Physician Edition


February 1, 2017

Volume 5-Issue 2

WHA Actively Monitors President’s Executive Order Imposing Temporary Travel Ban

Late in the afternoon Friday, January 27, President Donald Trump signed an Executive Order that, among other things, imposes a 90-day ban on entry into the United States for nationals of seven designated countries: Iran, Iraq, Libya, Somalia, Sudan, Syria and Yemen.

The Order applies to non-U.S. citizen nationals from the seven affected countries entering the United States, “as immigrants and nonimmigrants,” on any visa category, except for certain diplomatic visas. The Order states that other countries may be added to the banned list in the future.

Notwithstanding the travel ban, the Order gives the Department of Homeland Security (DHS) the authority, “on a case-by-case basis, and when in the national interest, [to] issue visas or other immigration benefits to nationals of countries for which visas and benefits are otherwise blocked.” Late January 29, DHS Secretary John Kelly issued a formal statement that declared if an otherwise affected traveler holds a green card, i.e., has been granted permanent legal residency in the United States, this would be “a dispositive factor in our case-by-case determinations.”

Since the Order was released, federal judges in several states have put temporary stays on portions of the Order, and more legal challenges are expected or already underway.

WHA will continue to monitor the Order for further clarifications from the Administration and the outcome of anticipated legal challenges. According to WHA President/CEO Eric Borgerding, “Wisconsin hospitals and health systems have a diverse health care workforce and...maintaining patient access to Wisconsin’s high-quality, high-value health care relies in part on our doctors and nurses from the international community.”

A copy of the Order may be found at: A link to the American Hospital Association’s official statement on the Order may be found at:

For additional information on the Order, two of WHA’s corporate member law firms, Hall Render and Quarles & Brady, have recently published guidance:

If you have questions about the Order, or if you are having any issues with foreign-born providers not being able to re-enter the United States, contact Andrew Brenton, WHA assistant general counsel, at or Matthew Stanford, WHA general counsel, at or 608-274-1820.

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WHA Launches Physician Quality Academy

Doctors’ role important in leading quality improvement projects

logoPhysicians have an important role in health care quality improvement projects in their organizations. Their clinical expertise and leadership are valuable assets in designing and conducting initiatives known to improve the quality of patient care.

While physicians are often asked to lead quality improvement activities, they may not have access to the resources they need to be successful. In response to this need, the Wisconsin Hospital Association (WHA) created the WHA Physician Quality Academy for physicians employed by its member hospitals and health systems.

“Quality improvement initiatives are powerful tools for making sure evidence-based practices make it to the bedside and are performed consistently,” according to Robert S. Redwood, MD, MPH, and faculty for the WHA Physician Quality Academy. “As physicians, quality improvement empowers our profession to use population health data to better inform our individual patient care.”

The WHA Physician Quality Academy will bring physicians together from across the state who can then collaborate and build on their QI knowledge. The Academy will support physicians by providing face-to-face education opportunities, as well as additional resources, to learn the newest tools and principles that lead to successful initiatives known to improve quality in hospitals, clinics and other care settings.

“WHA is a recognized national leader in offering our members the support and training necessary to help improve the quality and value of care for their patients,” according to WHA President/CEO Eric Borgerding. “The vast majority of physicians in Wisconsin are either closely aligned with or employed by hospitals and health systems, and their role in leading quality improvement is constantly expanding and evolving. The WHA Physician Quality Academy is a unique new resource that will provide cutting-edge techniques our members’ physicians can apply in their own organizations.”

The first Academy will be held in spring 2017. More than 200 physicians are expected to participate in the four learning sessions, which will feature both WHA in-house quality improvement experts and outside facilitators. WHA is offering the WHA Physician Quality Academy to member hospitals to ensure physicians have access to the training and resources necessary to lead quality improvement initiatives. The Academy is designed for physicians and advanced practice providers who have an assigned role related to quality measurement and improvement within a WHA member organization. For physicians who fit that description, share this message with them, and encourage them to register at

The Academy will be offered twice in 2017, allowing a physician to choose the cohort that works best for his/her schedule: Cohort #1 will be held May 10 and July 21, and Cohort #2 will be September 29 and November 3. Attendance will be limited to the first 100 registrants per cohort and is filling up fast, so register your physicians today at

For more information contact Jennifer Frank at or 608-274-1820.

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Register Today for WHA Physician Leadership Development Conference

Early bird discount expires January 15

Take advantage of the Early Bird discount by registering for the 2017 WHA Physician Leadership Development Conference before January 15.

This year’s conference, scheduled March 10-11 at The American Club in Kohler, will include a full day with Kevin O’Connor focusing on the skills needed to elicit connection, communication and cooperation from fellow medical professionals, in a session titled "Emotional Intelligence: The Final Frontier." In addition, a half-day discussion led by Jennifer Grebenschikoff will focus on the physician leader’s role in strategic physician recruitment and retention. Continuing medical education credits are available again this year.

Online registration is available at or directly at

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Borgerding Named to AHA Physician Leadership Advisory Committee

WHA President/CEO Eric Borgerding was named to the newly-formed American Hospital Association (AHA) Physician Leadership Advisory Committee. The AHA Board of Trustees approved the establishment of an advisory committee to consider various scenarios for future physician partnership and engagement in the Association. AHA Board member Melinda Estes, MD, president/CEO, Saint Luke’s Health System in Kansas City, Missouri, will chair the group.

The Physician Leadership Advisory Committee will present recommendations to the AHA Board of Trustees for discussion, launching the first generation of physician leadership activities to enhance current initiatives. In a letter, AHA said the dialogue of the Committee will be critical to the development of the next generation physician agenda. In addition, AHA will solicit input from a diverse group of stakeholders to inform the Committee’s deliberations.

WHA’s longstanding commitment to physician leadership development and expanding member/integrated physician agenda, including the recently-announced WHA Physician Quality Academy, position Wisconsin well to contribute to AHA’s Physician Leadership Advisory Committee.

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Assembly Health Chair Sanfelippo says Maintaining Coverage is “Priority #1”

Borgerding: WI well positioned to shape “the path forward” and sustain coverage gains

WHN panelHealth Committee Chair Rep. Joe Sanfelippo said Assembly Republicans are committed to preserving the gains in coverage Wisconsin made when Gov. Scott Walker used a unique approach to expanding Medicaid by lowering eligibility levels to 100 percent of the federal poverty level (FPL) and utilizing the exchanges to provide subsidized coverage to those with income above the FPL.

“We picked up nearly 200,000 people in coverage here; we don’t want to lose anything or give up any ground we have gained,” Sanfelippo said.

Sanfelippo told the group he believes allocating funds to the states for Medicaid through block grants, which are being discussed at the federal level, could be favorable for Wisconsin.

“There are a lot of good ideas that states are trying around the country and right now, you have to apply for waivers and it is hit or miss and it is cumbersome,” Sanfelippo said. “If you switch to block grants…the strings and waivers are gone, and it gives us the ability to put programs in place and adjust them once they are in place so they do what we want them to do.”

Sanfelippo emphasized the importance of state legislators working with the Wisconsin congressional delegation to ensure decisions made in Washington do not have an adverse impact “back home.”

Joining Sanfelippo at a panel discussion on “Trumpcare: What’s in Store,” sponsored by Wisconsin Health News (WHN) January 10 were WHA President/CEO Eric Borgerding; Coreen Dicus-Johnson, president/CEO, Network Health; Donna Friedsam, health policy programs director, UW Population Health Institute; and, Mike Wallace, president/CEO Fort HealthCare. WHN Editor Tim Stumm moderated.

Borgerding reiterated the important role that the Governor, who now leads the Republican Governors Association, and Speaker Paul Ryan could have in determining “what’s next.”

Borgerding said the achievements in coverage in Wisconsin have relied on the exchanges and the fact that those premiums are heavily subsidized. He said 67 percent of the coverage in the individual market comes through the exchange and well over half of those who get subsidies are under 200 percent FPL.

“The exchange has been a key tool in achieving the reductions in uninsured in Wisconsin,” Borgerding said. “We have to communicate that back to DC. If something changes, such as subsidies being based on age instead of income as is being discussed, what happens to those in Wisconsin who get premium subsidies who are 100-200 percent of FPL?”

Borgerding said state lawmakers have a critical role to play in shaping what is ahead.

“Wisconsin could be a model and join some of the other states that have used federal funds to expand Medicaid and get funding for what we did in Wisconsin,” he said. “Wisconsin is very well positioned to influence the path forward.”

Structural issues embedded in the ACA have created financial stress for insurers and providers alike. Dicus-Johnson pointed out the problems with allowing young adults to stay on their parent’s insurance and the impact that has on rates when they do not sign up for coverage.

“The individual mandate has not been effective. When you look at the penalty compared to cost associated with the plans, they say ‘I will just pay the penalty’,” according to Dicus-Johnson. “The issue is how do we have policies that require continuous care so they have access to affordable care? We tied an entitlement to a private market, and that just doesn’t work.”

Wallace said one of the greatest weaknesses of the ACA is the cost.

“We see what has happened with payers in the exchanges. We have more people covered but we are not covering the cost of caring for those people,” Wallace said. “We did a good thing, but it is not sustainable in its current form.”

Friedsam said the biggest success that came out of the ACA was it changed the national dialogue on insurance to a theme of how to make coverage affordable and accessible.

“Prior to the ACA, there was understanding about the lack of insurance coverage, but it is not clear we had agreement on the need for reform,” she said. “People now have access to some form of affordable insurance. The failure was in the inability to explain the benefits of it and some design flaws…some people did not buy in; we didn’t have balanced risk pools.”

In a sea of uncertainty, Borgerding said the biggest question is not whether the current law sunsets or disappears, but what happens in between. That is the crucial question, he said.

“Our position is they tend to recognize there needs to be a stable smooth transition and we think that is very positive. When you look at what is at stake in Wisconsin, we have about 250,000 covered by Obamacare. When you grasp those numbers, this is not something that can be unwound overnight,” according to Borgerding.

Watch the full discussion at See press coverage at

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WHA Participates in CMS Rural Health Care Listening Session

CMS rural health care listening sessionLeaders from the Centers for Medicare & Medicaid Services (CMS) held a rural health care listening session January 24 in Springfield, IL. The Wisconsin Hospital Association participated in the session and raised key issues with CMS, including telehealth, behavioral health and regulatory flexibility among others. In addition, WHA provided a memo to CMS highlighting these issues. Also participating in the listening session were Hospital Sisters Health System (HSHS) and the Rural Wisconsin Health Cooperative.

One of the policies raised by WHA and reiterated by others at the session was the importance of telehealth services, particularly in rural communities. CMS heard multiple times that it should do more to support the use of telehealth by removing the regulatory and reimbursement barriers currently in place.

“There are great opportunities to provide essential services, such as behavioral health care, in rural communities via the use of telehealth,” Jenny Boese, WHA vice president, federal affairs & advocacy, told CMS. “Unfortunately, current regulatory policies create unnecessary barriers and obstacles for its use in many rural communities where needs are greatest.”

CMS asked attendees to discuss other priorities the Agency should consider with respect to rural health care. In addition to behavioral health and telehealth, participants discussed the importance of the Critical Access Hospital program, the 340B program and swing beds, among others.

HSHS stressed, and WHA concurred, that CMS must provide more flexibility with respect to graduate medical education (GME). HSHS elaborated that CMS should allow hospitals to be able to accept additional residents under Medicare’s GME caps even if the hospitals had previously taken rural rotators for some short periods of time in the past.

During the session, CMS asked attendees what services are the most difficult to provide in rural communities. Participants indicated behavioral health, pediatric care, specialty services, oral health and pregnancy/maternity care.

CMS also provided attendees with a draft vision statement for rural health care. That statement focused on providing accessible, accountable and affordable care in rural communities. Through a facilitated discussion, attendees were asked to provide feedback on this vision statement and other questions, which CMS will now work to incorporate into the strategic plan it is developing for rural health care.

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Medicaid Eligibility Requirements Discussed by Walker, State Lawmakers

Governor Walker writes to Trump; state legislators write to Walker

As the incoming Trump Administration prepares to take office and many speculate about federal health care reform, Wisconsin officials are anticipating more flexibility in the Medicaid program and aren’t waiting to set down their own policy ideas related to the Medicaid program.

In December, Gov. Scott Walker sent a letter to President-elect Donald Trump outlining principles for more limited and controlled federal involvement in states and asking for help in implementing some policies in a number of areas that have previously been denied by the federal government. Related to Medicaid, Walker asks Trump for approval to implement differential premiums for childless adults “who purposefully increase their health risks while receiving benefits.” His idea is just one of a handful of provisions that were included in the state biennial budget in 2015. The language enacted in 2015 Wisconsin Act 55 calls for the state to seek a waiver from the federal government for this and other policies such as drug screening and testing and limiting eligibility to no more than 48 months. Under the Obama administration such policies were not approved.

Subsequently, on January 5, a group of 34 Republican state senators and representatives from across Wisconsin signed onto a letter to Walker requesting changes to public assistance programs and citing the recent election as an opportunity for more state flexibility. Specifically, these legislators seek to allow for a “sliding scale” in public benefits so benefits start to decrease as income rises. Without such a sliding scale, these legislators are concerned that individuals receiving public benefits hit a “fiscal cliff” and may turn down jobs, promotions and raises out of fear of losing their child care, food or health benefits. The letter calls for state agencies to review which programs have “fiscal cliffs” and request waivers to create and implement sliding scales. The exact structure of such a sliding scale for the Medicaid program was not included in the letter.

At a panel discussion sponsored by Wisconsin Health News January 10, WHA President/CEO Eric Borgerding said block grants could make sense on the surface, especially in states like Wisconsin where we have led the way in so many things, however, he believes the devil is in the details and he urged lawmakers to carefully consider the impact that changes in eligibility could have on Medicaid recipients to have access to care.

“There are a lot of things states can do with their Medicaid populations when they are given flexibility related to cost sharing. In the past, there were cost-sharing arrangements tried with populations that had eligibility criteria well above 100 percent FPL,” Borgerding said. “So as we talk about copays, premiums and those sort of things through a waiver or block grant process, while it may make a lot of sense to encourage people to have skin in the game, even in the Medicaid population, we cannot lose sight of the fact that in Wisconsin, Medicaid applies to those in poverty and that is below $11,700 per year. We have to be very cautious when we talk about what that means for that population either staying enrolled in Medicaid or having access to the services they need.”

The letter from Governor Walker to President-elect Trump can be found here:

The letter from Republican Legislators to Governor Walker can be found here:

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Walker Calls Special Session, Orders New Agency Actions in Fight against Opioid Abuse

Governor signs executive orders at ceremonies in three Wisconsin hospitals

In a statewide announcement, Gov. Scott Walker called the Wisconsin State Legislature into special session and issued new directives to state agencies January 5 in a continuation of the fight against the state’s heroin and opioid epidemic. Walker made the announcement during stops at three separate hospitals January 5, starting in Weston with a visit to Ministry Saint Clare’s Hospital, part of Ascension, then in Green Bay at Aurora BayCare Medical Center and ending the day at HSHS St. Joseph’s Hospital, Chippewa Falls. Lieutenant Gov. Rebecca Kleefisch and Rep. John Nygren joined Walker at all three locations where he signed executive orders to implement these directives.

Ascension Health Senior Vice President/Wisconsin Ministry Market Executive Bernie Sherry, Aurora Health Care President/CEO Nick Turkal, MD and HSHS St. Joseph’s Hospital President/CEO Joan Coffman all welcomed the Governor, Lieutenant Governor and Representative Nygren to their respective facilities for this announcement. In addition to hosting the announcement in Chippewa Falls, Coffman also serves alongside Kleefisch and Nygren as WHA’s representative to the Governor’s Task Force on Opioid Abuse.

"We’re grateful to have Gov. Walker here in support of those who struggle with heroin and opioid addiction," said Joan Coffman, president and CEO of HSHS St. Joseph’s Hospital in Chippewa Falls. "As WHA’s representative to the Governor’s Task Force on Opioid Abuse, it’s encouraging to see these robust executive orders. The state’s response is a boost to facilities like ours that work with people during their day-to-day struggles."

One of the Governor’s executive orders (#228) directs state agencies to implement recommendations made in a report from Kleefisch and Nygren, co-chairs of the Governor’s Task Force on Opioid Abuse. The report includes a wide range of recommendations, including initiatives proposed by WHA to expand physician training opportunities for addiction medicine and reform state regulations, specifically DHS 75, which have become a barrier to expanding treatment options for patients in need of substance abuse services.

A second executive order (#229) directs the Wisconsin Department of Health Services to apply for federal funding from the 21st Century Cures Act to support efforts to address opioid addiction in Wisconsin.

The final order calls for a special session of the state Legislature to pass various policy proposals (#230) recommended as part of the co-chair’s report, including investments for medication-assisted treatment, treatment and diversion programs and various other policies designed to encourage individuals with an opioid addiction to seek treatment.

In a statement, WHA President/CEO Eric Borgerding said, "It is fitting that the recommendations be released at three hospitals across Wisconsin, recognizing the role hospitals play in delivering care to those suffering from substance abuse, identifying community needs and recommending proactive solutions to address Wisconsin’s opioid abuse epidemic."

"Additional steps are needed to help those struggling with opioid addiction," Borgerding said. "WHA is committed to continuing our work with Governor Walker, Lieutenant Governor Kleefisch, Representative Nygren, and the Governor’s Task Force to develop additional recommendations that will help accomplish this important goal."

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New ePDMP launched January 17

Prescribers and dispensers will need to take action

Significant changes to the Wisconsin Prescription Drug Program (PDMP) are occurring, and prescribers and dispensers will need to act to continue to be able to access the PDMP and to start the process to connect to the new PDMP via their electronic health record (EHR).

On January 17, 2017, the Wisconsin Department of Safety and Professional Services (DSPS) launched the Enhanced Prescription Drug Monitoring Program (ePDMP) intended to provide more streamlined web access to PDMP data and new analytics and visualizations of the PDMP data. As communicated in emails December 16, 2016 from DSPS to licensed prescribers, licensed pharmacists and pharmacy managers, data users and submitters to the new ePDMP are required to re-register to use the new ePDMP. Information about the new ePDMP and registration can be found here:

In addition, DSPS has requested that WHA alert health systems that are interested in utilizing their federally-certified EHR technology to access the ePDMP data through their EHR to contact the Wisconsin Enhanced Prescription Drug Monitoring Program. DSPS is encouraging health care organizations to contact DSPS soon so they can complete the integration process before April 1, 2017. During a December 12, DSPS webinar on WI ePDMP-EHR Integration, DSPS directed organizations interested in connecting their EHR to the ePDMP to go to for technical/logistical details, which includes a subscription agreement contract with DSPS’s vendor and an outline of the implementation model.

For additional information about giving DSPS notice of your interest in EHR integration with the ePDMP, the Prescription Drug Monitoring Program can be reached at or 608-266-0011.

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WHA, Hospitals Asked to Testify at Assembly Mental Health Committee

Workforce, Payment and Regulatory Reforms Key to Addressing Needs

Dr. Matt Sager and WHA's Matthew StanfordHospitals and health systems are making investments to increase access to mental health services and transform how those services are delivered; however, addressing a critical mental health workforce shortage, MA reimbursement for mental health, and modernizing payment and regulatory policies are necessary to sustain those investments according to testimony provided at a January 17 Assembly Mental Health Committee meeting.

Testifying by invitation of the Committee, Pete Carlson, president – Aurora Psychiatric Hospital and Behavioral Health Services; Matt Sager, MD, psychiatric medical director, SSM Health; and, Matthew Stanford, WHA general counsel, each thanked the Committee and the Legislature for its new sustained policy focus on the importance of mental health and their efforts to advance accessible and well-coordinated care for individuals with mental health needs.

Pete Carlson testifyingCarlson detailed several investments to increase behavioral health capacity and access by Aurora Health care, including $35 million in improvements at its Wauwatosa campus to expand inpatient beds. Sager similarly shared news of SSM Health’s multi-million dollar expansion and transformation of its behavioral health services at SSM Health St. Mary’s Hospital in Madison. Stanford said other hospitals and health systems across Wisconsin have also recently made or are making investments to improve access to behavioral health services.

But while capacity is being increased, “the need for mental and substance abuse treatment continues to greatly outpace access to such services,” said Carlson. To address that need, Carlson, Sager and Stanford emphasized the need to address mental health workforce shortages and payment and regulatory reform.

“Unless Wisconsin addresses the shortage of psychiatrists and other mental health professionals, Wisconsin faces a future of declining accessibility of mental health services caused by a lack of workforce to meet the patient demand,” stated Stanford. “WHA encourages the Legislature to continue to identify opportunities for the Legislature to address this shortage and looks forward to working to implement potential solutions with the Committee.”

Stanford also called on the Committee to continue to explore new care delivery policy and payment reforms that can encourage greater patient access to modern mental health care delivery models. He said that regulatory and reimbursement policy is lagging behind the care delivery practices being encouraged, particularly regarding care coordination and integration of mental health services with physical health services.

Carlson specifically highlighted last year’s Behavioral Health Care Coordination Pilot bill signed into law in February 2016 - though implementation has not yet begun by DHS - as an example of a Medicaid payment reform that changes from “a fee-for-service-based delivery model that focuses on ‘sick’ patients to one that is value-based and focuses on prevention of illness.” He highlighted a care coordination model at Aurora Sinai Medical Center that has resulted in a 30-50 percent drop in ED visits and a corresponding $4 million reduction in charges.

“We believe that these results provide an example that could be replicated to help alleviate state budget constraints and lead to better patient outcomes,” said Carlson. “We look forward to the implementation of the behavioral health pilot by DHS.”

Other groups at the hearing similarly expressed the need to review Wisconsin regulations, particularly regulations governing outpatient mental health clinics. Gregory Jurenec, representing the Wisconsin Psychology Association called for the Committee to eliminate what he described as an unnecessary and burdensome certification requirement for outpatient mental health clinics that is redundant with the professional licensure requirements of the psychiatrists, psychologists and therapists that provide services in those clinics.

“WHA echoes the concerns raised by the Wisconsin Psychology Association that Wisconsin’s outpatient mental health certification rule has become outdated and is a barrier to access,” says Stanford. “Revisiting DHS’s outpatient mental certification rule is a key priority for Medicaid reform identified last fall by WHA’s Medicaid Advisory Work Group.”

Other issues highlighted by WHA included the need for targeted emergency detention clarifications and that WHA looks forward to working with the Committee this year to provide such new clarification. Stanford also provided an update on the WHA Information Center’s successful launch of the statewide voluntary inpatient psychiatric bed locator system that makes it easier for emergency departments to identify bed availability for patients in need of inpatient psychiatric treatment. He said since the inception of the program, it has generated nearly 2,000 queries by emergency departments.

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Reminder: Meaningful Use Attestation Deadlines for 2016

The Centers for Medicare & Medicaid Services (CMS) announced earlier this week that CMS’s Registration and Attestation System for the EHR Incentive Program is now open. Hospitals and physicians participating in the Medicare EHR Incentive Program must use the Registration and Attestation System to attest to the 2016 meaningful use reporting requirements by February 28, 2017, in order to avoid a Medicare reimbursement penalty in 2018. The 2016 EHR reporting period for hospitals and physicians is any continuous 90 days between January 1 and December 31, 2016.

The CMS announcements and the CMS Registration and Attestation System can be found here:

Hospitals and physicians participating in the Medicaid EHR Incentive Program have until March 31, 2017, to complete their meaningful use attestation for Program Year 2016. The 2016 EHR reporting period for hospitals and physicians is any continuous 90 days between January 1 and December 31, 2016.

Additional information about Medicaid EHR Incentive Program attestation, including instructions for how to attest, can be found at the Program website:

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Save-the-Date: Advocacy Day 2017 – April 19 in Madison

Make an impact in Madison for your hospital by marking your calendar to attend WHA’s Advocacy Day 2017 on April 19. Advocacy Day is one of the best ways your hospital employees, trustees and volunteers can make an important, visible impact in the State Capitol.

As always, Advocacy Day 2017 will have an outstanding keynote speaker and the popular legislative leaders panel discussion. In addition, Gov. Scott Walker has been invited to offer a luncheon keynote address.

The highlight of Advocacy Day is always the hundreds of attendees who take what they’ve learned during the day and then meet with their legislators in the State Capitol in the afternoon. Speaking up on behalf of your hospital by meeting with your legislators during Advocacy Day is essential in helping educate legislators on your hospital and on health care issues.

Save the date and plan to join over 1,000 peers from across the state at Advocacy Day 2017 at the Monona Terrace in Madison. A complete program of the day’s events and the link to online registration will be available at  in early February.

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