Wisconsin hospital patient care margins dropped to 3.1 percent in 2006, the lowest in eight years, and a decrease of 39 percent from 2005. At the same time, charity care provided by Wisconsin’s not-for-profit hospitals rose by 27 percent, to a total of $202 million. And government program payment shortfalls topped $1.6 billion in 2006, the highest ever.

According to the 2006 Wisconsin Hospital Fiscal Survey, collected by the WHA Information Center, hospitals saw a mixed result in volumes of patients treated in 2006. Admissions to Wisconsin hospitals dropped slightly from 598,000 in 2005 to 589,000 in 2006. In contrast, hospital outpatient services increased by 13 percent, keeping pace with a long-term trend that finds hospitals treating a growing number of patients in less acute settings.

An illustration of this shift in care settings can be found in the diagnosis and treatment of breast cancer. In 1996, 3,013 women were admitted to Wisconsin hospitals for this illness. By 2006, that number had dropped nearly in half to1,522. Several factors contributed to that change. First, there was a tremendous upsurge in breast screening, making earlier detection and treatment possible, with those treatments more likely to take place in an outpatient setting. Second, investments in new technology are making less invasive treatments possible and resulting in more procedures being performed in outpatient settings. The result for patients is greater comfort and more convenient treatment at a lower cost.

Shortfalls from government programs continued to increase in 2006. On average, the Medicare Program paid hospitals only 77 percent of the cost of providing care to beneficiaries, while Medicaid paid even less at 48 percent of cost. That translates into over $1.6 billion of hospital patient care costs not funded by government programs that were shifted to others—also known as the "hidden health care tax."

Uncompensated care—a combination of unreimbursed care provided to charity patients and bad debts for those patients able to pay but who fail to pay for services—totaled $614 million, increasing by $65 million (12 percent) over 2005, with charity care representing the larger increase of 27 percent, or $43 million. Bad debts accounted for $22 million of the increase. Contrary to some claims, a small percentage of charges are actually ever collected from those without insurance. These unpaid bills are also part of what hospitals must pass on to commercial payers.

"Wisconsin hospitals continue to provide high quality, cost-effective care," said WHA Senior Vice President George Quinn. "But unfunded patient care expenses—government program payment shortfalls and uncompensated bad debts and charity care—continue to increase and now amount to over 20 percent of the hospital bill for a patient with commercial insurance."

Critical components of Illinois’ state hospital tax, which is frequently held up by hospital tax proponents as a model Wisconsin should follow, are coming under serious fire from the Illinois Hospital Association (IHA).

At question is an effort in Illinois to require more Medicaid patients to move into managed care by implementing a two county pilot program. The IHA is balking at the notion, largely over concerns that increased hospital payments from their heralded hospital tax plan will disappear under a managed care payment system. The IHA is gearing up its members to oppose the plan, stating the following in an action alert that was sent this week to its entire membership:

"Hospitals in counties in the mandatory Medicaid managed care program would likely be required to pay the provider tax, but would probably not receive increased Medicaid payments from the state. Since most of their Medicaid patients would be enrolled in an HMO, the hospital would be paid by the HMO at its typical rates. This means that hospitals in the counties participating in this mandatory Medicaid managed care program could end up paying more in tax that they would receive in Medicaid payments (emphasis retained). Consequently, these hospitals would likely oppose any new hospital provider tax. Without broad-based support from the hospital community it may be impossible to continue the hospital provider assessment program."

IHA’s concerns about the once-embraced, existing hospital tax are strikingly similar to concerns raised in Wisconsin by WHA—skepticism that hospital tax-generated payment increases intended for hospitals will actually be passed through to hospitals, dollar-for-dollar, by Medicaid HMOs. In fact, the IHA is so concerned about the managed care payment program they believe it could jeopardize the entire hospital assessment program.

"From day one, we’ve told policymakers we are highly skeptical that higher payments promised from a $418 million tax on hospitals will materialize, largely due to the state’s reliance on HMOs as the payment delivery mechanism," said WHA President Steve Brenton. "So when we hear about the same concerns being raised in Illinois, a state that has had an apparently ‘successful’ tax for years, it’s pretty hard to ignore."

However, there is a major difference between the Illinois and Wisconsin hospital tax/managed care payment proposals. In Illinois, the managed care proposal is a comparatively small, two county pilot. In Wisconsin, 60 percent of promised, tax-generated hospital payment increases would be paid directly to HMOs with the assumption those increases would be "passed-through" to hospitals.

On top of the managed care concerns, the IHA also reports that Illinois will have to "pursue short-term borrowing to fund the FY2007 supplemental appropriation of $1.2 billion for the hospital assessment program." Apparently, the dollars for the hospital tax are not available to cover payment increases.

This development also echoes concerns raised in Wisconsin by WHA over the inability to protect hospital tax dollars and assure they are used for the stated purpose. As noted previously by WHA, the hospital tax proposed by Governor Doyle already skims $120 million off the top (about 30 percent of the total tax) for unrelated state spending.

"Given the budgeting process in this state, where ‘trust’ funds like that envisioned for the hospital tax are raided with regularity, I find it unlikely there would be support for borrowing to fulfill promised hospital payment increases," said WHA’s Executive Vice President Eric Borgerding. "There is already $120 million being taken from the hospital tax for other spending. Add the fact that there are some in the legislature that would today slap a corporate income tax on non-profit hospitals and/or return as little of the hospital tax as possible back to hospitals. My guess is that in Wisconsin, unlike Illinois, we would simply cut or delay payments to hospitals if the money from the tax had already been spent on something else. There wouldn’t be any borrowing."

As the Wisconsin budget debate continues in Conference Committee, WHA is looking to Illinois as a recent example of the need for extreme caution.

"It’s our hope that the budget writers will take a hard look at the hospital tax crystal ball that is Illinois," Borgerding said. "Our neighbors to the south have been touted here in Wisconsin as a successful example of a hospital-supported tax. But look at what is happening now—we are starting where Illinois is heading," Borgerding added.

A statewide survey of 500 likely voters found strong opposition to a state-run universal health insurance plan such as that being championed by some Senate Democrats in the Wisconsin Legislature. Key findings of the survey, conducted by Public Opinion Strategies and released this week by the Wisconsin Manufacturers and Commerce (WMC): 1) The public is far more concerned about health care costs than they are about expanding coverage and they don’t believe that state run health care will address their cost concerns; 2) Voters embrace the notion of "reform" as opposed to radical change; and 3) survey respondents were leery that government-run health care will provide them with the choices they have under the current delivery system.

"These survey results underscore the fact that the public wants health reform that is built upon the foundation of the current delivery and financing systems," said WHA President Steve Brenton. "More radical change, such as that proposed by some Wisconsin lawmakers, is supported by a distinct minority of Wisconsin voters."

Brenton agreed that the strong legislative interest in health care reform is resonating with voters and that the current political environment is conducive for dialogue and identification of meaningful solutions that address coverage, access and cost issues.

"A merger of Doyle Administration coverage proposals with GOP marketplace initiatives represents reform that builds upon the private sector with an appropriate role for government," Brenton said. "Such an approach can also tackle the service utilization cost driver in a meaningful way—a top priority if we are to effectively reign in rising costs," he added.

Public Opinion Strategies (POS), a highly regarded firm based in Virginia, has polled other key Wisconsin health care issues in the recent past. Perhaps most notable was a POS poll in February 2005 that showed overwhelming support (77 percent) for increasing the cigarette tax by $1.00 and using the revenues for health care programs (not filling budget holes).

This week the 2007 Wisconsin Hospitals Political Action Campaign surpassed the 75 percent mark of its fundraising goal of $195,000. To date, $148,650 has come in with over 75 percent being directed into the Wisconsin Hospitals Conduit.

482 individuals contributed this year to date as compared to 465 individuals at this same time last year. The average contribution is also up over six percent from last year.

For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.

A bill recently introduced by Charles Grassley (R, IA) and Max Baucus

(D, MT) would return us to the bad old days of Provider Review Organization (PRO) review of Medicare hospital stays. In the early 1990s, at the suggestion of the Institute of Medicine (IOM), HCFA transformed the PRO program (known by some as the most hated HHS program of the 80s) into the current Quality Improvement Organization (QIO) program, one that takes a collaborative systems approach to quality improvement rather than looking to blame and punish. While modern-day QIOs do perform a variety of case reviews for Medicare, it is done with an eye to education and improvement, not at generating sanctions.

S. 1947 would remove the review role from QIOs and place it in the hands of Medicare PROs. PROs would respond to patient complaints and perform other Medicare-required case reviews. Rather than being local organizations, they would likely be regional or national in scope and would focus on finding mistakes and meting out sanctions. And while QIOs would be required to adopt stringent guidelines for the composition and operation of their governing boards, PRO contracts could go to organizations with no such oversight and no duty to use physician experts in the review process as do QIOs. Besides returning hospitals and doctors to the days of responding defensively to issues identified in individual medical record reviews, this legislation would mean that hospitals in Wisconsin would be interacting with yet another federal contractor—one who may have no stake in what happens to quality of care within the state.

As the long-time director of Wisconsin’s QIO, I know how far we’ve come and want to avoid taking many steps backward on our joint path to providing the best care possible. On the House side, Wisconsin representative Tammy Baldwin (D) and Texas representative Michael Burgess, MD (R) have co-sponsored H.R. 1046, a much more reasonable approach to this issue, which preserves the gains we’ve seen in the QIO program while instituting important improvements suggested by the most recent IOM evaluation.

The most immediate threat posed by S. 1947 is that it will be attached to the S-CHIP bill and sail through in conference rather than being debated in open hearings where a more reasonable compromise between the two bills could be reached. MetaStar and our partner organizations will be working to ensure that what we have learned about improvement is not lost in this attempt to return to the past.

As reports of residential and commercial damage mount in Western Wisconsin due to torrential rain and flooding, most hospitals there report that they have maintained near normal operations.

Franciscan Skemp Healthcare in La Crosse said they were forced to close their Houston, Minnesota clinic and refer patients to the clinic they operate in Caledonia, Minnesota, after flood waters basically closed down the entire town of Houston. Franciscan Skemp told WHA that some of their employees have had difficulty getting to work due to road closures. The Franciscan Skemp Credit Union is working with employees who experienced property damage with finance options, such as reduced rate loans.

Gundersen Lutheran, also in La Crosse, reported that with the massive flooding, the hospital is experiencing some difficulties discharging patients who either live in a flooded area, or cannot get home because of road damage or downed trees and power lines. Power is not expected to be restored in parts of rural areas for some time. Gundersen is going ahead and discharging these patients from the hospital but then allowing them to occupy the room. The storm damage has also imposed many challenges on Tri-State Ambulance, a subsidiary of Gundersen Lutheran, because normal routes are impassable.

The hospital switchboard has fielded calls from patients who want to come in from outlying areas, but don’t know which roads are open and passable. From a staff perspective, many are having difficulty getting to work, so for staff who are already at work, Gundersen set up crisis pay so if they stay later, they receive additional pay. Some staff members have lost their homes and will be on leave indefinitely. Gundersen Lutheran is currently organizing a fundraiser for employees and local communities and are coordinating volunteer efforts for clean up.

Prairie du Chien Memorial Hospital housed 10 nursing home patients after the Sannes Skogdalen Heim Nursing Facility in Crawford County was forced to relocate patients when they lost their utilities due to a waterway blockage. Thirty other nursing home patients were transported to other nursing homes in the area.

Boscobel Area Health Care took 11 Sannes Skogdalen Heim Nursing Home residents into their long-term care facility and another six into the hospital. Numerous staff members volunteered on Sunday to help accept residents and prepare rooms for them. The hospital is currently identifying employees who live in the flooded area and are asking staff members to help with donations and assistance as appropriate. Initially, some employees were unable to come into work due to impassable roads, but that situation resolved itself as the water receded. The hospital is currently organizing volunteers from their staff to help Gays Mills and a few other communities in the Boscobel area with clean up activities.

In Richland Center, the Richland Hospital said a long-range pager tower was struck by lightning and as a result, they are more dependent upon cell phones. The hospital also minimized water consumption by cutting back on laundry services and by using disposables in their cafeteria after a city sewer main broke. Two Richland Center physicians stay on site when they are on call at night due to washed-out roads.

Employees at all the affected hospitals are providing community assistance by helping people pump out their basements, while others worked with local first responders in alerting the public to washed-out bridges and roads as the water levels rose.

Three people were killed at a bus stop in Madison when lightning hit a utility pole and the power line fell into a flooded intersection. Flash flood warnings are extended throughout parts of Southern and Western Wisconsin through Friday, hopefully ending over the weekend.

Tucked away in an Iraq War funding bill enacted earlier this year is a new Medicaid provision scheduled to go into effect October 1, 2007. The provision requires a Medicaid "prescription to be executed in written (and non-electronic) form unless the prescription was executed on a tamper-resistant pad." Due to this vague language, many questions have arisen. The Wisconsin Hospital Association has been meeting with other affected groups, including pharmacists and physicians, as well as the Wisconsin Department of Health & Family Services about these concerns and will continue to do so.

This past week the Centers for Medicare & Medicaid Services (CMS) released a guidance letter to the states regarding the new law. A summary follows:

• Exempted from the provision:
• Drugs provided in nursing homes (to the extent drugs are not separately reimbursed)
• Drugs provided in intermediate care facility for those who have mental retardation and other specified institutional/clinical settings
• Provision applies regardless of whether Medicaid is primary or secondary payer
• Provision does NOT apply:
• To refills of written prescriptions presented at pharmacy before October 1, 2007
• To payment limitation of e-prescriptions, faxed or telephone prescriptions
• When a managed care entity pays for the prescription
• (To the extent permissible under state/federal law) emergency fills of non-controlled or controlled dangerous substances for which a prescriber provides pharmacy with verbal, faxed, electronic or compliant written script within 72 hours after date on which script was filled
• To be compliant, a tamper-resistant pad must include at least one of the three following:
• At least one industry-recognized feature to prevent unauthorized copying of a completed or blank form
• At least one industry-recognized feature to prevent erasure/modification of form
• At least one industry-recognized feature to prevent use of counterfeit forms
• By October 1, 2008 all THREE of the above must be in place

As WHA continues work on this issue, contact Jenny Boese at jboese@wha.org or 608-268-1816 with thoughts or concerns.

During the August Congressional recess, Cong. Steve Kagen visited several of his district hospitals.

Ministry Health Care hosted Cong. Kagen at Howard Young Medical Center in Woodruff this past week. Cong. Kagen, a physician, was greeted at Howard Young by hospital president Sheila Clough, Vice President Laurie Oungst, and Ministry’s Northern Region CEO Brian Kief, as well as a number of physicians and other hospital staff. Following a hospital tour, the Congressman addressed approximately 60 staff members who had gathered in a town-hall format.

Hospital leadership made sure to thank Kagen for his efforts in opposition to CMS action on the Inpatient Prospective Payment System changes, which would cause millions of dollars in losses for all Wisconsin hospitals.

Kagen was also recently hosted at Community Memorial Hospital in Oconto Falls where he met with members of the medical staff, management, and board of directors.

Topics discussed included various health care issues such as health care reform and insurance coverage. The forum ended with a tour of Community Memorial Hospital and the opportunity for Cong. Kagen to meet members of the hospital staff.

Rep. Hraychuck at Burnett Medical; DOA Secretary Visits Ministry-Rhinelander

In recent days, Wisconsin hospitals hosted other legislators, too. State Rep. Ann Hraychuck (D-Balsam Lake) visited with CEO Tim Wick of Burnett Medical Center. Hraychuck toured the facility and saw progress on the building project.

Ministry Healthcare’s Sacred Heart-Saint Mary’s Hospital in Rhinelander hosted Wisconsin Department of Administration Secretary Michael Morgan. Secretary Morgan was visiting the area as part of Governor Doyle’s trip to northern Wisconsin. The Secretary was greeted by hospital president Monica Hilt, Vice President Bill Erickson, Dr. Dorothy Skye, and Ministry’s Northern Region CEO Brian Kief. After a hospital tour, Secretary Morgan spent time discussing health care issues with hospital staff.

If your hospital has hosted a policymaker, HEAT wants to know about it! Contact Jenny Boese at jboese@wha.org or 608-268-1816.

Dr. Marc Edwards, principal, Wilson/Edwards Consulting, addressed the WHA Council on Medical and Professional Affairs regarding a model to enhance the hospital peer review process. Dr. Edwards indicated that within most hospitals, the peer review process is focused on identifying physicians that are performing below the standard of care instead of learning from these cases how to improve clinical performance overall. By shifting to a model of performance improvement, hospitals can improve physician satisfaction, engage physicians in quality improvement activities, reduce adverse events and improve physician-hospital relations. Key differences inherent in this model are:

• Distinguishing between performance and competency
• Including peer review as a clinical performance measure
• Standardizing review committee processes
• Creating structured forms for case review
• Establishing effective governance
• Tracking outcomes

Wisconsin’s first regional information exchange project, the Milwaukee Emergency Department Care Coordination Committee IT Linking Project, was presented to the council by Bill Bazan, WHA’s vice president, Milwaukee Metro Region. This project is the result of work by the Milwaukee Health Care Partnership, which includes representatives from all five Milwaukee-based health care systems, the Federally Qualified Healthcare Clinics, and the State of Wisconsin’s Medicaid program. The IT Linking Project will provide emergency department staff near real time access to information on Medicaid and GAMP recipients regardless of where they have received their care in the past. The project will also encourage access to a primary care home for follow up care and care coordination for those who use the emergency department for non-emergent visits. This project is a potential model for the Governors’ e-Health Plan.

Finally, the Council engaged in a discussion of whether there is a need for a statewide standard for patient wristband colors used in hospitals. Several states have already standardized wristband colors to reduce the likelihood an error will be made, particularly for physicians and staff that work in more than one facility. The Council requested that WHA coordinate an effort to study this issue further.

The Wisconsin Board of Nursing approved a new RN license renewal process at their last board meeting. The new process will take effect January 1, 2008. Previously, full renewal applications were mailed to all licensed registered nurses on the Friday after Thanksgiving. In 2008, post cards will be mailed on or after January 1 (six weeks later than previous years) advising the nurse that their license is due for renewal and instructing them to go to the Department of Regulation and Licensing Web site to renew their license. Any RN who does not wish to renew and pay the renewal fee online will need to request a paper renewal form. The paper process is sure to be lengthy due to the size of the RN pool in Wisconsin. RNs must have their new license by the end of February to continue practicing.

The LPN renewal last year utilized this same process and 75 percent chose to renew online. This is a shortened time frame for the RN renewals, and a new online process, which is sure to come with a few snags. It may be helpful to inform your RN staff of the changes and advise them to watch for a post card, rather than a letter, shortly after the new year.

Wisconsin Technical College System (WTCS) representatives described for the WHA Workforce Council their plans to use data from a number of resources to drive decisions involving class size in their health care occupational training programs. Annette Severson, associate vice president, and Cathy Loppnow, education director at the Wisconsin Technical College System, told the council that data from sources similar to the Fox Valley Alliance Retirement Intentions Survey, and other resources will guide decisions about capacity growth in specific occupational programs. They provided reports on three new programs: Biomedical Informatics Technician, Clinical Research Coordinator, and Midwifery. The first two will begin this fall and are filled for this semester. Midwifery will begin in January.

Loppnow and Severson said WTCS has contracted with the College of St. Scholastica to provide training on a Cerner-based clinical information system named ATHENS. They discussed electronic health record (EHR) training for health occupations. Ten districts initially are participating in this training, with others expected to join soon. Future graduates will have had experience with an EHR both as a documentation tool and with case studies as a platform for teaching decision-making.

The group applauded the work of the WTCS, and all the efforts they have made to expand capacity in their programs, which has eased shortages of occupations prepared within their system. At the same time, Council members voiced their concern that the next big issue is at the university level as shortages have now shifted to positions prepared at the four-year level.

Sheri Busse, director of the Office of Caregiver Quality at DHFS, also presented to the Council. Busse’s office is responsible for implementation of the Caregiver Law, Nurse Aide Training and Testing and the Federal Background Check (Fingerprinting) Pilot in Wisconsin. Busse reviewed the caregiver abuse, neglect, and misappropriation reporting rules and described for the group who and what must be reported and the process within the Department when a report is received. The office is taking fewer than two months to determine if an investigation will be opened and about five to six months to complete an investigation. Busse also provided information about Wisconsin Act 388, which requires that caregivers report adults at risk. Her office is also responsible for these investigations and she answered questions from the group about reporting requirements and follow-up.

Following her presentation, Busse received a variety of questions from the Council, many about the finger printing pilot and related legislation introduced at the federal level. There was also discussion of criminal background checks, how employers might learn about ongoing investigations and employer concerns about providing references on employees of concern.

Joe Kachelski of the WHA Information Center asked the group for input on items in the annual survey of hospitals related to the number and type of employees within a facility. He offered some ideas of data that might be more relevant, but also, perhaps, more difficult to collect. The group offered feedback, but also suggested that other segments of the membership, such as chief financial officers, may have recommendations.

OSHA added a Health Care module to its Compliance Assistance Quick Start tool—the online guide to free compliance assistance resources on OSHA’s Web site. The module is designed to help employers understand OSHA regulations applicable to the health care industry, including recordkeeping, reporting and posting requirements. It also contains information on developing a comprehensive safety and health program and on training employees.

Making the transition from being a staff person one day to a supervisor or manager the next is a pretty significant step for nearly everyone. Those who make the leap discover they not only carry responsibility for high productivity combined with financial and regulatory prudence, but also must balance human relations skills to work closely and collaboratively with others.

Individuals who are new to hospital mid-level management, as well as experienced managers seeking a refresher, will find the "Leaping from Staff to Management" series helpful in making that initial leap.

Part one of the series, "You’re a Manager… Now What?" will be offered October 10 in Wisconsin Dells, and will explore the basics of management and leadership in theory and applied practice, and will lay the groundwork for continued development of leadership and management skills.

Part two of the series, "The Next Steps," is scheduled October 11, also in Wisconsin Dells, and will focus on learning and reviewing realistic and workable techniques for managing and leading people that will help ensure continued effectiveness and success.

New or experienced managers can register for either individual session, or discount pricing is offered to those registering for the full two-part series.

A May 2007 Joint Commission report recommends targeted strategies to address language and cultural issues that increasingly post challenges to hospitals seeking to deliver safe, effective care to the diverse American population. Moreover, the Joint Commission says it will educate its surveyors to better assess compliance with accreditation standards related to linguistically and culturally appropriate care.

To assist Wisconsin hospitals with understanding this Joint Commission focus, WHA is offering a one-day seminar, "Diversity and Cultural Competence in Health Care" from 8 a.m. - 4 p.m. on Tuesday, October 30 in Madison. This seminar is an introductory session to cross-cultural medical care and is intended to raise awareness of the issue, the requirements, and the changing health care environment. Practical steps to address racial, cultural, and linguistic disparities that are occurring in health care throughout Wisconsin will be discussed.

Always an active person, Lorraine Baudry found herself unable to drive last year after an accident resulted in the amputation of her foot. With no family close by, the Fond du Lac resident had to figure out a way to get back and forth to both therapy and her doctors’ appointments. Enter Agnesian Health Care’s Courtesy Van Service.

From infants to the elderly, the van brings patients to and from any Agnesian HealthCare appointments. "It is so good; so wonderful. It really came at a time when I needed it most," says Baudry.

In addition to finding much-needed transportation, Baudry also found a trusted friend in driver Jane Galligan, who picks her up right at the door, helps her to the van and makes sure she arrives safely at her destination. Galligan even helps coordinate Baudry’s appointments to ensure availability of the van service. "She treats me with the most utmost courtesy that any individual could expect to receive," adds Baudry.

A free service funded by the St. Agnes Hospital Foundation, the courtesy van is another way Agnesian HealthCare is serving the needs of our community … and making access to health care possible for patients such as Baudry.

Bill Beach, Sauk Prairie Memorial Hospital administrator from 1967-1995, died suddenly Tuesday, August 21. Those of you who had the great fortune of working with Bill know he devoted his career to building and growing the hospital in Sauk Prairie. His contributions to the hospital were many—including three facility expansions and acquiring the hospital-owned clinics. He was a founder of the Rural Wisconsin Health Cooperative and helped lead the development of Home Health United and HMO of Wisconsin. He was a strong voice for rural health.

Tim Size, executive director of RWHC, has warm recollections of Bill, both professionally and personally. "Bill was simply a great friend and mentor; for me, for RWHC and for rural health," Size said.

CEO Rick Palagi summed up the feelings of many of the people who worked with Bill during his tenure at the hospital. "Sauk Prairie Memorial Hospital & Clinics has lost a great friend. I’ve had the privilege and comfort of knowing Bill since I came here, and have always appreciated his wisdom, care and concern for our hospital and our communities," he said.

Our thoughts and prayers go out to his wife, Natalie, and to his children, Tim, Greg and Alison.

The nine leaders work with Ascension Health of St. Louis within specific geographic areas to increase links among the organization’s 38 Ascension Health Ministries, or local health systems, across the country.

The market leader concept is part of the organization’s distributed leadership model and allows flexibility to work with each geographic area’s challenges and opportunities.

Brideau will remain in his role at Columbia St. Mary’s with the increased responsibility of developing market strategies and identifying and sharing best practices, reporting to Robert Henkel, chief operating officer of Ascension Health and to the local board.