February 21, 2014
Volume 58, Issue 8

Legislation Reforming Hospital Regulations Heading to Governor Walker
WHA-backed Senate Bill 560 receives unanimous bipartisan support

Legislation to reform Wisconsin’s administrative code regulating hospitals passed both houses of the Legislature February 18. Senate Bill 560, authored by Sen. Leah Vukmir (R-Wauwatosa) and Rep. Howard Marklein (R-Spring Green), moved swiftly through the legislative process with a Joint Committee hearing last week and a final floor vote in the Senate and Assembly February 18. Passing legislation to reform Wisconsin’s outdated hospital regulations was one of WHA’s main legislative priorities for the 2013-2014 session.

Senate Bill 560 reforms state hospital regulations by sunsetting portions of DHS 124, the state administrative code regulating hospitals, on July 1, 2016. At that time, the Medicare Conditions of Participation would become the baseline for state hospital regulations. The bill would then allow the Department of Health Services to promulgate rules that are not covered in the Medicare Conditions of Participation.

After the bill passed, WHA Executive Vice President Eric Borgerding praised the passage of SB 560.

"Wisconsin’s hospital regulations have been in desperate need of modernization to more accurately reflect the advancements in health care delivery. The current state rules have not been significantly updated since 1988," Borgerding said. "Wisconsin health care leaders are committed to improving quality and patient outcomes. Compliance with regulatory standards is an important and significant commitment of hospital resources. Current and regularly updated regulatory standards are an important part of ensuring quality care."

Assembly lead author Rep. Howard Marklein released a press statement following passage of SB 560.

"This bill would make compliance and oversight less confusing for hospitals and the state regulators, thereby reducing those costs associated with hospital regulatory compliance while maintaining quality of care," said Marklein.

SB 560 received unanimous support in the Senate and the Assembly.

"We are very pleased with the bipartisan vote this bill received in the Assembly and Senate and commend the authors, Sen. Vukmir and Rep. Marklein, for their leadership," Borgerding said. "And a job well done by WHA’s legal and lobbying team. Their commitment over the last several weeks, and persistence over the past several years, is what got this bill finally passed."

The bill now heads to Governor Walker’s desk for his signature.

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WHA Board Approves 2014 Goals; Reviews WHIAC Medicare Campaign, Legislative Session

While the weather report was dismal and prevented an in-person meeting in Madison, the news delivered via teleconference to the WHA Board February 20 on the progress that has been made in the Capitol on some of WHA’s key priorities was anything but gloomy.

WHA Executive Vice President Eric Borgerding reported that several key WHA-supported bills await the Governor’s signature that address issues that WHA members have identified as major concerns. This week, both the Senate and Assembly passed SB 560, a bill that reforms the way hospitals are regulated in Wisconsin. (See story above) The Legislature also passed two mental health-related bills that were on WHA’s behavioral health agenda. AB 453 gives treating care providers access to patients’ mental health records, while AB 488 creates a new third party petition process for emergency detention if a county does not approve the initial request.

"The WHA team, with the support of and assistance from our members, has crossed the finish line on several issues that we have been working on for a number of years," Borgerding said. "The reforms these bills will bring hospitals and their patients may not be felt immediately, but they will make a lasting and positive impact on the way health care is delivered in Wisconsin for decades to come."

"Enough is Enough!" Wisconsin hospitals take $4 billion hit as Congress backfills other cuts

WHA President Steve Brenton presented the Association’s 2014 goals, which were approved by the Board. The 2014 goals set an aggressive work plan for staff and provide a method to measure and report the Association’s accomplishments. Brenton said the Board agenda aligns closely with the goals to ensure member input and feedback is received throughout the year on WHA’s top priorities.

Congress continues to cut Medicare payments to hospitals to pay for shortfalls in non-health care related programs. The latest Medicare cut was used to backfill the military pension cuts. Past cuts have paid for physician payments fixes. In fact, February 20 marked the anniversary of the first legislative ‘patch’ to Medicare’s fatally-flawed physician payment formula known as the sustainable growth rate (SGR). On Feb. 20, 2003, an appropriation bill containing the first SGR patch was signed into law and started an 11-year legislative pattern that has grown a fiscal problem rather than solve it, according to a statement released by the American Medical Association.

Brenton said the current SGR patch that stopped a major payment cut to physician payments expires March 31. Congress has cut hospital reimbursement to pay for a SGR "fix" in the past. However, the cuts now total more than $4 billion for Wisconsin hospitals. The Wisconsin Hospitals Issue Advocacy Council (WHIAC) initiated a campaign two weeks ago aimed at drawing attention to the impact Medicare cuts have on Wisconsin’s high-quality health care system. WHA has been hosting DC fly-ins to meet with Members of Congress to educate and inform them on the impact decisions in Washington are having on their local hospitals. (See Brenton’s column in this issue.)

"Every WHA Board member has said that thwarting additional Medicare cuts is their top priority," Brenton said. "Wisconsin only has 10 Members of Congress out of 540, but I want to make sure we leave no stone unturned with our delegation. We will do everything we can to continue to fight cuts and arm our delegation with the facts."

Brenton said WHA has been actively working with the Statewide Value Committee, which was formed in 2011. The multi-stakeholder group is comprised of payers, providers, insurers and state government working together to address issues related to cost, quality and payment. Wisconsin Medicaid Director Brett Davis has been committed to the Committee, which has helped to accelerate interest and participation in the group. The Committee is focusing on activities that will increase the value of care, including the development of a core set of measures that will be understandable to consumers. The group will also focus on population health as health care payment moves from volume to value.

Health care is just as important as roads, utilities to community economic development

Borgerding said WHA has enlisted the services of a research firm and a public relations agency to develop a state and national campaign that will leverage Wisconsin’s strong national position as a high-quality, high-value health care provider.

"We have been hitting on this message a couple of years, and it really resonates with legislators and the Governor that health care is an economic development asset," Borgerding said. "Our economic impact is not limited to the number of employees that we have or to the services that we procure locally. It is about the real value that we bring to employers by providing high-quality care."

Borgerding said WHA wants to partner with other organizations, including the Wisconsin Economic Development Corporation, to move the message out to their members and constituents.

"When a company is contemplating where to locate, grow and create jobs, we want to make sure that high-value health care is a part of the calculation, just as important as roads, utilities and pieces of a sound economic infrastructure," Borgerding added. "Because when it is factor, Wisconsin will have a big advantage over other states."

WHA Partners for Patients initiative starts year three

Kelly Court, WHA chief quality officer, reported that all hospitals that participated in the WHA Partners for Patients initiative in 2013 have renewed that commitment in 2014. In 2014, Court said the emphasis will be continued work on reducing harm by 40 percent and readmissions by 20 percent.

The WHA Quality Report, released a few weeks ago, has garnered considerable state and national media attention. Court said the progress that Wisconsin hospitals have made in improving quality are unique in that hospitals of all sizes are actively engaged in improvement projects and are reporting excellent results.

WHA work on Medicaid and exchange-related coverage issues continues

While the functionality of the health insurance exchange website has improved, Joanne Alig, WHA senior vice president, Policy & Research, said coverage issues continue to arise on an almost daily basis. As changes to Medicaid eligibility are set to go into effect on April 1, and open enrollment in the insurance exchange ends on March 31, WHA continues to work through its Enrollment Action Council, co-chaired by Therese Pandl, president/CEO, Hospital Sisters Health System, Eastern Wisconsin Division, and Mark Taylor, president/CEO of Columbia St. Mary’s, Inc.

Alig noted that several recent announcements from the federal government on areas of interest to WHA members are an indication of how the policy around insurance markets continues to evolve. These include recent guidance from HHS on the topic of third party premium payments on behalf of patients (available at www.wha.org/pdf/third-party-payments-of-premiums-for-qualified-health-plans-in-the-marketplaces-2-7-14.pdf), and federal guidance to insurers for submitting applications for qualified health plans in the exchange in the 2015 benefit year. The latter guidance also contained new information and requirements from HHS on network adequacy, an issue that is gaining in national attention.

"Enrollment and coverage issues as well as the overall regulation of the insurance market often ultimately impact our members—those who are directly providing care to patients," said Alig. "That’s why WHA will continue to engage in this work in the coming year. "

Alig noted that the member-only webinars WHA has hosted since last June on the insurance exchange have been well received, and WHA plans to continue offering webinars in 2014 to keep members apprised of the latest developments.

In other news, WHA Board Chair Ed Harding, president/CEO of Bay Area Medical Center in Marinette, introduced new board member Debra Standridge, president of Wheaton Franciscan Healthcare-North Market. Brian Potter, WHA senior vice president of finance, reviewed the preliminary 2013 financial results for both WHA and the WHA Information Center with the Board. Potter said the 2013 audit report would be distributed at the April board meeting.

Council Reports

Medical and Professional Affairs: Kelly Court asked the Board to consider two motions, both of which were approved. First, the Board approved removing the birth services information from CheckPoint, and second, they approved adding data related to the newborn screening program.

Rural: Planning continues on the Council for the 2014 Rural Health Conference, which will be held June 18-20 at the Osthoff Resort, Elkhart Lake.

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Hospital, Health System Leaders Express Concerns at Meeting With Rep. Kind
WHIAC "Enough is Enough" radio ad continues

On February 13, 16 leaders representing at least 10 hospitals and health systems in Rep. Ron Kind’s district met with him at Mayo Clinic Health System in La Crosse. The meeting with Kind was requested to express a growing frustration health care leaders have with Congressional attacks on Medicare reimbursements. The most recent example being the Congressional vote to extend Medicare cuts to hospitals, physicians and other providers an additional year (FY 2024) to offset the costs of making a change to military pensions. With the recent vote on military pensions, Congress crossed a line that had previously not been breached by cutting health care providers to pay for a wholly unrelated program.

"When the Medicare program already fails to pay the actual cost of providing care and you add an additional $4 billion + in Medicare cuts to Wisconsin’s high-value hospitals, continued Medicare attacks are baffling," began WHA Executive Vice President Eric Borgerding. "Cuts impact hospitals, services and programs and the local economy. There’s just no way around it."

The ongoing fight to educate the public about Medicare cuts has also led to a series of radio ads launched by the Wisconsin Hospitals Issue Advocacy Council, Inc. (WHIAC). The WHIAC is a 501(C)(4) organized to promote, develop, and encourage the distribution of information about Wisconsin’s health care climate and the importance of high-quality health care across Wisconsin. The radio campaign, "Enough is Enough," is aimed at educating the public about the real impact that the ongoing policy and fiscal negotiations in Washington are having on health care in Wisconsin. The ads also compliment WHA’s ongoing grassroots and advocacy efforts.

"We cannot continue to be Washington’s ATM machine," Borgerding said. "We are asking our Congressional Delegation to protect Wisconsin’s high-quality, high-value health care system."

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WHA, Hospital Representatives to Participate in March 11 Washington, DC Fly-in

The Wisconsin Hospital Association will travel to Washington, DC March 11 to participate in the American Hospital Association’s scheduled fly-in. Hospital leaders are encouraged to consider joining WHA in DC. With continued Congressional attacks on hospital payments—including the most recent Medicare cut to pay for a change in military pensions—Capitol Hill meetings will focus on how cuts negatively impact Wisconsin’s high-quality health care system and access to care for patients.

If you are planning to participate in this trip or would like more information, contact WHA’s Jenny Boese at 608-268-1816 or jboese@wha.org.

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President’s Column: D.C. Sausage Factory Revisited

Just one month ago, some in Congress were poised to use Medicare cuts to pay for an extension of unemployment compensation benefits. That effort failed but unfortunately 52 U.S. Senators appeared willing to extend the current sequester an extra year to pay for a temporary entitlement benefit unrelated to health care.

But last week, in a bipartisan vote, Congress walked back an earlier decision to reduce pension adjustments for young military retirees. They then funded the new costs by extending sequester cuts on Medicare, an extra year, through 2024.

What have we learned from these recent actions?

  1. Medicare cuts have morphed from being used to pay for health care programs—to now being used to pay for other legislative priorities.
  2. Health care providers have either failed to make a strong case or aren’t as politically popular as the unemployed and retired military personnel.
  3. Voting to cut Medicare ten years from now is easier for Congress than taking tough votes that have an impact today.
  4. The damage from Medicare cuts, which now surpasses $4 billion for Wisconsin hospitals and additional billions for physicians and long-term care providers, has yet to resonate with most members of Congress—at least resonate to the point of getting them to stop whacking the Medicare piñata.

So what’s next?

Congress must enact either a permanent or temporary Medicare physician payment (SGR) "fix" by March 31; otherwise physician payments are slashed by over 20 percent. A bipartisan plan to reform physician payment around "value" has been proposed. But the plan must be paid for. And new Medicare cuts are very much in play.

Since January, WHA’s HEAT program has generated over 1,200 grassroots contacts to our federal lawmakers opposing new Medicare cuts. The Wisconsin Hospitals Issue Advocacy Council, a 501(C)(4) focused on educating the public about Wisconsin’s high-quality health care environment, is complimenting these efforts through a statewide radio ad campaign that is generating several hundred more grassroots contacts with Wisconsin’s federal lawmakers. We’ve hosted district meetings between members of Congress and close to 100 local hospital and system leaders—with more meetings yet to come. Plus, dozens of hospital leaders and WHA have taken our message straight to Capitol Hill in conjunction with our national partners in DC.

We now must redouble our efforts in anticipation of the late March vulnerability. "Enough is enough" must resonate as a theme, making the case that these cuts will have consequences on health care quality, access and employment.

Steve Brenton

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Register Today for 2014 Advocacy Day
April 16, 2014 *** Monona Terrace, Madison

Make an impact in Madison for your hospital by attending Advocacy Day on April 16. Register your hospital team today, including senior leaders, trustees and volunteers, for this important event.

Online registration available at http://events.SignUp4.net/14AdvocacyDay0416

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Doctor Apology, CNA Bridge Program and other WHA-Backed Legislation Advances in Final Weeks of Session

The state Assembly and Senate were in full action the week of February 17 as the 2013-2014 legislative session is drawing to a close. Several WHA-backed pieces of legislation advanced in the Legislature.

Doctor Apology (Assembly Bill 120)

Assembly Bill 120 would allow health care providers to express an apology, condolence, sympathy, or other sentiment to a patient or patient’s family without those statements being used as evidence of liability or an admission against interest. This bill would encourage statements of apology or condolence by providers involved in patient care, which can allow the patient, family and provider to move toward resolution.

AB 120 was authored by Rep. Erik Severson, MD (R-Star Prairie) and Sen. Leah Vukmir (R-Wauwatosa). This legislation passed the Assembly on a voice vote on February 18 and has been sent to the Senate Committee on Health and Human Services for a hearing.

CNA Bridge Training Program (Senate Bill 212)

Senate Bill 212 requires the state Department of Health Services to approve a certified nursing assistant (CNA) "bridge" training program for individuals who have received less education than the 120-hour curriculum requirement in Wisconsin. For example, a CNA program in Minnesota requires 75 hours of education. A CNA trained in Minnesota would be able to work in Wisconsin after taking a certified bridge course, instead of being required to take the full 120 hour course.

The bill, as amended, requires that an individual must also pass the normal 120 hour examination to be certified. The amendment to the bill allows an out-of-state CNA who has two years of previous work experience to be employed in Wisconsin, based on certain conditions.

SB 212 was authored by Rep. Kathy Bernier (R-Chippewa Falls) and Sen. Sheila Harsdorf (R-River Falls). The bill has been passed by the Senate and the Assembly. SB 212 will now go to Governor Walker’s desk for his signature.

Setoffs against Tax Refunds for Ambulance Debt (Assembly Bill 341)

Assembly Bill 341 would allow private ambulance service providers, who contract with local government, to collect unpaid debt from an individual’s state tax refund. Under current law, ambulance service providers owned by local government can intercept an individual’s state tax refund for certain unpaid debt owed to the government ambulance provider. This bill would allow private ambulance services, who are operating under contract with the local government, to utilize this same process.

AB 341 was authored by Rep. Dean Kaufert (R-Neenah). The legislation has passed the state Assembly on a voice vote on February 20 and has been sent to the Senate for concurrence.

Licensure of Physicians (Senate Bill 579)

Senate Bill 579, which passed the Senate and Assembly on February 18, makes various changes to the licensure of physicians in Wisconsin—particularly for post-graduate residents. The bill was supported by the Medical Examining Board and various hospitals and health care systems. The legislation would permit an unrestricted license for individuals who have either completed 24 months of post graduate (residency) training or have completed 12 months of training, are currently enrolled in a residency program and have an unrestricted endorsement from the director of their residency program.

The bill creates a restricted license, a Residency Educational License (REL), granted to post-graduates currently enrolled in a residency program regardless of how long they have been in the program. This license is restricted to educational activities within the residency program.

SB 579 was authored by Rep. Erik Severson, MD (R-Star Prairie) and Sen. Leah Vukmir (R-Wauwatosa). The bill passed both chambers of the Legislature February 18 and will be sent to the Governor’s desk for his signature.

For a complete list of the changes, please see the bill language here: https://docs.legis.wisconsin.gov/2013/proposals/sb579

Workplace Wellness Grant Program (Senate Bill 73)

Senate Bill 73 creates a workplace wellness grant program, administered by the Department of Health Services, which would reimburse a small business for up to 30 percent of the cost of creating a workplace wellness program at a small business in Wisconsin. A business could only receive one grant per year and the maximum amount available in any fiscal year to all grantees is $3 million. Any workplace wellness program must include a health risk assessment that includes one of several components, including chronic disease prevention, weight management, worker injury prevention, nutrition education, etc.

SB 73 was authored by Sen. Terry Moulton (R-Chippewa Falls) and Rep. John Murtha (R-Baldwin). The bill has been passed by both houses in the Legislature and is now sent to the Governor’s desk for his signature.

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CMS Announces RAC Program Changes

On February 18, the Centers for Medicare & Medicaid Services (CMS) announced several changes to the Medicare Recovery Audit Contractor (RAC) program. The changes are highlighted below. While the changes are positive, WHA will continue to advocate for additional, necessary program improvements.

Read the CMS announcements at:

To receive regular RAC/audit program updates like the above, WHA reminds members of the WHA RAC Updates email list. To be added to the list, contact Jenny Boese at jboese@wha.org or 608-268-1816.

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Take Advantage of WHA RAC Summit Early Bird Registration, Ends February 21
Q & A with RAC Summit presenter, Ronald Hirsch, MD

Ronald Hirsch, MD, FACP, CHCQM, and vice president of the Regulations and Education Group of Accretive Physician Advisory Services (AccretivePAS) for Accretive Health, is a well-known physician leader, advisor and all-around guru in the audit realm. Hirsch will bring his expertise to Wisconsin for the Wisconsin Hospital Association inaugural RAC Summit being held in Wisconsin Dells March 26.

When asked about his session, Hirsch had the following to say:

WHA: What do you hope attendees will take away from your presentation, Dr. Hirsch?

Hirsch: There are so many recent changes to Medicare regulations recently that keeping up with them and keeping them straight is a full time job. Since that is actually my job, I am going to give you 75 minutes of must-know regulation pearls that you can take back to your facility and use the next day to improve compliance and performance.

Hirsch’s full session will provide helpful hints for hospital case management, a look at hot topics in the audit/RAC realm and some practical tips to help each facility implement changes for improvement. In addition to Hirsch, attendees will hear directly from Wisconsin audit contractors, physician leaders and RAC appeals experts. WHA plans to release data from its first Wisconsin-specific RAC survey at the Summit as well.

Register your hospital leaders and RAC teams today to get WHA’s early bird discount. The $50 discount is available only through February 21, after which time registration goes up to $225. WHA believes there’s something for everyone at the RAC Summit. If you are registering a group of six or more people, please contact WHA’s Lisa Little, llittel@wha.org, to discuss a group discount rate.

Register online at http://events.SignUp4.com/14RACSummit. The brochure is available at: www.wha.org/Data/Sites/1/education/2014rac3-26.pdf.

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WICD-10 Offering March Webinars Focused on Testing and Data Analytics

Wisconsin’s ICD-10 collaborative—WICD-10—is offering two complimentary webinars for those involved in ICD-10 transition planning in advance of the October 1, 2014, implementation date.

The first, titled "ICD-10 Test Considerations: A ThedaCare Perspective," is scheduled March 13 from 1:00 to 2:15 pm. During this webinar, representatives from ThedaCare’s ICD-10 prep team will share how their strategy for upgrading internal systems and their approach to overall testing made them "early testers" and afforded opportunities for end-to-end testing with a few of their key payers. Discussion will include best practices for integrated testing, how to develop effective and dual purpose test cases, leveraging your clearinghouse and other strategic partners, how to prioritize your testing tasks and steps to take if business partners aren’t ready. More information and online registration on this free webinar can be found at: http://events.SignUp4.net/14ICD10Testing0313.

The second webinar, titled "ICD-10 Intersects Data Analytics; Evaluating the Impact on Financials, Quality Metrics and Other Reporting," will take place March 28 from 9:00 to 10:30 am. This webinar will highlight the importance of providers understanding the projected impact on financial performance, quality metrics, public health reporting, research, and state data reporting within and outside their organizations. More information and online registration for this free webinar can be found at: http://events.SignUp4.net/14ICD10DataAnalytics0328.

ICD-10 team leaders and members, coding managers and staff, data quality managers, clinical documentation improvement specialists, CFOs, denials and appeals professionals, revenue integrity professionals and any other hospital or group practice staff who want to learn more about best practices of integrated testing or about the impact of ICD-10 on data analytics would benefit most from attending these complimentary webinars offered by WICD-10.

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Nurse Leaders and Managers Invited to Attend WONE Annual Convention

The Wisconsin Organization of Nurse Executives (WONE) will host its annual convention for nurse leaders and managers April 30-May 2 in Wisconsin Dells. With a focus on its theme of "Lights, Camera, Action: Nursing in a Leading Role," the convention will open with a keynote presentation from Ginny Beeson, focusing on putting the IOM Report on the Future of Nursing recommendations into action.

The agenda also focuses on a variety of other topics including a legislative update, examining the role of advance practice nurses in health care, engaging staff to improve patient satisfaction, improving physician relations and information about Wisconsin’s Nurse Leadership Academy.

The convention will also include opportunities to network with other nurse leaders and managers. A full convention brochure is included in this week’s packet and available online, along with online registration, at http://events.SignUp4.net/14WONE.

The convention will be held at Glacier Canyon Lodge at The Wilderness Resort in Wisconsin Dells. Anyone who has responsibilities for leading and managing RNs will benefit from the educational agenda and is welcome—you do not need to be an RN or a member of WONE to attend. For registration questions, contact Lisa Littel at 608-274-1820 or email llittel@wha.org.

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WisHHRA Annual Conference for Human Resource Professionals, April 9-11

The Wisconsin Healthcare Human Resource Association (WisHHRA) will host its annual conference for health care HR professionals April 9-11, at Glacier Canyon Lodge at The Wilderness Resort in Wisconsin Dells.

The 2014 conference will focus on delivering world-class service with a keynote session by Bryan Williams, a consultant, trainer and author who focuses on service excellence and organizational effectiveness. Williams will focus on strategies to encourage employees to work with a sense of ownership. In addition, this year’s conference will also include the popular annual legal and legislative update sessions, as well as several best practice sessions, allowing attendees to learn from their peers.

Anyone who has human resource responsibilities in a health care organization will benefit from the educational agenda and is welcome to attend. In addition, the program has been submitted to HRCI for continuing education/recertification credit.

The full conference brochure is included in this week’s packet and online registration is available at http://events.SignUp4.net/14WisHHRA. For registration questions, contact Lisa Littel at 608-274-1820 or email at llittel@wha.org.

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Register Today for ICD-10 Summit: Ready. Set. Go Live!
March 17-19, 2014 *** Kalahari Resort, Wisconsin Dells

WHA, along with the Wisconsin Medical Society and the Wisconsin Medical Group Management Association, have teamed up to offer the ICD-Summit to assist hospitals and clinics throughout Wisconsin in preparing for the October 1, 2014, implementation date.

A full agenda and online registration are available at: www.wha.org/icd-10summit.aspx

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New Survey Tracks Use of Locum Tenens Physician Staffing Services

Each year, Staff Care, a provider of locum tenens staffing services, conducts a survey examining the use of locum tenens physicians nationwide. Staff Care’s upcoming 2014 Survey of Temporary Physician Staffing Trends tracks the number of hospitals that have used locum tenens physicians over the previous 12 months, why they have used them, and what types of physicians are most in demand as locum tenens. The survey also looks at physicians who work on a temporary, locum tenens basis and reveals why these physicians choose to work temporary assignments.

Last year, Staff Care’s survey indicated that some 75 percent of hospitals and medical groups had used locum tenens physicians during calendar year 2012. According to Bonnie Britton, senior vice president of sales with Staff Care, the 2014 survey shows that 90 percent of hospitals and medical groups used locum tenens physicians in calendar year 2013.

"A growing number of health care facilities are using locum tenens physicians, for a variety of reasons," Britton notes. "These include filling gaps created by physician turnover, maintaining services while facilities are seeking permanent doctors, and providing coverage for physicians on vacation or CME."

Wisconsin Hospital Association members can obtain a free copy of the survey report by contacting Kelli Hummert at 469-417-7532 or by email at kelli.hummert@staffcare.com.

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