Many Iowans are still unsure how exactly federal health reform and other recent health policy changes will impact their families, businesses and communities. As state and federal congressional races start to heat up, people are getting the chance to address these questions directly with the candidates.

On July 8-9, Senator Charles Grassley will be hosting the following open public town meetings in four different Iowa communities; each event is planned for one hour:

Thursday, July 8, 2010
Guthrie County Town Meeting	Audubon County Town Meeting
Guthrie County Courthouse	Exira Public Library
Public Meeting Room	114 West Washington, Exira
200 North 5th Street, Guthrie Center	4:00 p.m.
2:15 p.m.
Friday, July 9, 2010
Union County Town meeting	Madison County Town Meeting
City Hall/Restored Depot	Earlham Community Building
Council Chambers	150 East 1stStreet, Earlham
116 West Adams Street, Creston	4:30 p.m.
9:15 a.m.

It’s official: Health care reform guru Donald Berwick has been formally announced by President Obama as his nominee to head the Centers for Medicare & Medicaid Services (CMS).  The first sentence of the president’s two-sentence statement about Berwick succinctly addresses why he was chosen: “Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost.” 

Bringing real value to government-supported health care will be Dr. Berwick’s foremost challenge.  And with health care reform set to trim billions of dollars from the Medicare program while adding millions of new enrollees to Medicaid, it is a formidable challenge, indeed. 

But Dr. Berwick has two things going for him.  First, he knows what he is talking about.  His work and leadership at the Institute for Healthcare Improvement (IHI), which he cofounded nearly 20 years ago, has led to changes in the way hospitals provide health care that have saved lives, lowered costs and improved quality.  IHI’s current initiative, it’s “Improvement Map,” is perhaps its most ambitious.  

The Improvement Map is an interactive, Web-based tool designed to bring together the best knowledge available on key process improvements that lead to exceptional patient care. It offers clear guidance through the often confusing health care landscape, helping hospitals set change agendas, establish priorities, organize work and optimize resources.  The Improvement Map is also a testament to IHI’s dedication to shared learning, which it established from its beginning through collaboratives, learning networks and mentor hospitals (among these are Mercy Medical Center and St. Luke’s Hospital in Cedar Rapids, University of Iowa Hospitals and Clinics in Iowa City and Buena Vista Regional Medical Center in Storm Lake). 

But leaders succeed only when they energize followers, and that is Dr. Berwick’s other strength.  Throughout the medical world, Dr. Berwick is highly respected not only for his ideas but for his ability to bring key players to the table and keep them there.  Time and again, Dr. Berwick has been described as “a visionary.”  Hospital leaders in Iowa continue to be pleased about his nomination: 

“I was very excited to hear of the nomination of Dr. Don Berwick as the administrator for CMS,” said Jim FitzPatrick, CEO at Mercy Medical Center-North Iowa in Mason City.  “Dr. Berwick has spent his career on a quest for improving quality in the nation’s health care system.  His passion for improving processes for our patients and keeping focus on the ‘big dot’ issues to eliminate defects in care makes him the perfect leader for CMS. 

“Dr. Berwick’s appointment to CMS would be very positive for the health care industry,” said Eric Lothe, administrator at Iowa Lutheran Hospital in Des Moines.  “He has a long history of setting transformational goals for health care quality and then achieving great results.  Dr. Berwick would continue the focused work of IHI to help physicians and hospitals improve quality, reduce errors and eliminate adverse events.” 

The real question is, can Dr. Berwick’s ability to unite diverse interests come through in a U.S. Senate that remains bitterly divided over health care reform?  Can he show that not only can Medicare and Medicaid lead the way in improving care, but they can do it at less cost?  And can he hold his ground should talk of “rationing” and perhaps even “death panels” rear its ugly head? 

Answers should come fairly quickly, as Dr. Berwick’s first stop will be in front of the Senate Finance Committee and its ranking Republican, Iowa’s own Chuck Grassley.

After months of negotiations, hours of committee meetings and hundreds of amendments, the Senate Finance Committee has voted to move its health care reform bill out of the committee phase thus moving health care reform efforts closer to the finish line.

The vote was 14-9 with Senator Olympia Snowe (R-ME) as the sole Republican vote for the bill.  Snowe said in her remarks that she will vote “yes” today, but that did not mean that she will vote “yes” in the future.  Iowa Senator Charles Grassley (R) voted “no” stating in his remarks, “This bill is already moving on a slippery slope toward more government control of health care.”

The committee’s move completes the committee phase on health care reform, as the other four Congressional committees (1 Senate, 3 House) have completed work.  The Finance bill will now be melded with the Senate Health, Education, Labor and Pensions bill before moving to the Senate floor for a vote.  Meanwhile, the House continues to wait and see what results in the Senate before taking its bill to the floor for a full House vote.

Many are speculating that the health care reform debate will continue, and some are questioning whether or not a bill will make it to the president’s desk before the Congressional Thanksgiving recess in November. 

Senate Finance Committee Chairman Max Baucus (D-MT) has released a document outlining a framework for health care reform which is likely to set the stage for draft legislation for committee consideration perhaps even yet this week.

The framework lays out several key priorities and is the result of ongoing negotiations in the Senate by the “Gang of Six” (key Democratic and Republican negotiators including Iowa Senator Charles Grassley) that has been working toward a bipartisan agreement. 

One major development in the Senate’s version is that instead of a government-run public insurance option as found in the House bill, the framework rather creates a network of nonprofit cooperatives that would be charged with pooling individuals and negotiating with insurance companies and providers.

Other initiatives include the establishment of health insurance exchanges in 2010 and requiring health plans to report the amount of money they spend on items other than health care and require insurers to cover pre-existing medical conditions.

The report is broken down into seven sections:

• Immediate Relief For Families And Small Businesses
• Ensuring Affordable Health Coverage
• Promoting Disease Prevention And Wellness
• Improving The Quality And Efficiency Of Health Care
• Transparency And Program Integrity
• Fraud, Waste, And Abuse
• Revenue Provisions

Baucus is also proposing tax credits to help individuals who earn up to 300 percent of the federal poverty level, or $66,000 for a family of four, to purchase health care coverage. In addition, individuals who earn between 300 percent and 400 percent of the federal poverty level would be eligible for a premium credit as a flat percent of income.

The Finance Committee is continuing negotiations and several concepts from the framework are expected to be included in the bill draft the committee will mark-up in the coming weeks.

Click here to read the framework document.

Iowa Senator Charles Grassley heard a clear, unified message from the state’s hospital leaders at a meeting in Des Moines this week:  stay at the health care reform negotiation table and fight to fix geographic variation in Medicare payment.  Grassley, who is one of six key Senators negotiating language for that chamber’s reform bill, said he is committed to including that fix in the final bill and will “be at the table until I am pushed away.”

At the same meeting, the American Hospital Association (AHA) backed the IHA-formulated plan to address Medicare geographic variation through value-based purchasing.

Meeting with more than 30 hospital CEOs and other executives at Des Moines University, Grassley told the group he wants to understand the priorities of Iowa hospitals.  “I appreciate the help we get from AHA and the work they do, but I am much more interested in how you folks see it,” Grassley said.  “I want to be able to gauge the progress of addressing your ideas.”

Over the course of the hour-long discussion, Grassley heard several concerns related to health care reform and its impact on Iowa hospitals, including the need to address Medicare payment issues for “tweener” hospitals through a low-volume adjustment and reauthorization of the Medicare Dependent Hospital program.  Grassley said Iowa hospitals have done a great job of keeping the “tweener” issue in the forefront, noting that he now had the names of the impacted hospitals memorized.

The meeting with IHA members was one of the last for Grassley before he returns to Washington, D.C. to resume work on the health care reform legislation.  Having spent most of August hearing the concerns of Iowans at well-attended town-hall meetings, Grassley said his faith in grass-roots democracy has been revived.  He also noted he consistently heard from hospital representatives at those forums.

“For the most part, Iowans can be proud of how they conducted themselves at those meetings,” Grassley said.  “A lot of what we saw on the media didn’t reflect what I saw here in Iowa.”

Developing more specific proposals and finalizing legislation will be difficult over the next three months, said Grassley, who reiterated his commitment to a bipartisan bill.  “There are a lot of unknowns out there,” he said.  “Maybe we’ll know after the president speaks next week,” he added, referring to President Obama’s speech on health reform before a joint session of Congress on September 9.

The last time a president addressed a joint session of Congress that wasn’t a State of the Union or the traditional first address by a new president was when President George W. Bush spoke about the war on terrorism following the 9/11 attacks.

Have thoughts about the health care reform debate and how it is impacting Iowa?  Leave your comments below.