March 8, 2013
Volume 57, Issue 10

Ministry Health Care Pilots Innovative APNP Hospitalist Program

Advanced practice nurse prescribers (APNPs) will soon be able to admit patients at Ministry Eagle River Memorial Hospital (MERMH), thanks to an innovative pilot program created by Ministry Health Care that was recently approved by the Wisconsin Department of Health Services and the Wisconsin Board of Nursing. Under the pilot program, APNPs would act as non-physician hospitalists at Ministry Eagle River Memorial to ensure that patients in Eagle River are able to receive care within their home community whenever possible. An advanced practice nurse prescriber is an advanced practice nurse who has been granted a certificate to issue prescription orders.

The pilot program is designed to ensure that any participating APNP will have the requisite education, training and experience to admit and care for eligible patients. Prior to providing hospitalist services, the APNP hospitalist will receive 6-12 months of additional education and training at Ministry Saint Mary’s Hospital in Rhinelander under the supervision of a physician specializing in hospital medicine. During this time, the APNP hospitalist will learn how to triage patients to the appropriate level of care, manage a previously identified scope of diseases, provide care using evidence-based order sets and learn to use telemedicine. Only after this training would the APNP hospitalist be transferred to MERMH to provide inpatient care, consistent with the pilot program. As a result, the design of the program ensures that the APNP hospitalist will be well equipped to admit and manage select groups of patients in a safe and effective manner. Two APNPs are expected to begin the program in March.

"From a rural hospital administrator’s perspective, I whole-heartedly believe the advanced practice clinician hospitalist model could be a sustainable solution for ensuring long-term access to inpatient care for rural communities, especially in light of the forecasted shortages of primary care physicians," said Ministry Howard Young Health Care President Sheila Clough. "Without innovative models like this one, small rural hospitals will struggle to recruit and retain physicians, which will significantly limit access to care."

To begin the process of utilizing APNP hospitalists in Eagle River, Ministry leaders explored the types of acute illnesses a hospitalist would deal with on a day-to-day basis. The research determined the bulk of admissions fell into 15 disease categories. Common diseases include pneumonia, heart failure, chronic obstructive pulmonary disease (COPD), alcohol withdrawal, urinary tract infection, atrial fibrillation and delirium, among others. The expectation during the pilot program for APNPs is to gain knowledge of the acute illnesses from an experienced hospitalist.

Until now, there wasn’t a provision to allow nurse practitioners to be the attending provider in the hospital as state law requires a physician, dentist, or podiatrist to admit patients. Ministry Eagle River Memorial Hospital applied for a waiver from the State of Wisconsin to allow APNPs to admit patients, and was granted the waiver in late January.

"The education the APNPs receive from the hospitalists during their 6-12 month period at Ministry Saint Mary’s was a major factor in the decision to grant Ministry the waiver," said Ministry Medical Group Director of Hospitalist Service, John Almquist, MD. "Another helpful aspect is the consultation the APNPs will receive using telemedicine from Ministry Saint Mary’s."

The hospitalist pilot program uses Marshfield Clinic TeleHealth to connect the APNP hospitalist in Eagle River with the hospitalist in Rhinelander. Despite being 23 miles apart, the high-resolution cameras and equipment allow the hospitalist at Ministry Saint Mary’s to connect with the APNP, and the patient, at Ministry Eagle River Memorial.

"The technology allows the patient in Eagle River to interact with the physician at Ministry Saint Mary’s as if they were in the room," said Laura Magstadt, director of nursing and operations, Ministry Eagle River Memorial Hospital. "The hospitalist in Rhinelander can listen to the patient’s heart, lung and bowel sounds, and also look in a patient’s ears or mouth to learn about their condition. It’s an exciting approach to connecting the patient and physician from different locations." The hospitalist can also view the patient’s electronic medical record, X-rays and lab work from their office at Ministry Saint Mary’s.

The pilot program trains the APNPs to care for patients with conditions that hospitalists encounter on a regular basis. To support their practice, the APNP hospitalists will use evidence-based order sets. "We wrote order sets for the common diseases we would see at MERMH, as well as other supporting order sets," said Dr. Almquist. For instance, there would be order sets for heart failure, COPD, urinary tract infection and congestive heart failure, but then there would also be supporting order sets for things like pain management, gout management, correction of low potassium or high potassium, dehydration, nausea, vomiting and linkable order sets. So if the APNP admitted someone, they’d have the admitting order, or if they admitted someone with congestive heart failure, they’d have the standard admitting order set and the heart failure order set.

According to Dr. Almquist, when the program begins in March, it could revolutionize the way hospitalists are utilized in rural communities. "This will be the first time that an APNP hospitalist has been supported by a regular hospitalist in another location," he said. "Once we get the pilot program up and running, Ministry could provide hospitalist services to all of its critical access hospitals. Think about how many places throughout rural America this could be done."

In June, Ministry Health Care leaders will be presenting the APNP hospitalist pilot program to CEOs in health care organizations around the state.

Top of page (3/8/13)

AHA Annual Meeting, DC Fly-in Set April 28-May 1
WHA to host two member events and coordinate Hill visits

American Hospital Association (AHA) members should have received materials for the AHA’s Annual Meeting to be held April 28-May 1 in Washington, DC. The Wisconsin Hospital Association (WHA) will coordinate a number of special member events during this time, including a luncheon issue briefing, a members-only dinner and Hill visits on Tuesday, April 30, with Wisconsin’s members of Congress.

"Hospitals and health systems have been facing billions of dollars in Medicare payment reductions and this year’s Capitol Hill visits will allow Wisconsin leaders to continue to provide the real-world impacts of those cuts," said WHA President Steve Brenton. "This DC trip is a continuation of WHA and our members’ efforts to protect hospital care for patients all across Wisconsin."

Attendance at the AHA Annual Meeting is not required in order to participate in WHA-specific events or Hill visits. To facilitate Hill visits, WHA staff will make appointments with members of the Wisconsin delegation on your behalf.

If you will be in Washington at this time and would like to participate in WHA member events and Hill visits, contact WHA’s Jenny Boese at or 608-268-1816.

If you are attending the AHA Annual Meeting, register directly with the AHA at:

Top of page (3/8/13)

WHA Hosts HIPAA Compliance Webinar

On March 5, WHA hosted a webinar for its members on the subject of HIPAA compliance in light of the January 25 publication of the HIPAA Omnibus Final Rule, which, among other things, implements statutory amendments made to HIPAA under the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH Act). The webinar was presented by Monica C. Hocum and Leia C. Olsen, attorneys with Hall, Render, Killian, Heath & Lyman, P.C.

Attendance at the webinar was strong and attendees learned from Attys. Hocum and Olsen how the Final Rule affected such areas of HIPAA as business associate agreements, breach notification, enforcement and penalties, fundraising, marketing, sale of protected health information and notice of privacy practices. The Final Rule goes into effect March 26, 2013, and covered entities and business associates must be in compliance by September 23, 2013 (except that certain "grandfathered" business associate agreements must be in compliance by September 22, 2014).

WHA and its partners strive to assist WHA members in remaining current in and being able to respond to changes in health care, like the recent amendments to HIPAA. Additional information on the HIPAA Omnibus Final Rule is available at

Top of page (3/8/13)

Register Today for 2013 Advocacy Day
April 23, 2013 *** Monona Terrace, Madison

Make an impact in Madison for your hospital by attending Advocacy Day April 23. Register yourself and your hospital team today, including senior leaders, trustees and volunteers for this important event.

Advocacy Day 2013 features noted national association leader David Rehr, PhD; Governor Walker, invited as the luncheon keynote speaker; the ever-popular legislative panel; and, meetings with your legislators in the State Capitol.

Advocacy Day is a free event, but pre-registration is required. Online registration is available at

Top of page (3/8/13)

Healthy Hospitals Initiative Supports Health Care Facilities Environmental Efforts

The Healthier Hospitals Initiative (HHI) is a national campaign to help hospitals incorporate environmentally-friendly practices into their daily operations. Nearly 1,000 hospitals across the country, including hospitals in Wisconsin, are participating in HHI and they are collaborating on ways to produce less waste, conserve energy and produce healthier outcomes not only for patients, but for staff, hospitals and communities.

Don Berwick, MD, former CEO of the Institute for Health Care Improvement, who will be speaking at the WHA Partners for Patients meeting March 12, says, "The Healthier Hospitals Initiative will help accelerate the adoption of improved practices that will help individuals and society at large."

Jeff Thompson, MD, CEO of Gundersen Health System, which is participating in HHI, said, "At Gundersen, we believe health care organizations need to be honest with themselves and ‘look in the mirror’ when it comes to environmental factors that affect human disease."

For more information, go to: or see:

Top of page (3/8/13)

President’s Column: The Promise of Statewide Health Information Exchange

Many of us can remember a world in which accessing money required a trip to a financial institution for an in-person transaction. In those days, customers who failed to work around "bankers’ hours" could find themselves without cash when they needed it.

Today, the term "bankers’ hours" has little or no meaning to those who have come of age since the development of worldwide remote banking services. These services were made possible by technology (automated teller machines and a communication network that enables transactions), policies (technical standards and other legal agreements among competing financial institutions) and a shared strategic vision that doing the right thing for customers is ultimately good business.

We now consider remote banking services as a given—it is virtually unthinkable that any bank or credit union would be "off the grid" in today’s world. It is simply assumed that remote banking is a win-win for financial institutions and their customers.

As a member of the Wisconsin Statewide Health Information Network (WISHIN) Board of Directors, I think remote banking is a useful example when considering the promise of statewide electronic health information exchange (HIE). What drives WISHIN is a simple concept: patients’ health records should follow them wherever they seek care.

WISHIN offers the technology and policy framework to allow the delivery of essential health information at the point of care, and I believe most health care organizations in Wisconsin understand that this is the right thing to do for them and for their patients. WISHIN handles the HIE-related requirements of federal Meaningful Use rules, of course, but its vision is much broader—a "community health record" that enables true interoperability between EHR systems.

It is time now for Wisconsin health care organizations to step forward and demonstrate their commitment to this vision of a truly statewide system of electronic HIE. Large or small, north, south, east or west, every health care organization treats patients who have received care elsewhere and transitions patients to other venues of care. Every organization has a stake in ensuring that medical decisions are made with the best and most current information possible.

Wisconsin health care organizations have been models for the nation in developing innovative and collaborative initiatives that advance the national goals of improved quality and cost of care, patient experience, and individual and community health. Indeed, the founders of WISHIN—the Wisconsin Hospital Association, the Wisconsin Medical Society, the Wisconsin Health Information Organization and the Wisconsin Collaborative for Healthcare Quality—are examples of the collaborative culture for which Wisconsin is famous.

WISHIN has time-limited access to grant funds that can cover implementation costs for organizations that act soon. I salute the organizations based in Milwaukee, Madison, Marshfield, La Crosse, Fond du Lac, Watertown, Tomah, Dodgeville, Darlington, Baldwin and elsewhere that have expressed their intent to be early adopters of WISHIN’s robust HIE services. I encourage every provider organization in Wisconsin to carefully consider the benefits of WISHIN and make a similar commitment.

With your support, I believe there will come a day when we will think of statewide electronic HIE the way we think about remote banking today: why would we ever go back?

Steve Brenton,

Top of page (3/8/13)

Grassroots Spotlight: State Rep. Mandy Wright Visits Ministry Saint Clare’s Hospital

Newly-elected 85th Wisconsin State Assembly District Representative Mandy Wright (D-Wausau) recently visited Ministry Saint Clare’s Hospital in Weston to learn more about the facility, Ministry Health Care and its efforts to improve patient quality and safety through the use of technology.

During her visit, Rep. Wright heard from hospital staff as they explained how the hospital was a leader in its use of technology, including being an all-digital hospital. Staff demonstrated several examples of how the innovative use of technology is making a difference in providing patient care for people in central Wisconsin.

"Health care is a major issue for the residents of my district," said Wright. "It’s also a major driver for our community as the industry provides thousands of jobs for those who live here, and it’s important for me to learn more about our high-quality health care systems and what they have to offer."

Highlights of the facility tour featured the Intensive Care Unit (ICU) where leaders showcased how staff is partnering with Advanced ICU Care to implement a collaborative electronic-ICU program. Wright also visited a recently-remodeled physical therapy gym located directly on the hospital’s orthopedic unit and learned how it is shortening length of stay and contributing to outstanding clinical outcomes for total joint replacements. Wright also learned how Ministry Saint Clare’s Sexual Assault Nurse Examiner (SANE) program is providing a safety net for victims of abuse in the emergency department and how patient satisfaction scores in Ministry Saint Clare’s Family Birth Center are among the highest in the country.

"We were happy to share with Representative Wright some of our success stories in improving quality and lowering costs with the use of technology to complement our bedside care," said Ministry Saint Clare’s President Mary Krueger.

Top of page (3/8/13)

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.

Hospital teaches kids the importance of bicycle safety

More than 500 students from kindergarten through fifth grade learned about bicycle safety and the importance of wearing bike helmets at educational programs conducted by the Ministry Saint Joseph’s Hospital Trauma Center’s Injury Prevention Program.

Education is provided through ThinkFirst classroom presentations, bike rodeos, and community educational events, which are funded by Ministry Saint Joseph’s Hospital and Children’s Miracle Network.

Amy Schmidt, injury prevention coordinator and chapter director, visited local area schools in Pittsville, Loyal, Spencer, Marathon, and the Child Care Center of Ministry Saint Joseph’s Hospital and Marshfield Clinic to teach students about the importance of wearing a bicycle helmet.

"Bicycle crashes can happen at any time," Schmidt said. "I talk to the children about the importance of protecting their brain by wearing a helmet every time they ride their bike. By bringing a model brain, skull and a helmet along with other aides to the class, I can show the kids how a helmet protects their brain."

Last year, more than 40 helmets were distributed to youth and parents in the community. Funding for these helmets was made possible by the Children’s Miracle Network.

The Hospital also annually purchases a bicycle and helmet for Bike to School Week in the fall. A lucky student who participates in the event by logging miles biked or walked to school is entered into the drawing for the bicycle. Schmidt also conducts bicycle rodeos.

Ministry Saint Joseph’s Children’s Hospital is also represented at the annual Community Safety Day event in Marshfield, and for nine years has been a part of Marshfield’s "Get Fired Up for Safety," a fire prevention event.

And, the Hospital sponsors free monthly car seat safety checks in collaboration with Safe Kids Wood County. In 2012, more than 60 seats were checked.

Ministry Saint Joseph’s Hospital, Marshfield

Bellin Health Superbowl of Safety returns to Lambeau

Electricity, fire and many household chemicals can be dangerous – even fatal – to children. That’s why on January 26, 2013 Bellin Health and Safe Kids Greater Green Bay hosted the 14th annual Superbowl of Safety event.

The family event at the Lambeau Field Atrium, teaches children and parents relevant tips on a wide range of safety topics, including car seat, food, poison, sun and water safety, proper 9-1-1 dialing and crime prevention safety.

"The annual Superbowl of Safety event is an opportunity to engage children and their families in an interactive way to better educate them about serious safety issues as well as general health issues," said Tracy McCormick, Packers Partnership Executive for Bellin Health. "At the event, parents receive expert advice on keeping their children safe and healthy. Although the messages are serious, like correct 9-1-1 emergency dialing, they are shared in a way that makes them fun and memorable for kids."

Event highlights will include safety booth demonstrations, high energy training drills with former Green Bay Packers player, Ahman Green, and participation in a game of Family Feud, among other offerings.

Safe Kids members at the event include: American Red Cross; Happily Ever After Animal Sanctuary; Bellin Health; Brown County Public Safety; Brown County Sheriff’s Department; Center for Childhood Safety; Crime Prevention Association of Brown County; the State Department of Natural Resources; De Pere Health Department; Greater Green Bay YMCA; Green Bay, De Pere, Ashwaubenon and Howard Fire Rescue; National Weather Service; NEW Curative Rehabilitation; Oneida Health Center; U.S. Coast Guard Auxiliary; U.S. Consumer Product Safety Commission; the Brown County Lead Coalition; Wisconsin Public Service; Wisconsin State Patrol; Managed Health Services; and UW Extension.

Other contributing organizations include the Green Bay Packers and WIXX Radio.

The Superbowl of Safety typically draws more than 2,000 people annually. For more information, visit

Bellin Health, Green Bay

Providing supportive care for victims of sexual assault

The Sexual Assault Nurse Examiners or SANE nurses are an integral part of the Gundersen Lutheran Trauma & Emergency Center (TEC). SANE nurses are available 24 hours a day, seven days a week to provide objective forensic evaluation of victims of sexual assault or domestic violence.

Gundersen Lutheran nurse examiners are experienced in working with victims of sexual assault and domestic violence so they understand how traumatic the experience can be. So while they are technically skilled evidence collectors, they are also compassionate and respectful of the patient’s dignity during the examination.

After the victim’s medical condition is stabilized or it’s determined that immediate medical care is not needed, the SANE nurse begins an evidentiary exam which may include:

If a court case should result from the report of a sexual assault, the Gundersen Lutheran nurse examiner is available to testify as an expert witness. The SANE nurses also speak to groups and organizations about the prevention of sexual assaults and domestic violence.

Gundersen Lutheran Health System, La Crosse

Submit community benefit stories to Mary Kay Grasmick, editor, at

Read more about hospitals connecting with their communities at

Top of page (3/8/13)