Policy & Opinion Papers


"Conversation Starters re Urban-Rural Language Differences and Other Stumbling Blocks to Understanding Our Working Together" by Tim Size, RWHC Executive Director

"The State of Rural Wisconsin Health" by Tim Size, RWHC Executive Director, Wisconsin Rural Health Conference, Wisconsin Dells, WI, June 13, 2019


A Very Partial List of Rural Health Innovations in Wisconsin "The Challenge is Not so Much New Models But Further Expanding a Culture of Innovation.' This brief compendium of 32 rural innovations was collected from Rural Wisconsin Health Cooperative (RWHC) Members and Staff for a Rural Policy Research Institute Health Panel meeting, supported by the Helmsley Foundation, for a conversation about innovations occurring in rural health practice, delivery system design and payment models on December 6 and 7 in Washington, DC."  Tim Size, RWHC Executive Director 

Rural Health in Wisconsin: Workforce Challenges and Bright Spots," a PPT by Tim Size, RWHC Executive Director for the University of Wisconsin’s Department of Family Medicine and Community Health Ground Rounds, 11/14/18.

"The Rural 'State of the State' in Wisconsin" byTim Size, RWHC Executive Director, Wisconsin Rural Health Conference, Elkhart Lake, WI, June 28, 2018

RWHC Commentary: "Celebrating Rural Hospitals, the 20th Anniversary of Critical Access"

by Tim Size, RWHC Executive Director for the National Rural Health Association Policy Institute on February 6th, 2018.


Rural Health Leadership Radio: A Conversation with Tim Size

"Rural Health Leadership Radio™ (RHLR) is the very first radio show of its kind!  RHLR is a weekly podcast featuring leaders working in rural health; leaders of hospitals, clinics, networks, companies and communities."

“If there was ever a need for strong leadership, that time is now.  RHLR’s mission is to provide a forum to have conversations with rural health leaders to discuss and share ideas about what is working, what is not working, lessons learned, success stories, strategies, things to avoid and anything else you want to talk and hear about.  RHLR provides a forum that is absolutely free to anyone who wants to tune in and listen.  RHLR provides a voice for rural health.  The only investment is your time, and our goal is to make sure you receive a huge return on your investment.”

"The State of Health Care in Wisconsin – Advocacy in a Divided Country" Tim Size, RWHC Executive Director, co-presented with the Eric Borgerding, Wisconsin Hospital Association's President/CEO, at the annual Wisconsin Rural Health Conference in the Wisconsin Dells on 6/22/17.

Finding Order During Chaos: The 2016 Post-Election Rural Perspective” (Video of RWHC Retreat Keynote Address, March 35d, 2017, 1 hr 19 min)

Brock Slabach is Sr. Vice-President, Member Services, National Rural Health Association. He was a rural hospital administrator for more than 21 years. He has been on the board of the National Rural Health Association, the regional policy board of the American Hospital Association, as well as many regional and state boards involving rural health. Brock discussed the 2016 election results and the potential impact of policy changes on health networks and their members. Rural providers of health care are disproportionately dependent on government payers to sustain the services they offer. Policy changes could create chaos. Network leaders should assume a leadership role in assisting their members to create order from the chaos that will translate into action for the communities they serve.

A Dozen Plus Two Needed Federal Regulatory Relief Actions

The Rural Wisconsin Health Cooperative (RWHC) has added two ideas to the original dozen regarding needed federal regulatory relief actions. We look forward to working with the incoming Trump Administration and the Congress to avoid negative consequences of urban-centric regulations and past decisions that limit the ability of rural providers to serve their communities.

"What Rural Health’s 'Early Days' Tell Us About Today," a commentary by Tim Size, Executive Director, Rural Wisconsin Health Cooperative.

Discovered in the Archives: A Video View of RWHC in 1995.


"One Advocate’s View of Rural Health in the 'Early Days' (1980-2000),"a perspective from Tim Size, Executive Director of RWHC, regarding the start of the rural health movement in the 1980s and 1990s requested by the Rural Health Information Hub, April, 2016 prepared by Tim Size, Executive Director, Rural Wisconsin Health Cooperative. Click here for PDF of script. October 27, 2016.

"Rural Life Suits WARM Grads" David Wahlberg wrote a great piece in the Wisconsin Academy of Rural Medicine, published above the fold in the Wisconsin State Journal's front page. Many good quotes from Dr Byron Crouse, WARM's "godfather." In addition to the above link, here it is as a pdf.

Bridging The Divide In Urban And Rural Healthcare "There's an urban-rural divide when it comes to health care--and a guest makes the case for doing more to make sure rural Wisconsin has access to needed medical services." By Rob Ferrett for Central Time on Wisconsin Public Radio on Tuesday, August 23, 2016.

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 Host: Rob Ferrett  |  Guest: Tim Size | Producer: Rob Ferrett 
Wisconsin Public Radio, © Copyright 2016, Board of Regents of the University of Wisconsin System and Wisconsin Educational Communications Board.

The Wisconsin Hospital Association in partnership with WisconsinEyepremiered the video, "Wisconsin Rural Health: Healthy Hospitals. Healthy Communities." at the the 2016 Wisconsin Rural Health Conference to highlight the attributes of Wisconsin’s rural health care system.

RWHC in Review, 2015-16: Our first ever "Corporate" Report; everything you every wanted to know about RWHC under one cover.


Dr. Jim Damos, Retired Program Director, Baraboo RTT, talks about "The Baraboo Story: Always Moving Forward in the Face of Chaos" as part of the The National RTT Collaborative Annual Meeting hosted in Madison and Baraboo, Wisconsin. Click here or go to http://ow.ly/Oo264 for the 22 minute video.

Rural Health in Wisconsin: Nimble & Evolving” by Tim Size, RWHC Executive Director at the Wisconsin Rural Health Conference, Wisconsin Dells, June 18, 2015

Health Policy Lessons from Baraboo: One Resilient RTT Changes a State; by Sandy Anderson, President & CEO, St. Clare Hospital, Baraboo and Tim Size, RWHC Executive Director at the RTT Collaborative Annual Meeting, 5/29/15.

Rural Network Leadership by Tim Size, RWHC Executive Director, in “On Center, at the The National Rural Health Resource Center, 4/30/15.

"What Is the One Thing from the History of Rural Health That We Should Not Forget?"by Brandon Baumbach, RAC’s Rural Health Policy Specialist in the Rural Monitor, 3/31/15

"The State of Rural Hospitals" The audio presentation http://www.wpr.org/state-rural-hospitals by Wisconsin Public Radio was extended to a full eleven minutes to allow for both national and state perspectives to be covered. You will hopefully pick up on the message that while we face some serious challenges in Washington DC, there is much to celebrate in Wisconsin. 4/6/15

“Rural Health and Network Adequacy” by Tim Size, RWHC Executive Director for the Webinar “Weekly Office Hours” at the Federal Office of Rural Health Policy, 2/18/15

“Advocacy for Rural Communities and in Particular, Rural Health,” PPT by Tim Size, RWHC Executive Director for the Sauk County Institute of Leadership, 2/12/15

NETWORK ADEQUACY IN RURAL WISCONSIN by Mike Vanderboom, J.D. This policy brief was developed with the Rural Wisconsin Health Cooperative while Mike was a clinical legal intern from the University of Wisconsin Law School. This review is not intended to be the definitive word on the subject but as a means to accelerate early understanding and action on this critical issue to the future of rural health during an age of accelerating “reform.”


"A Rural Vision for a Healthier Wisconsin: Place Based & Individual Centeredby Tim Size, RWHC Executive Director as part of the “Conversations for Change” Series sponsored by the Healthier Wisconsin Partnership Program in Wausau, Wisconsin on 11/11/14.

The State of Health Care in Wisconsin: Rural Opportunities and Challenges by Tim Size, RWHC Executive Director at the Wisconsin Rural Health Conference in Elkhart Lake, June 20, 2014.

"Rural Health and Critical Access Hospitals: Opportunities and Challenges" by Tim Size, RWHC Executive Director at the Ministry Door County Medical Center, Sturgeon Bay, WI on April 14th, 2014 

"Growing a Rural GME Collaborative: Advocacy, Collaboration & Good Fortune," a PPT by Tim Size, RWHC Executive Director and Kara Traxler, RWHC Director Rural GME Development & Support for the 2014 RTT Conclave in Athens, Ohio.

“The Serious Side of Humor and a Dozen Favorite Cartoons” by Tim Size, RWHC Executive Director for the 2014 RTT Conclave in Athens, Ohio.

RWHC Quarterly Member Commentary: "Operation MASH"  "Since last fall and throughout our very long winter, rural hospital CEOs and advocates in Wisconsin have been traveling to Washington DC on an almost monthly basis to meet with members of our Congressional Delegation. We have been doing this not to rack up frequent flier points but to keep rural hospital issues front and center during a time of significant uncertainty in Washington. The threats we face fall into two buckets, one from Congress and one from the Administration..."

“The Rural Context for Health Policy: An Advocate's View” PPT by Tim Size, RWHC Executive Director for the Wisconsin Academy of Rural Medicine, Elective 622-740, 2/27/14.

“Advocacy for Rural Wisconsin and in Particular, Rural Health” a PPT by  Tim Size, RWHC Executive Director for the Sauk County Institute of Leadership, 2/13/14.


Rural Health Policy: One Advocate’s Perspective in Forty Minutes–a PPT by Tim Size, RWHC Executive Director for the Rural Health Interest Group at the University of Wisconsin School of Medicine & Public Health, 12/2/13.

"Wisconsin Collaborative for Rural Graduate Medical Education" PPT by Tim Size, RWHC Executive Director & Kara Traxler, RWHC Rural GME Development & Support Manager, for "Taking the Next Step, a Statewide Conference on Graduate Medical Education, in Neenah, WI on 10/24/2013.

"Critical Access Hospitals Have a Strong Future," a talk by Tim Size, RWHC Executive Director for the Rusk County Memorial Hospital, Ladysmith, WI, 9/5/13.

"A Bit of History re the Development of CAHs" by Tim Size, RWHC Executive Director. PDF

"Rural Health in Wisconsin: Taking the Long View" by Tim Size for the Wisconsin Rural Health Conference in the Wisconsin Dells on June 28th. 

"Community Health: One Perspective Forty Years in the Making" by Tim Size, Executive Director at Fort HealthCare on 6/5/13

"Rural Health Policy: One Perspective in Forty Minutes" by Tim Size, RWHC Executive Director to the National Rural Health Student Constitutuency Group, May 8th, 2013 in Louisville, Kentucky.

Advocating for Collaborative Rural Health: One Perspective, 35 Years in the Making" by Tim Size, Executive Director, RWHC for the UW Population Health Services Fellow Meeting, 4/16/13 in Madison, WI. Click for PPT 

RWHC Hospital Trustee Manual Back By Popular Demand In 2000, RWHC put together a series of brief articles to be shared with Trustees at Member hospitals as an addendum to the hospital’s own Trustee Manual. Recently several Members have asked us to update and distribute the original materials.   We are distributing the RWHC Hospital Trustee Manual as a pdf file to maximize its distribution as well as our ability to update it every year or two. The Table of Contents, with materials from a wide variety of sources, is as follows:  

  1. Suggested Meeting Ground Rules
  2. Responsibilities and Liabilities of Non-Profit Directors
  3. Board Self Assessment Guide
  4. Ensuring High Quality Care
  5. Health Information Technology in Today’s Hospital
  6.  Leadership Development
  7. Advocacy for Rural Health
  8. RWHC Basics
  9. Top Rural Hospital Websites
  10. Glossary of Hospital and Health Care Terms

With its embedded links it is designed to be used as an e-manual or it can be printed as a 134 page paper document.

"The Future of Rural Health & Critical Access," a presentation by Tim Size for the Ministry Health Care Hospital Leadership, Stevens Point, April 8th, 2013.

"Rural Health Advocacy" presented by Tim Size, RWHC Executive Director to the Board of Directors of the Wisconsin Medical Society, 1/26/13


A talk on& Rural Healthcare, Critical Access & the Future by Tim Size, RWHC Executive director for the ACHE Leadership Day at Prairie du Chien Memorial Hospital on 8/24/12.Of special interest maybe the section on the history of Critical Access Hospitals and on current challenges CAHs face."

Advocating for Collaborative Work: One Perspective, 30 Years in the Making–a PPT by Tim Size for the Healthy Wisconsin Partnership Program conference, “Collaboration to Improve Rural Health" on June 7th, 2012.

"Health Networks of the Future (Doing More, Better, for Less)by Tim Size, RWHC Executive Director, National Cooperative of Health Networks Annual Educational Conference, Denver, Colorado, 5/18/12.

"Models for a Rural Healthcare Future, (Doing More, Better, for Less)" A presentation by Tim Size, RWHC Executive Director, at the National Rural Health Associations Policy Institute on February 1st in Washington, DC.   



WisconsinEye 12.08.11 | Newsmakers: Wisconsin Physician Shortage – A new Wisconsin Hospital Association (WHA) report estimated that Wisconsin faces a shortfall of about 2,000 physicians by 2030 -- a gap that could be made upif 100more physicians were trained each year. In a Newsmakers program on Dec. 8, four health-care professionals -- George Quinn, WHA senior policy advisor; RobertGolden, M.D., Dean of UW School of Medicine and Public Health; Timothy Bartholow, M.D., chief medical officer for the Wisconsin Medical Society; and Tim Size, Executive Director of the Wisconsin Rural Health Care Cooperative -- said the problem is quickly growing worse, and critical care gaps will soon emerge if changes are not made. Now, the UW Medical School graduates 175 students per year; the Medical College of Wisconsin, about 210. The report says one option is building a new Wausau-area medical school to train primary care physicians, although estimates say that would cost $70 million or more.

"Advanced Broadband: A Foundation for Care Integration"–a white paper by the Hospital Sisters Health Systems. The Challenge: Dense files of medical information cannot be shared in a timely and coherent fashion using low-capacity broadband. Commercially-provided private broadband—often analogous to a narrow two-lane road—cannot accommodate the advanced data exchange needs of hospitals (which are analogous to a multi-lane freeway). Essential applications such as accessing a Picture Archiving and Communications System (PACS) diagnostic file or sharing Electronic Health Records (EHR) require advanced broadband speeds of 100 megabits (Mbps) to one gigabits per second (Gbps)." "Rural Healthcare Leadership, An Advocate’s Personal Views" is a talk given by Tim Size, RWHC Executive Director to Wisconsin's American College of Health Executive's Leadership Development Program on 10/28/11 in Friendship, Wisconsin. Power Point.

Wisconsin Critical Access Hospital Data Report, 2011--Critical Access Hospital (CAH) designation was introduced through the Medicare Rural Hospital Flexibility Program (Flex Program) as part of the Balanced Budget Act of 1997. The first Wisconsin CAH hospitals were certified in 1999. One of the main objectives of the CAH program is to improve the financial stability of small, rural facilities. The purpose of these studies is to analyze the financial condition of Wisconsin’s CAHs.

Rural Hospital Talking Points and Questions for Meeting with CMS Administrator, Dr Don Berwick: Western Wisconsin Rural Health Roundtable with Congressman Ron Kind & Centers for Medicare & Medicaid Services (CMS) Administrator Don Berwick at Jackson County Courthouse in Black River Falls on August 18, 2011. 

Strong Rural Communities Initiative (SRCI) Program: Challenges in Promoting Healthier Lifestyles.” This article was in the Journal WMJ, advancing the art & science of medicine in the Midwest, Volume 110, Issue 3, June, 2011. “The Strong Rural Communities Initiative (SRCI) was created to address the health needs of rural Wisconsin communities through a multifaceted partnership that included the Medical College of Wisconsin (MCW), University of Wisconsin School of Medicine and Public Health (UWSMPH), the Rural Health Development Council (RHDC), and hospitals, public health departments, and businesses in 6 rural communities in Wisconsin. The SRCI provided a broad framework of leadership to assist each of the 6 rural communities in developing and implementing new, collaborative interventions that addressed the specific health needs of the community.” RWHC Comments re CMS-1345-P Accountable Care Organizations & Medicare Shared Savings Program: "The underlying goals for ACOs are important for our country’s health care system, rural and urban alike. CMS needs to create positive, workable rural solutions that reward better care at a more reasonable cost. ACOs are an important part of health reform in America, but as currently defined by CMS; RWHC believes they are largely impractical for most of rural America." Click  here for RWHC's Comments. Community Partnerships not “Business as Usual”: 8 Tips and a Few Observations" 

Rural Health Roundtable with Congressman Ron Kind, 2/23/11– (a compendium of rural policy issues) The Natural Synergy Between Advocacy & Shared Services by Tim Size, updated 2/23/11.  


The long worked forWISCONSIN 2010 RN Survey Summary from the Wisconsin Department of Workforce Development and the Wisconsin Center for Nursing is now available. Press release link: http://dwd.wisconsin.gov/dwd/news.htm & the “Survey Summary" linkhttp://worknet.wisconsin.gov/worknet/worknetinfo.aspx?htm=nurse_summary

Rural Health Access & Workforce" 
This PPT was developed for the Legislative Council Special Committee on Health Care Access on August 24th, 2010 by Tim Size, RWHC Executive Director. Also prepared for this sessions was "Additional Handout: Quality of Care in Rural America."

"Rural Heath Equity: An Interplay of Politics, Policy & Research" This PPT was developed for the Wisconsin Public Health Association's 2010 Annual Conference by Tim Size, Executive Director of the Rural Wisconsin Health Cooperative based in Sauk City and Shaun Golding an Epidemiologist with the Wisconsin Office of Rural Health at the University of Wisconsin's School of Medicine and Public Health. Shaun is presenting an epidemiologist's view of rural population health and healthcare access. Tim is sharing his experience regarding the myths about rural health he has experienced in his 30 plus years with the Cooperative as well as offering tips regarding advocacy. (Be patient if you are experiencing a slow down load speed; is a large file.)


"Calm in the Eye of the Healthcare Hurricane" by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: December, 2009 "Health insurance for all is necessary, but not sufficient, for rural America by Lynda Waddington in the Iowa Independent, 10/14/09.

"The Financial Effects of Wisconsin Critical Access Hospital Conversion" by Dale Gullickson, FHFMA and Richard Donkle, CPA, Rural Wisconsin Health Cooperative for the Wisconsin Office of Rural Health, August, 2009.

Telemedicine in Wisconsin: A report on the Wisconsin environment for patient care at a distance in 2009. The Project was initiated and funded by the Wisconsin Office of Rural Health with findings and report generated by RWHC, 7/09.

"What Do We Want When Our Time Comes?" by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: June, 2009 “A Rural Perspective on Physician Workforce Planning” by Tim Size, RWHC Executive Director for the WHA Board Planning Session, 7/23/09 PPT or PDF (The PDF is a large file so be patient.) "Wisconsin’s Urgent Need for Collaborative Health Workforce Planning," a statement of the Wisconsin Department of Workforce Development’s Select Committee on Healthcare Workforce developed by the Wisconsin Health Workforce Data Collaborative, 6/29/09.

"Three Rural Health Priorities and Key Threats to Rural Health in Current Congressional Reform Proposals" by Tim Size, Rural Wisconsin Health Cooperative, 6/29/09. One page talking points and four page expanded remarks.

Rural Wisconsin Health Cooperative (RWHC) comments regarding the preliminary definition of “Meaningful Use” as presented to the Health Information Technology (HIT) Policy Committee on June 16, 2009. The American Reinvestment & Recovery Act HIT incentives, if properly structured, have the potential to profoundly increase all provider HIT adoption and care quality. But by setting the bar at a place within reach of the average large facility yet out of reach of the average small facility, the federal government will effectively exclude the providers that serve predominantly rural areas. This will have a severely negative impact on rural providers, as well as on the rural communities and the 62 million rural residents that rely on them for healthcare.

"Fight Recession With Health" by Tim Size, a RWHC Quarterly Editorial for Member Newsletters. June, 2009 RWHC submitted comments in response to the United States Senate Committee on Finance white paper, Description of Policy Options, Financing Comprehensive Health Care Reform: Proposed Health System Savings and Revenue Options on 5/26/09.

Rural America and the American Recovery and Reinvestment Act of 2009: Summaries Now Available –“A valuable resource direct from the National Rural Health Association's Annual Conference is now available for the rural health community at large. The document provides a comprehensive summary of the investment the Federal Government is making in rural areas, and rural health in particular, through the American Recovery and Reinvestment Act of 2009."

Thrive Releases Healthcare Snapshot 2009. Thrive is an eight county collaborative economic development enterprise in southern Wisconsin that includes the state capital, Madison. Under Thrive’s leadership, thirty-plus healthcare visionaries have formed the region’s Healthcare Leadership Collaborative ( HLC), and in late March endorsed a bold plan to improve the health of the region’s workforce. This and other initiatives are covered in the 2009 "Snap Shot." 5/21/09

“Meaningful EHR Use,’ ‘Certified EHR,’ And ‘Open Source’ Recommendations” We hope this initial paper begins a discussion in the wider rural health community re ARRA implementation issues for CAHs and other small rural hospitals. Please feel free to share your comments on our blog at http://www.ruraladvocate.org/ or email lwenzlow@rwhc.com. Thanks to Louis Wenzlow, RWHC Director of Health Information Technology, who is the primary drafter and to other senior staff at RWHC who provided significant input. 5/20/09

Collaborative Rural Health Workforce Recruitment & Retention Opportunities, by Tim Size, RWHC Executive Director, at the National Rural Health Association annual meeting, 5/6/09 PPT 

"Density of HIT Adoption in Wisconsin Rural Hospitals," prepared by Louis Wenzlow, Director of Health Information Technology, Rural Wisconsin Health Cooperative, updated 2/23/09

"A Personal View of Rural Health Leadership: It’s All About Collaboration & Advocacy" by Tim Size, RWHC Executive Director for a HRSA "Rural Voices Leadership & Policy Meeting," Washington DC, 3/30 – 4/1/09. PPT slide or PDF handout version.

“How are Federal & State Policies Likely to Affect Rural Health?” by Tim Size to the Sauk County Institute of Leadership, 3/12/09. PPT slide or PDF version.

"A Commentary re Critical Access Hospitals and Health Information Technology Incentives in the Economic Recovery Bill" by Louis Wenzlow, Tim Size and Rich Donkle at the Rural Wisconsin Health Cooperative, updated 3/17/09.

"What's Next?" by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: March, 2009


Rural Wisconsin Health Cooperative Recommendations for HIT Stimulus Package Our smallest rural hospitals are struggling to implement HIT systems, includingEMRs (Electronic Medical Records), which have shown the potential to enhance carequality. These hospitals provide a critical service for rural and underserved communities and should not be left behind in the ongoing HIT revolution.

"An Opportunity for American Healthcare" by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: December, 2008

RWHC has developed a hospital based “grow your own” Pre-Employee Educational Loan Program sample loan agreement as well as the template of the policy document needed to manage such a program. Click here for a template of the policy document.

RWHC Recommended Narrative for the IRS Form 990. Each rural hospital is unique and depending upon a hospital’s distance from another hospital, this recommended supplemental narrative text may make sense to include in a rural hospital’s IRS Form 990, Schedule H, Part VI, 11/09Observations Regarding the Interface of Politics, Policy & Research: As Illustrated in Recent Issues of RWHC's Eye On Health by Tim Size, Executive Director for the University of Wisconsin-Madison, Robert Wood Johnson Health and Society Scholars Seminar, 9/27/08. (pdf file)

"It's Our Country, Whether We Like It or Not" by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: September, 2008

Testimony: “Assuring Healthcare ‘Reform’ Doesn’t Bypass Rural America” by Tim Size before the U.S. Senate Special Committee on Aging, A Hearing on “Growing Old in Rural America” July 31st, 2008. Executive Summary or Complete Testimony as Submitted

Wisconsin’s Strong Rural Community Initiative: Discussion Paper #1: Statewide Support for Business Sector to Expand Wellness Initiatives. This paper is the first in a series of five discussion papers with policy recommendations promised by the Strong Rural Communities Initiative as a deliverable in commitments made to its major funders–the Wisconsin Partnership Fund and the Wisconsin Office of Rural Health at the University of Wisconsin and the Healthier Wisconsin Partnership Fund at the Medical College of Wisconsin. July, 2008

"Rural Hospitals' Charitable Exemption" by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: June, 2008

“What Were They Smoking?
” by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: March, 2008     


"Does Healthcare Reform Affect Rural Health?" by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: December, 2007

Observations from the Interface of Politics, Policy & Research: As Illustrated in Recent Issues of RWHC's Eye On Health by Tim Size, Executive Director for the University of Wisconsin-Madison, Robert Wood Johnson Health and Society Scholars Seminar, 11/19/07.

"Healthcare Reform Without Communitywide Prevention Misses The Target" by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: September, 2007

“Seeking SatisfACTION: Personal reflections of a recent graduate” was written by Stacey Lindenau, MPH, MSIE as a narrative summarizing her experience as a graduate student with the Rural Wisconsin Health Cooperative. For a year she did an extensive literature review and over forty key informant interviews to form the foundation of a policy development agenda for the Rural Health Development Council’s Strong Rural Communities Initiative at Wisconsin’s Department of Commerce. Her field placement was generously supported by the Robert Wood Johnson Health & Society Scholars Program at the University of Wisconsin-Madison. 6/20/07

"Innovative Community Partnerships: Jackson County’s proACTIVE Wellness Initiative" Jackson County recognizes that strategies and approaches to overcome obesity and preventable health problems cannot be developed and implemented by health agencies alone. This summary describes a community initiative that is successfully incorporating the hospital, public health, school district, and local businesses to build and launch worksite wellness programs that are making a difference. 6/19/07

“Rural Hospital Leadership & Quality Improvement” by Tim Size for the WHA Rural Hospital Surgical Infection Prevention Project, 6/20/07 (PPT and PDF).

"Small Numbers Are a Big Deal " by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: March 2007 

“Pay 4 Performance & Consumer Driven Health Care” by Tim Size for the Stoughton Hospital Board of Directors, 5/21/07  (PDF-large file!) The Federal Pay 4 Perfomance Initiative: Congress has mandated that the Centers for Medicare & Medicaid (CMS) develop a plan to implement a Value-Based Purchasing (VBP) Program for all hospitals (other than Critical Access Hospitals) for implementation starting in late 2009. Given the immediate importance of this initiative to rural hospitals under the Prospective Payment System hospital and eventually, we believe, to all hospitals, RWHC submitted testimony in January and April of 2007.

"Small Numbers Matter" by Tim Size, Executive Director, Rural Wisconsin Health Cooperative, 4/2/07. "A diverse crowd of clinicians, administrators, academics, consultants and policy makers met in Dallas-Fort Worth in late March at the wonky but well named National Conference on Small Numbers. Thanks to the Federal Agency for Health Research and Quality for being the primary sponsor as “small numbers” is an issue that rural health and rural health providers need to address in a big way."

“The Role of Critical Access Hospitals?” St. Joseph’s Advisory Task Force, Hillsboro Wisconsin, by Tim Size, 3/21/07 (PDF - large file.)

“Don’t tax you, don’t tax me, tax that man behind the tree” by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: March 2007     


"Leadership Development for Rural Health" PDF by Tim Size, NC Med J 2006;67(1):71-76

Newly Muscular Middle to Define Health Agenda? by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: December 2006

"Rural Population Health, Hospital Balanced Scorecards and Community Collaboration" by Tim Size, RWHC Executive Director for the Second Annual Rural Hospital Performance Improvement Conference, San Antonio, Texas, November 16th, 2006.  PPT or a PDF (large file)

Rural Will Exceed Rising Quality Expectations by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: September 2006

"The Art & Science of Rural Health Network Development" by Tim Size, RWHC Executive Director, for HRSA Rural Health Network Planning Grantees, Washington, D.C., August 9th, 2006. Available on line as PPT or PDF (large files)

"It Takes a Community" by Jessica Zigmond in Modern Healthcare, 6/12/06: "As the federal government pushes the healthcare industry to adopt pay-for-performance measures, rural hospitals could have an advantage over their urban counterparts in one area: working collaboratively to improve the overall health of their community populations. One area where experts say rural hospitals could thrive is in their ability to use their strong set of connections in engaging other community players to improve the health of the area's population. While rural hospital leaders recognize that a pay-for-performance model to measure quality outcomes is imminent, they say it is too early to assess progress because the movement is in its infancy and many rural hospitals are not yet equipped with electronic systems to report data." Available from Modern Healthcare archive at http://www.modernhealthcare.com/

Strong Rural Communities Are Made, Not Born by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: June 2006

"Rural Health Advocacy, 24 hours a day, 7 days a week" is a presentation by Tim Size, RWHC Executive Director, for Pennsylvania's 2006 Rural Health Conference. It addresses rural myths, the “Almost Worst Rural Health Policy” Awards for 2005," a cross section of public-private rural health issues and how to be a more effective & active advocate. Click here for a copy of the PowerPoint.

VIEW FROM THE COUNTRY by Joseph Mantone, Modern Healthcare, March 13th, 2006, pages 40-41

COMMENTARY: POPULATION HEALTH IMPROVEMENT & RURAL HOSPITAL BALANCED SCORECARDS by Tim Size, MBA, David Kindig, MD, PhD & Clint MacKinney, MD, MS. The text is as submitted by the authors to the Journal of Rural Health on March 25th, 2005. The version of this article edited after peer review can be found in the Spring 2006 Issue of the Journal of Rural Health published by the National Rural Health Association. The definitive version is available at http://www.blackwell-synergy.com


National Advisory Committee on Rural Health and Human Services: The 2005 Report to the Secretary: Rural Health and Human Service Issues, May 2005. The 2005 report focuses on four important issues. The first is the value of promoting collaboration in rural communities. The second is how to improve administration of the Temporary Assistance to Needy Families (TANF) in rural communities. The third is access to obstetrical services in rural communities and the fourth is the impact of obesity in rural communities.

"Public Reporting of Hospital Quality in Rural Communities: an Initial Set of Key Issues," A Policy Brief adopted by The National Rural Health Association (NRHA) on May 20th, 2005 (PDF)

An Open Letter Regarding a Rural Perspective for the University of Wisconsin's Medical School Dean Search, Screen and Selection Process, May 17th, 2005. (PDF)

"ACT NOW: Oppose Medicare’s Proposed Construction Ban." For talking points download Word or PDF

“Rural Perspective On “Hospital Compare,” an editorial by Tim Size, RWHC Executive Director, 3/31/05.

“Rural Hospital Networks: Stability & Growth In Challenging Times” A talk by Tim Size, RWHC Executive Director, for the Iowa Medicare Rural Hospital Flexibility Program, May 4th, 2005. PPT or PDF

"Rural Can Lead Through Individual and Community Care Collaboration" A talk by Tim Size, RWHC Executive Director, for the 18th Annual NW Regional Rural Health Conference, Spokane, Washington, March 25th, 2005. PPT or PDF

"Rural Heath Trends: Opportunities & Threats" A talk by Tim Size, RWHC Executive Director to the annual meeting of the Sauk County Development Corporation, 2/21/05. Click here for the PPT file.  


RWHC Eye On Health Special Edition, Nov. 1, 2004 "Quality Through Collaboration: The Future of Rural Health" from the Institute of Medicine was released November 1st, 2004. The 200+ page report can be viewed on line or purchased at http://www.nap.edu.

“Rural Hospital Networks: Stability & Growth In Challenging Times”, PDF handout of presentation by Tim Size

Rural Wisconsin Health Cooperative comments on the proposed rules implementing the new Medicare Drug Benefit and the Medicare Advantage Program (Ref. File Code CMS-4068-P and CMS-4069-P) published in the August 3, 2004, Federal Register, 10/1/04.

Cooperative Opportunities for Balanced Scorecard Driven Strategic Planning and the Potential Relevance to Population Health Initiatives  (PDF), An Analysis by A. Clinton MacKinney, MD, MS & Gregory Wolf, MBA of Stroudwater Associates for and with the Rural Wisconsin Health Cooperative, April 30, 2004 (With July 9th and September 3rd Additions)

"Balanced Scorecards & Population Health."  Click for PDF handout of this presentation by Tim Size to the Midwest Regional Meeting of the National Organization of State Offices of Rural Health in Madison, Wisconsin on August 12th, 2004.

"State of Our State, The 'Calm' Before The Storm," PDF handout of presentation by Tim Size at Wisconsin's annual Rural Health Conference, 6/24/04

“Who Will Care for Our Patients?” a major new study by the Wisconsin Hospital Association and the Wisconsin Medical Society. The Task Force on Wisconsin’s Future Physician Workforce identified major initiatives that must occur if Wisconsin is to avert a major crisis. The complete report is available at http://www.wha.org/physicianshortage3-04.pdf

"The Art & Science of Networks" (PPT slides as a pdf file) by Tim Size for the Rural Health Network Development Planning Grantee Meeting, Chicago, 3/22/04

"Eleven Rural Health Hot Spots" (PPT slides as a pdf file), a presentation by Tim Size for the Association of Health Care Journalists, Minneapolis, 3/28/03

“MESH/Cooperative Nursing Staff Sampling Project 2003” by Dick Reynolds & Cheryl Pedersen at the University of Wisconsin Hospital and Clinics MESH program, 2/2/04

Is Your Hospital Board Considering Becoming A CAH?—PowerPoint presentation entitled “Critical Access Hospitals: Better Medicare Financing For Smaller Hospitals Serving Rural Communities” (PDF - color or black & white).  



RWHC Receives International Recognition Click here for an article from the November, 2003PDF Newsletter of the The International Health Co-operative Organisation (IHCO) a specialized organization of the International Co-operative Alliance (ICA).

Non-agricultural Cooperatives in Rural Areas: Fourteen Case Studies by the University of Wisconsin Center for Cooperatives, 2003 (RWHC is Case Study #10 on pages 28-32) Click here for article.PDF

"The Art & Science of Networks" by Tim Size for the Office of Rural Health Policy All Programs Meeting Seession for Rural Health Network Development Grantees, August 19th, 2003. Available as a PowerPoint Presentationor  HandoutPDF.

"Wisconsin can prepare and support rural physicians," a Guest Editorial by Tim Size in WMJ (the journal of the Wisconsin Medical Society), 12/03.

"Grant Writing—Nine Lessons Learned From Twenty Years Writing & Reviewing Grants" by Tim Size, Executive Director, Rural Wisconsin Health Cooperative, 3/18/03

Rural Health SWOT Analysis Results Respondents were asked to reflect on the Strengths and Weaknesses of providers in their community and the Opportunities and Threats faced by these providers. 12/3/03

The Financial Effects of Critical Access Hospital Conversion, by Richard Donkle, CPA and Dale Gullickson, FHFMA, 7/23/03. Available in full PDF or a PowerPoint.

"Health Care Quality: The Rural Context, A Report to the Secretary, U.S. Department of Health and Human Services," April 2003. Click here to download this import report.

Letter to Governor Jim Doyle and the Wisconsin Legislature from Eric O. Stanchfield, Secretary of the Department of Employee Trust Funds, and Tim Size, Chair of the Private Employer Health Care Coverage Program Board, dated 3/28/03

The Potential for a Small-Employer Purchasing Pool in Wisconsin:Issues and Options for Overcoming Barriers to the Development of the Private Employer Health Care Coverage Program (PEHCCP), Prepared for the Wisconsin Department of Employee Trust Fund by Rick Curtis, Rafe Forland and Ed Neuschler Institute for Health Policy Solutions, 3/03.

The Argument For The Rural Community Hospital Assistance Act (pdf file) by Tim Size, Executive Director, Rural Wisconsin Health Cooperative and Past President, National Rural Health Association presented on 2/14/03 in Washington D.C. in a briefing for staffers of Members of the U.S. Senate Rural Health Caucus and House Rural Health Coalition. This is an update of an editorial published by Modern Healthcare, (8/5/02), as “The way to pay for rural care: Cost-based payment would stabilize finances for a class of troubled hospitals.”

Summary of the Rural Community Hospital Assistance Act--The proposed Rural Community Hospital Assistance Act (RCHAA) has a number of facets. It strengthens the Critical Access Hospital (CAH) program by enhancing CAH reimbursement and permitting some needed changes in their operations. It also creates a new hospital payment status called Rural Community Hospital (RCH) and establishes reimbursement mechanisms that will allow these small hospitals to continue to serve the needs of their communities. This "side by side" comparison of the two programs, whether existing or proposed was prepared by John Sheehan, BKD Health Care Group, BKD, LLP for a Congressional briefing on 2/14/03.

Same Tax, Same Part B Premium Different Medicare Benefit, a chart showing Medicare Payments By State Of Residence Per Enrollee in 2000, 2/10/03    


The Economic Value of the Health Care Industry In Sauk County, Wisconsin (November 2000), study by Albert Lanier and Ron Shaffer, Center for Community Economic Development, University of Wisconsin-Extension. 

The Science and Art of Business Planning for Rural Health Networks by Tony Wellever and Bob Cameron, (input from RWHC), (pdf file)11/00

Communicating Value To Network Members (PowerPoint Presentation)11/00

RWHC Testimony before the Wisconsin Special Committee on Dental Care Access(9/00)    


5 Steps To Safer Health Care, is a "low tech" approach to improving patient safety that all providers and consumer should memorize and promote according to Dr. Greg Meyer at the second annual conference of the Wisconsin Patient Safety Institute. Dr. Meyer is Director of the Center for Quality Improvement and Patient Safety, at the Agency for Healthcare Research & Quality.


Medicare: a $2 Billion State Biennial Shortfall(11/98) PDF

Rural HIV/AIDS. Rural Health, FYI (5/98) 

Would John Wayne Ask for Prozac? Rural Health FYI (3/98) 

Annual Conferences--Not Just Cheesehead Hats(1/98)

Rural Minority Health: How do we respond to a voice of audacious and unjustified hope?" Rural Health FYI (1/98)


Developing Relevant Health Policy (11/97) 

GME Reform & Rural Shortages,Rural Health FYI (11/97) 

The One Choice We Don't Have Is Not Choosing, Rural Health FYI (9/97) 
Suggested Ground Rules for Collaborative Meetings PDF (9/97)

Guidelines To Enhance Cooperation: Among Rural Providers, Systems & InsurersPDF  (8/97)

Our Organization and Community: Coming Together for Rural America, Rural Health FYI(7/97) 

Testimony before the U.S. Senate Finance Committee on Medicare. (2/97) 

RWHC Business Advisory Letter from Federal Department of Justice (2/97)      


Business Advisory Letter from Department of Justice to RWHC (12/96)

RWHC Proposal Approved from federal Department of Justice Press Release (11/96)

Compendium Of Rural Health Medicare Proposals (11/96)

Antitrust & Rural Health: NRHA Policy (5/96)

Selected Federal Government Issues With Rural Health(4/96)

Rural Medical Center Update (2/29/96)

"Equitable Treatment..."(Corporate Report Wisconsin, 1/96)    


"Seeing Green" PDF (10/95)

"Cooperative provides link between rural hospitals" PDF (10/95)

Balancing "Competitive Vs. Collaborative" Forces(10/95)

Rural Medical Centers(8/95)

Medicare And Rural Health(7/95)

Rural Able Willing Providers (7/95

Antitrust And Certificates Of Public Advantage(6/95)

"Strategic Alliances, Some Lessons from Experience"PDF (3/95)

Statewide Primary Health Care Work Force Planning (4/95)

Executive Director's Wisconsin Policy Wish List (2/95)

The Occupational Mix Adjustment - A Billion Dollar Data Glitch (1/95) 


Managing Partnerships: The Perspective of a Rural Hospital CooperativePDF (1/94)    


A Pause On The Road To Rural Hospital Equity (11/92)

On Being An Advocate (10/92)

Government Intervention in the Private Sector?  (7/92)    


Efficient Rural Health Care(10/91)    


"Rural Wisconsin hospitals work cooperatively to maximize community-controlled services"PDF (12/81)

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