February 11, 2011
Volume 55, Issue 6

Governor Walker Preserves Medicaid in Budget Adjustment Bill
"We appreciate Governor Walker’s commitment to the Medicaid program"

At a press conference this morning, Governor Walker unveiled details of a budget adjustment bill he described as one that will balance the budget through June 30 and prepare Wisconsin for the next biennium. The state currently faces a $153 million dollar Medicaid deficit for this fiscal year, ending June 30. The bill introduced today increases Medicaid appropriations to address this deficit.

After the press conference, WHA Executive Vice President Eric Borgerding said, "We’re pleased that the proposed Budget Adjustment Bill addresses the Medicaid shortfall by providing GPR funds, not by shifting costs or otherwise causing the health care safety net to fray even further. We appreciate Governor Walker’s commitment to the Medicaid program."

An additional estimated $1.8 billion shortfall for the Medicaid program in the next biennium is a significant portion of the state’s overall budget deficit, now estimated at $3.6 billion. The state also faces over $250 million in liabilities that must be met related to repayment of the Injured Patients and Families Compensation Fund and to the State of Minnesota for tax reciprocity payments from prior tax years. All told, Wisconsin’s dire budget situation is now approaching $4 billion over the next 30 months.

In a letter to legislative leadership outlining the specifics of the budget adjustment bill (see www.wha.org/DOAbudgetRepairLetter2-11-11.pdf), Department of Administration (DOA) Secretary Mike Huebsch indicated the Governor was requesting immediate action by the Legislature. "The budget adjustment legislation I am forwarding to you on behalf of the Governor takes significant steps toward a truly balanced budget," Huebsch said.

Included in the proposal are significant changes to state employee compensation that increase employees’ share of their pension contributions to 5.8 percent and their health insurance premium contributions to 12.6 percent. The bill would also make changes to limit collective bargaining for most public employees to wages. Local law enforcement and fire employees, and state troopers and inspectors would be exempt from these changes.

In addition, the bill authorizes restructuring of principal payments in fiscal year 2010-11 on the state’s general obligation bonds, allowing the principal payments to be made in future years, and reducing the state’s debt service costs by $165 million for this fiscal year. The savings from this provision "... will help address one-time costs to comply with the Injured Patients and Families Compensation Fund state Supreme Court decision and make payments under the Minnesota-Wisconsin tax reciprocity program," Huebsch said.

In addition to increasing Medicaid appropriations for the remainder of this biennium, the proposal also authorizes the Department of Health Services (DHS) to restructure the program, notwithstanding current law. "The department is expected to develop new approaches on program benefits, eligibility determination and provider cost-effectiveness," Huebsch said. The proposed changes will require approval of the Joint Committee on Finance before implementation.

Some legislators and others have said that the legislature should not consider a budget adjustment bill but, instead, wait to address the budget issues in the upcoming biennial budget bill. That inaction, however, could mean that beginning in the spring, the Medicaid program would run out of money and the state would be unable to pay its bill. The proposed Budget Adjustment Bill would avert that situation. Action on the budget adjustment bill is expected quickly with the possibility of review by the Joint Committee on Finance on Tuesday, February 15. The bill could then be ready for consideration by the entire Legislature.

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Guest Column: Seize Your Opportunity to Rate WHA’s Effectiveness and Value
By Nick W. Turkal, MD, WHA 2011 Board Chair and President/CEO, Aurora Health Care, Inc.

WHA conducts a survey of the full membership about every two years, with the intention of staying aware of the members’ changing needs and priorities and getting a clear picture of what WHA should be doing to address those member priorities.

WHA will be conducting this survey again during the month of February, and I encourage you to carve out some time to provide WHA with your ratings and comments on a variety of essential topics. On February 16, one executive at each member hospital and health system will receive an invitation to complete the survey online. The survey will only take 10-15 minutes, but the feedback is essential to tee up the future priorities of the association.

Member participation in the confidential survey is critical to the success of this effort. Significant participation, followed by incorporation of survey findings into WHA’s current and future programming, can only enhance member value. The collective opinions and ratings will be reviewed by our senior management team, shared with you, and be used by the WHA Board for strategic planning later this year.

This is your opportunity to rate WHA’s effectiveness and value. Please take full advantage of it and provide your feedback. If you have any questions regarding the survey, please contact Jennifer Frank at 608-274-1820 or email jfrank@wha.org.

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Wisconsin Hospitals Continue to Make Progress to Standardize Code Alerts

The WHA Board recently approved a recommendation to standardize code alerts to plain language in Wisconsin hospitals by January 2012. Some hospitals have already converted to plain language, while others are in various stages of planning and implementation. While questions are still being fielded at both the Association and by the Wisconsin Hospital Emergency Preparedness Program (WHEPP), early indications are promising that by early 2012, a large majority of the hospitals in Wisconsin will have adopted the use of plain language in their emergency code alert systems.

WHEPP Director Dennis Tomczyk said code uniformity statewide enables individuals at multiple facilities to respond consistently to emergencies, which ultimately enhances safety for patients, visitors and staff.

"In an emergency, it is imperative that communications are easy to understand and that the action requested is clear," Tomczyk said. "By using plain text, we’ve moved in a direction that helps reduce confusion, enables a faster response, and ensures the safety of everyone involved in the response."

Five of Ministry Health Care’s hospitals have transitioned to plain language code alerts and Denny Thomas, director of risk management and disaster preparedness, said the remainder of the system, including clinics, will be converted by March 15.

"The myriad of systems used across the state, including numbers, alpha and color codes created confusion and increased the likelihood of miscommunication and the potential for compromising patient and staff safety. Many organizations share personnel and through the leadership of WHA and WHEPP we now have a consistent alert system that reduces the amount of information an employee must learn and a consistent system of alerting our patients, families and our emergency responders," said Thomas.

Thomas, along with Phil Niemer, director of safety and security, created a checklist that will help hospitals in the planning stages of a transition to plain language. Niemer admits he was skeptical at first whether it was the right move, but now, as he has witnessed it working in both large and small hospitals, he is a true believer that it is the right move.

"Our health care system sees a fair number of staff who move into our organization on a temporary basis for training—residents, nurses, technologists and such," Neimer said. "Having this common system of understanding and response no matter where they may go to work in the state is both beneficial and practical. As all health care institutions statewide focus on patient safety, this is a great step forward."

The checklist referenced in this article and an application for WHEPP grant funds to assist hospitals with implementation costs is available at http://www.wha.org/disasterPreparedness/default.aspx under WHEPP Funding Opportunities for Hospitals.

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Wisconsin Hospitals Encouraged to Complete WHA HIT Survey

As a follow up to WHA’s February 2010 survey on the then-proposed Stage 1 meaningful use requirements for the Medicare EHR Incentive Payment Program, WHA and the WHA HIT Task Force has developed a new 2011 survey on hospitals’ EHR implementation, meaningful use plans, and spending on EHR and meaningful use implementation. The new survey will provide key information to help WHA in its advocacy efforts relating to EHR implementation and meaningful use, and will help form the basis for WHA’s 2011 HIT Report.

It is important that WHA receive a large response to this survey from Wisconsin hospitals so that we can demonstrate to regulators in Washington, D.C. and to the Congressional Delegation in Wisconsin the need for the Medicare and Medicaid EHR incentive programs to be achievable and realistic if they are to succeed. Washington is already discussing how to raise the bar in future years, even before considering how hospitals are fairing under the current rules.

The survey must be completed by February 23
. With a few exceptions, the survey was sent to the CFO and information services contacts provided by your hospital for the WHA Directory. Questions should be directed to Matthew Stanford at mstanford@wha.org or 608-274-1820, or Jenny Boese at jboese@wha.org or 608-274-1820.

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President’s Column: Gov. Walker Protects Medicaid in Budget Repair Bill, the Physician Pipe Line and ACA Waivers

Absent Governor Walker’s proposal, Wisconsin Medicaid providers would have faced a pile of IOUs beginning in May as the program ran out of money. Such a scenario is at odds with complaints from some lawmakers who argue that a special session to take up a budget repair bill is unnecessary.

WHA remains committed to working with likeminded stakeholders to promote the need for our two fine Wisconsin-based schools to grow their class sizes and to lead efforts to develop new residency programs that will encourage newly-minted physicians to practice in the Badger State. Unfortunately, the sense of urgency described in Dr. Wilson’s message is not universally shared by some key stakeholders who must be counted on if we are to advance physician supply-related solutions. So look for WHA and hopefully others to soon begin discussing alternative strategies to address this looming crisis.

What is at stake here is the sustainability of low-cost health plans that are often offered to part-time and low-wage workers. Many of these plans fail to meet the medical loss ratios included within the reform legislation. Provisions in ACA will eliminate such plans in the future and instead likely force employers into more expensive coverage.

Look for public hearings in the House of Representatives next year to explore issues associated with waiver granting. It should be interesting to see what, if anything interesting, is under the sheets.

Steve Brenton

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ICD-10 Final Rule and Related WHA/RWHC Survey
Hospitals are urged to complete survey

On January 15, 2009, the Secretary of the Department of Health and Human Services released a final rule calling for the adoption of a new edition of the International Classification of Diseases (ICD) standards known as the 10th edition using Clinical Modifications (CM) and the Procedure Coding System (PCS). The final rule adopts ICD-10-CM for reporting patient diagnoses and ICD-10-PCS for reporting hospital inpatient procedures—both will replace ICD-9-CM in its entirety. The final rule, available at http://edocket.access.gpo.gov/2009/pdf/E9-743.pdf, was published in the January 16, 2009 Federal Register.

The use of ICD-10-CM and ICD-10-PCS applies to all "Covered Entities," that is health plans, health care clearinghouses and health care providers that transmit electronic health information in connection with the HIPPA standards. The compliance date for ICD-10 is October 1, 2013 (federal fiscal year 2014). The transition to ICD-10 will affect almost every department in the hospital. Key areas include HIM/Coding, billing, finance, information systems, quality and the medical staff. WHA and RWHC are collaborating in an effort to provide appropriate resources to hospitals to assist with this transition.

A survey regarding ICD-10 readiness was sent to chief executive officers today (with a copy to the HIM manager). The intent is to determine the phase of readiness for various hospitals so WHA Information Center (WHAIC) and WHA can understand what resources are needed. The results will be summarized and shared with WHA member hospitals. WHA and RWHC will develop tools and education based on the survey responses.

Direct questions about the survey or the implementation of ICD-10 to Debbie Rickelman, RHIT, senior director, WHA Information Center, drickelman@wha.org or 608-274-1820.

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Teleconference Series for Inpatient Coders Focused on Converting to ICD-10

Converting from ICD-9-CM to ICD-10-CM/PCS presents both opportunities and challenges for all health care delivery entities. The scope and complexity of the classification system changes are significant and the transition requires substantial changes affecting many systems, processes, and people. Those most affected by the change will be coders and documentation improvement specialists.

In addition to learning the new classification systems, inpatient coders and documentation improvement specialists must obtain a greater understanding of biomedical science, medical terminology, interventional technologies, and pharmacology to fully utilize the specificity the new classification system has to offer.

In an effort to assist with your ICD-10 readiness, WHA is offering a nine-part monthly teleconference series, from February through October, designed specifically for hospital inpatient coders and documentation improvement specialists, to prepare them to understand the ICD-10-PCS classification system while providing system and procedure-targeted anatomy, physiology, pathophysiology, medical terminology, and detailed procedure explanations.

Online registration is now open for this series at https://www.SignUp4.net/Public/ap.aspx?EID=11WI10E&TID=TRUE6%2fBPpdzMTU7Uisc8Tg%3d%3d. Participants can register for individual sessions or for a full series at a discounted fee. For registration questions, please contact Lisa Littel at llittel@wha.org or 608-274-1820.

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Supreme Court Grants WHA’s Request to File Brief in Property Tax Exemption Case

The Wisconsin Supreme Court this week granted WHA’s request to file an amicus brief in Covenant Healthcare System v. City of Wauwatosa, the case in which Covenant, now Wheaton Franciscan Healthcare, is appealing a decision by the Court of Appeals that denied the hospital property tax exemption for St. Joseph Hospital’s Outpatient Center. The Court of Appeals considered the case after the City appealed a decision by the Circuit Court that found the SJOC eligible for the property tax exemption.

In its request for permission to file a brief, WHA highlighted that the City has drawn a distinction between on-campus outpatient facilities, which the City acknowledges may qualify for a property tax exemption, and off-campus outpatient facilities, which the City suggests will not qualify even if they provide the same services as their on-campus counterparts. WHA emphasized that the City shifts focus from property use to property location as the determining factor in the exemption analysis.

Attorney David Edquist, von Briesen & Roper, who wrote the request to file the brief and will write the amicus brief on behalf of WHA, said, "WHA will address this shift in the context of the services that the healthcare industry and the Wisconsin legislature have traditionally considered to fall within the definition of a hospital." Edquist continued, "The legislature chose to distinguish ‘doctor’s offices’ from ‘hospitals’ when the legislature amended the nonprofit hospital exemption in 1977. WHA’s amicus brief will analyze this distinction against that historical backdrop."

In addition to WHA, the Rural Wisconsin Health Cooperative, the Wisconsin Association of Assessing Officers, and the League of Municipalities intend to file amicus briefs with the Court. A decision in the case from the Supreme Court is not expected until this summer.

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EHR Incentive Program Webinar, Checklist Now Available in WHA Toolkit

Hospitals can now view and hear the WHA-DHS EHR Incentive Program Webinar on the WHA Toolkit. The webinar was originally offered live in February, and discusses key issues related to the Medicaid EHR Incentive Program, including:

The WHA Toolkit also has an updated Checklist for hospitals that will be seeking the Medicaid EHR incentive payments. The Checklist provides key 2011 dates and processes for receiving Medicaid EHR incentive payments in 2011.

The WHA Toolkit on electronic health records can be found here: www.wha.org/toolKit/default.aspx.

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Make An Impact in Madison on April 27… Register Today for WHA Advocacy Day

Make an impact in Madison by attending WHA’s 2011 Advocacy Day on April 27. Register your hospital team today, including senior leaders, trustees and volunteers, for this important event. Advocacy Day is free of charge and takes place at the Monona Terrace in Madison.

This year’s Advocacy Day will kick off with an insider’s look at Washington, DC from Jim VandeHei, co-founder and executive editor of Politico, the highly-influential Web site that Washingtonian Magazine recently hailed as a "media phenomenon." Founded in 1996, the all-politics-all-the-time company now has more than 100 employees, all focused on meshing the old media values of fairness and accuracy with the speed and immediacy of new technologies. Politico’s Web site reaches more than three million unique visitors each month, and its Washington-based newspaper is distributed to more than 30,000 senior government officials, staff, lobbyists and political professionals.

VandeHei is a native of Oshkosh, Wisconsin, and a 1994 graduate of the University of Wisconsin-Oshkosh, with degrees in journalism and political science. He became interested in journalism after covering sports for the Oshkosh Daily Northwestern and then running The Brillion News, a small-town weekly, in the summer of 1993. He moved to Washington in 1995 to pursue a career in political journalism. Since that time, he has earned a reputation as one of a few people in Washington who offer his breadth of knowledge about political power and the future of media and newspapers.

With a close-up view of what really happens in Washington, VandeHei will bring a frontline journalist’s insight and insider knowledge of Congress and the White House to Advocacy Day attendees. A complete program and online registration are available at http://events.SignUp4.com/AdvocacyDay. For Advocacy Day questions, contact Jenny Boese at 608-268-1816 or jboese@wha.org. For registration questions, contact Lisa Littel at llittel@wha.org or 608-274-1820.

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H1N1 Corrective Actions Report Suggests "Good Can Get Better"

In the months following the H1N1 response, the Division of Public Health asked Wisconsin hospitals, nursing homes, physician offices and emergency responders to complete an "After Action Report (AAR)." The AARs were then compiled into one State Healthcare H1N1 After Action Report that was reviewed at two H1N1 After Action Reports Conferences in May 2010 in Madison and Wausau. More than 300 participants identified priorities that they believed required address: communications, immunization, and infection control. Workgroups comprised of individuals that were involved in one of the three priority areas did an in-depth review of the response, and developed recommendations that could improve future responses to a similar public health issue. Their recommendations range from improvements that can be made in the distribution of vaccine to ideas that would strengthen communications among all respondents.

The Division of Public Health, which compiled the corrective actions gathered from multiple sources, has started to work on implementing the recommendations in the three reports. Dennis Tomczyk, director of the Wisconsin Hospital Emergency Preparedness Program, thanked the individuals who devoted hours not only in responding to the H1N1 outbreak but also who also volunteered on a workgroup to identify areas of improvement.

"We will be better able to respond to future outbreaks because of the efforts of our health care providers and public health officials," Tomczyk said.

The three reports are available at:




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Holy Family Memorial’s Employee Flu Immunization Rate Reaches 80%

The challenges of last year’s flu season, which included a shortage of vaccine and questions about the then "new" H1N1 vaccine, didn’t prevent Holy Family Memorial Medical Center in Manitowoc from immunizing 80 percent of their health care workers during the 2009-2010 flu season.

Judy Check, RN, COHN-S, the employee health coordinator at Holy Family Memorial, said she believes the key is starting as early as September, with flu clinics scheduled in October. Flu clinics are offered at the hospital, and in the medical clinics. If an employee misses one of the scheduled flu clinics, vaccinations are available in the patient care areas and in the employee health office for several months.

"We communicate to our employees a month in advance of the employee flu clinics using a variety of mediums," she explained. Employees receive information through the hospital’s newsletter, email, and the employee intranet. Education focuses on dispelling the myths surrounding the vaccine.

Employees were asked to state reasons why they declined the immunization. The most common reason provided by employees is that they question the effectiveness of the vaccine. Check said she explains to those employees that the vaccine is 70 - 90 percent effective in preventing influenza in healthy adults under the age of 65.

Although it is true that virus strains undergo continuous change, vaccine manufacturers have a good track record of predicting strains that will circulate in an upcoming season based on historical surveillance and laboratory data. The vaccine provides some protection even when the vaccine does not closely match circulating strains because of cross reactivity among strains that reduces the severity of complications. And this year, according to Jonathan Temte, MD, PhD, a professor of family medicine at the University of Wisconsin School of Medicine and Public Health who also serves on the U. S. Advisory Committee on Immunization Practices, there is an excellent match between the vaccine and the circulating strains of the flu.

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Wisconsin Association of Healthcare Quality Announces Annual Conference

The Wisconsin Association of Healthcare Quality (WAHQ) will hold its annual conference on March 4, 2011 at the Crowne Plaza in Madison, Wisconsin. The conference, entitled "Dare to Prepare: Tactics for Today’s Quality Leaders," will focus on the impact of the external and regulatory forces on health care quality, performance metrics and quality measures for "meaningful use" regulations for organizations to update their current electronic health records. Additionally, the conference will provide an overview of the accountable care organization’s purpose, as well as current efforts and information on how lean manufacturing can be adapted to radically improve health care quality and reduce costs.

Those who have roles in patient safety, HIM, quality improvement, patient advocacy, patient care or corporate and regulatory compliance in health care are encouraged to attend. Registration information can be found at www.WAHQ.org.

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Wisconsin Hospitals Community Benefits: Access to High Quality Health Services

Hospitals do what they can to move health care services out of the clinical setting into the heart of the community. Community health screenings and education classes help raise awareness of small, and sometimes, big steps that individuals can take to improve their health. When people learn more about how their lifestyle decisions affect their health, they make changes that ultimately lead to better health, which raises the health status of the entire community.

Upland Hills Focuses on Hunters’ Health

On November 15, Upland Hills Health invited hunters to participate in a health check, aimed at reducing the number of heart attacks that typically occur on opening weekend of gun deer hunting.

"I’m really glad that the event was here. Too many guys go out there (into the woods) and don’t come back out. This way, at least you have an idea of your risk," said Ken Wunderlin of Livingston.

Hunters were offered cholesterol and blood glucose screenings, blood pressure checks, and even a stress test for nominal fees. Michelle Helin, staff development coordinator at Upland Hills Health, showed each participant the important skill of compression-only CPR, in the event that a hunting partner may need this life-saving assistance. Educational materials were provided about recognizing signs of heart attack and stroke, and reducing risk for stroke.

"I’m happy to have been a part of the event. Unfortunately, no one believes that they will experience a heart attack. We all like to believe we are in better shape than we are. If we were able to get these hunters at least thinking about their cardiovascular health before they go into the woods and exert themselves, then we were successful," explained Dr. Mark Bishop, who administered the stress tests.

Upland Hills Health, Dodgeville

Tick. Tock. How healthy is your heart?

Tick. Tock. How Healthy is Your Heart? That’s the question Memorial Health Center asked the public at a free educational session presented by the Aspirus Heart & Vascular Institute. Individuals at the event assessed their heart health, learned what they can do to address heart disease risk factors, and discovered how to recognize the warning signs of a heart attack. It is Memorial Health Center’s goal to help people better protect their hearts and the hearts of their friends and family members.

Education about atrial fibrillation

Atrial Fibrillation (A-Fib) is a heart condition that causes the heart to beat irregularly. It affects about 2.5 million Americans, greatly increasing their risk of stroke. To better educate people with A-Fib about their condition, Memorial Health Center invited the Aspirus Heart & Vascular Institute to present a free public seminar about A-Fib and its treatment options. Those attending learned how they can get off medication, prevent strokes, and live longer. Memorial Health Center is an Aspirus Heart & Vascular Institute satellite campus.

Memorial Health Center – An Aspirus Partner, Medford

Saving young brains: Test measures ImPACT of head injuries

Student athletes at three area high schools have a new tool to help protect them this year, and it’s not a new piece of equipment — it’s a test.

Sauk Prairie Memorial Hospital & Clinics’ (SPMHC) athletic trainers, which serve the school districts of Sauk Prairie, Lodi and River Valley, now offer ImPACT, a new concussion management tool for high school athletes. Throughout the summer, the athletic trainers met with student athletes to administer the 20-minute test that assesses reaction time, processing speed, and different types of memory. The score is a baseline, representing how that athlete’s brain functions normally.

If the athlete gets injured and a concussion — or brain injury — is suspected, they can be tested again to see if it has affected their brain function.

"It’s basically an assessment of their neurocognitive functioning so you can compare what their baseline is prior to an injury to how they score after an injury," said Kristin Kolodziej, athletic trainer at River Valley High School. "You want both tests to be similar. If they aren’t, the athlete isn’t ready to go back on the field."

If an athlete returns to the field before recovering from a concussion and injures their brain again, the injury could be much more severe.

Lodi High School athletic trainer Renee Schutte said, "Previously, we relied a lot on what the athlete told us about their symptoms. Now we have objective data about their brain to help make the best recommendation for that athlete. It’s a huge help."

While the school districts do not require athletes to be screened, many coaches support the program and the goal is to screen every athlete. And thanks to a grant from Sauk Prairie Memorial Hospital’s Foundation, the testing is available to high school athletes in the three school districts free of charge.

SPMHC has a health care provider in each of its community clinics who can assess concussions. In Lodi, Dave Eberdt, PA-C, works with the athletic trainers to establish the best course of action for these athletes.

"Managing these head injuries, concussions, dingers, or bell ringers…it’s a whole different concept now than when I was getting banged around playing football in the 70s," said Eberdt.

According to Eberdt, today medical professionals better understand that the brains of student athletes are still developing and are fragile when suffering an injury. And while sitting out a game or two may be upsetting for some, the long-term consequences are not worth the risks.

"Six weeks, one week, whatever of a child’s life is not going to dramatically alter their ability to become a professional athlete," said Eberdt. "More so, if we don’t manage concussions properly, it is going to affect their ability to grab their diploma or do well on their ACT or SAT exams."

Sauk Prairie Memorial Hospital & Clinics, Prairie du Sac

Submit community benefit stories to Mary Kay Grasmick, editor, at mgrasmick@wha.org.

Read more about hospitals connecting with their communities at www.WiServePoint.org.

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