As part of the 2010-2011 State budget, the Legislature and the Governor designated $600 million in savings to the Medicaid program. Those savings were not specified and it was left to the Department of Health Services (DHS) to identify where they would be generated. DHS involved providers, managed care companies, and members of the public in this effort, and convened several meetings over the past three months. These meetings produced over 500 suggestions covering provider payments, managed care organizations, and administrative savings.

On July 15, DHS released its list of recommended savings. In arriving at its recommendations, DHS stated that it wanted to maintain current coverage levels, continue expansion of coverage to the uninsured, and avoid across-the-board cuts to providers. Savings by category are outlined below.

Additional details on the savings:

• The bulk of the managed care savings would result from entering into a competitive bidding situation in Southeast Wisconsin, with the goal of reducing costs and increasing quality. In addition, DHS plans to reduce the amount of HMO capitation relative to administration.
• Of the $27 million in hospital savings, $18 million is identified as "Critical Access Hospital payment reform." DHS is sending a letter to WHA President Steve Brenton offering to work with WHA in identifying options for these savings.
• $28 million of the $56.8 million in physician savings is identified as "Evidenced-based health care initiatives." The intent is to align payment with value rather than volume.
• In the pharmacy area, $63 million of savings is expected to come from the transition from brand to generic drugs, and $45 million from alternative maximum allowable charge (MAC) pricing.
• For long term care, $15 million in savings is projected from updating acuity RUGs status on a more frequent basis, and $19 million from a one-month delay in Family Care payments.
• Of the $50 million in administrative savings, $20 million is projected from a one month delay in claims payments.

A complete listing of the sources of the savings is incorporated into the DHS PowerPoint presentation, which is on the WHA Web site at www.wha.org/financeAndData/2009RateReform7-13.ppt.

DHS will present its recommendations to providers and managed care organizations starting this week, and intends to begin implementation as early as August 1.

WHA will provide more details in the coming weeks. In the meantime, if you have any questions, please contact us.

WHA and the Rural Wisconsin Health Cooperative have joined to create a new Task Force charged with addressing issues associated with the Department of Health Services (DHS) recommendation to reduce Critical Access Hospital Medicaid payments. The new Task Force on CAH Payment Reform will be chaired by Ed Harding, president/CEO, Columbus Community Hospital.

"Our CAHs are ‘safety net’ providers in 60 Wisconsin communities," said WHA President Steve Brenton. "This potential payment reduction is troubling, especially for high Medicaid volume facilities that are already struggling financially."

In a letter to Brenton, DHS Secretary Karen Timberlake proposed that WHA work with DHS to "re-evaluate this (current CAH payment) methodology." Secretary Timberlake noted that the current cost-based methodology "creates significant inequities with non-critical access hospitals and appears to be unsustainable."

WHA and RWHC will work collaboratively on the important effort and regularly report to members.

This week a "tri-committee" of the U.S. House released the "America’s Affordable Health Choices Act of 2009," HR 3200. The legislation was developed jointly by the leaders of three key House committees: Ways & Means, Energy & Commerce and Education & Labor.

One of the central elements of the House legislation is an open-ended "public plan" option. WHA is particularly concerned by this feature as it would likely lead to the migration of hundreds of thousands of commercially-insured lives to a Medicare-type plan that pays physicians and hospitals less than the cost of care.

"Health care reform should be just that: moving us toward a better aligned system where payments reward performance," said WHA President Steve Brenton. "Cutting provider payments and then baking those low reimbursement rates into an open-ended public plan option is not ‘reform.’"

The legislation is more than 1,000 pages long, but following are some of the key provisions impacting hospitals:

• Payment rates: $119 billion in Market Basket reductions over 10 years. Includes a "productivity adjustment" for inpatient, outpatient, long-term acute care, rehabilitation and psychiatric hospitals.
• Public option: Provides a public insurance option that pays hospitals at Medicare rates; allows Medicare providers, including hospitals, to opt out of participation in the public option.
• Geographic adjustment: The Institute of Medicine will report on the validity and effects of the geographic adjusters used for physician and hospital payments, and make recommendations for improvements. In response, the Centers for Medicare & Medicaid Services (CMS) may spend up to $4 billion a year for two years.
• Medicare DSH: $10 billion in cuts. If the uninsured rate is reduced between 2012 and 2014, Medicare DSH payments are reduced beginning in 2017, to the "empirically-justified level," but with an upward adjustment for hospitals with high levels of uncompensated care costs.
• Medicaid DSH: $10 billion in cuts. Beginning in 2017, federal spending is reduced $10 billion over three years ($1.5 billion in 2017, $2.5 billion in 2018, $6 billion in 2019). No later than 2016, the Secretary must report to Congress with recommendations on the appropriate targeting of DSH payments within states, and the appropriate distribution across states. The methodology for cuts would depend on state rates of uninsured, and use of DSH money, which would be measured by uncompensated care and hospital Medicaid volume.
• Readmissions: $16 billion in cuts. Reduces payments in 2012 to hospitals, including critical access hospitals, based on the value of each hospital’s percentage of potentially preventable readmissions for three conditions. Beginning in 2013, expands the policy to an unlimited number of other conditions.
• Bundling: Calls for the HHS Secretary to develop a plan to reform Medicare payment for post-acute care services. The legislation does not call for additional bundling demonstrations, but converts the current Acute Care Episode demonstration to a pilot program by January 1, 2011, and expands the pilot program to include post-acute care and other services. Participation in the pilot is voluntary.
• Healthcare-associated infections (HAI): Requires hospitals and ambulatory surgical centers to report on HAIs to the Centers for Disease Control and Prevention.
• Healthcare-acquired conditions: State Medicaid programs are required to include policies that do not allow higher payments to a hospital if a patient gets a health care-acquired infection during the hospital stay, similar to the Medicare hospital-acquired conditions policy.

On a related note, the U.S. Senate HELP Committee passed its version of health care reform on a party-line 13-10 vote. The U.S. Senate Finance Committee is now the only key committee yet to release its official version of health care legislation.

Read the House bill online at: http://energycommerce.house.gov/Press_111/20090714/aahca.pdf.

Read the Senate HELP Committee summary of their bill at:http://help.senate.gov/Maj_press/2009_07_15_b.pdf.

A disturbing trend has emerged over the past couple of weeks in Washington, D.C. The health reform discussion has morphed into a debate about how much to cut provider payments so that "savings" can be spent to expand coverage for the uninsured. In addition to large Medicare cuts, the other area of focus has been on the "public (government) plan alternative".... whether or not there will be a Medicare-like program that will "compete" with commercial insurance. That issue is an ideological litmus test for many lawmakers and, like large Medicare cuts, is problematic for providers.

But the missing issue is....REFORM. The importance of aligning payment and delivery is an essential element of transformational reform. And transformational reform is a key principle in most state and national hospital association health reform platforms. Those statements of principle are supposed to serve as a roadmap to achieving lower costs and improved outcomes. So it’s problematic that specific initiatives that actually incent this alignment are missing in action at this late stage of the national debate.

Take a close look at the Senate HELP Bill and the House Leadership Bill and what appears to be included in the Senate Finance Committee legislation. The sum total as to how transformational delivery reform is recognized and incented in these proposals is just about nil, unless you count the nebulous discussion of Accountable Care Organizations (ACOs) and "demonstration projects" that might be encouraged (but no new dollars are identified in the proposals) beginning years from now. That’s just plain wrong.

Health reform must align payment with high level performance. No less than President Obama, just two weeks ago, called for such an outcome. That’s why WHA has joined with a handful of other state hospital Associations to support a value-based incentive approach. The concept of real reform shouldn’t be MIA.

Steve Brenton
President

Note: A couple of national stories have confused the efforts of WHA and others to advance a value-based incentive approach as somehow an "alternative" to AHA’s recent spending "agreement" with Senate Finance Committee Chair, Max Baucus (D-MT) and President Obama. We aren’t competing with AHA. We support AHA’s important work. Our effort is additive to the larger discussion.

A poll released this week by the University of Texas Health Science Center at Houston and Zogby International provides insight into the public’s leeriness on pending health care reform legislation. (See related article "House Officially Releases Health Care Reform Legislation.")

"By a 50-42 margin, Americans oppose the House of Representatives’ bill introduced July 14," said S. Ward Casscells, MD, vice president of external affairs and public policy and the John Edward Tyson Distinguished Professor in Cardiology at the UT Health Science Center at Houston. "This bill would call for most employers to sponsor health plans and would also create a Medicare-like plan for those under 65 who have no other health plan. The increased costs would be covered by increasing income taxes on individuals making more than $280,000 and families making more than $350,000."

A majority—59 percent—believe a public plan option would undermine private insurance companies. Only 28 percent believed it would not.

When asked how to pay for health care reform, respondents overwhelming opposed reducing federal payments to hospitals and decreasing payments to doctors and hospitals for procedures.

Regarding other funding options, more respondents than not indicated opposition to:

• Rationing health care
• Requiring employers to offer insurance choices and cover two thirds of the cost
• Requiring everyone in the U.S. to have health insurance
• Insuring everyone through a single-payer plan
• Increasing taxes on families making more than $250,000 per year

When survey respondents were asked how much they would be willing to pay in extra taxes so everyone would have health insurance, the majority responded, "zero."

The survey conducted by Zogby International is the largest poll this year to examine American attitudes toward health care reform and legislation. The online survey of 3,862 adults nationwide was conducted June 18-22, 2009, and carries a margin of error of +/- 1.6 percentage points.

This week the Health Information Technology (HIT) Policy Committee, a federal advisory committee created under the American Recovery & Reinvestment Act (ARRA), agreed by consensus to a revised definition of "meaningful use," a lynchpin definition to qualify for HIT incentive payments under ARRA. WHA and close to 800 others submitted comments in June to the Office of the National Coordinator for Health Information Technology (ONCHIT) regarding the initial draft definition.

"While we appreciate the HIT Policy Committee addressing several areas of concern, we remain apprehensive with the breadth of this definition and how much still needs to be determined with respect to other elements of implementing the ARRA HIT incentive payments," said Jenny Boese, WHA vice president of external relations & member advocacy. "And all of these determinations need to be finalized well in advance of 2011 so our hospitals can prepare to be meaningful users of this technology."

Only hospitals that meet the definition of a meaningful user of a certified electronic medical record can receive the billions of dollars available in HIT incentive payments. Hospitals failing to be meaningful users by 2015 will begin to see Medicare payment penalties.

Under the first draft, the HIT Policy Committee recommended that in order to qualify as a meaningful user, hospitals would have to meet an increasingly higher threshold to do so in years 2013 and 2015.

Many expressed concerns this would serve as an obstacle to providers in the very early stages of HIT adoption. The revised draft definition includes a new concept called the "adoption year." The HIT Policy Committee explains the concept this way: "Under this scenario, qualifying for the first-year incentive payment would be assessed using the ‘2011 Measures.’ The payment rate and phase-out of payments would follow the calendar dates in the statute, but qualifying for incentives would use the ‘adoption-year’ approach."

During the comment period WHA and others also expressed concern that many hospitals would not be able to meet the threshold of using Computerized Physician Order Entry (CPOE) for all order types, including medications, by 2011. The HIT Policy Committee revised this to instead require CPOE for "10 percent of all orders (any type) directly entered by authorizing provider (e.g. MD, DO, RN, PA, NP) through CPOE)."

Other changes in the revised draft affect information exchange, requires insurance eligibility checks to be done electronically (2011), requires claims submission electronically (2011) among others.

The HIT Policy Committee’s recommendations must still be considered and approved by the Centers for Medicare & Medicaid Services, after which CMS will then promulgate into a proposed rule. That rule is expected in late 2009, with a final rule in early 2010.

Access the HIT Policy Committee’s revised "meaningful use matrix" online at:

As health care reform proposals race through Congress and with the dust settling on the 2009-11 state budget, the WHA Public Policy Council met July 14 to discuss the latest developments in what continues to shape up as one of the most turbulent health care industry environments in recent memory.

AHA Executive Vice President Rick Pollack joined the discussion via teleconference to provide Council members a real-time status report on federal health care reform from the nation’s capitol. Pollack offered veteran perspective on the various reform plans being debated, and detailed how they would impact hospitals. (See related story on House reform bill.)

Pollack said the agreement announced last week between the White House and Senate Finance Committee Chairman Max Baucus (D-MT), AHA, the Catholic Health Association (CHA) and the Federation of American Hospitals (FAH) provides a reform framework and caps hospital spending cuts to help pay for coverage expansions. Pollack said the agreement means hospitals will do their part to expand coverage while capping hospital spending cuts at $155 billion over 10 years.

WHA President Steve Brenton provided an in-depth look at national health reform efforts and its implications for Wisconsin. Discussion in Washington continues and consensus has bogged down over three key issues: a public plan "option," an employer and/or individual mandate for coverage, and how to pay for the proposal.

Brenton described a WHA-backed multi-state effort that is pushing the importance of value in the health care reform debate. He stressed that reform efforts must recognize and incentivize high-quality, high-value care delivered in states like Wisconsin.

Jenny Boese, WHA vice president of external relations and member advocacy, updated Council members on other pending federal issues including Health Information Technology (HIT) developments under the American Recovery and Reinvestment Act (ARRA), bills related to nurse staffing ratios and the latest developments on the Employee Free Choice Act (EFCA).

WHA Executive Vice President Eric Borgerding delivered a state advocacy report, including an analysis of state budget deliberations and their developing impact on hospitals in Wisconsin.

Borgerding said the hospital assessment formula remains intact in the budget signed by Governor Doyle late last month and has resulted in the first Medicaid payment increase for hospitals in over a decade. Also significant is the statewide expansion of BadgerCare Plus for Childless Adults which will provide basic health insurance coverage for thousands of low-income, uninsured citizens.

But troubling information came this week as details of the previously "unspecified" cuts from the Department of Health Services (DHS) were released. The cuts being sought by the DHS ballooned to $205 million GPR ($600+ million AF-all funds) by the conclusion of the budget process (see related articles). A hospital workgroup, including WHA and member hospitals, continues to meet with DHS to discuss how the recommended reductions would impact hospitals and other cost-saving ideas.

Borgerding briefly discussed the outcome of several other budget-related provisions including the joint and several liability proposals removed from the budget by the Legislature, medical record copy fees and additional funding and positions for the Department of Regulation and Licensing.

Bill Bazan, vice president, metro Milwaukee, discussed development of a document relating to provider orders for life-sustaining treatment (POLST). Bazan said the POLST document would act as a compliment to a patient’s advance directives and serve as a medical order that outlines a patient’s end-of-life treatment decisions.

Judy Warmuth, WHA Vice President of workforce development, updated Council members on the status of legislative proposals to ban mandatory overtime for health care workers. The proposals, which received hearings earlier this year, remain in committee.

Paul Merline, vice president of government affairs, reviewed recent legislative discussions related to transparency in health care and highlighted WHA Information Center upgrades from earlier this year to the PricePoint Web site (www.wiPricePoint.org). Merline also discussed the latest efforts surrounding the development of Wisconsin’s action plan for reporting health care acquired infections (HAI).

WHA Senior Vice President and General Counsel Laura Leitch discussed worker’s compensation, including highlights of recent Workers Compensation Advisory Council meetings. Leitch also updated Council members on two of the legal cases being tracked by WHA: the decision currently under appeal relating to the Injured Patients and Families Compensation Fund (IPFCF), and a case in which a city in southeastern Wisconsin is appealing a trial court decision that recognized a hospital’s property tax exemption. WHA filed an amicus brief in the IPFCF case and will file a brief supporting the hospital’s property tax exemption.

The next meeting of the Public Policy Council is scheduled November 10.

Leaders and staff from Saint Clare’s Hospital in Weston spent a portion of the day on July 13 highlighting the advantages of the all-digital environment to a key state leader.

State Senator Jon Erpenbach of Waunakee serves as chair of the Senate Committee on Health, Health Insurance, Privacy, Property Tax Relief and Revenue.

"We are thankful that Senator Erpenbach took the time to learn more about our system at Saint Clare’s and the significant role our all-digital environment plays in our delivery of high quality care," said Saint Clare’s President Mary Krueger.

Erpenbach spent his time at Saint Clare’s getting a firsthand look at how physicians and staff in the Emergency Department and Intensive Care Unit are using the electronic medical record, advanced ICU monitoring systems and other aspects of the all-digital environment to improve patient care.

"You have a wonderful facility which is serving as a model for all of the state," said Erpenbach. "As we continue this debate on health care reform, we need to consider all options, and it’s important for us to explore all uses of technology."

Jenny Boudreau, formerly with WHA Financial Solutions, recently accepted a newly-created position in WHA’s Public Policy Department as director of advocacy support. In this role, Boudreau assumes responsibility for supporting advocacy efforts at the state and federal levels with fundraising, events, publications and grassroots within the government relations department.

Boudreau, brings more than 12 years of Association experience and a strong commitment to serving WHA members. She reports directly to Executive Vice President Eric Borgerding.

"Jenny is a strong addition to advocacy efforts. Her knowledge of member relations and health care issues combined with her considerable administrative, creative and problem solving skills are assets in our advocacy efforts at both the state and federal level," Borgerding said.

Boudreau holds a B.A. in management and communication from Concordia University Wisconsin. Prior to this role, Boudreau worked in WHA Financial Solutions as director of marketing. Boudreau, will continue to work with WHA, WHA Financial Solutions, and WHA Information Center on marketing projects.

WHA testified ‘for information only’ at this week’s hearing on AB 267, a bill to require licensure of individuals that practice radiography. This is a very large group of potential license holders. Testimony provided at the hearing indicated that there are more than 7,000 individuals already certified as radiographers within the state of Wisconsin. It is unknown how many people that are currently uncertified would be added to the group, but it would certainly be the third largest licensed group in the Department of Regulation and Licensing behind registered nurses and physicians.

WHA’s testimony, presented by Judy Warmuth, vice president, workforce, centered on the 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’s ability to conduct and complete complaint investigations.

In cooperation with WHA, the Department of Regulation and Licensing has been working to improve the timeliness of all licensing processes. Progress has been made and WHA is pleased with changes the Department and its Boards have implemented to streamline requirements, alter staffing patterns, and review policies and procedures that lead to better service to professionals, health care facilities and ultimately, improve access and care to Wisconsin residents.

WHA cautioned that adding to the Department’s workload at this time may undo the progress that has been to date. During each of the last three sessions, the Legislature has created new licensed groups and occupations. Statutes regulating the new groups have not always included or allocated the resources necessary to support them. The time and effort required to implement these statutory changes has competed with efforts to increase the speed of investigation and licensing of professionals now holding or seeking licenses. This session, legislation to license radiographers and dietitians has been introduced, as have changes to physical therapist and podiatrist licensure.

WHA concluded their testimony by restating its belief in the importance of protecting the public, but also restated that timely investigation of complaints and timely licensure for new graduates also offers important protection. WHA asked that the latter not be sacrificed for the former. WHA requested that the Legislature not take actions that would undo the efforts and progress that has been made to date.

"We asked that licensure of new groups and occupations be done thoughtfully, state resources be used wisely, Department work processes be considered and the ability of the Department to serve existing customers and consumers be maintained," Warmuth said in her testimony.

Current licensure bills are on the agenda for the WHA workforce council meeting August 14. Members are encouraged to contact Warmuth with questions or concerns on any licensure issues so they may be included in that discussion. jwarmuth@wha.org or 608-274-1820.

Dorothy Erdmann is the new administrator/CEO at Shawano Medical Center. Erdmann has more than 15 years of experience in hospital management in both community and tertiary settings. She is also experienced in physician practice development.

Erdmann is originally from Northeast Wisconsin and completed both undergraduate and graduate studies at UW-Oshkosh. Since 2005, she has served as CEO at Owatonna Hospital in Owatonna, Minn., part of Allina Hospitals & Clinics. Prior to that, Erdmann was executive director of Cardiovascular Services for Abbott Northwestern Hospital in Minneapolis, also part of the Allina system. In addition, she has served in senior management positions at Bellin Health in Green Bay and Howard Young Healthcare in Woodruff.

With a background as a family nurse practitioner, Erdmann sees her position in administration as one with close ties to patient care.

"(My experience in nursing) brings a nice perspective to a leadership role. I understand the value of quality patient care," Erdmann said. She also sees the administrator’s role as a community leader and advocate for patients in the face of a changing political climate.

Do you know a great country doctor? The kind of physician who still makes house calls and accepts the occasional apple pie or roast turkey for a fee? If so, he or she may qualify as the 2009 Country Doctor of the Year. Presented by Staff Care, Inc., a national health care staffing firm based in Irving, Texas, the Country Doctor of the Year Award honors the spirit, skill and dedication of America’s rural medical practitioners.

Nominations for the 2009 Country Doctor of the Year Award will be accepted for physicians who practice in communities of 20,000 or less and who are engaged in such primary care areas as general practice, family practice, internal medicine, and pediatrics. Anyone can nominate a physician, including friends, patients, co-workers or family members, and all stories or anecdotes about the physician’s practice are welcomed.

Past recipients of the award have received national news coverage in media outlets including USA Today, People magazine and The Today Show. In addition, Staff Care provides the award recipient with two weeks of complementary locum tenens physician coverage, a service valued at $10,000.

Nomination forms can be downloaded from the Country Doctor of the Year Award Web site at www.countrydoctoraward.com, or you may call Staff Care for a nomination form at (800) 685 2272. Completed nominations must be received no later than October 15, 2009.

It was just another day at Wesley Scott Senior Living Community in Milwaukee until Patti Cobb, chief clinical dietitian at Froedtert Hospital, announced a cooking demonstration would begin in five minutes. Cobb enticed residents to participate with the guarantee, "Who wants to learn how to cook stew on a budget and taste free samples?"

One by one, residents headed toward the community kitchen. The menu: black bean soup and taco chili. Cobb described the differences in cost between name brand and generic while fellow dietitian Caitlin Rondello taught residents how to properly read nutrition labels. Each person eagerly followed along in their recipe packet as they learned to prepare healthy meals for about $1 per serving. During the workshop, one resident lamented about the difficulties of cooking for one and its associated high cost. Cobb reminded residents they could package meal-sized portions and freeze them for a quick, nutritious meal later.

The bi-monthly cooking and nutrition sessions are a collaborative effort by Froedtert Hospital, Wesley Scott Senior Living Community, Westside Healthcare, and the Campus Kitchen at Marquette University. The sessions, which focus on healthy living, offer residents a way to socialize and participate in a group learning activity.

Residents enjoy the programs and obviously look forward to future sessions. "This partnership is helping to provide services to an otherwise underserved community," stated Maxine May, program coordinator at Wesley Scott Senior Living Community. "It is offering seniors access to information that will improve their quality of life, while causing them to rethink their assumptions about health, nutrition and wellness."

Ministry Dental Center, a partnership of CAP Services, Delta Dental Plan of Wisconsin and Saint Michael’s Hospital, serves families with Medicaid coverage.

Several years ago, Karl S. Pnazek and his wife established an acorn fund at the Community Foundation of Central Wisconsin to provide dental services to low-income children not eligible for BadgerCare. The idea was to supplement the services offered at Ministry Dental Center that were limited to Medicaid recipients.

An acorn fund is designed to grow over the years and, when fully endowed, to distribute its earnings for the purpose for which it was organized. CAP Services, a nonprofit agency that helps low-income families in central Wisconsin, is the fund representative with input from Delta Dental and Ministry Dental.

In December 2008, Terry Rothman of the Community Foundation of Central Wisconsin reached out to Karl. The Community Foundation administers the Tooth Fairy Fund, which pays for dental emergencies not covered by Medicaid. A local grade school nurse had contacted Terry to inquire about obtaining dental services for a six-year-old first grader at Madison School in Stevens Point. The parents had lost their BadgerCare eligibility because they both found jobs and their employer did not offer dental insurance. The six-year-old had been taking Tylenol all weekend and had already taken two more that morning for pain. His teacher called the school nurse to see what she could do.

Working with Brenda Diamond at Ministry Dental Center (where the child had previously received services when the family was on BadgerCare), he was given an emergency appointment that afternoon. It turned out that the tooth was abscessed and the patient had significant facial swelling. Pulling the tooth relieved the pain almost immediately.

While at Ministry Dental Center, Dr. London Cooper also assessed the child’s oral health and noted that a tooth needed a filling. She addressed that problem, completing a cleaning and a fluoride application. By 4:00 p.m., the problem was resolved. The Tooth Fairy Fund reimbursed Ministry Dental for its costs.

Langlade Hospital held its first Spring Health & Wellness Expo that was dedicated to bringing important insight to local families to improve their health and well being. Langlade Hospital provided over 20 booths, screenings and mini-educational seminars facilitated by hospital professionals, and a total of 25 outside vendors participated to ensure that valuable tools and information were available to all attendees from small children to senior adults. Screenings included cholesterol and osteoporosis and demonstrations (Tools for Exercise and Weight Loss, Recipe Makeovers and Healthy Eating Tips, Surgery Simulation, Latest Cancer Treatment Options) were plentiful. Buckle Bear was on hand to teach kids the importance of car seats and buckling up safely.

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

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