Health care delivered in the final months of life is filled with complexity for families and health care providers alike, but in spite of the uncertainties, Wisconsin hospitals compared favorably to other states on cost and utilization for patients in their last two years of life. How the health care system is organized to treat the elderly who are dying of a chronic illness is the focus of a major study released on May 16 by the Center for the Evaluative Clinical Sciences at Dartmouth Medical School. It compared end of life care and costs among all 50 states and the District of Columbia.

The study shows Wisconsin hospitals’ costs for caring for Medicare patients over the last two years of life are below the national average. During their last two years of life, Wisconsin Medicare patients visited primary care physicians more often than specialists, a practice favored by the study authors. Elderly patients also spent fewer days in intensive care, and were less likely to be hospitalized.

"Patients near the end of life don’t want to be in the hospital, so physicians are doing everything they can to reduce the use of the ICU, refer them less often to specialists, and provide the patient and families options for care that do not require a hospital stay," according to Charles Shabino, MD, senior medical advisor at the Wisconsin Hospital Association. "This pattern of care is consistent with the research that indicates that as elderly patients near the end of life, less aggressive care is indicated and preferred by the patient, and other care options, such as hospice, should be utilized."

Determining when curative efforts stop and palliative care begins is an area that is challenging to physicians and nurses. However, Carl Getto, MD, associate dean for hospital affairs at the UW School of Medicine and Public Health and senior vice president for medical affairs at UW Hospital and Clinics said the UW Medical School curriculum includes discussion on and strategies for working with both patient and families on this difficult subject.

"It is equally if not more important to emphasize that discussion of end of life issues is an essential part of residency training in all specialties," Getto said.

Awareness of hospice services is one area that Wisconsin communities and health care providers could improve. The report contends that nationally too much money is spent on what researchers called "futile care," while hospice services, which are less expensive and generally regarded as preferable to patients and families alike, are underutilized.

Hospice is relatively new in the United States. Founded in England, hospice was only introduced about 25 years ago in the U.S. Hospice care, either inpatient or in the home, is available in every community in Wisconsin.

"End of life care is an area that is still evolving in our country. Since the end of World War II, we have moved from a time when people died at home, usually without insurance, to an age where more elderly people die in the hospital, covered by Medicare," according to Melanie Ramey, executive director of Hospice Organization of Palliative Experts (HOPE). "This study sheds light on a subject that is difficult for us as a society to talk about, but importantly, it helps increase our understanding of the challenges that are before our hospitals and communities in building awareness of end-of-life care options, such as hospice inpatient facilities and hospice services delivered in the home."

See the President’s Column in this Valued Voice for Steve Brenton’s thoughts on the Dartmouth study.

The full study is available at www.dartmouthatlas.org. NEW to the WHA Toolkit is a list of resources on end of life care. It is found at www.wha.org; click on WHA Toolkit, then End of Life.

Make plans today to attend this year’s Wisconsin Rural Health Conference, scheduled for June 21-23 at The Abbey Resort on beautiful Lake Geneva in Fontana, Wisconsin.

Keynote speaker Ron Bachman will open this year’s conference when he examines the health care consumerism trend, what’s driving it, and the results to date. Bachman worked closely with the White House and the IRS to develop the Health Reimbursement Arrangement (HRA) guidelines as well as the Health Savings Account (HSA) legislation and regulations.

Following the keynote session is a full agenda, with a variety of plenary and concurrent sessions to choose from, focused on the hottest issues facing rural health providers. This year’s conference also includes an education track devoted specifically to governance, with one of the country’s top governance speakers.

This year’s conference will be held at the newly renovated Abbey Resort. The Abbey Resort and the Fontana/Lake Geneva area offer a variety of activities for attendees and their guests, including The Fontana Spa and several activities designed especially for children. Hospital administrators, chief financial officers, management staff, nurse leaders, physicians, and board of trustee members are encouraged to attend this event. The full conference brochure with registration information is included in this week’s packet and is available online at www.wha.org. Conference and golf outing registrations are due to WHA by June 2.

Conference attendees can make room reservations with The Abbey Resort by calling 800-558-2405 and asking for a room in the WHA block, by May 30. The group rate is $129 for a single/double. Because the conference is during the busy summer season at the resort, the group rate will only be honored until

May 30 or until the room block fills, whichever occurs first. The special group rate will not be honored after the cut-off date of May 30, and no additional rooms will be held for conference attendees, so make your reservations early!

Nominations are now being accepted for WHA’s annual Distinguished Service Award and Trustee Award, as well as for the ACHE Young Healthcare Executive Award. These important awards recognize those who display leadership, dedication and professionalism to their community or the Association.

WHA will recognize the award winners at the 2006 Annual Convention in September. You may know someone in your region, in your hospital or on your Board of Directors who deserves such an honor. You now have an opportunity to nominate them for one of these annual awards:

• Distinguished Service Award is presented to a senior health care executive who has made an exemplary commitment to WHA, his/her hospital, and the communities he/she serves.
• Trustee Award honors a trustee of a WHA member organization who has made an exemplary commitment to his/her community and to the organization on whose board he/she serves.
• ACHE Young Healthcare Executive Award is presented to a member of the American College of Healthcare Executives under the age of 40 who has shown exceptional professional development. Nominations for this award should be sent to Greg Banaszynski, president, Wisconsin Chapter of ACHE, Synergy Health, 551 South Silverbrook Drive, West Bend, WI 53095.

Administrators, trustees, senior managers, nurse leaders, volunteers and others are encouraged to review the criteria for the awards and consider nominating someone to receive one of these honors.

The deadline for submitting nominations is July 21. Details about the nomination process and criteria for nomination can be found in the annual awards brochure included in this week’s packet and on the WHA Web site at www.wha.org/about. For more information, contact Roberta Riddle or Steve Brenton at WHA, 608-274-1820.

The final Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) rule for Rate Year (RY) 2007 (July 1, 2006-June 30, 2007) is expected to increase IPF Medicare payments by an average of 4.0 percent for discharges occurring on or after July 1, 2006. This is the first update since the IPF PPS was implemented in January 2005.

The Centers for Medicare and Medicaid Services (CMS) published the IPF PPS final rule in the May 9 Federal Register. The rule along with a detailed summary can be found on the WHA Web site at www.wha.org/financeAndData/pps_inpatientpsych.aspx.

CMS’ major change in the final rule is the adoption of the new Core-based Statistical Area (CBSA) labor markets for use in determining the wage index adjustment. The final rule also makes minor changes, including:

• Increase per diem rate to $595.09
• Adopt the inpatient rehabilitation facility, IPF, and long-term care hospital method for determining inflation in the costs of goods and services
• Increase the outlier fixed dollar loss threshold from $5,700 to $6,200
• Increase payment for electroconvulsive therapy (ECT) treatment from $247.96 to $256.20
• Add new International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes to the Chronic Obstructive Pulmonary Disease and Renal Failure, Chronic comorbidity categories

CMS in the final rule implemented no updates to the previous regression analysis used to calculate many of the adjustment factors, until one year of IPF PPS claims data and cost report data are available to analyze. Therefore, the current Diagnosis Related Group, Rural, Teaching, Variable Per Diem, Age, and Comorbidity Conditions adjustment factors in the 2006 IPF PPS final rule will not change.

The much anticipated Dartmouth Atlas Project study (The Care of Patients with Severe Chronic Illness: A Report on the Medicare Program) was released this week with much fanfare. The gist of the report findings is that there is significant variation in spending on medical care in the last two years of a dying patient’s life. The Dartmouth study further concludes that expensive treatment provided to chronically ill, terminal patients produces no gain in quality of life or patient satisfaction.

As expected, some media response to the Dartmouth study focused on local and regional differences on a hospital-specific basis. The study’s author, John Wennberg, a professor at Dartmouth Medical School, was widely quoted as calling "unacceptable variations in patterns of care" as "harmful" to patients and in some cases actually hastening the dying process.

Overall, for Wisconsin, the Dartmouth study validated the fact that spending on end of life care for Medicare patients is relatively conservative compared to national averages. For the timeframe measured by the study, Medicare spent an average of $25,343 in the last two years of a patient’s life in Wisconsin, 13 percent below the national average, and almost 40 percent below the average spent in New Jersey, the state with the highest spending. WHA’s public statements pointed to this statewide differential and the fact that hospital-specific circumstances exist that need to be understood in digesting the Dartmouth study. We also noted that we have much work to do to improve end-of-life care provided to our patients.

Ultimately, the hospital and medical community are best served by acknowledging that the Dartmouth Atlas report provides valuable information that must be harnessed to advance initiatives that will reduce unnecessary and expensive medical care provided in the latter stages of the dying process. Specifically, the proactive embrace of Hospice care and other palliative care initiatives is essential to better managing end of life care. Current Wisconsin "best practices" must be identified and showcased to the medical community and to the larger public to facilitate necessary dialogue about treatment options. And specific palliative care protocols should be identified, measured and reported to hasten the implementation of clinical improvements.

Nationwide, the hospital and medical community made a major mistake in 2000 in our reaction to the IOM study/publication "To Err is Human: Building a Safer Health System." We focused on the accuracy of the claim that 98,000 people die yearly from medical errors in hospitals as opposed to the larger truth that process improvements must be made to improve health care quality and safety. Our initial defensive response, thankfully, was soon replaced by a series of national and statewide initiatives designed to improve patient safety through improving defective processes that cause errors.

Hopefully, we have learned something from our previous mistakes. Today, the hospital and medical community should not quibble over technical deficiencies that may be embedded in this Dartmouth study. Instead, we should acknowledge that we have much work to do to promote the more efficient delivery of health care services for end of life care, thus benefiting patient quality of life during terminal illnesses and spending less money on futile care services.

Steve Brenton
President

Legislation to increase health insurance flexibility for small businesses stalled in the U.S. Senate last week. The Health Insurance Marketplace Modernization and Affordability Act, S. 1955, failed to receive the needed 60 votes in order for a final vote on the bill. (60 votes were needed for a final vote to occur. The vote was only 55-43.)

The bill’s author, Wyoming Senator Michael Enzi, had this to say after the vote, "Actions speak louder than words…Unfortunately, there were many [Senators] who sacrificed this moment of action and made a statement instead. They argued that we should deny the people in small business from having anything until we can get them everything."

The Enzi-Nelson bill would have allowed small business associations to pool their members across state lines to leverage combined purchasing power and negotiate more affordable insurance options. Supporters cited actuaries who projected that the legislation would lower health insurance premiums by 12 percent and bring one million people into the insurance market. Opponents of the legislation, however, claimed that the legislation would remove hard-fought for state insurance coverage for illnesses such as cancer, chiropractic care or diabetes.

In the weeks leading up to the vote, Senators worked to find a suitable compromise while still maintaining the bill’s desired flexibility. In the end, that compromise was not found.

As a component of WHA’s Healthier Choices health care platform, WHA supports efforts to provide increased flexibility in insurance so coverage can better meet employer and employee needs.

The U.S. House recently passed legislation extending a program to assist Critical Access Hospitals (CAHs) in making capital improvements to their existing facilities. The Rural Health Care Capital Access Act, H.R. 4912, provides a five-year extension for CAHs for the Federal Housing Administration’s (FHA) mortgage insurance program.

The FHA has insured hospital mortgages to finance replacement and modernize facilities since 1968. However, that 1968 law required that 50 percent of the patient-bed days in a facility be devoted to acute care in order for that hospital to qualify for the loan. Unfortunately, many rural facilities combine hospitals and nursing homes to reduce costs and often do not meet the so-called "patient-day test." To address the situation Congress exempted CAHs in 2003 from the patient-day test so they would be able to still qualify for the FHA loans. That three-year exemption is set to expire July 31.

HR 4912 will extend the exemption through July 2011. The U.S. House overwhelmingly approved it and the legislation now resides in the U.S. Senate Housing, Banking and Urban Affairs Committee.

The Wisconsin Hospital Association and nurse leaders recently teamed up during a session at the Wisconsin Organization of Nurse Executive’s (W-ONE) Annual Convention to provide attendees with an actual taste of the legislative process. Attendees were able to see how the legislative hearing process works during a "mock" hearing.

"Nurse leaders need to be engaged in the issues that impact our delivery of health care in our communities," said Mary Beth White-Jacobs, W-ONE legislative committee co-chair and one of the session’s planners. "This ‘mock’ legislative hearing was a perfect way to help W-ONE members see the legislative process in a life-like, learning environment."

The mock hearing focused on hypothetical legislation impacting nurses and hospitals so attendees could see the need for nurse leaders to be active in the legislative process. Attendees were provided background information on the issue to facilitate the session.

The first to testify was Jennifer Rutkowski, vice president of professional services at Grant Regional Health Center, who provided the example of what not to do while testifying at a legislative hearing. The "don’ts" include reading testimony verbatim, making up an answer when you don’t know, referring to legislators by their first names, chewing gum and stopping mid-testimony as legislators talk among themselves.

The second to testify was Beverly Hoege, chief nursing officer at Reedsburg Area Medical Center, who served as an example of how to provide effective testimony. The "dos" when testifying include establishing your credibility on the issue, providing personal examples of how the issue will impact your delivery of health care, keeping testimony short and to the point, not being rattled by the commotion in a typical hearing and being prepared to answer questions.

"When testifying at a legislative hearing, our messages must be succinct and meaningful due to time constraints, but legislators DO want to hear from us," said Beverly Hoege. "Even though it can be nerve wracking, it is essential for those of us working in a given setting to share the message of how a particular piece of legislation impacts us."

Being an "actor" in the mock hearing was a learning experience for testifier Jennifer Rutkowski. "I feel all people working in health care need to have an active voice in health care legislation, and nurse executives are in a perfect position to assist their staff, providers and board members in becoming more active in legislation," she said.

"In preparing for the mock hearing, I learned many of the dos and don’ts of testifying, and although I was nervous about being in front of the audience and the camera, I learned how easy it is to make a difference!"

Jenny Boese, WHA’s vice president of external relations & member advocacy, rounded out the session through an interactive discussion with attendees about the importance of grassroots involvement in the legislative process. Session attendees also received a grassroots handbook jointly produced by the Wisconsin Hospital Association and W-ONE.

State Senator Julie Lassa (D-Stevens Point) was recognized at Saint Michael’s Hospital-Ministry Health Care during Shaken Baby Syndrome Awareness Week for her efforts to reduce the occurrence of the syndrome. Her recognition came shortly after enactment of legislation on preventing Shaken Baby Syndrome, which Lassa authored.

Sen. Lassa first became interested in Shaken Baby Syndrome when she and her husband took a birthing class at Saint Joseph’s Hospital-Ministry Health Care in Marshfield. They watched a video on this tragic form of child abuse, which prompted Sen. Lassa to spearhead legislation requiring education for new parents and child care providers.

During her visit to Saint Michael’s, Senator Lassa also visited the hospital’s drop-in day care center, which provides free child care services for parents who are visiting the hospital or the co-located Ministry Medical Group Clinic. Lassa’s visit included meeting a new mom in the hospital’s birthing unit and ended with a roundtable discussion with hospital employees on overall health care issues.

Saint Michael’s President Brad Neet made sure to thank Sen. Lassa again for her support of recent efforts to restore a cap of $750,000 on non-economic damages in Wisconsin.

State Senator Ron Brown (R-Eau Claire) traveled to Tomah Memorial Hospital during their annual Hospital Week "Awards Day" program held on May 9. Sen. Brown attended the event to thank hospital staff for their work and to recognize 35 employees for more than 2,004 total years of service to the hospital.

CEO Phil Stuart made certain to thank Sen. Brown for his recent vote against the Taxpayer Protection Amendment (TPA). The Wisconsin Senate rejected two versions of the legislation during a late night session May 4. WHA and Tomah Memorial Hospital opposed the TPA due to its negative impact on programs such as Medicaid.

Has your hospital recognized a legislator for their efforts on health care? Please contact Jenny Boese at 608-268-1816 or jboese@wha.org so the HEAT grassroots program can highlight your efforts!

By now, all hospital leaders should have received the Wisconsin Hospitals Political Action fundraising campaign materials to kick off the 2006 political action fundraising campaign. The goal in this 2006 election year is to raise at least $185,000, which is an increase over the record setting amount of $175,000 that was raised in 2005. If every donor were to increase their contribution by a nominal 7 percent and if new donors contributed, the 2006 goal will be met and even exceeded.

To date, the campaign has taken in nearly $50,000 in contributions to the three funds. At the beginning of July, aggregate individual totals by hospital/system will be published in WHA’s The Valued Voice spotlighting those who have really stepped up to the plate early in this important election year. These individual totals will again be published later in the year.

"We’ve come a long way in the last five years as individuals recognized the value of political advocacy by making a contribution to these funds, but we can’t simply rest on our past achievements to continue to be successful; we must continue to push forward on our successful path to work toward the stretch goal of raising at least $200,000 by 2008," says Jodi Bloch, WHA vice president of government affairs.

If you have any questions about this year’s campaign or would like to receive more brochures, contact WHA’s Jodi Bloch or Jenny Boese at 608-274-1820.

The Wisconsin Society of Anesthesiologists (WSA) is seeking to confirm that state statutes require the administration of anesthesia by a certified registered nurse anesthetist (CRNA) to be supervised by a physician. The Administrative Law Judge (ALJ) considering WSA’s Petition for Declaratory Ruling has issued a Memorandum on the Prehearing Conference of April 28, 2006. The WSA Petition argues that, in Wisconsin, the administration of anesthesia is a delegated medical act, and thus requires supervision and that the Governor did not have authority to request an "opt-out" of the Medicare supervision requirements for CRNAs. See the June 6, 2005 issue of The Valued Voice and the WHA Web site for more details on this issue.

The ALJ’s Memorandum recognizes that the settlement discussions between the parties are at an impasse and that, unless new proposals for settlement are made, no further discussions will be scheduled. The ALJ established a schedule for filing briefs, with the hearing on the petition scheduled for September 19, 2006.

The ALJ specifically asked the parties to provide the following:

• A description of the practice of a CRNA
• A factual description of CRNA training and experience, especially in the areas of emergency intervention and rescue from complications

A copy of the ALJ’s Memorandum is available on the WHA Web site under Legal and Regulatory.

The Center for Medicare and Medicaid Services (CMS) has submitted proposed rules to the Federal Register that will change reimbursement for hospitals that are paid under the inpatient prospective payment system. The proposed amendments to regulation 412,64(d)(2) include a 2.0 percentage point reduction in the payment update for FY 2007 for hospitals that do not comply with requirements to report quality data provided for under section 5001(a) of Public Law 109-171. To participate in the hospital reporting initiative, hospitals must:

1. Maintain a QualityNet Administrator.
2. Complete a revised "Reporting Hospital Quality Data for Annual Payment Update Notice of Participation" form no later than August 1, 2006.
1. MetaStar will notify hospitals when this form is available on the QualityNet Web site.
3. Submit an expanded set of quality measures for heart attack, congestive heart failure and pneumonia patients. In addition, it is proposed that surgical infection prevention measures be added to the measure set.
1. The total number of proposed measures is 21. This measure set has not been finalized.
2. The deadline to submit 1Q2006 data on all measures is August 15, 2006.
3. Hospitals must submit complete data in accordance with the joint CMS/JCAHO sampling requirements for each measure.
4. Hospitals must pass the data validation minimum requirement of 80 percent reliability for quarters 1, 2 and 3 of 2005 combined based on the current chart audit validation process (see the Federal Register for the detailed proposed two-step calculation process).

Note: Although the HCAHPS patient survey will be implemented beginning in October 2006, CMS does not anticipate requiring participation for the FY2007 annual payment update.

For additional information about this proposed rule, refer to the Federal Registry, Vol. 71, No. 79, pages 24091-24101, or contact Dana Richardson at drichardson@wha.org or 608-274-1820.

    Rosa is a young woman and mother of two children. She was introduced to A Woman’s Place (AWP) in her ESL class as they came to AWP for a tour and a breast self-exam class. She was so excited to hear about all of the services and information that AWP could offer her. In addition, she enrolled in the Reproductive Cancer Screening Program, had her exam, and later found out that her pap smear was abnormal. Because she was so concerned and afraid, she came back to AWP to receive more information about her health, and the Hispanic Health Educator assisted her in applying for Prevea Clinic and SMH’s Community Care program so that she could receive the treatment needed.

She is currently going to follow up appointments every month at Prevea and is glad she received the help and care needed to maintain good health. Now she will also be able to have a mammogram due to the Packer Pink Hat Fund. This fund provides mammograms and diagnostic breast services to women not eligible for the Wisconsin Well Woman’s Program due to their age.

    Fransisca is a 60-year old Latina who has been living in the USA for several years with her 16-year old son. She has a full-time job working in a hotel as a housekeeper with no medical benefits. She attends St. Willebrod Church in Green Bay and attended one of the free cardiovascular screenings offered by AWP at the parish. While she was at the screening, she complained about severe abdominal pain that she had been having for several months. When the nurse providing the screening checked her abdomen, she knew that something was wrong and immediately referred her to the local community clinic for medical care. The next day she was diagnosed with uterine cancer.

She had surgery the following week and began chemotherapy treatments.

While undergoing chemotherapy, she returned to AWP to utilize the American Cancer Society Loan Closet to obtain a wig and some hats. She stated that the reason she had not gone to the doctor was her work schedule, lack of transportation and the impossibility of scheduling an appointment at the local clinic. The screenings were more available to her. It has been one year since Fransisca finished her chemotherapy and was told by her doctor that the cancer was gone. She stated that in some way AWP’s screening saved her life and hopes that we can continue providing this needed service.

    IM came from her native country two years ago with her three children. She moved to Green Bay just two months ago looking for better opportunities. IM was feeling lost with many health concerns, very little money, and not knowing what to do when she heard about A Woman’s Place (AWP) through AWP’s Hispanic Health Educator at her church. At the time, she was living with friends and did not have a job or a vehicle. She came to AWP looking for guidance in how she and her children could receive eye exams and how she could have a pap smear.

At AWP she was enrolled in the Wisconsin Well Women’s Program, referred to the Literacy Council for ESL classes, referred to St. Vincent De Paul for housing, and to the Lion’s Club for an eye exam. Her children were referred to the Health Department to check their vision too.

IM’s life has changed a lot since she moved to Green Bay and got in contact with AWP and other community agencies through AWP. She moved into a St. Vincent De Paul home with her children, had her eye exam and received glasses through the Lion’s Club, is going to ESL classes once per week at the Literacy Council’s office and sees a tutor who is teaching her English once per week at her home. Her children were recently screened at school, and one of them was referred to a local eye clinic for an eye exam through the Health Department. She is scheduled to have her pap smear soon. Presently she has been able to take care of her health and basic needs, has a part time job, and is hopeful that learning English will help her to have a better future.

Submit hospital community benefit stories to Mary Kay Grasmick, editor, mgrasmick@wha.org or call 608-274-1820.

The new community benefits reporting initiative is nearing the first stage of completion as the deadline of May 31 for filling in the on-line survey draws near. Mandy Ayers, WHA’s community benefit survey coordinator, reports that a majority of the hospitals have started filling in sections of the survey, while other hospitals say they have collected the required data on paper and will soon transfer that information to the survey tool.

Ayers, WHA’s key contact for hospitals when they have questions, said employees designated to fill out the survey are telling her it’s easy to use and the prompts help answer questions as they move through and complete the various sections.

"At this point, more than 90 hospitals out of the 132 participating have logged on and completed one or more sections of the survey, while seven have completed it," according to Ayers.

Once the survey results are in, WHA will begin planning the statewide release of the aggregated data, which will include the publication of a statewide community benefit report, at least one statewide news conference, and working to help coordinate local activities related to creating more awareness of these important activities.

Mary Kay Grasmick, WHA vice president of communications, emphasized that community benefits activities do not generate revenue, but rather, are created to fill a need in the community.

"These are the activities that hospitals do every day as part of their mission to serve. We hope by building awareness of these programs and actions, our communities begin to understand that hospitals are interested in improving the health status of the entire community, not just in treating acute disease," Grasmick said.

In this week’s Community Benefits highlights in The Valued Voice, St. Mary’s Hospital and Medical Center in Green Bay shares several first-person stories that illustrate how their programs have benefited people in the Green Bay area.

Many community benefit program resources for those filling the survey and writing stories are located at www.wha.org, click on the Toolkit icon on the right side of the front page, and scroll down to Community Benefits.

WHA will continue to check in with hospitals to ensure that the survey is completed on time. Questions about the survey can be directed to Mandy Ayers, mayers@wha.org or call 608-274-1820.

Back by popular demand, Fred Lee will present his service excellence and patient loyalty workshop, "If Disney Ran Your Hospital: Some Things You’d Do Differently," for WHA members on July 18. The program is based on his book, If Disney Ran Your Hospital – 9 ½ Things You Would Do Differently, which won the ACHE 2005 James A. Hamilton Book of the Year award.

Additionally, on July 19, Lee will present a new, advanced Part II program entitled "If Disney Ran Your Hospital: Keys to Culture and Customer Service." Special two-day and team discount registration rates are available.

Lee has the unusual distinction of having been both a senior vice president of a major medical center and a cast member at Disney University. Lee was recruited by Disney because of his expertise in helping hospitals achieve a culture that inspires patient and employee loyalty. This followed his role as senior vice president at the 1,500 bed Florida Hospital, where he developed a nationally acclaimed guest relations program.

An Institute for Credentialing Innovation’s Magnet Designation Workshop will be held on June 8–9 at Aurora Health Care’s Heil Conference Center in Milwaukee. This seminar is co-hosted by Aurora Health Care. The conference, "Forces of Magnetism," will help hospitals understand the application process, and learn more about the Magnet Recognition Program. For more information on this educational session, go to http://guest.cvent.com/EVENTS/Info/Summary.aspx?e=0ad79eb8-f7c4-493d-835f-85ffcbf1ed60.

Currently, five health care providers in Wisconsin have Magnet Recognition from the American Nurses Credentialing Center. They are: Aurora Health Care Metro Region; St. Marys Hospital Medical Center, Madison; Children’s Hospital of Wisconsin, Saint Joseph’s Hospital/Ministry Health Care, Aspirus Wausau Hospital. The Magnet Recognition Program is based on quality indicators and standards of nursing practice as defined in the American Nurses Association’s Scope and Standards for Nurse Administrators (2003). The Magnet designation process includes the appraisal of both qualitative and quantitative factors in nursing.

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