September 21, 2012
Volume 56, Issue 38

WHA Nominating Committee Selects Harding 2013 Chair-Elect
Neufelder will chair Association in 2013

Edward Harding, president/CEO, Bay Area Medical Center in Marinette, has been selected by the Wisconsin Hospital Association Nominating Committee to serve as WHA’s chair-elect in 2013 and chair in 2014.

Harding joined Bay Area Medical Center in December 2010. Prior to that, he served as president/CEO of Columbus Community Hospital from 2000 to 2010. His experience also includes being vice president of strategic planning, marketing and professional services at Mercy Medical Center, Clinton, Iowa.

A WHA Board member since 2006, Harding currently chairs the Council on Rural Health, is a member of the WHA Executive Committee, and serves on the Medicaid Reengineering Group.

A native of Sturgeon Bay, Harding received his master’s degree from the University of Minnesota in 1990. He received his bachelor’s degree from the University of Wisconsin-Stout in 1985. He is a Fellow of the American College of Healthcare Executives and is ACHE board certified in Healthcare Planning and Managed Care.

Dan Neufelder, president and chief executive officer, Affinity Health System, will chair the WHA Board of Directors in 2013.

Prior to joining Affinity, Neufelder served for 12 years as the executive vice president and chief operating officer of Memorial Hospital of South Bend, Indiana; 10 years with the Community Health Network of Indianapolis, with the last four of these years as the executive vice president and chief operating officer of Community Hospital East; one year with St. Vincent Hospital and Healthcare System in Indianapolis, Indiana; and five years as a health care management consultant with Ernst & Young. He has been a member of the WHA Board since 2008.

Throughout his career, Neufelder has volunteered with numerous community-based organizations with special emphasis on serving the sick and poor.

Neufelder received his bachelor’s degree from the University of Southern Indiana in 1979 and his master’s degree in business administration from the University of Indianapolis in 1989. He is the recipient of the 1997 Young Healthcare Executive of Year Award for Northern Indiana, and he is a Fellow in the American College of Healthcare Executives, and a Certified Public Accountant. He received the ACHE senior–level health care executive award in 2012.

Top of page (9/21/12)

MEB Continues Debating Revisions to MED 10
Rules will affect health care quality and delivery system change

The Medical Examining Board (MEB) this week continued its efforts to revise MED 10, the administrative rule that defines unprofessional conduct for physicians. The Wisconsin Hospital Association, in writing and through testimony, has alerted the Board to a number of issues important to hospitals and health systems.

The MEB has been considering several proposals put forward by an MEB workgroup that could weaken local peer review. WHA cautioned the MEB that any action that weakens local peer review could harm the health care community’s strong quality improvement efforts. During the last legislative session, WHA led a coalition of organizations representing health care providers, employers, advocates, and insurers that worked to strengthen Wisconsin’s peer review statutes, encouraging even more robust quality improvement programs. WHA emphasized to the Board the importance of protecting local peer review. In its August 15, 2012 letter to the MEB (, WHA wrote, "Physicians and other practitioners who participate in the local peer review process must be assured that the process is confidential and protected." During a nearly four-hour discussion that ranged from deep policy to highly-technical wordsmithing, MEB Chair Sheldon Wasserman, MD, and the MEB members consistently indicated strong support for local peer review and their intent to protect the process.

The MEB also considered a physician’s duty to obtain the patient’s informed consent in the context of unprofessional conduct. WHA, the Wisconsin Medical Society, and other organizations have been working on legislation that would clarify Wisconsin’s informed consent law to address the Wisconsin Supreme Court’s decision in Jandre v. Injured Patients and Families Compensation Fund. Enacting this legislation will be a top priority for WHA in 2013. WHA asked the MEB to cross-reference the informed consent statute to ensure that the rule would reflect any changes in the statute. WHA Senior Medical Advisor Chuck Shabino, MD, emphasized, "Standards of conduct that are confusing and potentially inconsistent do not advance and actually can frustrate the goal of excellent patient care."

WHA also encouraged the MEB to craft carefully the rule provisions aimed at physician business practices to ensure that the rules are flexible enough to recognize evolving health care structures and do not hamstring efforts to move even farther toward quality-driven, value-based health care.

"In this time of tremendous change in health care delivery, change that Wisconsin’s hospitals and health systems are leading, it is imperative that we have rules and regulations that foster, not hinder, this change," said WHA Executive Vice President Eric Borgerding. "That is why work now being done at the MEB is so important, and why WHA is so engaged in these deliberations."

WHA, the Wisconsin Medical Society, the Rural Wisconsin Health Cooperative, and the Marshfield Clinic have worked together to analyze the various proposals and provide input to the MEB as it works through the sometimes knotty issues. The MEB will continue discussing MED 10 during its October meeting; the agenda likely will include unprofessional conduct as it relates to social media among other issues.

Copies of WHA’s letters to the MEB are available on the WHA website at Watch The Valued Voice for updates as the MEB continues its deliberations on MED 10.

Top of page (9/21/12)

State Agencies Submit Initial 2013-2015 Budget Requests
DHS asks for increased Medicaid expenditures of nearly $950 million; MCW requests funding to expand physician education capacity and Wisconsin-based residencies

In what is the start of the 2013-2015 biennial budget process, state agencies were required to submit their initial budget request documents to the Department of Administration (DOA) on September 17, four to six months in advance of the expected release of the Governor’s biennial budget bill.

The proposal submitted by the Department of Health Services (DHS) includes about $950 million in added expenditures for the Medicaid program. Of this, approximately $650 million is in state GPR expenditures.

Overall costs are expected to be shifted from the federal government to the state as DHS anticipates a reduction in federal funding for the Medicaid program. The reduction of close to $200 million results from an expected decrease in the federal match rate, which is based in part on the state’s per capita income relative to other states.

About half of the overall funding increase is due to enrollment and costs in the Family Care program. DHS indicates that enrollment is expected to grow by about 11,000 people, and per-member costs are expected to increase 1.8 percent per year. The costs estimates do not include any expansion of the program to additional counties beyond 2013.

It is important to note that the budget proposal does not include any anticipated effects of possible implementation of the health care reform law. DHS indicates PPACA will continue to develop at the national level, and the Department will work with DOA to "identify any appropriate actions for the Governor’s budget." Estimated program costs for this initial budget request are based on continuation of the current program. Thus, although the current BadgerCare Plus waiver ends on December 31, 2013, DHS assumes the waiver would be renewed.

"This is our first indication of what it will cost the state to continue its current Medicaid program, and does not include any additional costs associated with Medicaid expansion under the Affordable Care Act," noted WHA Executive Vice President Eric Borgerding. "The Supreme Court ruling and the upcoming elections in November bring an element of uncertainty that we will be watching closely."

Next week, WHA reconvenes its member task force on Medicaid issues, the Medicaid Reengineering Group chaired by Ministry CEO Nick Desien, to begin an in-depth examination of various issues related to coverage expansion in the ACA.

"As we did in 2011, WHA will work with legislators and the Walker Administration in the coming months on policies that are in line with our WHA principles for preserving Medicaid as a safety net for our most vulnerable citizens and minimizing the cost shift from unreimbursed Medicaid services," Borgerding said.

Spending increases are anticipated as a result of enrollment and intensity changes, resulting in higher costs for a variety of services, including managed care and federally qualified health centers. The proposal assumes intensity increases for inpatient and outpatient hospital services of .7 percent each in 2014 and 2015. The proposal anticipates declines in nursing home utilization. The Department estimates savings from a variety of proposals including a new electronic system to verify residency, hiring of a medical coder to review reimbursement policies and ensure coding accuracy, and hiring state staff to improve third party liability collections.

Separately, DHS proposes a reduction in funding for the SeniorCare program of nearly $46 million in state and federal funding (about $20 million in state GPR funds) resulting from a decline in SeniorCare utilization as seniors shift drug costs to Medicare Part D.

The total proposed budget for behavioral health programs remains nearly unchanged, though some funding is being shifted within behavioral health program budgets. DHS also proposes some goals to improve care continuity and provide more integrated care for all individuals with complex medical needs who are enrolled in publicly-financed health care programs. The implementation of health homes is one part of these goals, and DHS plans to seek approval from CMS for a state plan amendment to implement health homes for fee-for-service and BadgerCare Plus populations with complex medical needs. Although individuals with behavioral health needs do not appear to be specifically targeted as part of this goal, the population of individuals with behavioral health needs could be a significant beneficiary of the creation of the implementation of a health home model if existing care coordination barriers can be addressed.

MCW Requests $6 Million to Fund Community Medical Education Program
Request aligns with WHA’s goal to increase medical student training opportunities

While their budget request did not include an increase over last year, the Medical College of Wisconsin (MCW) did include a "Supplemental Budget Submission" of $6 million to fund their Community Medical Education Program. MCW is developing the program to address the need for providers in underserved areas across the state.

In their submission, MCW cited reports from prominent state and national medical organizations, including WHA, that have projected significant shortages of physicians, especially in primary care and in rural and underserved areas. In November 2011, WHA released the report "100 New Physicians a Year: An Imperative for Wisconsin" (see related story from December 2, 2011 Valued Voice), that laid out issue areas requiring attention and included potential options to address the looming shortage of physicians.

WHA’s report showed a direct and significant correlation between where a student is from, where they attend college and medical school, and where they complete their medical residency as indicators of where they are likely to practice medicine.

For the 30 years prior to 2003, the State of Wisconsin had provided tuition assistance of about $10,000 per year to Wisconsin residents who enrolled at MCW, bringing tuition there roughly in line with the tuition at the University of Wisconsin School of Medicine and Public Health. The program was successful in encouraging Wisconsin residents to enroll at MCW.

In 2003, the Legislature cut the assistance in half, and reduced annual increases by less than one percent per year. By 2010, the MCW net tuition was $11,000 greater than the UW tuition, which has led to a decrease in the number of Wisconsin residents attending MCW.

As part of their efforts to expand their community medical education program, the MCW submission includes a request to restore tuition assistance for Wisconsin students attending MCW to pre-2003 levels, approximately $10,000 per year, per Wisconsin student, amounting to $2,178,500 GPR annually.

Restoring tuition assistance at MCW was an option included in WHA’s "100 Physicians a Year" report.

The MCW submission included a request for $582,500 in annual GPR funding to expand existing family medicine residency sites. Also known as graduate medical education, or GME, residencies provide specialty training to newly-minted physicians as part of the completion of their professional training. The additional funding would create 12 residency positions over the 2013-15 biennium.

Also included was a request for a $292,500 annual GPR increase over base-level funding to support planning and development efforts related to a new family medicine graduate medical education program in Northeast Wisconsin.

"The Medical College of Wisconsin community-based expansion of its medical school and creation of more GME positions are important contributions to addressing Wisconsin’s physician workforce shortage," said WHA Senior Medical Advisor Chuck Shabino, MD.

WHEFA budget request

In its budget request, the Wisconsin Health and Educational Facilities Authority (WHEFA) asked for the ability to issue bonds on behalf of all 501(c)(3) non-profit organizations. The Authority has been providing capital financing assistance for health care institutions since 1979. Its charter has also been expanded over the years to include the issuance of bonds for educational and non-profit research facilities.

In order to increase its competitiveness, WHEFA is also seeking to allow all bonds it issues to be exempt from state income tax when such an exemption is already available through another conduit issuer. WHEFA points out in their budget request that under current law, the interest income to Wisconsin taxpayers who own bonds issued by WHEFA is exempt from Wisconsin income taxation only if the proceeds of such bonds are used by a health care facility to acquire information technology hardware or software.

This provision was included in the 2011-12 State Budget by Governor Walker, but was removed by the Joint Finance Committee. The Legislative Fiscal Bureau concluded that the provision would not have a negative impact on the State’s revenues.

Over the coming months, and leading up to the introduction of Governor Walker’s budget bill in February, 2013, WHA will be meeting with key policymakers to discuss Medicaid, physician education and several other policy priorities for hospitals and health systems that will be debated during the budget process.

Top of page (9/21/12)

WHA Shares Wisconsin Health Care Quality, Value Message at Green Bay, Appleton Editorial Board Meetings

Wisconsin’s health care quality and value is an asset to the economic climate here, but an asset that is overlooked. The Wisconsin Hospital Association is looking to change that through a long-term campaign that this week included visits with the editorial staffs of the Appleton Post Crescent and the Green Bay Press Gazette. The Post Crescent featured the meeting on their "News Makers" program. A link to the interview is here:

Joining WHA Executive Vice President Eric Borgerding at the Post Crescent meeting were Dean Gruner, MD, president/CEO of ThedaCare, and Travis Andersen, president, Ministry-Affinity St. Elizabeth Hospital. They met with Post Crescent staff members Larry Gallup, senior editor/community conversation and Larry Avila, business editor.

In Green Bay, Borgerding, along with Therese Pandl, president/CEO, HSHS Eastern Wisconsin Division; Ashok Rai, MD, president/CEO, Prevea Health Services; George Kerwin, president/CEO, Bellin Health System; and Dan Meyer, chief administrative officer, Aurora BayCare Medical Center, met with editorial staff at the Green Bay Press Gazette.

WHA has now completed three editorial board visits. Borgerding said the health reform law has heightened interest among the media in knowing how Wisconsin health systems are preparing for it. While other states may still be formulating their response, Borgerding said hospitals and health systems in Wisconsin are not waiting to see what happens next, instead, they are ahead of the curve.

"Wisconsin is entering the era of health reform ahead of many other states that have taken a ‘wait and see’ attitude," according to Borgerding. "We started transforming the delivery of and payment for health care long before there was a new reform law. Our high quality, high value care sets us apart from other states and puts us in the position of being a leader state as we position for the future."

WHA believes Wisconsin’s focus on high quality, high value care is a story that needs to be more widely told—a competitive advantage for the badger state.

To learn more about WHA’s efforts to tell the Wisconsin story, visit a special section of our website at

Top of page (9/21/12)

President’s Column: "Let’s Blame the Providers" Makes Medicare Cuts Palatable for Some

WHA heard from several members this week about a quote attributed to a candidate for Congress, who referred to massive Medicare hospital cuts included in the ACA as "overpayments to providers that were not doing anything to make patients healthier." The candidate’s remarks came during a statewide Sunday show "UpFront with Mike Gousha." During a political campaign, those claims might make answering tough questions easier, but the realities on the front lines of health care warrant more than talking points.

The fact is Wisconsin hospitals are paying $2.6 billion over ten years to finance ACA expansions. Those are very real cuts that come from a variety of annual market basket adjustments. High uncompensated care volume hospitals are particularly hammered. Nursing homes, home health care agencies and Medicare Advantage plans (and their subscribers) are also on the hook for millions in reduced payments. These cuts are from a program that pays far less than costs to begin with. And the Medicare sequester is less than 100 days out with its own two percent across-the-board hit, an annual $100 million impact on Wisconsin hospitals.

As predicted just a few weeks ago, this column will showcase "Medicare-related lies and distortions" that will be common currency from both Democrats and Republicans during the election season (suggestions welcome). Rack this one up as a distortion. It is unsettling that the opinion seems to diminish, as inconvenient, the fact that large provider cuts won’t harm patient care. Outstanding access to care should not be assumed as a given.

The emerging game plan seems to embrace the theme that ACA-related Medicare cuts won’t affect Medicare beneficiaries. Instead, they somehow will be painlessly extracted from providers. That logic runs counter to a recent decision by a Madison-based primary care medical group to limit their practice to Medicare patients (

The concern here is that politicians who trivialize the impact of provider cuts this election season will have difficulty pulling back those opinions after November 6. Hence, they require a sharp rebuke now.

Steve Brenton

Top of page (9/21/12)

WHA Board Approves Nominating Committee Recommendations

The Nominating Committee will recommend to the WHA Board at their October 18 meeting that the following members be approved as new board members. When they are approved, their appointments will take effect January 1, 2013.

Nick Desien, President/CEO, Ministry Health Care, Milwaukee
(2nd term)

Duane Erwin, Chief Executive Officer, Aspirus Wausau Hospital, Wausau
(2nd term)

Mark Herzog, President/CEO, Holy Family Memorial, Inc., Manitowoc
(1st term)

George Hinton, Chief Administrative Officer, Aurora Sinai Medical Center, Milwaukee
(2nd term)

Catherine Jacobson, President, Froedtert Health, Milwaukee

Mary O’Brien, Chief Administrative Officer, Aurora St. Luke’s Medical Center, Milwaukee
(1st term)

Bill Sexton, Chief Executive Officer, Prairie du Chien Memorial Hospital, Prairie du Chien
(2nd term)

Mark Taylor, President/CEO, Columbia St. Mary’s, Inc., Milwaukee
(1st term)

Top of page (9/21/12)

WHA Testifies at Informational Senate Hearing on Workforce
WHA recommends state-level data collection, coordination among state agencies

The Wisconsin Hospital Association (WHA) was invited to provide testimony at a Joint Informational Hearing on Job Training and Job Creation held September 19 in Oshkosh by the Senate Committee on Job Creation, Energy and Utilities, and Rural Affairs and the Senate Committee on Job Training, Technical Colleges, and Workforce Development. The hearing gave the invited organizations an opportunity to discuss the skills gap in Wisconsin and highlight examples of successful job training efforts, which included partnerships between employers and technical colleges, industry-specific workforce training collaborations and skilled trade training programs.

Invited speakers were asked to provide an overview of the initiatives in which they have participated to address specific workforce shortage or training issues, if the initiative was successful, and what could be learned from those efforts as public policymakers consider proposals to enhance workforce training efforts throughout the state.

Presenters were also asked to suggest recommendations for targeting additional resources and public sector investments, as well as recommend state-level policy changes to most effectively meet the state’s workforce development needs.

Judy Warmuth, WHA vice president for workforce, testified on the health care workforce, its size and projected growth, and described several initiatives currently underway, including the data collection efforts and physician supply activity. Kathy Duchac, senior human resources consultant, Agnesian Health Care and current co-chair of the Alliance, testified with Warmuth and described the work of the successful Fox Valley Healthcare Alliance. Duchac outlined the membership and mission of the Alliance and described the many successes of the group, including standardization of clinical placement documents and processes, two retirement and departure intentions surveys and the dramatic increase in the number of high school students who receive health care career information.

Warmuth and Duchac provided four recommendations for the committee:

  1. Data collection on the current health care workforce is critical. Nurses already provide information about their employment and intentions to stay in the workforce as part of re-licensure. Other licensed health occupations must also be expected to provide workforce information when they renew their licenses. Specific groups for which this data is seriously needed include: dentist, dental hygienist, physician, psychologist, physical therapist, physician assistant, pharmacist and clinical social worker.
  2. The State of Wisconsin should have a coordinated function for the collection and analysis of workforce data, workforce planning and the assignment of funding for workforce training and education. Currently, multiple sections across several departments perform this work. A more centralized function is greatly needed to support regional groups such as the Fox Valley Healthcare Workforce Alliance in their work.
  3. The Legislature should create an expectation that State of Wisconsin-funded educational programs assure easy and seamless transfer of credits that will apply to similar programs of study at all facilities in Wisconsin. In this era of scarce economic resources, requiring students to repeat classes cannot be tolerated.
  4. The K-12 education system must be more involved in solving the job/employment gap. Career guidance begins early in the educational process. Students should be accurately advised about options for life work. They also need to be carefully directed toward coursework necessary for career entry programs.

Senator Dave Hansen (D-Green Bay) commented on WHA’s work on the physician shortage and expressed concern about the number of residency slots available in his area. Representative Penny Bernard Schaber (D-Appleton) concurred with Warmuth’s testimony about the need to reconsider the structure of clinical learning experiences for health professional students.

The state Department of Workforce Development, representatives from Wisconsin technical colleges, workforce development professionals, representatives from the construction trades and business representatives also testified.

Top of page (9/21/12)

Governor Nominates Dietsche, Wallace to Serve on State Boards

Governor Scott Walker has appointed two WHA members to serve on state boards. Mike Wallace, president/CEO of Fort HealthCare in Fort Atkinson, will serve a two-year term on the Public Health Council and Jim Dietsche, executive vice president/CFO at Bellin Health System, Green Bay, has been appointed to the Wisconsin Health and Education Authority (WHEFA) Board. WHA recommended both gentlemen to the Governor for these appointments.

The Public Health Council was created by 2003 Wisconsin Act 186 (s. 15.197(13), Wis. Stats.). By statute, the Council’s purpose is to advise the Department of Health Services, the Governor, the Legislature and the public on progress in implementing the state’s 10-year public health plan and coordination of responses to public health emergencies.

Wallace has a special interest in population health. Fort HealthCare has committed to greater engagement in the overall health of the community and is actively engaging other area players. Wallace believes that as this occurs, the area will secure the long-term economic and physical welfare of its communities and people. This improved health climate will foster economic growth as employers are more willing to hire when local efforts yield more manageable health care costs.

WHEFA has been providing capital financing assistance for health care institutions since 1979. Its charter has also been expanded over the years to include the issuance of bonds for educational and non-profit research facilities.

Dietsche was nominated to fill a public member seat on the WHEFA Board for a term expiring on July 1, 2019.

As CFO, Dietsche is responsible for leadership of the economic operation of Bellin Health System, as well as for financial planning, investment, and analysis for the organization. His background in health care, and specifically health care financing, will be valuable assets to the Authority as it works to understand the benefits of potential financing projects for Wisconsin communities.

Required Senate confirmation for Dietsche’s appointment is expected in the next legislative session. No confirmation is required for Wallace’s appointment.

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DHS Offers Training on New Enhanced Ambulatory Patient Grouping (EAPG) System

Beginning January 1, 2013, the Department of Health Services (DHS) will begin reimbursing hospitals for outpatient services based on a new EAPG system. The new reimbursement structure will apply to claims for services provided to members enrolled in BadgerCare Plus, Wisconsin Medicaid, and the Wisconsin Chronic Disease Program. EAPGs will apply only to fee-for-service claims in 2013. DHS expects implementation for managed care services to begin in 2014.

More information about the policies behind the system—and all inpatient and outpatient rate issues—will be discussed with hospitals at Medicaid Advisory Group meetings this fall. In the meantime, DHS is offering training sessions on the EAPG implementation.

Trainings are for hospital billing staff and billing vendors beginning in October. Registration is required. On-site sessions are offered in Eau Claire, Wausau, Madison, Green Bay and Pewaukee. DHS will also host "virtual" sessions online in November. For more information, you can link to the ForwardHealth Update:

Top of page (9/21/12)

WHA Staff Visits Aurora Sinai

On September 13, several members of WHA’s senior staff toured Aurora Sinai, one of Milwaukee’s safety-net hospitals. The visit was an opportunity to better understand the challenges of providing accessible, high quality health care in an urban setting.

As WHA staffed learned, quality initiatives are taken seriously by Sinai’s experienced caregivers. Several nurses lauded WHA’s assistance in working to implement the Comprehensive Unit-based Safety Program (CUSP), which has enabled Sinai to successfully target central line-associated bloodstream infections.

"WHA has been great in helping drive the quality of care," one nurse said. "We know you’re there with the resources to help us."

During the guided tour with George Hinton, Sinai’s President since 2000 and a member of the WHA Board of Directors, WHA staff learned firsthand about Sinai’s role as both a teaching hospital and a community hospital. Hinton explained how the hospital works to implement high-quality, evidence-based practices with a "patient comes first" philosophy. Sinai also works to connect its patients with a medical home and primary care, fostering the idea that a patient’s introduction to health care need not be in the hospital or emergency room setting, which is extremely important to a hospital that has sees a high number of visits each day.

WHA staff, individually or in groups, regularly "hits the road" to meet directly with members in their facilities. The interaction helps WHA better understand our members issues and challenges, and as a result, be even stronger advocates on their behalf.

Top of page (9/21/12)

WHA Signs Partnership Agreement with AHRQ

The Wisconsin Hospital Association and the Agency for Healthcare Research and Quality (AHRQ) are pleased to announce a partnership to promote AHRQ’s patient-centered outcomes research, also known as comparative effectiveness research. AHRQ is a federal agency of the U.S. Department of Health and Human Services charged with improving the quality, safety, efficiency, and effectiveness of health care for all Americans. This research is designed to inform health care decisions by providing unbiased comparisons of drugs, medical devices, tests, surgeries, or delivery methods for various health conditions.

AHRQ conducts and translates patient-centered outcomes research into a number of valuable patient and professional materials. These evidence-based tools include plain language consumer and clinician guides, continuing medical education/continuing education (CME/CE) activities, faculty slide sets, web conferences, audio podcasts, and more. All of these tools are designed to encourage and support shared decision making between clinicians and patients, with a goal of better care and increased patient satisfaction.

As the Wisconsin Hospital Association focuses on medical care grounded in evidence-based research, this new partnership with AHRQ ensures timely access to these valuable free resources and connects all of us with national efforts to improve health care outcomes. WHA will be maintaining current links to this information through the WHA Quality Center at You can also access the information directly via the links below.

Learn more about AHRQ’s Effective Health Care Program at: View AHRQ research summaries at:

For additional information, contact Kelly Court at WHA at or 608-274-1820.

Top of page (9/21/12)

Wisconsin Hospitals Community Benefits: Charity Care

Fear of a bill should never prevent a patient from seeking care at a Wisconsin hospital. Wisconsin hospital charity care programs provided $232 million to more than 700 patients each day last year. The stories that follow illustrate the deep commitment and continuing concern that hospitals have to their patients to ensure they receive the care they need regardless of their ability to pay.

Encouragement to get back on track

A single father of two came in very upset. He had just lost his job. His wife recently passed away, and now he was losing his health insurance. He had numerous bills from the past year due to his wife’s illness and didn’t know what he would be able to do.

Jennifer Patzer, a patient financial advocate at Community Memorial Hospital in Oconto Falls was there to help. "I first went online and got the children enrolled with BadgerCare," she said. "I walked him through the actual online application for the program for himself and the children."

Jennifer then sat down with him and explained the Community Care program at Community Memorial Hospital may be able to assist with the past accounts as well as any out-of-pocket expenses he may have with the state program.

"We were able to complete the application for charity care that day," said Jennifer. "He went home, got me all the necessary paperwork, brought it back, and I copied it. I was able to expedite the application and offer him a 95% discount on past accounts and a rolling six-month period."

He was so thankful to Jennifer and Community Memorial Hospital for helping him and for understanding the stressful situation he was dealing with.

About three months later he came back to Jennifer’s office to thank her again and to give her an update. He had found a job and was looking forward to starting. "He was so thankful for our help that he wanted to bring a thank you card just to say, again, thank you," said Jennifer. "He said he knows that I stopped what I was doing to help him, and that gave him the encouragement to really get things back on track."

Soon he was able to start his job, get new insurance, and no longer need the charity program. He stated, "I will never forget what Community Memorial Hospital did for me and my family and how it changed my outlook on my future."

Community Memorial Hospital, Oconto Falls

Beaver Dam Community Hospital helps man in need

Homeless for five years and unemployed for two, Steven Wright was at the end of his road.

Severe degenerative arthritis in his right hip was so painful he was unable to continue working his maintenance job. Four times the maximum dose of Aleve wasn’t dulling the pain and he could barely walk.

The physical pain of each step was compounded by the emotional hurt he suffered as he became increasingly isolated from friends and family. Feeling depressed due to his financial situation, he withdrew from his sisters, assuming they had lost respect for him.

"No money, no dignity, no respect, loss of family… I had no hope," Wright said. "But if I was able to get my hip fixed, I could be a man again. I would have self esteem again. Maybe I could lift my leg into my van, or be able to tie my shoe."

Just when he felt like he was out of options, Steven found Church Health Services of Trinity Methodist Church in Beaver Dam, Wis. In collaboration with Beaver Dam Community Hospitals (BDCH), they provided Steven with the new hip he needed to begin turning his life around.

"They believed I wasn’t worthless," Wright said. "They looked over all my problems and started to work. I know that asking to have my hip replaced was a tall request, but maybe now I won’t be in pain all the time."

To begin the process, Church Health Services coordinated the removal of an abscessed tooth with the help of a local dentist. Then on July 25, 2011, Beaver Dam Community Hospitals’ Dr. Bob Coe provided advanced joint replacement care for Steven’s right hip.

For Steven, the experience has restored his faith in God and in the generosity of others.

"Everyone told me that God loves me. But how, when nobody else cared?" Steven said. "The rest of the world turned its back on me because of my social position. But BDCH and Church Health Services helped. And now, maybe I walk closer to God."

Through its Community Care Program, Beaver Dam Community Hospitals, Inc. provided $1,555,659 in free care to patients over the last fiscal year.

Church Health Services, Inc. was created in 1993 to meet the increasing health care needs for the less fortunate. BDCH provides diagnostic testing, surgical services, inpatient care and infusion therapy to Church Health Services patients. The BDCH Foundation has also provided materials and donations of time and equipment to support this much-needed service.

Beaver Dam Community Hospital, Beaver Dam

Still young, but too old

For many parents, the years after their children have graduated from college and found full-time jobs should put them at ease about the well-being of their children. But that was not the case for these Janesville area parents. Their son suffered a severe fracture in his foot, which sent him to the Emergency Department (ED) at Aurora Lakeland Medical Center. He was active in sports, had a full-time job for one year, but no health insurance, and he was too old to be covered under his parents’ plan.

Upon being discharged from the ED, he received a referral to see an orthopedic ankle-foot specialist in Milwaukee at Aurora St. Luke’s Medical Center (ASLMC). The patient and his mother met with Aurora financial counselor Myra Steinke, who discovered that, "If the young man did not have the repair surgery within a week, he was at risk for losing his leg."

Myra sprang into action along with another financial counselor at ASLMC and discovered that the patient would qualify for the Aurora Helping Hand financial assistance program.

The mother then drove back to Janesville to collect the few required documents for Myra to process the application. Within four days, the family received news that the patient was approved for a 100 percent discount through the Aurora Helping Hand program.

Following the procedure, Myra noted, "The mother wanted to express her thanks and could have just called, but instead, she drove back from Janesville to thank me in person for my help. She kept on crying, but I knew those were happy tears. She was just so grateful, and being able to help this family was just as gratifying for me."

Aurora Lakeland Medical Center, Elkhorn

Hospital helps patient get back on her feet

At the age of 45, Christine McDonald was working and living in Ireland with her husband when both of them decided it was time to make a change. He loved his native country; she longed to return to the United States.

After making the difficult decision to move back to Wisconsin alone, Christine was trying to get back on her feet when she started having health issues. She was experiencing extreme abdominal pain, and she was downright scared.

"I called the emergency room in the middle of the night," Christine recalled.

She went to Wheaton Franciscan Healthcare - St. Francis and was treated in the Emergency Department. That’s when doctors discovered a tumor on her uterus, which would require that she have a hysterectomy.

With no job and no insurance, Christine felt helpless. It was then that financial counselor May Yang assisted her and told her about Community Care, Wheaton Franciscan Healthcare’s program providing free or discounted care to those in need.

"I literally collapsed in her arms," said Christine.

She quickly applied for Community Care and was approved. Dr. Daniel Gilman performed the surgery at Wheaton Franciscan Healthcare - Franklin. Afterward, Christine developed some complications and required regular follow-up care, but she had no means of transportation.

Another financial counselor, Linda Stevens, turned to the Foundation for St. Francis and Franklin for help. The Foundation provided cab vouchers so Christine could travel to her doctor appointments at the Franklin hospital.

"In this day and age, there aren’t enough resources to help people," said Christine. "Yet to have Wheaton Franciscan Healthcare embrace me like it did is absolutely incredible."

Wheaton Franciscan Healthcare – Franklin

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