May 25, 2012
Volume 56, Issue 21

Assembly Health Committee Learns About Hospital and Health System Efforts to Transform Health Care
Quality and value key themes of informational hearing

On May 22, the Assembly Health Committee held an invitation-only informational hearing to discuss efforts underway at Wisconsin hospitals and health systems that continue to make Wisconsin a national leader in health care reform.

The hearing was called by Committee Chairman Representative Jeff Stone (R-Greendale) to provide Committee members an opportunity to learn about and discuss the many positive trends and developments in Wisconsin health care.

In addition to WHA, Committee members heard from Jim Dietsche, chief financial officer for Bellin Health System; Dr. Jeff Thompson, chief executive officer at Gundersen Lutheran Health System; and Sue Wick, RN, BSN, director, Population Health Management Services for Aurora Health Care along with consultant Gerald Frye, president of The Benefit Services Group, Inc.

"No matter what happens with the federal health reform law," Rep. Stone said, "I think what we see in Wisconsin is a change in health care and in how we are working to get to better outcomes and better value that will maintain Wisconsin’s standing as a national leader in health care."

Driven by a strong presence of integrated hospital and health systems that include employed physicians, a commitment to measuring and transparent reporting of quality improvement, a high rate of adoption (ranked second nationally) of electronic health records (EHR) technology, and a focus on efficiency initiatives that include an increasing adoption of LEAN principles, health care reform in Wisconsin is producing impressive results in quality and value improvements that have attracted national attention.

"In many ways, Wisconsin is a leader in a national transformation," said WHA Executive Vice President Eric Borgerding.

"Wisconsin is making an effort to repurpose and retool the structures in health care delivery and finance, away from volume-driven, fee-for-service reimbursement toward a system that demands and rewards better quality and better outcomes and that will produce more value for our health care dollars," Borgerding said. "Improving health care value and quality is health reform."

While Wisconsin is consistently ranked at or near the top nationally in health care quality, health care providers’ relentless pursuit of quality improvement continues. For hospitals, this includes participation in "Partners for Patients," the national initiative aimed at preventing avoidable hospital-acquired conditions (HACs) and reducing unnecessary hospital readmissions. An incredible 98 percent of Wisconsin hospitals have enrolled in this effort.

In response to a question about other examples in which hospitals are improving quality, WHA Chief Quality Officer Kelly Court explained that in the past, quality improvement projects were initiated by managers who were not on the front lines of patient care.

Through WHA’s participation in a separate national effort supported by the Robert Wood Johnson Foundation called "Aligning Forces for Quality," Wisconsin hospitals are implementing a new process to speed improvement called "Transforming Care at the Bedside (TCAB)."

In the past, quality improvement projects started at the management level and worked their way to the bedside. "TCAB puts a structure in place for front line nurses to meet, review how effective and efficient the processes are around patient care, and then they have the authority to initiate a change and see if it improves patient care," Court said. "What we have found is this process is effective at eliminating duties and activities that do not add value for the patient."

"This sounds similar to what they are doing in manufacturing, where employees look for a way to improve quality, add value, and improve efficiencies," Rep Stone commented.

Borgerding agreed, saying TCAB and other efficiency strategies like Lean are showing promising results.

"It is a cultural shift to a mindset where quality becomes everyone’s business. We are seeing it at all levels of health care, from the largest multi-hospital systems to a 25-bed rural hospital like Prairie du Chien Memorial, which is fully engaged in Lean engineering."

The vision at Bellin Health System, according to Dietsche, is that the people in their region will be the healthiest in the nation. "When you set a goal like that, you begin to measure things that you have never measured before," Dietsche said. "We know that you cannot improve what you don’t measure, and our vision can be measured. Employers need to reduce their health care costs. We are looked at as a cost—if we can’t do things efficiently and effectively, it costs employers money. That decreases the economy in our region. We work with municipalities, schools, and employers because we need to be a viable component to their business."

In his comments, Dr. Thompson said Wisconsin is unique because of its high level of health care system integration, which facilitates better coordination of care.

"We have more alignment among provider groups, associations, and our partners and state agencies than any state around the country," Thompson said in his opening comments to the Health Committee. "And, we have results that can really show that."

"When we talk about value, we have to do it in a way that is sustainable and in a way that it will reach the breadth of the communities that we are responsible for," said Dr. Thompson. "An important tool to do this is to have an integrated health system. An integrated system says we are going to invest heavily in primary care, insurance products that focus on primary care, in preventive health, and rehabilitation. That is the fundamental baseline."

"One important thing to understand is there is a difference between ’market dominance’ and integrated care. Integrated care with the right focus can deliver great value to the community," Thompson said.

"We work with the state on a lot of efforts," Thompson added. "I think the theme, which was echoed by Bellin, is we have to think of a way to imagine that health care costs are not a doctor’s or a hospital’s sole responsibility. Do I believe that Bellin, Aurora and Gundersen Lutheran can get more efficient? Yes. But, so much of health care cost is social, so much of it is personal responsibility. That is why a collaborative approach is necessary between state and communities."

"Don’t remove care from the Medicaid population," Thompson said. "But ask them to be more responsible. Move them from using the emergency room to an urgent care setting. We can expect that of them, and there is a fair amount of evidence that they will respond," Thompson said.

Improving efficiency is also a key focus at Aurora. "Care management starts with the medical home, a model that Aurora Health Care believes is essential to improving health, quality, and in controlling costs," said Wick.

"Our ability to be doing care management as a provider organization and to marry that with population health management not only improves the health of an individual, but from that we are able to identify opportunities for improvement that drive operational efficiencies," Wick said.

Frye’s consulting company represents 1.2 million employees. About half of them are located in Wisconsin. He said data is a critical element in managing health and costs.

"If we have the right tools to identify the right population management strategy, then we also have the data and the tools so we can do the financial management, too," Frye added. "The interesting issue is everyone can tell you that 35 percent of the care delivered is unnecessary, but which 35 percent?"

Getting to the episode level of data is important, according to Frye, and he said WHA’s support for the Wisconsin Health Information Organization (WHIO) is very good. "It is not about unit price—it is what happens on that critical pathway when a patient enters the health system; it’s the cost of the entire episode of care," Frye said.

Frye also mentioned the study released at the end of last year by Milliman and Mercer for the Greater Milwaukee Business Foundation.

"Milliman-Mercer looked at southeast Wisconsin hospitals commercial payment compared to the nation and found that Milwaukee is growing at a slower rate in operating expenses than the national average for hospitals. The Milwaukee hospitals are taking cost out of the system," Frye said. "These are costs that come from the payers. Our hospital groups are doing the things they need to do to control costs, and yes, they are beating the national averages."

"There’s a good story taking shape, and we should start telling it," Borgerding said. "Access to quality and efficient care should be as much a part of our economic infrastructure as roads and utilities. Few other states are as well positioned or committed to succeed—if not thrive—in this emerging health care value dynamic. That is a Wisconsin strength that we believe can transform into a Wisconsin advantage."

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WHA Hosts Jandre Work Group
Begins review of informed consent statute

Attorneys from the Wisconsin Hospital Association, Wisconsin Medical Society, and other health care organizations have begun work on draft legislation to address the Wisconsin Supreme Court’s recent decision in Jandre v. Injured Patients and Families Compensation Fund. (See April 20, 2012 Valued Voice article.)  WHA and the Society invited the participants to a meeting this week at WHA headquarters in Madison.

In the lead opinion, Chief Justice Shirley Abrahamson wrote that the scope of a physician’s duty of informed consent under Wisconsin law is determined on a case-by-case basis using the "reasonable patient" standard. The opinion said a physician’s duty of informed consent is determined by asking what a reasonable person in the patient’s position would want to know to make an intelligent decision with respect to the choices of treatment or diagnosis. Health care providers, payers, policymakers, and four of the Supreme Court’s seven justices are concerned that the Jandre decision will lead to defensive medicine. Supporting the work group’s goal of addressing the Court’s decision, WHA Executive Vice President Eric Borgerding said, "Defensive medicine works against larger efforts initiated by government, the health care community, employers and others to move from volume to value-based health care."

Mike Van Sicklen, an attorney at Foley & Lardner and the attorney who represented the physician before the Supreme Court in Jandre, provided an overview of the case and other informed consent decisions and posed a number of difficult questions for the group to consider. Guy DuBeau, an attorney with Axley Brynelson and the attorney who represented WHA, the Society, and the Wisconsin Chapter of the American College of Emergency Physicians as amici in the case, provided insight from the perspective of the courtroom. DuBeau encouraged the group to think about the interaction between physicians and their patients and the physicians’ professional judgment.

The work group will continue discussing options for what the group expects to be a proposed statute change considered during the next legislative session. Society General Counsel Ruth Heitz noted, "The Justices’ three separate opinions in Jandre underscore the complexity and need for clarity on the informed consent issue." WHA General Counsel Laura Leitch agreed, "As Justice Prosser noted in his concurring opinion, it is time for a thorough review of Wisconsin’s informed consent statute. We appreciate the commitment of the community to work on this important issue."

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Wis. Supreme Court Decision on Alzheimer’s Patient Leaves Uncertainty

On Friday, May 18, the Wisconsin Supreme Court in a 6-0 decision affirmed the Wisconsin Court of Appeal’s decision in the In Re Helen E.F. case that overturned a Chapter 51 mental health commitment of a plaintiff with Alzheimer’s disease exhibiting aggressive behavior and refusal of meals and medication. The Wisconsin Supreme Court held that the plaintiff was "more appropriately treated" under the provisions provided in chapter 55—Wisconsin’s protective placement and services statute—than those provided in chapter 51—Wisconsin’s mental health commitment statute.

"We conclude that [the plaintiff] is not a proper subject for [involuntary treatment under chapter 51] because while her Alzheimer’s disease may be managed, she is not medically capable of rehabilitation, as required by the chapter," stated the Court’s opinion written by Justice Michael Gableman. "[C]h. 55, unlike ch. 51, is better suited for [the plaintiff’s] situation because her Alzheimer’s Disease is not treatable."

While there are similarities between chapter 55 and chapter 51—both chapters provide processes for providing necessary involuntary care and both chapters require county government to provide certain services under both chapters—there are differences between the chapters. As a result of the Supreme Court decision, health care providers may now find that county agencies, local law enforcement, county corporation counsel, and local courts may employ new procedures and policies when considering involuntary care for individuals with Alzheimer’s disease.

The decision does leave some unanswered questions that will impact the application of this decision to future practices and procedures.

The Court specifically did not address whether an individual who has both Alzheimer’s disease as well as mental illness, a developmental disability, or alcohol or drug dependence may be involuntarily committed or detained under chapter 51.

Chief Justice Shirley Abrahamson also noted other questions in a concurring opinion. "Does this opinion govern all Alzheimer’s patients or only [this plaintiff]?" wrote the Chief Justice. The Chief Justice also noted that the "majority opinion provides a potentially powerful tool for an individual seeking to avoid involuntary commitment under Chapter 51. The broadest possible reading of the opinion would be that any person with an ‘incurable’ condition may not be involuntarily committed….Individuals with conditions that might otherwise appear to qualify for involuntary commitment…may now argue that they are not proper subjects for ‘treatment because their condition is incurable.’"

In a related legislative development, the Legislature’s Joint Legislative Council has approved the formation of a Special Committee on Legal Interventions for Persons with Alzheimer’s disease and Related Dementias. The charge of the Special Committee is to review and develop clarifying legislation regarding chapter 51 and chapter 55 and their application to individuals with Alzheimer’s disease. The Special Committee will be made up of both citizens and legislators. WHA has recommended an individual to the Joint Legislative Council for inclusion on the Special Committee; final membership for the Special Committee is expected to be set in the next few weeks.

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Register Today for the 2012 Wisconsin Rural Health Conference
The Osthoff Resort, Elkhart Lake *** June 27-29, 2012

Reminder… Osthoff Resort Room Reservation Cut-Off: Wednesday, June 6

Due to other large events in the area, it is very likely hotel rooms will not be available after the June 6 cut-off date, so make your reservations ASAP.

More information and online registration is available at

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President’s Column: Wisconsin Health News, 5/18/12
On the Record with Steve Brenton, president, Wisconsin Hospital Association

Edited and reprinted with permission from the Wisconsin Health News, Tim Stumm, editor

At an Assembly Health Committee hearing on May 23, hospital representatives provided examples of what they are doing to transform health care payment toward a model that rewards value over volume. It’s a message Wisconsin Hospital Association President Steve Brenton hopes to spread far and wide.

Brenton expects these efforts to continue regardless of what happens with the federal health reform law. And, in some cases, despite the law.

"One of the concerns I have is that PPACA doesn’t begin to go far enough in rewarding value or incenting already existing value," he said. "Although it does push experimental things like accountable care organizations, at the end of the day, I don’t think it went far enough."

In a recent interview with Wisconsin Health News editor Tim Stumm, Brenton discussed the federal health reform law, Medicaid, and more. Edited excerpts are below.

WHN: What are the biggest issues facing Wisconsin hospitals today?

SB: Medicare and Medicaid payment is obviously a key point. The physician workforce issue has been our second biggest issue for the past four or five years. The WHA report documents the shortage, which is largely in primary care. It’s incumbent upon the state’s hospital and health systems to help grow residency programs and opportunities. We know that a physician who completes a Wisconsin-based residency program is more likely to stay in Wisconsin.

WHA is also very involved in working with our member hospitals to advance clinical performance improvement. We started by voluntarily publicly reporting hospital specific clinical measures about eight years ago, before any other state. We’ve been highly transparent and, largely, the measures we have reported have shown improvement over the past eight years. We’ve also been very involved with the Wisconsin Collaborative for Healthcare Quality, the Wisconsin Health Information Organization, the Wisconsin Statewide Health Information Network, and the Partnership for Healthcare Payment Reform. And then, finally, we recently signed a major two-year contract with CMS for a program called Partners for Patients. The focus is on reducing preventable readmissions by 20 percent and hospital-acquired conditions by 40 percent in the next 24 months.

WHN: The Assembly Health Committee held a hearing on efforts by Wisconsin hospitals to transform payment to a model that rewards quality and better outcomes. What was the goal of this hearing?

SB: The goal is several-fold. We really believe that the high quality and relative efficient performance of our provider organizations—our hospitals and physician groups—at the end of the day is a competitive advantage for Wisconsin as it relates to attracting and retaining employment. In Wisconsin we have high value health care. We need to showcase it and then deploy that value for competitive advantages. The legislative hearing is one venue to do this.

WHN: Why is Wisconsin so ahead of other states?

SB: We have several advantages in this state. Wisconsin, historically, has had large physician groups. That has led to a level of hospital-physician integration that really has been a catalyst of early adoption of electronic health records. We have a significant number of physician leaders in this state who are committed to performance improvement. Health care is not a silo mentality in this state, where you have the hospitals free standing and the physicians free standing, competing with each other over payment-related issues. That phenomenon is not really occurring in Wisconsin. I think integration is a huge reason. Also, health care in Wisconsin has largely been non-profit and community-based. So I think there is more of a sense of mission than what may exist in some other parts of the country. Providers in Wisconsin do, in general, see Medicaid patients. That’s not the case elsewhere. Finally, we are fortunate to have physician leaders who understand the dynamics at play in health care and have a vision and the ability to implement it.

WHN: And these efforts will continue regardless of what happens with the federal health reform law (PPACA)?

SB: Absolutely. If anything, one of the concerns I have is that PPACA doesn’t begin to go far enough in rewarding value or incenting already existing value.

WHN: Do you support the federal health reform law?

SB: Personally, I have reservations about PPACA. My members may have diverse views. I think the insurance provisions are certainly positive. The experimentation with things like bundled payments and accountable care organizations are positive. Some of the funding for the innovation activities, which is in part funding our Partners for Patients initiative, is a positive feature. I am positive about the Medicaid expansion, although Wisconsin is already at the 2014 federal standard. The areas I have a lot of concern with are the Medicare pay cuts. What I see is a strong potential for employers to shed private coverage and push their employees into subsidized insurance exchanges. I believe the bill underestimates the migration of current private covered lives into insurance exchanges. What does that mean? It means that very quickly the money will be gone. That’s a strong potential threat to the current delivery system. The other shortfall is that there is little recognition to pay for value and recognize already high performers.

WHN: Many of WHA’s members are moving forward with initiatives financed by the federal health reform law. What happens to this work if the law is struck down or repealed?

SB: Politically, if Republicans do a clean sweep on November 6, I think they will largely repeal PPACA. It is likely, however, that they will replace it with a number of provisions that I suspect will include a lot of the insurance reforms as well as the provider payment-related issues that will likely be a catalyst for the kind of delivery changes that we need. Some Republican leaders are talking about repeal and replace. I think replace may even include insurance exchanges, while significantly scaling down subsidies. I think the political solutions will largely align with the things that work in Wisconsin. As it relates to the court, if the decision is just to repeal the individual mandate and certain aspects that link into the mandate, that type of court action may not impact the positive aspects of the law, like dollars for innovation and dollars for performance improvement. If there is a total repeal, I think the jury is out as far as dollars that have already been committed and are being spent.

WHN: Does WHA plan to continue to support and fight for the hospital assessment?

SB: Absolutely. It generates $250 million a year net in higher payments to hospitals based on their Medicaid business, and at the same time provides tens of millions of dollars to the state to pay for what has been an underfunded Medicaid program. It’s been a win-win-win. A win for our hospitals, especially our highly dependent Medicaid hospitals. It’s been a win for the state. It’s provided funding for the underfunded Medicaid program. And it’s been a win for private payers, employers, because it’s slightly reduced this hidden tax of the difference of what Medicaid costs and what Medicaid was paying us. It’s something we support today and will continue to support in the future. I think it’s highly unlikely Governor Walker or any governor in Wisconsin will be able to find the dollars necessary to replace the hospital assessment. We recognize it works and will work hard to make sure it continues to work.

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Dean Health System CEO Samitt Appointed to MedPAC

Craig Samitt, MD, president and chief executive officer of Dean Health System, has been appointed to the Medicare Payment Advisory Commission (MedPAC). His term will expire in April 2015.

"Medicare is one of the federal government’s most significant responsibilities, and MedPAC has a significant role in ensuring responsible stewardship of this important program. We were fortunate to be able to consider many highly qualified applicants. The five new individuals selected this year bring impressive credentials to the commission," said Gene L. Dodaro, comptroller general of the United States and head of the U.S. Government Accountability Office (GAO) in the official announcement released May 24, 2012.

"Wisconsin has a national reputation for delivering high quality care in highly-integrated systems. We’re pleased to see Dr. Samitt’s appointment to MedPAC. He understands the interplay between cost and quality and the importance of delivering value to employers and consumers for their health care dollars," according to WHA President Steve Brenton. "Dr. Samitt’s experience and knowledge will be assets to the Commission."

Samitt, MD, MBA, is also a chair-emeritus of the Group Practice Improvement Network and co-chair of the Patient Centered Primary Care Collaborative Center for Accountable Care, a coalition of 900 members, including major employers, consumer groups, patient quality organizations, health plans, and providers. He previously served as an advisory and faculty member of the Center for Medicare and Medicaid Services’ Accountable Care Organization (ACO) Accelerated Development Learning Sessions. His prior positions include chief operating officer of the Fallon Clinic in Massachusetts, senior vice president at Harvard Pilgrim Health Care, and chairman of medicine and executive director of the Kenmore Center at Harvard Vanguard Medical Associates.

Congress established MedPAC in 1997 to analyze access to care, cost and quality of care, and other key issues affecting Medicare. MedPAC advises Congress on payments to health plans participating in the Medicare Advantage program and providers in Medicare’s traditional fee-for-service programs. The comptroller general is responsible for naming new commission members.

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Richland Hospital CEO Nockerts Announces Retirement

After 10 years as the Richland Hospital CEO, Steven Nockerts will retire this summer. Nockerts joined The Richland Hospital as chief executive officer in January 2002.

During his tenure, Nockerts led the hospital through many strategic initiatives, which included securing critical access status for the hospital, expanding existing services and initiating new programs designed to better serve the community’s health needs. Nockerts also had oversight on multiple building, renovation and expansion projects.

Nockerts started his career with the State of Wisconsin, then served as director of data management and research at the Wisconsin Hospital Association, was vice president at Mile Bluff Medical Center, and held the position of CEO at Adams County Memorial Hospital in Mauston prior to joining the Richland Hospital.

Richland Hospital Executive Board President Dennis Hamilton recently honored Nockerts at the Richland Hospital’s Annual Recognition Banquet. "After 10 years of focused leadership, we wish Steve the very best as he approaches this new chapter in his life."

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Grassroots Spotlight: Mercy Medical (Oshkosh) Hosts Rep. Gordon Hintz

In a follow up meeting to WHA’s Advocacy Day, State Rep. Gordon Hintz (D-Oshkosh) met in Oshkosh with a dozen hospital employees and volunteers at Mercy Medical Center.

"These types of meetings and Advocacy Day are important to keep hospital issues at the forefront," said Rep. Hintz.

During the hour-long discussion, the group hit on the need for physicians and the importance of training and retaining those physicians in the state.

"Wisconsin is a good place to practice," Hintz said. He added that the state needs to be "using the different levers available, such as loan forgiveness programs."

Mercy Medical Center President Bill Calhoun highlighted how Wisconsin hospitals are providing high value, high quality care. Calhoun said hospitals in the Fox Valley and across the state are committed to providing as much value as possible for the health care dollar. However, he pointed out that "there are unintended consequences" to such efforts "when federal reimbursement or funding is cut." This was a reference to various proposals being discussed by Congress and the Administration that would impact Medicaid or Medicare reimbursements.

Calhoun went on to provide specific insight into how Mercy and its parent organization, Ministry Health Care, provide integrated care through 15 hospitals, several physician groups and a health insurance plan. Calhoun said this pattern of integrated care is found across Wisconsin, but is not replicated in many other states across the country.

During his time at Mercy, Rep. Hintz participated in a tour of Mercy’s Cancer Center and learned about several healthy community programs.

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WHA Partners for Patients Initiative Has "Post Position" in Drive to Improve Quality, Value

All eyes are watching Wisconsin as hospitals begin their work toward improving performance. Nearly every hospital in the state—98 percent—is participating in the national Partnership for Patients initiative sponsored by the Centers for Medicare and Medicaid Services. The national effort seeks to prevent 1.8 million injuries to patients in hospitals, and save more than 60,000 lives over three years across the country.

Speaking at the Partners for Patients kick-off meeting recently held in Eau Claire, quality expert Chris Goeschel, assistant professor and the director of strategic development and research initiatives for The Quality and Safety Research Group in the Johns Hopkins School of Medicine, said Wisconsin is positioned well to meet the goals of the project, which are to reduce readmissions by 20 percent and decrease hospital-associated complications by 40 percent.

"I think there is no doubt that you will be successful…centralize your resources, organize your work, and don’t constrain [people]," Goeschel said. "Give your [teams] evidence-based tools, and trust that they will know how to use them."

Goeschel emphasized the need for measuring the results. "Measurement is important and too often I think in quality improvement initiatives, we say, ‘you will have to trust us on that because we don’t have hard data,’" she said. "Understanding the importance of measurement is critical, but be respectful of how hard it is to do this work. Collect the minimum amount of data that is required, but go ‘narrow and deep’ in the organization and get it from everybody that is participating in this project."

The amount of work required by the project is not insignificant, but Kelly Court, WHA chief quality officer, said every effort has been made by her and her staff to align the Partners for Patients work with existing quality improvement efforts that hospitals are now engaged in either by mandate or voluntarily.

"The WHA Board made it clear when I presented the project that aligning the Partnership projects with their existing quality improvement work was absolutely essential," Court said.

The WHA quality staff is actively working with the hospital teams to help them select their areas of improvement. WHA is also designing webinars and creating tools that will facilitate the clinical work.

"Wisconsin had a head start on this work because we are by our very nature so willing to collaborate to raise the bar on quality in this state," Court said. "Wisconsin is the envy of many other states where collaboration is not as common. We don’t have to ‘teach or nag’ to get hospitals to work together. They understand and have experienced the benefits of working together to ensure all patients receive the best, safest care possible."

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Hospital Foundation Workshop Offered June 5

Registration is still open for the June 5 event "Prescription for Success: A Workshop for Hospital Foundations." This workshop, which will be held in Wisconsin Rapids at the Hotel Mead, will focus on successful ways of sharing your hospital foundation’s message of impact, the all-important "ask," and how to engage physicians in your fundraising efforts.

Due to the partnership and support of the Wisconsin Office of Rural Health (WORH), the Wisconsin Hospital Association (WHA) and the Rural Wisconsin Health Cooperative (RWHC), this workshop is available at no cost to hospital foundation directors, their board members and hospital executives; however, pre-registration is required.

To view the full day’s agenda and to register, please visit

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Wisconsin Hospitals Community Benefits: Mental Health and Mental Disorders

Mental disorders vary in severity and in their impact on people’s lives. The symptoms can be severe and extremely destructive, causing immeasurable suffering for the patient and their families. Hospitals see an ever-increasing number of patients seeking treatment for mental disorders in their emergency departments. Hospitals that can offer inpatient treatment generally operate this service at a loss. With a disturbing shortage of mental health professionals, hospitals will continue to partner with each other and their communities to meet the growing demand for these services.

Paws with Heart

Inpatient and outpatient therapy services at Lakeview Medical Center (LMC) have gone through several key evolutions over the last 10 years. Our staff has looked beyond traditional rehabilitation methods, finding successful options – even one that involves man’s best friends – therapy dogs.

Five-year-old Chester has been involved in the Paws with Heart program through LMC Hospice for two years. His handler, Laurie Schwab, says he has been a natural at it, and the positive results seen with patients are undeniable.

Research has shown that therapy dogs help spark patients’ memories and allow them to reminisce. This helps reduce the patient’s focus on their pains, and patients look forward to the planned therapy dog visits. The visits help combat loneliness, provide visual and tactile stimulation, help reduce anxiety and offer comfort to patients. Therapy dogs give unconditional love to everyone they meet, resulting in a positive experience for patients.

"You might go into patients’ rooms and they are feeling really blue, but when they start petting Chester, they begin to remember when they had a pet, and lots of warm feelings come back," Schwab said. "Pretty soon, the pains are gone and they are in a different frame of mind for that period of time; and Chester likes to be petted, so it works out well!"

LMC staff assists with the therapy dog program, but community involvement is key to the program’s success. A dog with a great personality can be a candidate for the program, but both dogs and handlers must go through extensive training and must stay up-to-date with many training points.

"It’s lots of training, but it’s also lots of fun," Schwab stated.

Lakeview Medical Center Hospice Care Volunteer and Bereavement Coordinator Tammy Koger explains, "LMC has approximately 94 hospice volunteers, ranging from students to retired persons. These volunteers visit patients in assisted living, nursing homes, the hospital and hospice facilities. Volunteers visit 14 different facilities in addition to having a canine reading program with children at a local library."

"Many patients have dementia or other ailments, and they respond to dogs better than other humans," Koger explained. "The dogs seem to have the ability to reach them on a different level. One patient had started out in her own apartment but was forced to move to a nursing home due to health issues – it was a very hard transition, but the dog visits remained the same, and the services we provide to her didn’t change; we just made the move with her and kept the visits constant.

"Recognizing that it’s hard for people to accept certain changes, she says, "We strive to develop relationships that go beyond a program at a facility and reach to the individual."

Lakeview Medical Center, Rice Lake

Hospital offers a healing paw

The spring of 2010 marked the beginning of a new free therapy program for patients at Black River Memorial Hospital. This therapy, however, is not geared toward physical healing or increased mobility. Instead, its purpose is to heal the patient emotionally by lifting their spirits. Generally, this can be achieved by visits from friends and family members, but what better way than to have man’s best friend stop by for a visit! Black River Memorial Hospital now has a therapy dog to do just that.

Ike, a three-year old orange belton English Setter and certified therapy dog, and his handler, Ann Pederson, have been making weekly visits to patients who wish to participate since May. The dog and handler volunteer their time. Every Wednesday, around 10:00 a.m., he begins his rounds on the second floor after receiving a warm welcome from staff and his room assignments.

"I think he brightens the patients’ day because we have a lot of people who are animal lovers," says Tammy Vehrenkamp, nurse manager. Pederson believes that Ike takes the patients’ minds off their problems and provides a sense of comfort. Studies have shown therapy dogs to have a positive effect on patients during their stays. In fact, Pederson remembers a day when she was going to come back to a patient’s room after noticing he was on the phone but he insisted that she and Ike come in. He said, "Come in. ‘I’ll call you back. Ike’s here!’" This is proof that the program is wanted by the patients and they love seeing a dog.

The program has had such positive feedback already that there has been talk of adding more certified dogs and handlers to allow the opportunity for more visits during the week. It is truly a beneficial extra to the hospital’s excellent care and service.

Black River Memorial Hospital, Black River Falls

Mental health support group

A free support group held every Monday night from 6:00 to 7:00 pm at Aurora Psychiatric Hospital can help an individual cope and address stress associated with any day-to-day issue. The support group is open to adults, male or female, to address major crises, such as job loss or bereavement, as well relationship struggles, addictions or any other mental health issues that can put an individual into emotional distress.

Activity Therapist Michael (Mike) McDonald is a facilitator to the support group. He explains what distinguishes this support group from most others.

"The support group is peer empowerment model around life challenges. Participants continually come back to give and receive emotional and practical support, as well as to exchange information in a safe environment. I help guide the group to stay focused on one topic at a time and provide minimal advice when needed. For example, I have two people who have been attending for over 12 years. They continue to attend the group for support; it is a chance for them to be with others who struggle with mental health issues to stay well. It is also a way for the couple to stay connected with friends they have made over the years to offer them encouragement and support," said Mike.

On average this free support group has up to 16 participants attending each Monday night. The meeting begins with Mike facilitating the discussions for topics ranging from understanding their illnesses to wellness skills that may impact their daily lives.

"I encourage participants to speak up during the support group because information that is shared can be useful to others. There may be a preconceived notion that this support group is all about mental health issues. An individual may need to attend at least two to three sessions to realize that there is more to this support group than mental health issues," notes Mike.

Aurora Psychiatric Hospital, Wauwatosa

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