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:

Donald Berwick

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.

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. 

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.

Charles Grassley

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.

It is very important for hospital leaders to attend these forums to address concerns and share ideas.  IHA has produced talking points for hospital advocates to use while addressing Iowa’s congressional delegation in these meetings.  Our health care reform hospital talking points have been updated to include the recent announcements of major cuts to Medicare.

Events hosted by Senator Grassley

Grassley is the ranking member on the Senate Finance Committee that oversees the Medicare program and other health care finance related issues.  He is not holding specific hospital meetings, but will be holding the following events:

Events hosted by Senator Harkin

Harkin chairs the Health, Education, Labor and Pensions Committee’s Prevention and Public Health Working Group charged with crafting the prevention and public health components of the health reform bill. Notice time change for Cedar Rapids.

Attending an event? Send us your feedback

If you attend any of these events, feel free to send us your notes or feedback about what was discussed. We’d love to continue these conversations on our blog.

Content can be forwarded to Dan Royer.

Social media penetrates politics and the public

This leads us to today, when individuals, groups and companies are using freely available technology to engage loyal supporters and introduce their messages to people who may never have heard them before.  Aside from consumers and private-sector organizations, these users also include members of local, state and federal government.

What was once often only discussed behind closed doors or in whispers between party members is now made available to consume in the public forum.  This new age of transparency and interaction allows people to make opinions and thoughts known before they have the chance to pass through political filters or press secretaries.

Be ready for real-time feedback and responses

A recent example includes several messages sourced from Senator Chuck Grassley (R-IA) illustrating his frustration with President Obama, who was making a stop in Europe last week.  There is nothing new about Senators and politicians having disagreements with the president, but the channel through which Grassley’s views were presented and the public availability of said comments would have been unheard of just a few years earlier.

Grassley posted several messages on his Twitter account, a microblogging social network where users can exchange short messages with friends, addressing his concerns with the president:

“Pres Obama you got nerve while u sightseeing in Paris to tell us ‘time to deliver’ on health care.  We still on skedul/even workinWKEND.”

“Pres Obama while u sightseeing in Paris u said ‘time to delivr on healthcare’ When you are a ‘hammer’ u think evrything is NAIL I’m no NAIL.”

These messages from Senator Grassley were seen by at least 11,000 people who follow the senator’s messages (tweets) directly, while hundreds and perhaps thousands more read them as the media caught wind of the story.  There is nothing inherently wrong with what Grassley posted (and they are still available to see at http://twitter.com/chuckgrassley), but the message and the lesson are that we need to be aware of the tools that surround us and know how best to use them.

People are out there talking; are you ready to listen?

Conversations are taking place all over the world about the topics, issues and concerns of everyone, just as they always have.  The new problem is understanding how those messages can spread and what role we play in addressing or interacting with them.

IHA has taken a strong stance in the realm of social media – this interactive, participatory two-way type of dialogue – by establishing our own grounds online and staking claim to the issues most important to Iowa’s community hospitals.  As the voice of hospitals and health care in Iowa, it is IHA’s responsibility to be represented wherever discussions are happening, be it on Capitol Hill or Facebook.

Apart from the IHA Web site, the blog acts as IHA’s authoritative clearinghouse for contact via social media with the public and beyond.  All of our interactive actions direct back to this home base in an effort to clarify IHA’s mission, vision and values.

As IHA continues along this path into the future of communication and dialogue, it will adapt to change, but the core existence and purpose will remain:  supporting the missions of Iowa’s hospitals.

Looking to learn more about how IHA is engaging individuals and influencers by using these social technologies? Keep reading our blog and see the about page for more details.

What questions do you have? How are you using these techologies to impact your goals?

However, long before you could follow The Ellen Show or Ashton Kutcher on Twitter, U.S. Senator Chuck Grassley was posting (also called “tweeting”) with the service while at events in Iowa (see Grassley’s first tweet from November 26, 2007).

Tweets from the Senator encompass what he is up to during the day and read as if he was holding a conversation one-on-one with his audience.

Whether it be “Ran in 45degree weather Tues morn. On way frigid iowa. Don’t LOL. TTYL” or “Just finishd hour long meeting in Rep caucus w Obama. He was recd well. Good discusion on stimulus and recession,” Grassley uses the 140-character platform to inform his 4,900+ followers about current issues, upcoming appearances and his role as a representative of the state of Iowa.

In February 2009 Grassley made Politico.com’s list of “10 most influential D.C. Twitterers,” which is impressive considering the number of legislators now joining the flock in D.C. tweeting with their constituents.

Tweet Congress Tracks Legislators on Twitter

The number of Congress members using Twitter has grown so much that a website called Tweet Congress launched to help citizens track which of their legislators were on Twitter (and enables users to petition those who’ve not yet made the jump).

Of the seven legislators serving the state of Iowa, just three are active on Twitter, with Grassley greatly overshadowing the others in terms of followers, number of messages posted and time using the service.

Iowa Legislators on Twitter

• Sen. Charles Grassley joined Twitter in November 2007 and has posted the majority of his 130 updates via text message. Follow @chuckgrassley for updates.
• Rep. Thomas Latham joined Twitter in November 2007, but has only posted 15 updates since then. He is becoming more active in recent months. Follow @tomlatham for updates.
• Rep. Leonard Boswell joined Twitter in March 2009 and is excited about it. Follow @leonardboswell for updates.

Iowa Legislators NOT on Twitter

• Sen. Thomas Harkin isn’t on Twitter. Sign the TweetCongress petition asking him to join.
• Rep. Bruce Braley isn’t on Twitter. Sign the TweetCongress petition asking him to join.
• Rep. Steve King isn’t on Twitter. Sign the TweetCongress petition asking him to join.
• Rep. Dave Loebsack isn’t on Twitter. Sign the TweetCongress petition asking him to join.

Follow the Iowa Hospital Association on Twitter

As IHA continues to stay on top of developing trends, we’ve also launched a Twitter account of our own (@iowahospital) to keep interested parties aware of relevant information and announcements.

You can visit our Twitter profile and read the latest updates, or create an account on Twitter and subscribe to our updates by clicking the “Follow” button on our Twitter profile.

At the health care reform summit last week, President Obama told attendees, “The time for reform is now and these regional forums are some of the key first steps toward breaking the stalemate we have been stuck in for far too long.  The forums will bring together diverse groups of people all over the country who have a stake in reforming our health care system and ask them to put forward their best ideas about how we bring down costs and expand coverage for American families.”

The forum will be hosted by Iowa Governor Chet Culver and, according to a statement released by the White House, the dialogue will include “participants ranging from doctors to patients to providers to policy experts.  They will be open conversations with everyday Americans, local, state and federal elected officials both Democrat and Republican, as well as senior Obama administration officials.”

The Iowa event will be held in Des Moines on March 23 and is tentatively scheduled to be located at the Polk County Convention Complex.  The governor’s office has indicated that 200-500 individuals representing a wide variety of perspectives on the issue will be invited to attend.  The conference will begin with a video recorded by the president, a summary of the findings from the Health Care Community Discussions that took place in December and an overview of the discussion that took place at the White House Forum on Health Reform.

“The governor is thrilled that the White House has chosen Iowa to host one of these important health care meetings,” Culver spokesman Troy Price said.  “So many Iowans and Americans face challenges to accessing quality, affordable health care every single day.  Now they will be given an opportunity share those concerns.”

Iowa Senators Tom Harkin and Chuck Grassley have both indicated they plan to attend the forum.

A live video stream of the forum is intended to be available on the newly created Health and Human Services Web site at www.healthreform.gov so that the public can be involved in what is being discussed.