Iowa’s community hospitals generate more than 136,000 jobs that add nearly $6.2 billion to the state’s economy, according to the Iowa Hospital Association’s latest Iowa hospital economic impact report.  In addition, Iowa hospital employees by themselves spend $1.7 billion on retail sales and contribute more than $104 million in state sales tax revenue.

“People are often unaware of the contributions that hospitals make to their local economies, including the number of people they employ, the significance of hospital purchases with local businesses and the impact of their employees’ spending for the entire region,” said Kirk Norris, IHA president/CEO.  “Just as no one provides the services and community benefits found at our hospitals, there is also no substitute for the jobs and business hospitals provide and create.”

The IHA study examined the jobs, income, retail sales and sales tax produced by hospitals and the rest of the state’s health care sector.  The study was compiled from hospital-submitted data on the American Hospital Association’s Annual Survey of Hospitals and with software that other industries have used to determine their economic impact.

The study found that Iowa hospitals directly employ 70,363 people and create another 65,783 jobs outside the hospital sector.  As an income source, hospitals provide $3.9 billion in salaries and benefits and generate another $2.3 billion through other jobs that depend on hospitals.

In all, Iowa’s health care sector, which includes employed clinicians, long-term care services and assisted living centers, pharmacies and other medical and health services, directly and indirectly provides 333,554 Iowa jobs, or more than one-fifth of the state’s total employment.

Complete information from the study, including economic impact data for each of Iowa’s hospitals, is available on the IHA website.

Fifty-four Iowa towns and cities have submitted applications to be among the first demonstration sites for the state’s Blue Zones Project, a cornerstone of the Healthiest State Initiative.  Demonstration sites are communities where Blue Zones principles will be applied with the assistance of national experts and will serve as models to other communities in Iowa.

In November, 58 communities were invited to submit applications based on previously submitted statements of interest indicating their desire to become a Blue Zones Project demonstration site. These communities were chosen based on a mixture of criteria, including civic structure and engagement and how many residents live and work within the community.  Collectively, the 54 communities that provided applications represent the geographic and demographic diversity of Iowa.

Hospitals continue to be key players and motivators in the Blue Zones process.

“Promoting healthier lives has always been the mission of Spencer Hospital and it’s really exciting to see such a great grassroots effort in our community working to achieve Blue Zones status,” commented Bill Bumgarner, CEO at Spencer Hospital. “Community members are already embracing health improvement initiatives and striving to live healthier.  We anticipate this movement continuing to grow with the potential support of the Blue Zones initiative.”

“Assuming an even greater accountability for the wellness of our community is an exciting and daunting challenge,” said Susan Thompson, CEO of Trinity Regional Medical Center in Fort Dodge.  “I am pleased the Fort Dodge community has embraced this opportunity and stepped forward in partnership. As the community hospital and leader in health promotion, we are very engaged in this process remaining hopeful while looking forward to be named a Blue Zone community.”

Teresa Newman, Trinity Regional’s healthy living manager, has been one of the leaders in Fort Dodge’s Blue Zones effort.  She said the application process was beneficial.

“Many of us on the committee were unaware of programs currently offered by various businesses in our community,” Newman said.   “This new-found awareness will allow us to work together to enhance and collaborate our current program offerings as well as develop new programs.  That was definitely an unexpected benefit of the Blue Zones application process.”

Upon assessment of the applications, up to 10 finalist communities will be announced on February 10.  These selected communities will host site visits from February 27-March 16.  This process will culminate with the selection of the demonstration sites in May.

Communities not chosen as demonstration sites will also benefit.  An Iowa “Blue Zones Institute” is being established this year to provide leadership training and tools to help leaders transform their communities, work places and home environments, using a self-directed approach to becoming a Blue Zones Community.  An online learning collaborative to showcase how communities have implemented Blue Zones principles as well as a suite of online tools is also being developed.

For more information in the Iowa Blue Zones Project, click here.

Miracles happen at hospitals every day.  Nowhere is that more evident than on the obstetrics unit – where the babies are.  This is not just where infants are born, it’s where families are made and enhanced.  It’s where lives are changed in a way that is joyous and forever.

But there was no miracle for the twin girls born late last week and then found dead in the trunk of their mother’s car in Story County.  Now their mother, Jackie Burkle, is facing murder charges.  Few details have emerged about the case, but there is only real question:  Why?  What would lead a young woman to give birth and then allow – if not purposely bring about – the deaths of her infant daughters?

This is particularly frustrating for hospitals and the people who work in them, not only because they are mission-bound to protect lives, particularly the lives of children and other vulnerable people, but because there are laws – laws that hospitals advocated for – to help these mothers in distress and their babies.

Iowa’s “safe haven” law was put on the books in 2001.  Under the law, which was strongly supported by IHA, unwanted babies age 14 days or younger can be surrendered at a hospital or even a nursing home.  The law provides that the child’s parents will be immune from prosecution (assuming the child is unharmed), their identities will be kept private and the child will be cared for and eventually adopted.

Fourteen Iowa infants have been adopted under the law.  But, sadly, at least a half dozen have died since then in circumstances similar to those playing out in Story County.

In response, IHA worked with the Iowa Department of Human Services (DHS) and former Iowa First Lady Mari Culver to produce television (see video below) and radio ads in 2007 that explained the law and promoted hospitals as safe havens.  The ads ran that summer on television and radio programs that were popular with young people.

Up to that time, nothing formal had been done to publicize the law.  With information and assistance from IHA, hospitals put up signs and promoted the law with their local media when it was first passed.  But, except for that summer nearly five years ago, no money has ever been allocated by the Legislature to keep the public aware of safe havens.

Maybe it’s time that a coalition of Iowa human and health services organizations (including hospitals) – as well as state agencies – figured out how to ensure that a minimal year-to-year effort is made to raise safe havens awareness.  It may never be enough to keep these tragedies from happening, but safeguarding the lives of newborns deserves more than nothing.

The innovative Undergraduate Rural Medicine Education and Development (URMED) program created four years ago in Storm Lake through a partnership between Buena Vista Regional Medical Center (BVRMC) and Buena Vista University (BVU) has reached another milestone.

Beginning this month, Lakes Regional Healthcare at Spirit Lake will join the network of hospitals participating in URMED, which also includes BVRMC, Humboldt Community Hospital, Loring Hospital in Sac City and Pocahontas Community Hospital. The increase in hospital participation also created an additional internship position in the program.

BVRMC provides experiential learning opportunities throughout the academic year for BVU students pursuing careers in medicine and other health care professions, says Dr. Richard Lampe, professor of biology who helped develop the URMED partnership. Lampe is also current chair of the BVRMC Board of Trustees.

The capstone of the URMED program is an intensive January internship for selected BVU pre-med students who have an interest in practicing rural medicine. Students compete for the January internship slots, which include $3,000 stipends to help defray the costs of applying to medical school.

The URMED program was designed as one possible solution to the impending national shortage of physicians and other health care practitioners in rural communities. URMED has attracted interest from the University of Iowa Carver College of Medicine as well as a national program that seeks to interest young people in health care careers, notes Lampe.

While the URMED alumni have no obligation to return to the communities where they interned, BVU science faculty, and officials at BVRMC and the other participating hospitals stay in regular contact and build ongoing relationships with them. “We have already seen interest in several medical students in coming back to Storm Lake to practice,” notes Lampe. The URMED program is also attracting new students interested in health care careers to BVU, he notes.

Students selected for the 2012 URMED January internships are:

• Cammy Matters, a junior biology major from Humboldt
• Whitney Nelson, a junior biology and history double major from Audubon
• Alex Davis, a junior biology major from Webster City
• Sabrina Martinez, a non-traditional student from Storm Lake, who is completing her pre-med course requirements at BVU. A 2008 Columbia University graduate in political science, she is a former admissions representative and assistant director of admissions at BVU.

Matters, Nelson and Davis will each intern at BVRMC for two weeks and then one week at the hospitals in Humboldt, Sac City, or Pocahontas. Martinez will spend all three weeks of her internship at Lakes Regional Healthcare at Spirit Lake.

During their internships, the students will work alongside physicians and other health care practitioners to learn what it is like to interact with patients in hospital, surgery, emergency room and clinical settings. They can also attend lectures and continuing education programs for medical staff.

The participating hospitals and BVU, through donor support, provide the financial resources for the stipends. “This year we had nine very fine URMED applicants but could only fund the four internships,” notes Lampe. “If we had additional financial support and participation from other area hospitals we could grow the program to accommodate the interest that our BVU students are showing in rural medical careers.”

So far, six BVU graduates and two current students have completed URMED January internships. Two are now enrolled in medical schools and others are working in related fields and plan to reapply to med schools, or are in graduate programs.

Two 2009 BVU graduates, Kyle Glienke of Aurelia and James Alstott of Laurens, also completed internships at BVRMC that became the model for the URMED program, says Lampe. They are third-year medical students at the University of Iowa Carver College of Medicine and were on campus in September to talk with URMED students about their experiences in medical school.

It wasn’t long ago that the Centers for Medicare & Medicaid Services was rather tight-fisted with data like that found in this new report, in particular numbers related to annual Medicare spending per enrollee.  A few years back, when IHA was fighting to make the case that Medicare exploited low-spending, high-quality states like Iowa to subsidize states on the other end of the value spectrum, this information was as hard to find as a black cat in a coal crib.

Things have changed. Oh, Iowa is still low on Medicare per-enrollee spending, though we’ve moved from the bottom five to the bottom 10.  But at least the data is there – and there’s plenty of it to mull over as the report covers two decades of health care spending by Medicare, Medicaid and the population as a whole.  And though there are a lot of numbers, there are not a lot of easy answers about why the numbers are so different from one place to the next.

Here’s what the numbers tell us.  First, states with relatively low per-capita spending tend to have younger populations that don’t “use” a lot of health care, like Utah (median age: 28.8; annual per-capita health care spending: $5,031).  They also have another group that tends to use less care – the uninsured – like Texas (percent of population uninsured: 26 percent; annual per-capita health care spending: $5,934).

Iowa sits in the middle (28^th) for per-capita health care spending at $6,921.  This may seem surprisingly high, but it makes sense because Iowa is well insured (10 percent uninsured – only three states do better) and has a relatively large population of senior citizens (15 percent of Iowans are 65 years or older, the fifth highest rate in the nation).  Massachusetts provides the perfect storm for pushing up health care costs: nearly everyone is insured (4.4 percent uninsured) and the median age is high (39).  But most important is Massachusetts’ unrivaled density of medical providers; the state has one physician for every 189 people; in Iowa, there is one physician for every 479 people.  No wonder Massachusetts’ per capita health care spending is $9,277 (the highest of all states and 30 percent more than Iowa).

Older people are more expensive to keep healthy than younger ones, which is why in nearly every state (Alaska is the exception) more money is spent on each Medicare recipient than on the typical resident.  In Iowa, it’s about 22 percent more; in 18 states, it’s at least 50 percent more.  Some of that difference can be explained by a relatively young total population that keeps per capita costs down in some states.  However, while there are a lot of uninsured in Texas and the median age is 33 (it’s 38 in Iowa), that doesn’t completely explain why a Medicare patient costs nearly twice as much as a plain ole Texan, on average.  It certainly doesn’t make sense in Florida, where the median age is 40 but a Medicare patient costs 66 percent more than everybody else.

What about Medicaid?  Well, Medicaid doesn’t serve the same populations as Medicare – not exactly, anyway.  Most significantly, many Medicaid recipients are children or young mothers, so you’d expect Medicaid costs per enrollee to be quite a bit less than Medicare and about the same as everybody else (or somewhat higher because many Medicaid recipients are dealing with chronic health problems).  In Iowa, that’s exactly the case – the cost per Medicaid enrollee is 99.5 percent of the cost of a typical Iowan.

However, the real cost of taking care of a Medicaid patient is significantly higher – Iowa hospitals and physicians lose millions of dollars a year because of Medicaid underpayment.  But it could be worse.  California, which spends nearly $11,000 on each Medicare patient each year (ninth highest in the nation), spends only $4,569 on each Medicaid patient (the least in the nation).

Does that mean Iowa is spending too much on Medicaid?  Only if you feel ok about scores of physicians refusing to be part of the program, effectively making millions of Medicaid patients uninsured.  That is precisely what has happened in California, which is more than happy to take advantage of low-cost states like Iowa to pump up its Medicare spending, while strangling providers with ridiculously low Medicaid payments and thereby cutting off health care to millions of the state’s poorest and most vulnerable citizens.

“Wide variation” comes up a lot when discussing numbers like these and how much is spent on seemingly the same patient groups in different parts of the country.  As this brief discussion shows, there are many factors to consider.  Still, while the actual cost of providing health care may be more in Manhattan than Marengo, it doesn’t completely explain why a New York Medicare patient costs 31 percent more and a Medicaid patient costs 37 percent more than the same patients in Iowa.

It is complicated, but it starts with providing value and making value a strategic priority in every Iowa hospital.  It’s about providing quality care, not just quantity care.  And it’s about putting patients first.