeliness of that issue. In 2008, the "economy" ranked number three but disappeared as an issue this year. Importantly, the physician workforce issue emerged as a top tier concern in 2006 and has remained as a key priority going forward.

Importantly, 98 percent of WHA members believe WHA is relevant in addressing their top concerns, a slight increase from 2008. What is noteworthy is the fact that nearly three-quarters of WHA members view the Association as being "extremely relevant." That is a significant improvement as measured in the trending over the past several years. It is also the highest score measured by our vendor for our peer group.

Next week, this page will continue to highlight issues revealed in the 2011 member survey including member perceptions relative to WHA’s effectiveness, performance and value.

Steve Brenton
President

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Grassroots Spotlight: Rep. Marklein Holds Listening Session at Sauk Prairie Memorial

Rep. Howard Marklein held a listening session Friday, May 6 at Sauk Prairie Memorial Hospital & Clinics. Marklein sought feedback from area residents regarding his upcoming vote on the state budget.

In announcing the listening session, Rep. Marklein said, "The budget is a fluid and changing process; I want to keep my constituents updated with any changes to the proposed budget. This is a good opportunity for me to connect with my constituents and make sure they are informed about what we are debating in Madison."

Approximately 30 people attended the listening session, asked questions and provided comments during the two-hour discussion.

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Wisconsin Supreme Court Considers the Physician Duty of Informed Consent
WHA, WMS, and WACEP file joint amicus brief

The Wisconsin Hospital Association, Wisconsin Medical Society, and the Wisconsin Chapter of the American College of Emergency Physicians today (May 20) requested permission to file and filed a joint amicus brief in an important informed consent case pending before the Wisconsin Supreme Court.

The case is a medical malpractice action in which the plaintiff claimed that an emergency room physician was negligent diagnosing the plaintiff’s condition and breached her duty of informed consent by failing to provide the plaintiff with information about diagnostic procedures that could have been performed. The Court of Appeals held that that even though the physician made an appropriate diagnosis, she was obligated under Wisconsin Statutes to tell her patient that the diagnosis may be wrong and give him the option of submitting to additional diagnostic testing in order to rule out a condition the physician had ruled out by other means.

In the joint amicus brief, Guy DuBeau, an attorney with Axley Brynelson representing the amici, wrote, the amici "are resolute in their belief that the requirements imposed by the Court of Appeals are unworkable and that attempted adherence to those rules will not achieve the benefits the law intended but, rather, will undermine the delivery of health care in Wisconsin." Describing the effect of the Court of Appeals decision, DuBeau wrote, "If the rule is, as held below, that physicians are required to provide diagnostic options based on diagnoses not made, then the next question must be how far a physician needs to go to meet their legal duty."

The brief also describes the ultimate outcome of the Court of Appeals decision, "The system would be overrun by patients who desire the tests, but also by physicians who now feel they have no choice but to practice overly defensive medicine. This may, from time to time, avoid a truly unusual situation, but mostly it will delay access to treatment, run up the costs of treatment, run up the costs of insurance, make insurance less affordable and, since most insurance is provided through employment, suppress employment."

The brief points the Court to an appropriate interpretation of the informed consent statute that is workable in practice and preserves a patient’s right to compensation for physician error and does not harm societal interests. Watch The Valued Voice for updates on this important case.

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Nearly 100 Hospitals Participate in "Operation Vigilant Guard" Exercise
Hospitals made critical investments to ensure they are "ready to respond"

This week, nearly 100 hospitals in Wisconsin participated in a statewide emergency preparedness exercise with the Wisconsin National Guard called "Vigilant Guard." The Vigilant Guard exercise spanned several days while scenarios were staged that ranged from tornados and earthquakes to chemical spills and cyber attacks. Nearly 3,000 participants—representing up to 48 federal, state, county, volunteer and private agencies—responded to complex mock emergencies in several communities across the state during the exercise.

Marge McFarlane, lead controller for the Wisconsin Hospital Emergency Preparedness Program (WHEPP) "Vigilant Guard" statewide exercise, said that overall, the exercise went really well.

"The most important aspect of this exercise is that hospitals have practiced all these individual capabilities for the past five to six years," McFarlane said. "But, this is the first time we have been able to ‘play’ all together on a statewide level."

McFarlane said Vigilant Guard provided an opportunity to identify strengths and opportunities for improvement. Among the strengths she listed:

The opportunities for improvement are:

With the assistance of federal funding through the Wisconsin Hospital Emergency Preparedness Program (WHEPP) and using their own resources, hospitals across the state have invested in critical equipment, emergency preparedness planning and employee and volunteer training. All hospitals, large and small, have improved their capabilities to manage locally with their own resources, until resources from other hospitals and emergency responders become available.

"Hospitals have always been central to a community’s ability to respond to an emergency," said WHA President Steve Brenton. "Communities look to hospitals to take care of the sick or injured and coordinate relief and recovery efforts. Thanks to WHEPP, Wisconsin hospitals have invested heavily in planning and have tested these plans in exercises to be better prepared to respond to large-scale emergencies to save lives, ease suffering, and mitigate loss."

To learn more about the WHEPP program, see the 2011 WHEPP Annual Report at: www.wha.org/disasterpreparedness/pdf/wheppreport2011.pdf or visit www.dhs.wisconsin.gov/preparedness/hospital.

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Kohl: FTC Should Consider Drug Production Capacity, Potential Shortages in Merger Review

U.S. Senator Herb Kohl sent a letter to Federal Trade Commission (FTC) Chairman Jonathan Leibowitz on May 19 urging the FTC to consider the impact pharmaceutical company consolidation has on the nation’s limited drug supply. Prompted by recent news reports that doctors and hospitals are struggling with an "unprecedented surge in drug shortages in the United States," Kohl suggested that the industry’s capacity to produce vital medicines might have been hampered by a decade of industry consolidation. Kohl chairs the Senate Committee on the Judiciary Subcommittee on Antitrust, Competition Policy and Consumer Rights, which has oversight authority over the FTC.

In his letter to Leibowitz, Kohl writes: "Maintaining a competitive pharmaceutical market is the highest priority…While I recognize that often shortages are likely to have causes not related to these competition issues, antitrust enforcers—particularly when reviewing drug company mergers—must be cognizant of these shortages when applying antitrust law to the drug industry."

Kohl also cites a 2009 prescription drug pricing study authored by the Government Accountability Office, which contends "[f]ewer drug companies competing in a therapeutic class may lead to fewer prescription drugs being developed and sold within that class."

Hospitals have shared their concerns on this issue with members of Congress, including Sen. Kohl. WHA President Steve Brenton said the Association has received numerous reports from member hospitals that they are experiencing critical shortages of frequently used drugs. Practitioners are deeply concerned with the "ripple effect" drugs shortages could have on patient care.

"Our hospitals’ top priority is patient safety. The widespread and growing shortages of commonly-used drugs that they are now experiencing is forcing them into using less familiar substitutions," Brenton said. "Clinicians have no choice but to use drugs that they normally do not prescribe, which can delay treatment and therapies and create new shortages as the demand for substitute drugs overwhelms the supply."

The American Society of Health System Pharmacists (ashp.org) and the FDA (FDA.gov) are both posting information on the reasons for the shortages of specific drugs, the likely duration of the shortage, as well as leads on alternative drugs. WHA staff will continue to monitor the situation and work with Wisconsin’s Congressional Delegation to support any legislative efforts that could alleviate shortages.

The full text of Sen. Kohl’s letter is available at: www.wha.org/FTCprescriptionDrugs5-19-11.pdf.

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CMS to Host ACO Accelerated Development Learning Program

The Centers for Medicare and Medicaid Services will hold an ACO Accelerated Development Learning Program (ADLP) in Minneapolis June 20-22, 2011. The program is aimed at leaders in organizations that wish to become ACO entities. There is no cost to attend, but participants must register in advance at: https://acoregister.rti.org.

This meeting will provide executive leadership teams from existing or emerging ACO entities an opportunity to learn about essential ACO functions and ways to build capacity needed to achieve better care, better health, and lower costs through improvement. Four ADLPs will be offered in 2011. Each will offer a focused curriculum on core competencies for ACO development, such as improving care delivery to increase quality and reduce costs; effectively using health information technology and data resources; and building capacity to assume and manage financial risk.

The goal of these sessions is to prepare participants to:

  • Understand their current readiness to become an ACO
  • Identify organization-specific goals for achieving the three-part aim of improving care delivery, improving health, and reducing costs through improvement
  • Begin to develop an action plan for establishing essential ACO functions

Registration is available for teams of between two and four senior leaders from health care delivery organizations interested in forming an Accountable Care Organization (ACO) or from an existing ACO. At least one executive with financial/management responsibility and one with clinical responsibility should attend with each team.

The session will provide participants with:

Access to faculty with ACO experience. Faculty at each ADLP will be senior leadership from organizations that have already developed many of the characteristics of an ACO. These practitioners have first-hand experience with what is working and not working in the field.

Deep understanding of ACO core competencies. The ADLP will cover several core competencies and strategies for building ACO capacities. Individual sessions and faculty will help participants complete corresponding sections of a comprehensive ACO implementation plan, including defining ACO goals and an action plan for establishing ACO core competencies.

Guided start to developing an implementation plan. Participants will complete a comprehensive implementation plan for establishing the core competencies of an ACO, based on an understanding of their current readiness and gap analysis. Each organization will begin the crucial process of identifying specific goals for care improvement. Resources, toolkits, and faculty support will be provided to help participants complete, update, and prepare to implement a comprehensive implementation plan that includes benchmarks for developing each core competency over the next one to three years.

For more information or to register for this program, visit: https://acoregister.rti.org, or their Frequently Asked Questions page.

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Committee Unanimously Recommends Van Meeteren for WHEFA Board Appointment

This week the Senate Health Committee, chaired by Senator Leah Vukmir (R-Wauwatosa), unanimously approved the appointment of Bob Van Meeteren, CEO at Reedsburg Area Medical Center, to the Wisconsin Health and Educational Facilities Authority (WHEFA) Board. Van Meeteren’s appointment now moves to the full Senate for consideration and final confirmation.

WHEFA has been providing capital financing assistance for health care institutions since 1979. Its charter has also been expanded over the years to include the issuance of bonds for educational and non-profit research facilities.

Van Meeteren, whom WHA recommended for the appointment, was nominated by Governor Walker to fill a vacant seat on the WHEFA Board with the term expiring July 1, 2013.

"I am honored to be considered for this appointment and if confirmed, will do my best to be an active board member and advocate for the needs of all of Wisconsin’s health facilities," Van Meeteren said in testimony before the Committee.

Joining Senator Vukmir in the unanimous vote were Senators Pam Galloway (R-Wausau), Terry Moulton (R-Chippewa Falls), Jon Erpenbach (D-Middleton) and Tim Carpenter (D-Milwaukee).

Van Meeteren’s appointment is expected to be taken up by the full Senate in early June.

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Wisconsin Hospitals Community Benefits: Mental Health and Mental Disorders

Mental disorders vary in severity and in their impact on people’s lives. The symptoms can be severe and extremely destructive, causing immeasurable suffering for the patient and their families. Hospitals see an ever-increasing number of patients seeking treatment for mental disorders in their emergency departments. Hospitals that can offer inpatient treatment generally operate this service at a loss. With a disturbing shortage of mental health professionals, hospitals will continue to partner with each other and their communities to meet the growing demand for these services.

Free women’s heart disease support group

Edgerton Hospital is proud to offer a women’s heart disease support group in our local community. Together with WomenHeart, we provide a forum for women who are living with heart disease to exchange information and experiences, which can help reduce the feelings of loneliness, social isolation and shame that many women heart patients experience. In addition, educational speakers provide an opportunity to learn about this ever-changing disease. So many times women who have experienced a heart attack feel alone and isolated, as was the case for our group leader, Kathleen.

"I had a heart attack in 1996 at the Edgerton Hospital. I had the most wonderful medical treatment. The only thing missing was another woman to talk to about it. I felt very isolated and alone and as if I had done something wrong because no other women I knew had had a heart attack or heart disease. The missing piece to the puzzle was joining a support group with women that knew exactly what I was going through. Although I’m the coordinator for the group, I leave every meeting feeling as though I received much more than I gave. It has made all the difference in my recovery and my life."

The goal of these meetings is to improve the quality of life and the quality of health care for all women heart patients through support, information and advocacy. Edgerton Hospital and WomenHeart want to make sure that every woman receives early detection, accurate diagnosis and proper treatment. These meetings are free and are for women who have heart disease or who are at risk for heart disease. The support group meets on the fourth Thursday of the month from 6-7:30 p.m. in the cardiac rehab department.

About our partner—founded in 1998 by women living with heart disease, WomenHeart is a national program that is dedicated to reducing death and disability among the 8,000,000 American women living with heart disease.

Edgerton Hospital, Edgerton


Mental Health Task Force Receives Commitment from Amery Regional Medical Center

ARMC pledges $25,000 to help improve mental health awareness throughout the county

Amery Regional Medical Center (ARMC) committed to a contribution of $5,000 per year for a five-year period to help the Mental Health Task Force (MHTF) of Polk County reach their goal of increasing awareness of mental health issues. The Task Force is a non-profit organization composed of mental health professionals and interested parties from private and public facilities in Polk County.

As Amery Regional Medical Center celebrated over one year of offering behavioral health services to the region, they are committed to the success of the county program. In fact, Cindy O’Keefe, the assessment and outreach coordinator at ARMC’s Behavioral Health Center, is a member of the Mental Health Task Force. She has been instrumental in assisting with the development and implementation of the newly-formed program.

The Task Force worked together over the past two and a half years on a major campaign to "Reduce the Stigma of Mental Illness." The committee researched the most effective way to increase awareness of mental health issues and is currently marketing their program throughout the county.

Since Cindy helps families and individuals struggling with mental health changes on a daily basis at the Behavioral Health Center, she sees the difficulty patients deal with first-hand. "Sometimes people are faced with problems they simply cannot overcome by themselves. It’s hard to admit you need help and when a negative stigma is involved—it makes seeking help even more difficult."

The Mental Health Task Force of Polk County is dedicated not only to increasing awareness of mental health issues, but also to increasing access to affordable care. Cindy believes through proper education and improved access to mental health care, detrimental connotations can be reduced.

"The Task Force wants to squelch the negative through education, accessibility, and awareness. Asking for help and receiving it can lead to so many positive outcomes. Our success is everyone’s success," added Cindy.

Amery Regional Medical Center, Amery


Tinsel and Tears, because kids need access to grief counseling

Grief and loss are a part of life and affect everybody at some point. Children also can sometimes experience the pain and grief of loss. Often, though, adults have a difficult time talking with them about their grief and their feelings associated with loss, particularly when major holidays approach.

The Aurora Visiting Nurse Association of Wisconsin held a special day camp called Tinsel & Tears for grieving children ages 4-12 and their parent/guardian. Seven children participated accompanied by five parents/grandparents.

"The group of kids was pretty young but a couple of kids found enjoyment and meaning in using crafts to create positive memory experiences about their loved ones," says Harry Carlsen, bereavement coordinator for the Aurora VNA hospice. "As they worked on the craft projects, they were able to share stories about those people," he explained. "Since the losses of the seven youngsters were varied, it was clear that missing their loved one was a theme that we were able to work with," he added.

According to Mary Jane Misner, also bereavement coordinator with Aurora Visiting Nurse Association, it is not easy for parents, teachers and loved ones to approach children about their grief. The premise of the camp was to help foster ongoing conversation to sort out any lingering emotions and feelings.

"Open communication is one of the keys toward healing,’’ said Misner. "Children need to know that it’s okay to acknowledge these feelings and that they are not alone."

Aurora Lakeland Medical Center, Elkhorn


Women and men supporting each other: a matter of access and advocacy

Social and emotional support is a necessary component of prevention – and so is community leadership and advocacy. Grassroots leaders are the key. For African American women and men diagnosed with breast cancer, those leaders can be found in a unique advocacy-focused breast cancer support group.

Women and Men Supporting Each Other has over 100 members from Milwaukee, Racine and Kenosha Counties. Its mission is "…dedicated to support, education and enhancement for quality of life within the family and community, to bring about awareness of the effects of breast cancer and the need for early detection and treatment."

Oza Holmes, RN, MSN, OCN, breast care coordinator at Aurora Sinai Medical Center, is the principal force behind the group. She shared their philosophy:

"Women and Men Supporting Each Other is committed to providing education, support and enhancement to women and men challenged by breast cancer, and is concerned with the overall welfare of our community. We recognize there is a limit to the individual and collective resources available. Therefore, we are committed to providing an environment that allows for collaboration on the promotion of awareness, access, early detection and treatment to decrease the incidence of breast cancer."

All members of the group are active in community outreach efforts. Besides frequent participation in health fairs throughout the year, several members took mentor training with After Breast Cancer Diagnosis and are now certified to assist other African-American women and men in their communities. The members also work with the Wisconsin Breast Cancer Coalition (WBCC) on legislative issues and lobby in Washington, as well as Madison, and with the National Breast Cancer Advocacy Coalition to address health care issues and other issues surrounding breast cancer and access to quality cancer care for everyone.

Aurora Sinai Medical Center, Milwaukee


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

Read more about hospitals connecting with their communities at www.WiServePoint.org.

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