Amid the heated debate over health care reform, La Crosse has drawn national attention as a model for end-of-life planning.
Both of the city's medical centers have used an advance directive program - a means of having patients stipulate what medical care they want at the end of life - for more than 15 years.
The practice has earned praise from media and even former Republican House speaker Newt Gingrich, even as the same concept came under fire in the proposed health care reform bill.
Bernard Hammes, medical ethicist at Gundersen Lutheran, has appeared on ABC's "World News Tonight" and "Good Morning America" touting the program's success at Gundersen Lutheran and Franciscan Skemp.
It since has been adopted at more than 60 sites in the U.S. and throughout Australia, Hammes said.
He disputes the claims that including advance directives in a national health care plan would lead to the government controlling the level of care.
"The bill was simply providing a benefit to all adults in this country so these conversations about end-of-life care become routine, and there's some reimbursement to physicians," Hammes said. "This is not as scary or frightening as people think."
Hammes and Nickijo Hagar, Franciscan Skemp vice president of mission and organizational development, in 1991 spearheaded the La Crosse Medical Centers Task Force on Advance Directives, which worked to educate the community on the importance of advanced planning.
"The research shows when a loved one is put into a position of guessing what a spouse or family members wants, they often guess wrong," Hagar said.
The original goal was to have 50 percent of patients have an advance directive before they had a medical crisis, Hammes said. But since the program began in 1993, virtually all patients at both medical centers have written advance directives, Hagar said.
Research indicates advance care planning can increase quality of care and reduce costs, he said. Patients in La Crosse have half the number of hospital days that other cities have, he said, and cost about $6,000 less per patient.
When asked about end-of-life care, most people say they'd prefer to die at home, surrounded by loved ones, with some level of comfort, Hagar said.