September 6, 2013
Volume 57, Issue 36
43 Critical Access Hospital CEOs Send Letter to CMS
Sen. Baldwin leads Senate letter; WHAís Brenton on WI Eye
This week 43 Wisconsin critical access hospital (CAH) leaders sent a joint letter to Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services (CMS), expressing concerns with the Department of Health & Human Servicesí Office of Inspector General (OIG) report on CAHs. In its report, the OIG recommended that CMS seek legislative authority from Congress to remove "necessary provider" status from CAHs that do not meet certain distance requirements. The Wisconsin Hospital Association believes this recommendation could impact up to 90 percent of the stateís CAHs.
"Not only would the OIG recommendation up-end health care in rural communities across the country and impact millions of Medicare patients," read the CEOís letter to Tavenner, "we believe it fundamentally misunderstands the value, quality and efficiency of rural health care delivered by CAHs to Medicare beneficiaries."
"Our hospitals, along with all other Wisconsin hospitals, are also proud to be proactive national leaders in delivering high-quality, cost-efficient care, as evidenced by third-party research and our own voluntary quality reporting on Wisconsinís ĎCheckPointí website, www.wicheckpoint.org."
The letter went on to point out the negative impact this proposal, if enacted, would have on rural economies.
"In addition, we believe CAHs in Wisconsin play a vital role in providing access to health care, economic security, and jobs to our rural communities. Rural hospitals are often one of, if not the largest, local employers, providing family-supporting wages that ripple throughout rural communities and that generate tax revenue to support state and local services."
Read the full letter at: www.wha.org/pdf/CAHCEO-OIG-9-5-13.pdf.
Nationally, Wisconsin Members of Congress are also weighing in with their opposition to the OIG proposal. Recently, Sen. Tammy Baldwin led a letter with 19 of her U.S. Senate colleagues on this issue to key Senate Finance Committee leaders. U.S. Rep. Ron Kind is leading a similar letter in the House of Representatives.
"CAHs play a vital role providing access to health care, economic security for families and seniors, and jobs to rural communities across the nation," the Senate letter read. "These hospitals are safety nets for hundreds of thousands of Americans, providing inpatient and outpatient services, as well as 24-hour emergency care. CAHs make it possible for patients with complex medical needs to remain home in rural communities."
The letter closed with, "As your committee considers changes to Medicare policy, we believe that indiscriminate cuts to CAHs are not the answer. This is particularly true concerning the elimination of the CAH designation to hospitals based on an arbitrary number of miles between facilities."
Read the Senate letter at: www.wha.org/pdf/CAHSenate-8-22-13.pdf.
And closer to home, Wisconsin Hospital Association President Steve Brenton joined four others on Wisconsin Eye, the stateís version of C-Span, for a "Newsmakers" panel discussion on the OIGís CAH recommendations.
In addition to Brenton, the panel included: John Russell, CEO, Columbus Community Hospital; Tim Size, executive director, Rural Wisconsin Health Cooperative; State Senator Dale Schultz, whose district includes many CAHs; and Dr. Byron Crouse, associate dean for rural and community health, UW School of Medicine & Public Health.
Watch the Wisconsin Eye "Newsmakers" program at:www.wiseye.org/videoplayer/vp.html?sid=10500
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Rewritten Unprofessional Conduct Rule Now in Effect
Legislature reviewing amended physician assistants rule
The Wisconsin Medical Examining Board (MEB) has finalized its rewrite of the administrative rule that defines unprofessional conduct for physicians. According to the Legislative Reference Bureau (LRB), Med 10 went into effect October 1, 2013, the day after the LRB published the new rule in the Wisconsin Administrative Register.
The new rule clarifies a number of issues. For example, Med 10.03(2) will include the following language:
"Unprofessional conduct" includes the following, or aiding or abetting the same:
(k) Aiding or abetting the practice of medicine by an unlicensed, incompetent, or impaired person or allowing another person or organization to use his or her license to practice medicine. This provision does not prohibit a Wisconsin physician or any other practitioner subject to this chapter from providing outpatient services ordered by a physician licensed in another state, if the physician who wrote the order saw the patient in the state in which the physician is licensed and the physician who wrote the order remains responsible for the patient.
Other issues addressed in the new rule include patient abandonment, informed consent, and wrong site surgery. To view a copy of the important new rule, go to:https://docs.legis.wisconsin.gov/code/chr/related/2013/cr_13_008/cr_13_008_final_rule_filed_with_lrb
The MEB filed with the Legislature proposed changes to Med 8, the administrative rule that establishes certain licensure and practice standards for physician assistants. If the Legislature does not object to the proposed changes, the administrative rule, among other things, would allow a physician to supervise up to four on-duty physician assistants. Under the current rule, a physician may not concurrently supervise more than two physician assistants without MEB approval.
The deadline for action by the standing committees of the Legislature on the physician assistants rule is September 25, 2013. To view a copy of the proposed amendments to Med 8, go to:www.wha.org/pdf/AmendmentsMed8.pdf.
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New Legislator Profile: Rep. Joe Sanfelippo (R-West Allis)
As a former member of the Milwaukee County Board, Rep. Joe Sanfelippo knows that systemic mental health reform is needed in Milwaukee County. What he soon realized after being elected to the state Legislature in 2012 is that mental health reform is needed not only in Milwaukee, but at the state level as well. As a member of the Speakerís Task Force on Mental Health, Sanfelippo has heard over the last several months about the changes that need to take place in Wisconsin to remove barriers to integrated, coordinated care for individuals with mental illness and to improve access to preventive, community-based mental health services throughout Wisconsin.
At public hearings held around the state earlier this summer, Task Force members heard from primary care physicians, psychiatrists, mental health workers, clients and patients. The feedback was valuable, according to Sanfelippo, and it helped focus the Task Force on the most pressing issues.
"One of the single biggest problems that we heard consistently in all our meetings is that it is an extremely frustrating process that health care workers cannot share information they need to successfully treat patients, so there has to be some Ďharmonizationí among our laws," according to Sanfelippo. "We went maybe a step too far in Wisconsinówe have to protect patientsí confidentiality, but we also need to get the proper information from caregivers and doctors so patients can get appropriate treatment. It is a problem that we heard about at every public hearing."
Sanfelippo said concern about the issue is high, legislators seem willing to act, and the Governor has committed $28 million toward improving mental health care in Wisconsin. Because of that, Sanfelippo is hopeful that any mental health reform legislation that "will move us in the right direction" can be enacted before the end of the current legislative session.
"What we have to do is step up our level of mental health care services statewide so that the consumers that we are providing these services to are really getting what are the best practices in the field," he said. "We need to make sure that we are giving patients the level of services that meet their needs. There is not a Ďone-size-fits-allí approach. If the changes we make can result in fewer emergency detentions and fewer people going into crisis, we need to do that. If we wait until they are in crisis, we have failed. That is what we are lacking, and that is what we are trying to do. And if we manage to do that, it is what I would consider a success for the Task Force."
Another issue that is a priority for Sanfelippo is to update Wisconsinís Administrative rules, such as DHS 124, which will help business operate more efficiently by reducing red tape and administrative burden. Sanfelippo is a member of the Assembly Committee on Health, which held an informational hearing in early April about reforming DHS 124, the stateís Administrative Code regulating hospitals.
"When you look at the thousands of pages of rules that we have in the state, and you are still using some that were written 30 years ago that simply donít apply any longer, you realize that it is imperative that we go through and Ďright the rulesí and clean them up," he said. "The cost of doing business, especially for hospitals, to comply with these regulations is staggering. It just adds unknown costs to patients."
As a former business owner, Sanfelippo knows that high-quality, high-value health care plays a key role in the stateís economic development. He is quick to name the attributes that he believes makes Wisconsinís health care "second to none" in the nation.
"We have great doctors, great health care organizations and dedicated professionals in all aspects of care," he said. "As an employer, you have to pay a good wage and offer good benefits. If your benefit package and providers are subpar, it will hurt your recruitment efforts."
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Political Action Fundraising Campaign Surpasses 65 Percent
Now over 65 percent to the goal to raise $260,000 by yearís end, the Wisconsin Hospitals Conduit and State Political Action campaign has raised more than $170,000 from 253 individuals.
So far individuals are contributing an average $672 and the median contribution is $500. Of the total contributors so far, 10 more individuals have been added to the Platinum Club in the last month putting the total members at 57 to date. Platinum Club members are those campaign leaders who have contributed $1,500 or more to the 2013 campaign.
All individual contributors are listed in The Valued Voice by name and affiliated organization on a regular basis. Thank you to the 2013 contributors to date who are listed below. Contributors are listed alphabetically by contribution amount category. The next publication of the contributor list will be in the September 20 edition of The Valued Voice. For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.
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The Wisconsin Hospital Association will lead a trip of hospital leaders and advocates to Washington, DC on October 29 to participate with the American Hospital Associationís fly-in. As Congress faces multiple fiscal deadlines, including the federal budget and debt ceiling, hospitals must remind elected officials of the effects of their decisions on high-value health care providers like those in Wisconsin.
"From the recent OIG report, essentially advocating that up to 90 percent of Wisconsin critical access hospitals lose this important designation, as well as multiple other proposals seeking to cut larger rural, urban and suburban hospital payments, we must be present in DC as fiscal decisions are being made this fall," said WHAís Vice President, External Relations & Member Advocacy Jenny Boese. "We encourage hospital leaders and advocates to consider joining WHA for this important trip."
The WHA will coordinate, schedule and staff Hill visits on October 29 with Wisconsinís Members of Congress. WHA will host a dinner and briefing the evening before (October 28) for all Wisconsin attendees. If you are interested in participating or need additional information on the fly-in, contact WHAís Jenny Boese at email@example.com or 608-268-1816.
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On September 11, 2013, at 1 pm Central time, the federal Centers for Medicare and Medicaid Services (CMS) will hold its third Wisconsin-specific stakeholder call on the health insurance exchange. The call will feature Jackie Garner, the consortium administrator for Medicaid and Childrenís Health Operations and acting regional director for the U.S. Department of Health and Human Services (HHS).
Registration is required. Register at: www.cmsregion5himwi3.eventbrite.com.
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CMS has issued a new FAQ document specifically for providers. Many providers have had questions about certified application counselors (CACs), including the process for designating an entity as a CAC organization, requirements of the CAC entity, and training. The document provides answers from CMS to several of these questions. You can find the FAQs on the WHA website atwww.wha.org/data/sites/1/medicaid/CMSFAQsabout-cac-designationAug2013.pdf.
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Presidentís Column: HIRSP, ETF, Special Recognition and Rural Health
HIRSP will disappear on January 1, 2014, when the ACAís mandate for "guaranteed issue" takes effect. HIRSP, the second largest program of its type in the nation, is in the process of shutting down and will likely pay its last claim sometime next summer.
Special kudos to HIRSP CEO Amie Goldman and to all who have served on the HIRSP Board over three decades. And letís hope that the 24,000 HIRSP-covered individuals moving to the Wisconsin exchange/marketplace will find a smooth transition to adequate and affordable coverage.
Some are now suggesting moving away from the successful model and turning over the entire book of business to one commercial carrier. This comes even after three independent studies suggest such a switch will not likely be cost effective for state taxpayers. WHA staff is sorting through the implications of this potential change. Stay tuned.
Just last week, Davis completed a statewide tour of WHA-organized meetings that attracted scores of participants eager to help achieve Governor Walkerís stated goal of reducing Wisconsinís uninsured rate by half. From Prairie du Chien - to Hayward - to Green Bay and additional venues, Davis effectively presented and addressed questions regarding the role hospital volunteers can and will play in assisting individuals and families gain coverage. COMMITMENT FULFILLED!!
Rural health care will be a major issue this fall. Not only must we be vigorous in touting the value of the CAH program, but we will need to make sure that Congress extends other important programs vital to larger rural hospitals in communities like Fort Atkinson, Portage, Beaver Dam and Mauston.
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Preventing patient falls is an ongoing challenge for hospitals, so when Holy Family Memorial in Manitowoc set out to reduce the number of falls occurring on the medical/surgical floor, they looked to the WHA Partners for Patients initiative for new ideas.
"We had been working to reduce falls all along, but what we really wanted to do is benchmark our work and look for new opportunities to improve patient safety," according to Sally Eckardt, RN, falls project lead at Holy Family Memorial (HFM). "We felt we could do that by networking with other hospitals through the WHA Partners for Patients."
HFM implemented several safety interventions at the time the project began, including bed alarms, yellow wrist bands and yellow leaves affixed to the doors of patients at risk, and hourly rounding. Patients at risk of falls were in rooms located closer to the nursing desk. Then, the floor implemented the 4 Pís (pain, potty, positioning, and possessions). This provides a structured protocol for care providers to follow when checking on patients in their room. When completed, the patients are less likely to fall because their core needs are met. In addition, after-falls huddles were introduced, incorporating the staff and supervisor or team leaders, which provided a root-cause analysis if a fall with injuries occurred. HFM used the white board in patient rooms, which also engaged the patient and their family in helping to maintain a safe environment.
"The evidence-based practices on how to reduce falls is readily available to all hospitals. The challenge is integrating those processes into the existing system," said Tom Kaster, WHA quality improvement advisor. "Holy Family Memorial has done an excellent job including staff members in their implementation teams and having them test the new processes to work the kinks out before they are introduced to the larger staff."
The staff reports that since they initiated the falls prevention project, their patients are receiving higher quality care from the nurses. When falls are prevented, it gives staff more time to spend with patients and workflow is not disrupted so care can be delivered more effectively and efficiently.
The falls team credits their participation in the WHA Partners for Patients webinars with giving them new ideas on how to prevent falls from hospitals statewide who are also working on medical/surgical floors.
"The webinars and coaching provide tangible, real-life improvement methods so we donít have to start from scratch on our efforts," according to Eckardt. "The webinars help to provide a simple plan for making changes in small, doable steps. It also provides us with encouragement and an infusion of enthusiasm for helping to keep our patients safer."
HFM plans to continue staff education on the 4 Pís and after-fall huddles, and they are working with the rounding team to set standards of care that all staff must follow to ensure patient safety.
Support from administration is essential. "Show your staff you value their efforts by allowing them time to work on the projects and provide feedback to them," Eckardt said.
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Elizabeth Stower, originally from Amery and current primary health care aide in Rep. Ron Kindís Washington, DC office, visited several Wisconsin hospitals as well as the Wisconsin Hospital Association during the Congressional August recess.
Stower, pictured with Tomah Memorial Hospital (TMH) CEO Phil Stuart, visited TMH on August 27. She met with CEO Phil Stuart and other hospital leaders to discuss a number of health care issues, including a recent federal recommendation calling for the removal of critical access hospital (CAH) status for a number of rural hospitals, including TMH.
Stower reported that Rep. Kind (D) La Crosse, together with U.S. Rep. David McKinley (R) West Virginia, are leading a bipartisan House letter denouncing the federal Department of Health & Human Servicesí Office of Inspector General (OIG) recommendation rescinding CAH status for roughly two-thirds of the nationís CAHs. In Wisconsin, it could impact up to 53 of 58 CAHs.
Wisconsin hospitals and WHA appreciated the opportunity to meet and talk with Stower.
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The Centers for Medicare and Medicaid Services (CMS) has issued guidance interpreting its new requirements for admission and medical review criteria for hospital inpatient services under Medicare Part A. In its guidance, CMS indicates that the order for inpatient services may be documented by an individual who is not a physician, such as physician assistants, residents, or registered nurses, provided the documentation is consistent with State law, hospital policies, and medical staff bylaws and rules.
Among other things, the guidance states the following concerning the qualifications of the ordering/admitting practitioner:
The order must be furnished by a physician or other practitioner ("ordering practitioner") who is: (a) licensed by the State to admit inpatients to hospitals, (b) granted privileges by the hospital to admit inpatients to that specific facility, and (c) knowledgeable about the patientís hospital course, medical plan of care, and current condition at the time of admission. The ordering practitioner makes the determination of medical necessity for inpatient care and renders the admission decision. The ordering practitioner may be, but is not required to be, the physician who signs the certification.
At some hospitals, practitioners who lack the authority to admit inpatients under either State laws or hospital bylaws may nonetheless frequently write the sets of admitting orders that define the initial inpatient care of the patient. In these cases, the ordering practitioner need not separately record the order to admit. Following discussion with and at the direction of the ordering practitioner, the order (including a verbal order) may be documented by an individual who does not possess these qualifications (such as a physician assistant, resident, or registered nurse), as long as that documentation (transcription) of the order is in accordance with State law including scope-of-practice laws, hospital policies, and medical staff bylaws, rules, and regulations. In this case, the order must identify the qualified "ordering practitioner," and must be authenticated by the ordering practitioner (or by another practitioner with the required admitting qualifications) prior to discharge. A transcribed and authenticated order also satisfies the order part of the physician certification as long as the ordering practitioner also meets the requirements for a certifying physician.
The guidance also clarifies other elements of the physician certification and recertification of inpatient services of hospitals. A copy of the CMS guidance is available at: www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Downloads/IP-Certification-and-Order-09-05-13.pdf. The American Hospital Association anticipates CMS will issue additional guidance in the coming weeks.
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Registration is still open for WHAís Leadership Summit, planned for September 19, at Country Springs Hotel in Pewaukee. View the dayís agenda and register online at: http://events.SignUp4.com/13LeadershipSummit0919.
This one-day event is focused on providing WHA members with the leadership and management practice tools and techniques needed to stay ahead in the changing world of health care. This event will highlight examples of innovative and bold leadership, offer actionable strategies, and provide attendees with valuable peer networking opportunities.
The variety of sessions will be presented by nationally-known and respected faculty, including Bob Murphy, Elizabeth Holloway, Dr. Joe Bujak and Jamie Haeuser. In addition, a panel of local health care experts will discuss their perspectives on the future of health care financing. The panel will be moderated by Steve Kennedy of Lancaster Pollard, and will include Weldon Gage, CFO of Childrenís Hospital and Health System; Gail Hanson, CFO of Aurora Health Care; and Patrick Walsh, attorney for Hall, Render, Killian, Heath & Lyman, P.C.
The panelists will share their outlooks for Medicare, Medicaid, private insurance, pay-for-performance and consumer-driven products, and their impact on organizational strategy and planning. They will also discuss strategic approaches to monitoring and adjusting to changes in the financing environment.
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On October 24, the Wisconsin Council on Medical Education and Workforce (WCMEW) will host the one-day conference "Taking the Next Step: A Statewide Conference on Graduate Medical Education."
Hospital and health system leaders should attend to learn why and how they can be part of contributing to graduate medical education (GME) in Wisconsin. WCMEW, with the partnership of WHA, is sponsoring this statewide event to provide information on taking that next step toward becoming part of the solution to the urgent problem of providing an adequate future medical workforce for Wisconsin.
Participants will collect both practical and strategic information by listening to and interacting with expert and experienced speakers who represent academic medical centers, teaching hospitals, residency programs, policy planners, current collaborative GME efforts and more. In particular, one session will specifically focus on the current GME funding environment, including information from a representative of Wisconsinís Department of Health Services to discuss their grant programs.
The conference will be held Thursday, October 24 at the Best Western Bridgewood Resort Hotel & Conference Center in Neenah. An agenda and online registration are at http://events.SignUp4.com/13GME.
For questions, contact Chuck Shabino, MD, WHA senior medical advisor at firstname.lastname@example.org, or George Quinn, WHA senior policy advisor at email@example.com.
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The Hermes Monato, Jr. Prize of $2,500 is awarded annually for the best rural health paper. It is open to all students of the University of Wisconsin (any campus) as well as those who will be recent graduates at the time of submission. Students are encouraged to write on a rural health topic for a regular class and then to submit a copy to the Rural Wisconsin Health Cooperative as an entry by June 1, 2014. Previous award winners, as well as judging criteria and submission information, are available at: www.rwhc.com/Awards/AnnualMonatoEssay.aspx.
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Early growth and development have a profound effect on health across the life span. Developmental disabilities can often be mitigated if they are detected early. Every week in Wisconsin almost 100 infants are born with low birth weight, and about six percent of those will die before their first birthday. Hospitals are striving to decrease infant mortality by providing pre-conception and inter-conception care to those affected by poor birth outcomes.
Safe mom, safe baby
Intimate partner violence is a significant risk for pregnant women and their babies.
Unfortunately, Jessica knows the effects of this type of violence well. The abuse Jessica was experiencing while living with her husband escalated when they discovered she was pregnant with their third child. As she moved further into her pregnancy, the violence worsened to a level that caused Jessica to consider an abortion just to escape the abuse.
When she finally found the strength to remove herself and her children from this violent situation, she tried to live with her mother. Sadly, her relationship with her mother was strained and her mother would only allow the children to live with her. Through the Milwaukee Womenís Center, Jessica was connected with a counselor from the Safe Mom, Safe Baby program at Aurora Sinai Medical Center.
Aurora Sinai Medical Centerís Safe Mom, Safe Baby (SMSB) program was launched in 2005 to provide sensitive and effective services to pregnant women who have been screened and identified as experiencing intimate partner violence. The goal of the program is to increase safety and health for women and their babies while lowering their risk for complications such as pre-term birth and low birth weight.
The SMSB counselor met Jessica at the Womenís Center for their initial meeting. She opened the conversation by asking Jessica the same question she asks all of her clients, "What can I do to help you right now?"
Jessica explained to the counselor that she had no job and was struggling to meet her basic needs such as finding food and shelter. The counselor immediately contacted a local shelter that was able to provide Jessica with housing. She then supplied her with a grocery store gift card so that she could buy some nutritious food to keep her and her unborn child healthy. She also followed up with Jessica to counsel her through some of the challenges she continued to face as she transitioned into being a single mother.
A few months after their final meeting, the counselor received notification by email that Jessica gave birth to a healthy baby, was now working, and was living in a stable environment with all of her children. Jessica wrote "Thank you for providing me with the tools I needed to get away from the violence and into a safe place for my family."
In 2012, the SMSB program completed screenings for over 50 pregnant women.
Aurora Sinai Medical Center, Milwaukee
Learning about childbirth online
Attending a childbirth class may be difficult for some expectant parents, such as women on bed rest for medical reasons or who live in a rural setting that makes travel more difficult and expensive. Mayo Clinic Health System offers a new course for expectant parents to take in the comfort of their homes. The online course is interactive and offers more than 100 pages of pregnancy, birth and newborn information.
"Itís a great way for people to take part in childbirth classes at their leisure," says Heather Costley, outpatient director of the Womenís Health Center at Mayo Clinic Health System in Eau Claire. "Itís easy to use, and itís accessible. Weíre really excited to offer it."
The course also is a good option for parents who have given birth before and want a refresher or for those who want additional information after attending a classroom-based childbirth education course.
Once accessed, the course may be used for 180 days, giving ample time for expectant parents to refresh their knowledge before and after birth.
"We wanted parents to have the opportunity to go home, acclimate to having a baby and remember they have the opportunity to use the newborn information as an additional tool," Costley says.
The course provides a comprehensive overview of pregnancy, nutrition issues, childbirth support, discomforts of pregnancy, labor guidance, delivery and anatomy, postpartum care and breast-feeding benefits. The course is available to any expectant parent, regardless if patients deliver at a Mayo Clinic Health System hospital.
Mayo Clinic Health System, Eau Claire
CenteringPregnancy™ Program prevents infant mortality one baby at a time
The CenteringPregnancy™ Program is giving pregnant women like Shannone Brown the support and guidance needed to raise a healthy and happy baby.
Developed by the Centering Pregnancy Institute, the program focuses on the three major components of pregnancy care: health assessment, education, and support. Offered through the Wheaton Franciscan Ė St. Joseph Womenís Outpatient Center and Wheaton Franciscan Healthcare Ė All Saints, six to eight women with similar due dates gather in a group setting to learn care skills, participate in facilitated discussion, and develop a support network. In addition to the clinical aspects of pregnancy, women also bond and offer support and reassurance to one another.
"Prenatal care isnít just about listening to heartbeats or measuring bellies and checking blood pressure," said Amber Grant, a Nurse Practitioner at the Womenís Outpatient Center. "We want to address the emotional situation, the social networks, and just any little thing that could impact the outcome of the pregnancy."
"Anyone interested in the program can join, but the typical participants are young, single females who are looking for a connection," added Lisa Lockett, Nurse Practitioner at the Womenís Outpatient Center.
The CenteringWomen™ Program has helped women like Shannone Brown be secure and educated about their pregnancy. "They gave me the comfort to know that itís okay; letís embrace the fact that you are bringing a child into the world," Shannone shared.
Of the 65 CenteringPregnancy participants so far, all but three have had full-term babies and all been able to successfully breastfeed.
Wheaton Franciscan Ė St. Joseph, Milwaukee
Submit community benefit stories to Mary Kay Grasmick, editor, at firstname.lastname@example.org.
Read more about hospitals connecting with their communities at www.WiServePoint.org.
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