March 30, 2012
Volume 56, Issue 13

Legislative Fiscal Bureau, Constitutional Law Scholars Headline WHA Public Policy Meeting

Discussions of timely issues were the focus at the March 27 Public Policy Council meeting as special guests from the Legislative Fiscal Bureau (LFB) and the University of Wisconsin-Madison were on hand to share their expertise and viewpoints on topics that will significantly impact hospitals and health care consumers and payers over the coming months and years ahead.

Council receives Medicaid program status update

LFB analysts Charlie Morgan, health team leader, and Grant Cummings, health services program supervisor, reviewed the state budget and the ever-fluid and difficult to predict status of the Medicaid program for Council members.

Approximately 30 staff members at the LFB make up the non-partisan service agency for the Wisconsin Legislature that provides fiscal information and analysis for legislators—especially the Joint Committee on Finance during the Committee’s deliberations on the state budget—and works closely with state agencies to maintain accurate information on state programs.

Morgan gave Council members a snapshot look at the state’s general fund condition statement as of February 2012. The fiscal year (FY) 2012-13 opening balance was $11.8 million, down from $85.6 million for 2011-12. While projected revenues are higher for 2012-13 at $14.2 billion versus the $13.9 billion seen for 2011-12, net appropriations, transfers, and reserves are also higher at $14.4 billion for 2012-13 versus $13.9 billion for 2011-12.

Taking into account the required annual statutory balance of $65 million leaves Wisconsin’s biennial 2011-13 budget with a projected $53.2 million shortfall for 2011-12 and a $208.2 million deficit for 2012-13.

Morgan highlighted the significant percentage funding for Medical Assistance (MA) takes up of the overall state budget, for the 2011-13 biennium amounting to over $4 billion or 14 percent of GPR (state funds) and over $14 billion or nearly 22 percent of all funds (AF, state and federal).

The MA budget is a sum-certain appropriation, Morgan said, meaning that the Department of Health Services (DHS) must spend within the amount they are appropriated and operate based on funding that is available. The amount that is budgeted for spending is largely based on enrollment and utilization projections. If they are short funding, their options are to go to the Legislature and request additional funding, or look elsewhere—such as reductions to provider payments—to support program benefits.

"It is for this very reason that WHA has been adamant about protecting against inaccurate enrollment and utilization projections," said WHA Executive Vice President Eric Borgerding.

Cummings focused more specifically on the status of the MA program, including a history of MA benefits expenditures. From FY 2007-08 through projected FY 2012-13, MA spending will have increased from $4.9 billion (AF) to over $7 billion (AF). Over the same period, average monthly enrollment jumped from 873,000 in 2007-08 to 1,175,000 through February 2012.

The December 2011 estimated MA shortfall was approximately $92 million GPR ($230 AF).

Cummings said based on changes since then, such as the removal of the Family Care enrollment cap (as required by CMS), non-Maintenance of Effort items still being negotiated with CMS, administrative program changes, and assuming the savings from all DHS reform efforts are realized, there is the potential for surplus of $29.9 million GPR ($373.5 million AF). Both Morgan and Cummings emphasized again that the surplus is only possible if all reform savings are realized.

Under a WHA-backed budget provision, DHS is required to report quarterly to the Joint Finance Committee on the status of the Medicaid program. The next DHS quarterly report to the Joint Committee on Finance is due today.

UW Professors discuss Supreme Court review of PPACA

This week, with the United States Supreme Court in the middle of hearing an extraordinary five and one-half hours of oral arguments on the challenge to President Obama’s Patient Protection and Affordable Care Act (PPACA) (see related story), the timing was perfect for a discussion with two recognized constitutional law experts.

Professors Don Downs and Ryan Owens from the UW-Madison Political Science Department were both on hand to provide their perspectives and insight into what the high court will be considering as well as what to look for as the justices deliberate what has been called the most significant and controversial question of law and public policy in the last 50 years.

Professor Downs, who received his PhD from the University of California-Berkeley and began at UW-Madison in 1985, has authored numerous books on constitutional law and civil liberties and has been engaged in issues regarding law, politics, and academic freedom nationally and internationally for years.

Downs said there are five major provisions in PPACA:

  1. Insurance industry reforms
  2. New state-run health insurance exchanges
  3. An individual mandate of "minimum essential coverage" that requires the uninsured to purchase insurance—or face a penalty that is apportioned to their wealth
  4. Employer mandates
  5. Expansions of Medicaid that expand required coverage and do not allow states to lower coverage from existing levels.

Oral arguments this week focused on the individual mandate; if the mandate is found unconstitutional, does the entire PPACA fall with it, or is the mandate "severable" from the rest of PPACA and the constitutionality of the Medicaid program expansions.

Downs expanded on several key questions the lower courts dealt with, but reached different conclusions, including: Is choosing to forego the purchase of medical insurance an economic activity that can be regulated by the federal government? If such a choice is not an economic activity, does Congress still have the power to penalize it?

Professor Owens received his J.D. from the University of Wisconsin in 2001 and his PhD from Washington University of St. Louis in 2008, practiced telecommunications law in Madison and was an assistant professor at Harvard University prior to arriving at UW-Madison in 2011. An expert on judicial politics and American political institutions, his work has appeared in many prestigious journals.

Owens has used statistical analysis of prior justice behavior to predict the outcome of cases and has found that it can be more accurate than subjective expert forecasting.

At the meeting, Owens explored the question of what typically motivates justices and how that might play out in their review of PPACA. In particular, he said while justices vote primarily based on their ideological considerations, how the case is ultimately framed may generate different ideological outcomes.

Owens focused on the importance of the oral arguments and whether they can be used to predict the outcome of a case—specifically, the number of questions asked, as well as their tone, or emotional content, and whether they can be a potential indicator of the position being formed by a justice.

Both Downs and Owens said predicting the outcome of the PPACA case with any certainty is difficult, but suggested the majority of the court would struggle with the individual mandate.

Council begins discussion of legislative priorities

Efforts aimed at fine-tuning WHA’s advocacy agenda continued as Council members weighed in on issues that will be important as Wisconsin’s health care delivery system continues to evolve.

Council members began a ranking of issues across broad topic areas including hospital and health system operations, health care reform, Medicaid, Medicare, other reimbursement issues, electronic medical records, health information technology and transparency, health plan and insurance issues, behavioral health issues, and health care workforce and labor issues.

Topics and issue discussions will help WHA staff prepare for the 2013 legislative session and beyond.

Top of page (3/30/12)

Several Bills Make Their Way to Governor Walker

Governor Walker was at Marshfield Clinic on March 28 to sign a number of health care-related bills. The legislation enacted into law included:

Senate Bill (SB) 317, authored by Senator Leah Vukmir (R-Wauwatosa) and Rep. Jeff Stone (R-Greendale), which allows electronic prescriptions for Schedule II controlled substances. Previously, Schedule II controlled substances, which have high potential for abuse and dependence, could not be dispensed without the written prescription of a practitioner, which has lead to fraudulent prescriptions.

SB 383, authored by Sen. Alberta Darling (R-River Hills) and Rep. Erik Severson (R-Star Prairie), allows for licensure for anesthesiologist assistants and creates the Council on Anesthesiologist Assistants. The Council provisions are effective the day after publication of the law, while the licensure provisions go into effect the first day of the 7th month beginning after publication.

SB 421, authored by Sen. Vukmir and Rep. Warren Petryk (R-Eleva), expands the authority of physician assistants (PAs) to perform specific independent tasks. These tasks are similar to those that were legislated for Advanced Practice Nurse Prescribers last session.

New laws not expressly prescribing the time they take effect shall take effect on the day after date of publication as designated by the secretary of state. The date of publication may not be more than 10 working days after the date of enactment.

Several other bills are scheduled to be signed by Governor Walker next week, including:

SB 487, authored by Sen. Pam Galloway (R-Wausau) and Rep. John Nygren (R-Marinette). WHA supported the proposal as a measure that will enhance the state’s third-party liability identification efforts and help ensure Medicaid is the payer of last resort. SB 487 aligns Wisconsin law with federal law to require both self-insured health plans and pharmacy benefit managers to be held to the same requirements as other third-party entities with respect to Medicaid reporting requirements.

SB 409, the Biennial Worker’s Compensation Advisory Council (WCAC) bill, establishes the maximum fee for health care services provided to injured workers at 1.2 rather than 1.4 standard deviations above the mean charge, using the current certified databases to establish the maximum fee. It also requires a committee of the WCAC to audit the certified databases for compliance with program requirements. If the required audit does not commence within six months of the date of the bill’s enactment, the maximum fee increases to 1.3 standard deviations above the mean charge. The bill also includes an increase in payments to injured workers who are permanently partially disabled.

WHA, a health care liaison to the WCAC, closely monitors Council activity and provides input on Council actions.

SB 297, authored by former Senator Pam Galloway and Rep. Jeff Stone, which as originally drafted would have eliminated the ambulatory surgery center (ASC) assessment. SB 297 was amended to not eliminate the ASC assessment, but instead include statutory language that provides ASCs protection in the event the federal government stops paying the federal share of MA, consistent with language that WHA insisted on for the hospital assessment.

Similar to the hospital assessment, the ASC assessment collects additional funding for the Medicaid (MA) program and generates additional federal MA dollars for Wisconsin. It also allows for a proportional increase in ASC MA reimbursement related to the number of MA patients seen by the ASC. WHA did not take a position on SB 297, but legislators raised concerns about the need to replace the lost ASC revenue and its corresponding MA funding.

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Guest Column: Community Health Needs Assessment: What’s On Board and What’s "Over Board?"
By David Edquist, Attorney, von Briesen & Roper, s.c.

March 23 was a significant date for hospitals grappling with the new requirements for community health needs assessments (CHNAs) imposed under the Patient Protection and Accountable Care Act. For tax years beginning after 3/23/12, hospitals must have performed a CHNA and adopted an implementation strategy in that tax year or one of two previous years.

March 23 was also the date on which WHA conducted a day-long conference on CHNAs that provided its members with the tools to meet these new federal requirements. One clear message from attendees involved the need for an answer to this fundamental question: what does the law actually require? This article zeroes in on your core obligations under PPACA as discussed at the conference.

Identify the community.
The IRS does not prescribe any specific approach for defining the community served by the hospital. The IRS generally expects a geographic-based definition, which might be based on county designations, metropolitan statistical areas, or zip codes. For example, a service area might consist of contiguous zip codes where the hospital has a market share above a certain level, or zip codes that meet a certain threshold percentage of the hospital’s total discharges and outpatient visits. For specialty hospitals, the community might be better defined through identification of target populations rather than geography. There are no bright-line tests, giving you flexibility so long as you do not define community in a manner that intentionally excludes populations or circumvents the requirement to assess health needs and obtain input from the community.

Describe your process and methods. A CHNA must identify and assess the health needs of the community served by your specific hospital facility. Once again, the IRS allows a lot of flexibility in how this is done. Hospitals are not required to perform their own primary research, and IRS encourages use of existing statistical and demographic data. The IRS also encourages collaboration with other organizations in conducting the CHNA, and you should identify collaborators in your report. But if you do collaborate, you cannot use the same report for everyone. Rather, you still need a separate tailored report for your community, your strategy, and your resources. That report must be transparent in describing how you conducted your assessment. And as you consider existing community assets and document needs and deficits, you are required to identify information gaps that impacted your ability to assess your community’s needs.

Get input from others. While the IRS gives you flexibility in many areas, one point that is not optional involves the need to get input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge or expertise of public health issues. The IRS expects you to take into account input from federal, tribal, regional, state or local health departments or agencies with current information on health needs in the hospital’s community, and also expects input from representatives of medically underserved, low-income, and minority populations and populations with chronic disease needs. You are expected to provide names and titles of the key individuals from these outside resources, and describe how you took their input into account. Beyond that, though, hospitals retain the ability to choose the organizations and individuals from whom they will seek input and with whom they will collaborate. You also have flexibility in deciding how to obtain that input, whether through surveys, interviews, focus groups, or other methods.

Make your CHNA widely available. A CHNA is performed when your written report is made "widely available," which means finalized and posted on your hospital website. It is not enough just to have the report available for viewing on your website. Rather, anyone with an internet connection must be able to access, download and print the report in the same image as the original and without any specialized hardware or software. Though not required, hospitals may elect to make the report available in other ways, such as by making copies available at local libraries or community centers, or through community presentations to local governmental bodies and other organizations.

Adopt an implementation plan. It is not sufficient just to identify community needs. Hospitals must then adopt an implementation strategy for meeting those needs. Once again, IRS provides flexibility in how you do this. Hospitals may collaborate on how to meet needs; in that case, the implementation plan should identify collaborators. But just as each collaborating hospital must have its own CHNA, each hospital must also have a separate implementation plan that is tailored to the particular hospital facility, taking into account its specific programs and resources. The plan should prioritize needs and identify the process used in setting those priorities. The plan should identify what resources are going to be committed and the strategies for meeting those needs. Hospitals are not required to address every need that was identified in the CHNA, but the plan must identify those needs that are not being addressed and describe the reasons for excluding those needs from the implementation plan. You are required to adopt the implementation plan in the same year that you finalize your CHNA, and then attach the implementation plan to your 990. You are not required to publish the implementation plan on your hospital’s website.

Look at the big picture. Given the significant amount of time invested in preparing a CHNA, hospitals should also look to leverage that effort in ways that go beyond core compliance. Opportunities include overall strategic planning as CHNAs identify demographic trends that portend shifting demands for health care services, which in turn reflect key directions for the hospital; review of criteria for board recruitment and development; and identification of collaboration partners as candidates for ACO-type cooperation and activities. Organizations should also be mindful of how CHNAs integrate with other elements of PPACA, such as the new requirements governing financial assistance policies and debt collection practices.

For further information, WHA members should review the IRS guidance in Notice 2011-52 available at

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U.S. Supreme Court Considers Constitutionality of Health Reform Law

The Patient Protection and Affordable Care Act ("PPACA" or "the Act") had its days in court this week when the U.S. Supreme Court heard an almost unprecedented six hours of arguments supporting and opposing the Act. With a decision not expected before the end of June, the constitutionality of the Act’s requirement that most people purchase insurance and its Medicaid expansion and then the question of what will remain of the Act if the Court finds the mandate unconstitutional are sure to be hotly debated topics for the next three months.

On March 26, the parties argued whether the tax Anti-Injunction Act ("AIA"), a law that has been on the books since 1867, precludes the Court from considering the challenge to PPACA at this time. The AIA prohibits suits that restrain the assessment or collection of taxes. Because the penalty associated with the mandate would not be due until 2015, some people, but neither of the parties, have argued that a suit challenging the mandate could not be brought until that time. Court observers believed the Court seemed skeptical that the AIA would bar the current suit.

The parties presented their arguments concerning the constitutionality of the individual mandate on March 27. The Act’s challengers argued that Congress exceeded its authority when it required most individuals to purchase insurance. The government, supporting the Act, argued that the mandate is well within Congress’s authority. At the conclusion of the day’s arguments, experts and pundits parsed the justices’ questions looking for suggestions of support for the various arguments. Justice Elena Kagan noted that the mandate was just a matter of timing. She maintained the individual mandate effectively pushes the moment of regulation from the point of sale backward. On the other hand, Justice Anthony Kennedy asked the government, "Can you create commerce in order to regulate it?" and observed that the mandate "changes the relationship of the federal government to the individual in a very fundamental way."

On the final day of oral arguments, the Court considered how much of the Act would survive if the Court finds the individual mandate unconstitutional. The parties argued whether the mandate is the "heart" of the law, which would be left an empty shell without it or if "half a loaf is better than none." In the afternoon, the parties argued whether the Act is unconstitutional because it coerces the states to expand their Medicaid rolls because a state that does not expand would risk losing all of its federal Medicaid funds.

The audio and transcripts for these historic arguments are available on the U.S. Supreme Court’s website at:

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Guest Column: Why I Support Advocacy Day
By: Dr. Nick Turkal, President & CEO, Aurora Health Care, and immediate past WHA Board Chair

As the immediate past Board Chair of the Wisconsin Hospital Association and as its current Advocacy Committee Chair, I continue to be committed to the role that hospital advocates play in positively affecting public policy. We can only be effective if we are involved in that process, which is why I continue to support Advocacy Day.

As 2011 WHA Board Chair, I had the privilege of serving as emcee of Advocacy Day last year. I remember looking out from the lectern and seeing nearly 800 hospital advocates who had traveled from all corners of our state to ensure legislators knew our opinion on issues that matter most to our patients. It was an impressive vantage point. I was proud to be among all the capable, compassionate and committed volunteers, employees and community members at the Monona Terrace that day.

We had come together to learn and do more on policy that shapes Wisconsin’s future. One of the topics that I’ve been outspoken about over the years is reframing how policymakers and business leaders view health care – not as a cost of doing business, or simply as an important part of the health and wellness of our citizens, but also as an economic force that raises the overall economic vitality of Wisconsin. I continue to believe we play a large role in helping improve the larger economic outlook for this state.

For those who attended last year, on behalf of WHA I want to acknowledge your advocacy work. Thank you for supporting your community hospital through this event.

For those who assembled large contingents and traveled to Madison for this day, thank you for working to expand our advocacy mission farther.

And for those who have yet to attend Advocacy Day, I encourage you to stand with your peers by coming to Madison for 2012 Advocacy Day.

I’m proud of our contribution to Wisconsin, and I hope you are, too. Please join me in supporting 2012 Advocacy Day on April 24 in Madison.

We hope you agree about the value that Advocacy Day brings to your hospitals, your communities and your patients. A complete program and easy online registration for 2012 Advocacy Day are available at

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Community Health Needs Assessment Conference Brings Hospitals Together with Partners
Sponsored by WHA, UW Population Health Institute, Healthy Wisconsin Leadership Institute

The passage of the Patient Protection and Affordable Care Act (PPACA) established new requirements applicable to not-for-profit hospitals, including the requirement to develop a community health needs assessment (CHNA) every three years.

On March 23, the WHA, along with its partners at the University of Wisconsin Population Health Institute and the Healthy Wisconsin Leadership Institute, held a one-day seminar in Wisconsin Dells aimed at familiarizing hospitals with the new standard. In addition, several hospitals along with their community partners presented case studies on how they organized their local effort to develop, and implement, a community health needs assessment.

David Edquist, an attorney with von Briesen & Roper (see guest column in this issue), provided a detailed summary of the key provisions in PPACA. He then led attendees through the specific requirements of the PPACA, emphasizing the difference between what is required and what additional activities could be perceived as requirements.

"The IRS gives a broad statement of what is required and then it provides some concepts about what they are expecting to see," according to Edquist.

The requirement includes identifying groups that can provide input from the broader interests of the community and expertise in or special knowledge of public health. Edquist said the IRS would "expect" to see involvement from local, tribal and state health departments, for example. It would also include gathering information from low income persons, minorities, those with chronic disease, and while the IRS doesn’t specify what groups, it is looking to see how information on these populations was gathered.

Once completed, the CHNA should be posted to the hospital website with clear links and instructions on what it is, and beyond that Edquist suggested making it available in waiting areas or in the hospital lobby, at the public library, and to consider public presentations.

"The key principle to remember is that of inclusion when you are developing your community health needs assessment," Edquist said.

Hospitals Partner with Public Health Departments on CHNA

As Edquist encouraged collaboration, Julie Willems Van Dijk, RN, PhD, with the University of Wisconsin Population Health Institute, said Wisconsin statute requires public health departments to conduct a local health needs assessment. There are, according to Willems Van Dijk, similarities to the PPACA requirement, and it makes sense for public health and hospitals to work closely together on their CHNA processes. In Hudson and Milwaukee, hospitals are working together with public health and other partners on the development and implementation of CHNAs. The program also included sessions on how to find funding for community health improvement activities, where to find data, and how to know when enough data has been collected.

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Coalition Asks CMS to Implement Wage Index "Equitably" to Prevent Manipulation

The manipulation of the Medicare wage index by the Commonwealth of Massachusetts that gleaned more than $367 million annually from the other 49 states is still the focus of attention for a coalition of 20 state hospital associations and the National Rural Health Association (NRHA) that are pressing for a "fix."

In a letter to CMS Acting Administrator and COO Marilyn Tavenner dated March 26, the Coalition asked CMS to ensure that provisions pertaining to Medicare’s hospital wage index are implemented on an equitable basis, consistent with Medicare’s long-standing policy.

The letter reads: "We ask that CMS in its upcoming IPPS rulemaking use its administrative authority to rectify a misguided statutory policy, initially called for under section 3141 of the Patient Protection and Affordable Care Act (ACA), which has permitted the Commonwealth of Massachusetts to manipulate the Medicare program…and unfairly favoring one state’s hospitals and Medicare beneficiaries to the detriment of others."

It goes on to point out that in last year’s FY 2012 IPPS final regulation, CMS effectuated the above-referenced change called for by the ACA, which allows for the conversion of Nantucket Cottage Hospital from a Critical Access Hospital (CAH) to an IPPS hospital. CMS expressed concern that changing hospital status, such as what was done in Massachusetts (via ACA), results in significantly inflated wage indexes across a state. Specifically, CMS stated:

"…In recent years, we have become concerned that hospitals converting their status significantly inflate wage indices across a state…Hospitals in Massachusetts can expect an approximate 8.7 percent increase in IPPS payments due to the conversion and the resulting increase of the rural floor. Our concern is that the manipulation of the rural floor is of sufficient magnitude that it requires all hospital wage indices to be reduced approximately 0.62 percent as a result of nationwide budget neutrality for the rural floor (or more than a 0.4 percent total payment reduction to all IPPS hospitals)."

The Medicare Payment Advisory Commission (MedPAC) also noted in its FY 2012 IPPS comment letter to CMS, dated June 17, 2011, that this "…exception triggered in the state of Massachusetts will have a large impact on hospital payments..." MedPAC further stated that as a result of the budget neutral change, "…all hospitals—including rural hospitals—will absorb the financial loss…"

If left uncorrected, hospitals in 49 states will experience reduced funding of more than $3.5 billion over the next ten years. The Coalition letter emphasizes that "hospitals nationwide are already struggling with reduced government payments and the potential for cuts through the federal deficit reduction discussions and health care reform. Scarce Medicare funding should reward value and efficiency in health care—principles that CMS has worked tirelessly to ingrain in numerous Medicare initiatives that are presently ongoing or in the works—and not be diverted based on artful manipulation of obscure payment formulas."

"WHA will continue to participate in the Coalition and advocate on behalf of our members to get back our hospitals’ money and to prevent this from happening again," said WHA President Steve Brenton.

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WRPRAP Accepts Proposals to Create/Expand Rural Training Tracks

The Wisconsin Rural Physician Residency Assistance Program (WRPRAP) announced that it is accepting proposals for developing programs to create new or expand existing Rural Training Tracks (RTTs) or rural residencies in Wisconsin. According to Wilda Nilsestuen, the WRPRAP program coordinator, the proposals must describe an implementation plan that would achieve one of those goals. Nilsestuen said application forms for smaller grants—e.g., for supporting rural rotations or feasibility planning—are also available on the WRPRAP website at

WRPRAP has awarded one grant this year to an applicant that responded to a Request for Proposals posted November 15, 2011. The application dates for that RFP have expired, but the RFP announcement was re-posted to serve as guidance for eligibility, submission expectations and procedures, and criteria for acceptance for unsolicited proposals. Grant awards for up to $150,000 are available for applications that meet the criteria and present substantial evidence of a workable, sustainable plan that would contribute to Wisconsin’s rural medical workforce over the coming decades.

This funding is available only for graduate medical education (resident training) done in rural settings and does not apply to medical student training or non-rural locations. Applications will be considered on a rolling basis.

Interested applicants should contact the WRPRAP office to discuss whether the intentions for use of the grant qualify for WRPRAP funding and whether the request meets the eligibility criteria outlined in the authorizing legislation that created the WRPRAP grant. After the preliminary screening, applicants will be asked to outline the substance of the plan in a letter before submitting the full proposal.

Contact WRPRAP Program Coordinator Wilda Nilsestuen at or call 608-262-2764.

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Wisconsin Workforce Partnership Grant to Address Skills Gap
Grant will develop skilled workers for manufacturing employers-win for both

Many hospitals and health care systems are actively involved in economic development activities in their communities. The Wisconsin Covenant Foundation, Inc. unveiled a new Wisconsin Workforce Partnership Grant designed to strengthen business and education partnerships focused on advancing manufacturing employment needs. WHA encourages its members and Wisconsin employers to consider how they might bridge the gap between available jobs and unemployed workers’ skills.

The three-year, $4 million grant is designed to strengthen the connection between Wisconsin Technical Colleges and Wisconsin businesses with advanced manufacturing employment needs.

Through the program, currently in pilot form, the Foundation aims to support the rapid expansion or development and implementation of degree, diploma, or certificate programs that increase the number of program graduates who achieve job placement in occupations at Wisconsin businesses in need of employees with specific skills. Results will be tracked closely by the Foundation and used to inform future funding decisions.

The Wisconsin Workforce Partnership Grant is intended to bring businesses and technical colleges together, to help connect Wisconsin’s "middle-skill" jobs and available workers. Middle-skill jobs, which require more than a high school diploma but less than a four-year college degree, are projected to remain at 50 percent of the state’s workforce needs. Advanced manufacturing occupations are among the fastest growing middle-skill opportunities.

"There is an urgent need for more Wisconsin residents to secure family-sustaining jobs. At the same time, Wisconsin employers report having trouble finding workers with the skills needed to fill open positions," said Foundation Board Chair Richard D. George. "We are pleased to make private funds available, and to spur additional private investments, to address these issues so critical to Wisconsin’s future. We look forward to gaining a better understanding of what makes such partnerships successful, to inform future efforts."

"When workers experience full employment with strong benefits, the entire community, including hospitals, benefit," according to WHA Vice President of Workforce Development, Judy Warmuth. "Wisconsin has been experiencing a decline in employer-sponsored insurance. Moving an individual from no job or one with no insurance to a job in advanced manufacturing helps that individual, his or her family, the community and the local health community."

Warmuth added that while health care offers great job opportunities, so do many other industry sectors in Wisconsin. This may be an opportunity for hospitals to participate in important community development work, according to Warmuth.

Grant applications are available at and will be accepted through 5:00 p.m. Central Time on May 9, 2012.

To learn more about the Wisconsin Covenant Foundation’s commitment to forging public and private partnerships in support of postsecondary education, contact Amy Kerwin at 608-246-1785.

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New Book Released by Gundersen Health System Seeks to Empower Patients

According to the Dartmouth Atlas, Wisconsin health care providers participating in the Medicare program provide among the highest quality care at the lowest cost in the United States. The La Crosse metropolitan area is often cited by Dartmouth as being a national model for care delivery. But here, in a state where hospitals strive to deliver ever higher standards of care and attain even higher patient satisfaction with that care, it would seem the next step is to more fully engage Wisconsin patients and their families.

A new book just released by Gundersen Health System highlights innovative, proven models of person-centered care from around the United States and Australia. "Having Your Own Say: Getting the Right Care When It Matters Most" was written to help empower people with advanced illness to receive the quality care they want, with greater patient and family satisfaction and, while it is not the goal, lower costs.

"Getting the care we wish to receive that fits within our individual goals and values is what every American wants when faced with an advanced illness, such as cancer, Alzheimer’s disease or heart disease. Our new book shows how this can be done in diverse regions of the United States, and even other parts of the world," says Bernard Hammes, PhD, editor of Having Your Own Say and the director of Medical Humanities and Respecting Choices at Gundersen Health System.

According to Hammes, when hospitals and health care systems adopt the models described in the book, patients receive better, more compassionate care that is consistent with their wishes. Too often, people with advanced illness are not made aware of all of their options.

"The ultimate aim of the care models highlighted in the book is making sure patients receive treatment they want based on truly informed decisions and avoiding over- or under-treatment. It’s about quality of living as defined by each individual and, for families, it’s about making sure their loved ones’ wishes are known and followed. The cost savings that have been noted in places where effective planning has been implemented are an unintended benefit," according to Gundersen Health System CEO Jeff Thompson, MD.

Estimating national savings from these models is challenging. However, research shows that if proven advanced care interventions were provided to the five percent of the U.S. population that currently accounts for 50 percent of all health care costs, about $25 billion could be saved.

The models of care described in Having Your Own Say have proven outcomes that can be replicated anywhere, from a small Midwestern community to a large California metropolitan area to the entire nation of Australia.

Having Your Own Say is a collaborative effort between Gundersen and health care groups including Aetna, Amedisys, Sutter Health, Honoring Choices Minnesota, Respecting Patient Choices in Australia and more.

The book includes introductions from Michael Leavitt, former secretary of the U.S. Department of Health & Human Services and former governor of Utah, and U.S. Senator Mark Warner from the Commonwealth of Virginia.

Having Your Own Say is available at

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Wisconsin Hospitals Community Benefits: Injuries and Violence

A teen arrives in the emergency department by ambulance following a terrible car accident. A child receives head injuries while bicycling without a helmet. A woman walks into the emergency department with injuries inflicted by an abusive spouse. These are stories of pain and tragedy that hospital personnel see all too often. Injury is the most under recognized major public health problem facing the country and it is the leading cause of death in people ages 1 to 44 in Wisconsin. Wisconsin hospitals devote significant resources to reduce the number of intentional and unintentional injuries that occur in the communities they serve.

Safe Kids car seat check program saves lives

Baby Elijah Ehmcke was born six weeks early at Wheaton Franciscan Healthcare – All Saints. After spending two weeks in the neonatal intensive care unit, he was ready to go home. But before Elijah could be released, he had to pass a car seat check.

Erin Donaldson, coordinator of Safe Kids Kenosha-Racine, checked Elijah’s car seat and found it to be too large for the five pound three ounce infant. Parents Brian and Callie were advised to purchase a different car seat that would be a better fit for a preemie. A few days later, Erin checked Elijah’s new car seat, and the Ehmcke family headed home.

In the last year, more than 230 car seat checks have been conducted at All Saints through the Safe Kids program, which is led by Wheaton Franciscan Healthcare. Established in 2001, Safe Kids works to prevent accidental injuries to children through education on topics such as child passenger safety, safe sleep, fire safety, home safety, and poison prevention.

"Erin was great to work with. She showed us how to properly install the car seat and walked us through every step of the process," Brian said.

Little did the Ehmckes know what a lifesaver the car seat check would be a few months later. On their way home from Tomahawk, the Ehmckes’ Jeep Cherokee hit a patch of black ice and slid head on into a concrete barrier. Miraculously, no one was injured in the accident and baby Elijah’s car seat escaped without a scratch or dent.

"We are so thankful that Erin had to check Elijah’s car seat before we could leave the hospital," Brian said. "The wait was definitely worth its weight in gold."

Wheaton Franciscan Healthcare – All Saints, Racine

River Falls Area Hospital partners with area schools to prevent and manage concussions

In 2011, River Falls Area Hospital partnered with area schools to launch a new program focused on the prevention and management of concussions. With the support of the River Falls Area Hospital Foundation and the Wisconsin Office of Rural Health, the hospital began providing ImPACT testing for student athletes in the River Falls, Ellsworth and Prescott School Districts.

ImPACT stands for "immediate post-concussion assessment and cognitive testing." Through the program, all student athletes complete a 20-minute online test to assess neuro-cognitive functioning, providing a baseline against which future test results can be compared, should a student sustain a head injury. These measures provide a useful tool for athletic trainers and primary care providers trying to determine if and when it is safe for a student athlete to return to the field.

As part of the program launch, trauma coordinator Cyndy Bayer and athletic trainer Shari Durch did extensive community outreach, providing education sessions for coaches and parents about the goals of the program and the value of the assessments.

"Coaches, parents and student athletes are very receptive to the program," said Bayer, "and appreciate the fact that we are using an evidence-based model to help manage treatment for these kinds of injuries."

River Falls Area Hospital, River Falls

Hospital staff helps teach important lessons about drinking and driving

The crash scene was horrific, but it wasn’t the real thing for the hundreds of West Bend High School students who watched on the sidelines. For the sixth year, the Washington County Injury Prevention Coalition presented the "Every 15 Minutes" program, a dramatic mock crash and program intended to drive home a powerful message about the consequences of drinking and driving. Froedtert Health St. Joseph’s Hospital played an important role in the event, its fourth time as the receiving hospital.

Students played the roles of dead and injured teens. The event involved many months of planning and was coordinated through the efforts of the coalition, West Bend Police Department, Washington County Sheriff’s Department, West Bend Fire Department, West Bend High Schools, and community businesses and sponsors.

Dramatic scenes were filmed by students at the crash scene and at St. Joseph’s Hospital’s Emergency Care Center, on the helipad and in the CT suite. The students’ video documenting the impact of a drunk driving crash was shown the next day for students, parents and the community.

Participating staff members at the hospital included emergency and security staff, radiology staff, public relations staff and others.

Froedtert Health St. Joseph’s Hospital, West Bend

Men standing up for women

Fox Valley Voices of Men continues to rally men to stand up and speak out against the abuse and disrespecting of women and girls.

"Our long-term goal is to change the attitudes and actions of men and boys that contribute to the abuse of women and girls," said Dave Willems, a member of Voices of Men. "We can do this by making it clear that this is our problem to own, and that well-meaning men must be willing to let the much smaller percentage of perpetrators and disrespectful men know that their actions are unacceptable."

The organization began in 2007 with an outreach effort by Harbor House Domestic Abuse Services, the Sexual Assault Crisis Center, Christine Ann Domestic Abuse Services, and Reach Counseling Services. In 2008, the organization received a boost from the Community Health Action Team (CHAT), led by ThedaCare (which includes Appleton Medical Center and Theda Clark Medical Center), which saw that men needed to speak up and take a stand against domestic and sexual violence.

The organization works in partnership with many Fox Valley community agencies. Members also give presentations in the community and take a stand by joining in on the social media conversation via Facebook and Twitter. Hundreds of men have joined to "Take the Pledge." They also show support and spread the word by actively participating in any educational and other types of opportunities, activities and events developed or endorsed by Fox Valley Voices of Men.

"More than 400 Fox Valley men have signed on with the White Ribbon Pledge to not commit, condone or remain silent about men’s violence against women," said Willems, noting that many more have taken the pledge at events throughout the area and still others can do so at

ThedaCare, Appleton

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