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Last week I was out of the office on Thursday afternoon to participate on a TV program called the Iowa Journal, produced by Iowa Public Television.

At the Iowa JournalPaul Yeager, the show’s host, contacted me a few weeks prior regarding my recent hire as director of social media at the Iowa Hospital Association and asked me to appear in the studio to join their discussion on social media.

In the studio I was joined by Michael Libbie, principal and owner of Insight Advertising, Marketing & Communications, a Des Moines-based advertising agency that specializes in traditional media messages from print to television to social media. Michael also hosts a number of radio shows in the Des Moines market dealing with issues revolving around advertising and the rural lifestyle.

Iowans connecting with social media

Paul Yeager opened the show with some descriptive analysis of the various social media platforms in use today, while our 19 minute studio session made up the second portion of the half hour program.

Our discussion covered several questions about what social media is, how businesses are using it and whether or not it is making our lives better. Michael Libbie described how Insight Advertising has leveraged these new types of tools to the benefit of their clients. My role on the program was to talk about why I was hired at IHA and how we are using social media to interact with our member hospitals and health care professionals across Iowa.

Watch the episode online

This episode of the Iowa Journal also featured a friend of mine who has started his own social media consulting company, Lava Row, and includes footage from a tweetup, a meet up of Twitter users, held in Des Moines a month ago.

You can watch this episode of the Iowa Journal in its entirety on the IPTV website.

Iowa Journal Episode 230 on Social Media

For more on the day’s activities, take a look at the post on Paul Yeager’s blog, Public Paul and Media, or Michael Libbie’s post on the Insight Advertising blog.

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Approximately 25% of the U.S. population lives in rural areas, but only 10% of physicians practice in rural areas.  This maldistribution of physicians over the last several decades has occurred for many reasons:

  • Medical education in the United States has become specialized, centralized and urban.
  • Many practitioners emerge from medical programs with a staggering amount of debt and go on to practice in urban areas, where they often receive a higher salary.

More doctors is not the answer

Simply increasing medical school slots is not the answer. According to the Robert Graham Center: Policy Studies in Family Medicine and Primary Care, “Sizeable growth of the physician workforce in the last two decades has not resolved the maldistribution of physicians.”  On March 24, 2009 — House Energy and Commerce Committee Chairman Henry A. Waxman said that a congressional overhaul of the health care system must not only provide for universal coverage but also for more primary care doctors and nurses to ensure that an insurance card actually gives the holder access to treatment.

Physicians need to be rooted in the rural community

In a joint 2008 statement, the American Academy of Family Physicians and the National Rural Health Association stated that medical education anchored in rural places, nourished and funded through significant federal, state and local community support, and meaningfully connected to both regional academic institutions and local physicians in practice has great potential to address both present and future needs for physicians who provide care to rural populations.

DMU launches program to combat rural physician shortage with incentives

Concerned about the growing physician shortage in rural Iowa, Des Moines University (DMU) has embarked upon a “grow your own” program.  DMU and its Area Health Education Center have created the Rural Iowa Provider Education (RIPE) Program.

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The RIPE Program provides specialized education, training and tools to better prepare students for service in rural, underserved areas of Iowa.  Because one of the known barriers for students choosing a rural medical practice is the tuition debt load from medical school, DMU has made an on-going commitment to annually provide the equivalent of six full tuition scholarships to students enrolled in the Rural Medicine Educational Pathway. In return, graduates agree to maintain a fulltime primary care medical practice in an approved Iowa community for a period of four years.

Are plans like DMU’s RIPE the answer to the shortage of physicians in rural areas? Are there other concerns or issues at hand? How would you bring more physicians into rural areas?

You can find more information about the RIPE Program on DMU’s website.

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iherf_logoIHA’s Iowa Hospital Education and Research Foundation (IHERF) has awarded $72,000 in scholarships to 24 college students from all parts of Iowa. The students, who are all studying in health care fields, will each receive $3,000 for the upcoming academic year and each is eligible for up to $6,000 in assistance from IHERF over two years.

IHERF Health Care Careers Scholarship Program

IHA established the IHERF Health Care Careers Scholarship Program in 2004 to help address the ongoing shortage of health care professionals and encourage young Iowans to remain in the state as they establish their careers. The first scholarships were awarded in 2005, and now more than 100 students have benefited from the program. In exchange for financial support, scholarship-receiving students agree to work one year in an Iowa hospital for each year they receive an award.

280 Student Submissions for 2009

The IHERF Board, hospital leaders and IHA Auxilian/Volunteer Board members from throughout the state evaluated scholarship applications from more than 280 students, who were judged on grade-point average, a written personal statement, letters of reference, and extracurricular, community and health care-related activities. Those evaluating the applications noted that this year’s group, which includes both graduate and undergraduate students, was especially competitive and highly qualified.

The next scholarship application period will begin in January 2010.

If you would like to receive an application packet at that time, send IHERF an e-mail.

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Hospitals are routinely asked to participate in surveys measuring the quality of care provided. As hospitals consider whether to invest the time and manpower into completing these surveys, they need to be assured the survey is using evidence-based metrics that promote quality and safety improvement. For that reason, Iowa hospitals have historically not participated in the Leapfrog Group Survey.

The history of Leapfrog

Leapfrog logoIn 2000, a number of large employers and public purchasers founded the Leapfrog Group in an attempt to persuade hospitals to adopt practices thought to improve the quality and safety of medical care. The Leapfrog Group initially recommended three hospital patient safety practices, or “leaps”:

  • Computerized physician order entry.
  • Staffing of intensive care units by trained intensivist physicians.
  • Evidence-based referrals for high-mortality surgeries.

Unfortunately, these leaps primarily targeted urban hospitals. In Iowa, this would equate to 18 percent of the 117 community hospitals. To quote the Leapfrog Group, “Computer physician order entry and ICU physician staffing are still considered a stretch for rural hospitals because of the staffing and resource constraints involved in fully complying with them.”  This may lead one to question why Leapfrog  set forth benchmarks that hospitals would be unable to achieve.

The Leapfrog Safe Practices Survey and response from JAMA

JAMA logoIn 2004, Leapfrog adopted a fourth initiative, the Safe Practices Survey. Leapfrog said this would allow all hospitals to report efforts toward implementing the National Quality Forum’s Safe Practices for Better Healthcare.

Fast forward five years to a study just published in the April 1 edition of the Journal of the American Medical Association. That study showed hospitals that ranked highly on the Leapfrog Group’s Safe Practices Survey had about the same inpatient mortality rates as facilities with lower rankings.

In a written response, the Leapfrog Group said that the study addresses only one of several elements of the hospital survey, adding that the data used in the comparison “limits the conclusions that can be generalized from the study.”

The Leapfrog Group adds that although the process and structure measures in the Safe Practices Survey are “perfectly sensible…clearly we cannot assume that structural and process improvements automatically lead to the outcomes we desire.”  This explanation from Leapfrog echoes Albert Einstein, who said, “Not everything that can be counted counts, and not everything that counts can be counted.”

Iowa hospitals continue to receive high marks

In study after study, Iowa hospitals continue to rank at the top of the leader board for quality patient care. Part of this success can be attributed to the ongoing work of the Iowa Healthcare Collaborative, a provider-led nonprofit organization designed to promote rapid cycle clinical performance improvement. IHC’s initiatives facilitate engagement, the sharing of data and the rapid deployment of best practices. IHC highlights success stories and reports on clinical performance information in its 2008 Iowa Report. The IHC Board has also affirmed its position that Iowa hospitals not report to the Leapfrog Group.

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Questions?

Do you have questions about the Leapfrog Group survey or IHA’s position on this issue? Please leave a comment and a member of IHA’s staff would be happy to respond.

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Nearly everyone agrees that the more than 50 million uninsured Americans are placing an enormous burden on the nation’s health care system.  Understanding the pressures that uninsured citizens place on the overall health care system has prompted many advocacy groups to organize over the years.  These groups generally agree on the desired outcome (health care for all, universal coverage etc.) but disagree on the particular means for achieving that end.

With health care reform, because of the complexities of current payment and coverage system, it is easy for some advocacy groups to try and advocate for an approach that, on paper, looks great and appears to have all of the answers.  But these proposals often fail to take into consideration the impact they could have on the system as a whole and the providers of health care like hospitals and physicians.

On health care coverage solutions, this is the case.  There are several groups who agree that the number of uninsured need to be reduced in America, but each of these groups has outlined vastly different methods of doing so.

The debate on this issue in Congress is shaping up to be, perhaps, the largest and most contentious battle this Congress will face this year.

Without a doubt, hospitals agree that when more people have health insurance both the patient and the hospital are in better financial shape.  But the question that keeps coming back to the table is just how exactly would all of these different proposals work? And who, if anyone, has the right answer?

Below are samplings of the top health care coverage reform concepts outlined and supported by many advocacy groups.   IHA invites readers to review the proposals listed below and share comments on which approach (or combination of approaches) would be the best solution to guarantee health care coverage for all Americans.

Single Payer:

A single-payer health care system is one, as modeled in some other countries like Canada, that would be the sole payer for health care as well as the sole provider for health insurance nationwide.  Citizens would pay the government, which in turn would pay the health insurance claims.  Advocates for a single-payer system like the Physicians For A National Health Program argue that that the advantages include administrative simplicity for patients and providers, and resulting significant savings in overhead costs.

Medicare-Like Coverage System:

Others advocate for an expanded “Medicare-like” or “Medicare For All” public health insurance option administered by the Federal Government.  This type of program would be available to the uninsured and would use the existing Medicare program’s infrastructure.  Potential pros would be that the current Medicare infrastructure is already in place and could be ready quickly to accept new enrollees.

State-Run System:

Another approach would give states the power to decide on methods aimed toward enacting universal health care coverage plans.  One option would be for states to allow individuals to purchase coverage through the state employee plans, or provide comprehensive statewide health care reform as seen in Massachusetts.

Third-Party Administrators:

In the Senate Finance Committee Option Paper on health coverage reform, it was proposed that a public health insurance option be created where multiple government-run regional third-party administrators would provide coverage.  These administrators would be required to establish networks of participating medical providers as well as payments for participating providers.

No Change:

Is there enough good (or potential) in the current system that could be used to argue against the need for massive reforms to the system?

IHA is eager to hear your thoughts and comments on the health care reform issue.  Over the past several months, IHA and many other health care stake holders have been working with elected officials to help provide the hospital perspective on this issue.

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