The year 2010 will not be soon forgotten and the Iowa Hospital Association hopes this holiday greeting will help you to reflect on what was great about the past year as well as put a smile on your face.

IHA is thankful for the opportunity to represent Iowa’s 118 hospitals that are caring for the sick and healing the injured in the communities they serve each and every day of the year. Wishing the best to all members of IHA in 2011.

YouTube link: http://www.youtube.com/watch?v=dwR0AtmHrDg

Click here to download the PDF of the video’s poem.

The Des Moines Register’s December 4 editorial basically calls for two things:  the end of the Iowa Hospital Licensing Board and requiring hospitals to report so-called “never events.”  Its reasoning for both is flawed and misleading. 

The hospital licensing board is not unlike numerous other boards the state has created to help it oversee certain industries and the professionals who work in them. Two examples are the Board of Nursing and the Board of Medicine. It should come as no surprise that those boards include nurses and physicians and that the hospital licensing board includes some people with an understanding of hospital operations. These boards are designed to offer some insight on the industry so that state agencies can understand the impact of their regulations.  

Let’s be clear: Only one of the members of the hospital licensing board is a hospital employee, and none of the members serve the Iowa Hospital Association in any capacity. The board members, who are all volunteers, are expected to work in the public’s interest, and there is nothing to indicate the licensing board members have not fulfilled that obligation. 

At the licensing board’s last meeting, there were several presentations on “never events” – extremely rare medical errors such as operating on the wrong body part or leaving a surgical instrument in the body. The Register would have readers believe the board was expected to vote on regulations, then and there, that would require hospitals to report these events, but that wasn’t the case. The presentations were just part of the information-gathering process – a process that is continuing, as it should be.  The absence of a Register reporter at this meeting is likely the cause of this lack of understanding. 

No one is arguing that “never events” aren’t important or that health care providers must continue to improve quality and safety.  The question is whether reporting has improved care in the states that require it.  

There is no evidence to demonstrate that public reporting of these events has improved patient safety or the care patients receive. The states that have reporting have taken years to implement their systems, some of which remain far from perfect.  And while these states provide a resource as Iowa considers implementation, it should not be assumed that another state’s system could – or should – simply be transplanted into Iowa, as the Register is apparently advocating. 

Also, state legislatures, not regulators, implemented those requirements. They did so only after it was clear how the information would be reported and used and how those providing the data would be legally protected. And they worked collaboratively with hospitals to make it happen. 

As an appointed public official directing the Iowa Department of Inspections and Appeals, Dean Lerner’s unilateral expectations have been whole-heartedly endorsed by the Register throughout his tenure.  Yet, contrary to the inference of the Register’s articles and editorials, board members have publicly registered their “disgust” with Lerner’s lack of collaboration and leave meetings frustrated.  Any CEO of any organization would be dismissed for having a similar relationship with a board. 

Iowa hospitals have a long history of working with government at all levels to provide and improve health care. The quality and safety of health care in this state is well documented.  Proof of our hospitals’ willingness to be transparent is found not only on the Iowa Hospital Association website (www.ihaonline.org) but also on the Iowa Healthcare Collaborative website (www.ihconline.org), where hospitals have voluntarily provided a massive amount of data about their safety and quality, including infection rate data, which is much more important to the safety and protection of more than 30,000     patients cared for on a daily basis by Iowa hospitals than is reporting of “never events.” 

Like health care itself, the work of the Iowa Hospital Licensing Board is complex, important and demanding. The board should be commended for taking its job seriously and being thorough.  It is that thoroughness, as opposed to the do-it-now and do-it-my way approach advocated by one appointed official, that ensures the state improves health care with thoughtful action.

Taking a moment to reflect back on 2009, the Iowa Hospital Association staff would like to express their gratitude to all of the Iowans helping the sick and injured every day.  IHA has sent out this holiday greeting card to all of its members as a way of wishing everyone a safe and happy holiday season.

You can check out all of the IHA videos on by visiting our YouTube profile.

As news events and announcements unfold today (7/8/09) concerning the American Hospital Association (AHA), Catholic Hospital Association and American Federation of Hospitals agreement with the White House and Senate leaders on the hospital community’s financial contribution toward health reform, the Iowa Hospital Association (IHA) is providing an update on the conversations this organization has been having with Iowa’s delegation and AHA on this subject over the past two weeks.

IHA’s public policy stance on payment reform for several years has been that Medicare should move to a payment system that recognizes value.  IHA defines value as the combination of quality outcomes and resources utilized to achieve those outcomes.  Although value-based payment has coalesced around the quality measures being reported by Prospective Payment System hospitals, until recently there has not been a methodology suggested for recognizing resource use, often referred to as efficiency.

New proposals for value based payments

In the past year, the Mayo Health System has proposed a value-based payment methodology for physician and hospital payment.  To summarize, the Mayo hospital payment proposal includes the factors of mortality, patient satisfaction and spending per Medicare beneficiary.

More recently, a coalition of state hospital associations (including IHA) has devised another proposal.  This value-based payment proposal includes evaluation of quality measures by hospital referral regions and Medicare spending per beneficiary. The Mayo proposal for physician payment has been incorporated in the House health reform proposal and is intended to be incorporated in the Senate Finance Committee’s proposal. To date, neither proposal includes recognition of spending per Medicare beneficiary in proposed changes for hospital payment.

IHA has been participating in an AHA board-appointed payment reform task force to evaluate various proposals.  IHA has advocated for recognition of spending per Medicare beneficiary in this forum and believes that factoring in efficiency will be acknowledged in this work group’s final report.

However, acknowledgement in a report is not binding on AHA’s current advocacy and does not mean it will be recognized in legislation that is evolving daily.  Toward this end, IHA has also advocated with key members of Iowa’s congressional delegation that their priorities include recognition of geographic variation in spending as defined by Medicare spending per beneficiary.

IHA is not arguing for redistribution of Medicare dollars; both of these proposals suggest a payment incentive for hospitals that perform above the norm in quality and below the norm in resource use.  IHA has proposed that the total cost of doing this is less than $1.6 billion per year, reasonable given the fact that several hundred billion dollars over the next 10 years is being considered in current negotiations.

IHA has communicated to legislators that IHA’s commitment to any “deal” that national organizations are making concerning cuts in payment to hospitals is contingent upon recognition of Medicare spending per beneficiary within any value-based payment proposal.  IHA has also repeatedly communicated this position to AHA.  Unfortunately, to date this concept has not been recognized in any legislative proposal.

Hospitals need recognition of spending per Medicare beneficiary

The catalyst for AHA’s negotiation with policy makers to accept $155 billion in lower Medicare and Medicaid payments is the fundamental belief that with the coverage of 95 percent of America’s uninsured, hospitals will receive a financial windfall in the neighborhood of $170 billion over 10 years. AHA has done good work in negotiating down the overall hospital commitment to pay for health reform below this expected windfall.

However, the largest proportion of the negotiated cuts is to annual hospital payment updates, which again disproportionately impacts highly insured, low-cost states like Iowa.  This is not meant to criticize AHA, as its overall strategy (like IHA’s at the state level) is always to keep more versus less money in the system.  However, it does mean that IHA, as in the past, will continue to advocate the need for recognition of spending per Medicare beneficiary pending its “sign-off” on any proposal.

Please share your thoughts on the current state of health reform activities

There is still opportunity in at least the next two months to impact the question at hand.  Please feel free to leave a comment on this post regarding your opinion of current health reform activities.