Dartmouth is a natural for this sort of endeavor primarily because it is home to the Dartmouth Institute for Health Policy and the Dartmouth Atlas of Health Care, which have been studying variation in health care delivery and spending for a couple of decades.  But while the Atlas gives Dartmouth the data, the college’s home state, New Hampshire, isn’t exactly a shining example of health care value. 

At more than $7,800 per Medicare recipient per year, New Hampshire spends nearly 20 percent more than Iowa ($6,686).  Of course, that’s not nearly as bad as nearby Massachusetts ($9,568) or New York ($9,995), both of which should provide convenient laboratories for what not to do for value-based health care delivery. 

This is worth noting because of something Dartmouth’s president, Jim Yong Kim, mentioned when the center was announced over the weekend.  According to Associated Press coverage of the story, Kim and state leaders have “discussed using the center to make New Hampshire a model for innovative health care.” 

This brings one thought immediately to mind: Why not Iowa? 

Obviously, Dartmouth has every right and reason to focus on its home state.  But this deserves serious consideration in Iowa, where IHA has made “value” a health care watchword.  Certainly, the tools and the people are there. The Iowa Healthcare Collaborative has united hospital and physician interests under the value flag and, like the Dartmouth Atlas, has become a vast data collector.  

The University of Iowa (UI) and Des Moines University both offer excellent schools of health care administration and medicine with easy access to not only urban medical centers but also nearby rural referral centers and Critical Access Hospitals, many of which are on the cutting edge of innovative health care delivery models.  The schools of engineering at UI and Iowa State, along with major businesses (including hospitals) that have adopted ideas like Lean and the Toyota model of process improvement, offer expertise and laboratories for systems analysis. 

What Iowa doesn’t have is seed money, like the $35 million that was anonymously donated to fund the Dartmouth center.  Perhaps if we can broaden our state leaders’ views on what drives a healthy economy (hint: it’s more than wind turbines and gambling halls) and quality of life (more than good schools and smooth roads) to realize the impact of high-value health care, some investment capital might emerge.

IHA has been meeting in-person with each of the offices of Iowa’s congressional delegation and has drafted a delegation letter to CMS urging immediate action on this issue.  To date, Senator Tom Harkin, and Representatives Leonard Boswell, Steve King, Tom Latham, and Dave Loebsack have all confirmed their support on the issue and have agreed to sign onto the letter.  Staff from the offices of Senators Chuck Grassley and Harkin have also been in contact directly with CMS to outline their concerns and staff for Senate Finance Committee Chair Max Baucus have been in communication with CMS on this issue as well.

Earlier this week, CMS hosted a rural health open door forum conference call and spent most of the time discussing physician supervision.  CMS acknowledged the arising complications and encouraged hospitals to continue reaching out to help CMS understand the “real-world” impact of its policy.

CMS verbally qualified its position by stating that physicians or other allied professionals, recognized in the outpatient rule should be “fairly immediately available” and recognized that the rule doesn’t anticipate clinicians “hanging around the emergency department” with no knowledge of anticipated patient arrivals.  CMS stated that determination of “immediately available” is essentially at the discretion of the hospital.  CMS also acknowledged that this billing policy predominantly creates an issue with observation status, which is currently billed as a therapeutic service.  However, CMS stopped short of backing away from the rule as written, but confirmed that further written guidance will be provided on this topic.

IHA will continue working with Iowa’s Congressional Delegation, the Senate Finance Committee staff as well as the American Hospital Association to seek clarification and resolution of this issue.  Pending further guidance from CMS, IHA will survey Critical Access Hospital members to further refine its understanding of the scope of the problem and potential solutions.

Ringgold County Hospital will open in its new facility on December 20. The hospital replaces a building that was built nearly 60 years ago.

The new facility will provide many advantages compared to the old hospital, which was built in 1951. One of the most important aspects of the new building is the efficiency of space. The new medical complex is 61,000 square feet, a vast improvement over the old, land-locked hospital with 38,000 square feet.  With the additional space, many of the medical areas and services will become more departmentalized.

The new one-level facility will also have two entrances. The south entrance will be for patients, visitors and employees, the north is for delivery and ambulance services. The helipad will be in its own area on the north side of the building. This will eliminate the problem of re-routing traffic and parking that existed at the old facility, where he helipad is in the center of the parking lot.

Other new additions patients can expect to see will be 16 private patient rooms and seven dialysis stations. With the seven dialysis stations, it will ease the problem at the old facility of patients having to start dialysis treatment at 4:30 a.m.so everyone can get through. There will also be radiant heating panels above each station.

Construction on the new hospital began in October 2008.

Ringgold County Hospital employs more than 120 people and has a $7.2 million impact on the area.

Support ’em with makeovers
Jane Klingson, a volunteer cosmetologist at the Trinity Regional Medical Center Cancer Center, sees her work with the Look Good … Feel Better program as more than a chance to make a difference.  It’s helping cancer survivors or women fighting cancer get back what they might have lost to the disease.  November 9, Fort Dodge Messenger)

Iowa State engineers develop 3-D software to give a view inside the body
James Oliver picked up an Xbox game controller, looked up to a video screen and used the device’s buttons and joystick to fly through a patient’s chest cavity for an up-close look at the bottom of the heart.  And there was a sight doctors had never seen before: an accurate, 3-D view inside a patient’s body accessible with a personal computer.  (November 11, Genetic Engineering & Biotechnology News)

Unity receives grant money to help flood victims
Help is available for Muscatine County residents still feeling overwhelmed by the 2008 flood or other natural disasters.  Unity Healthcare New Horizons recently received a $19,360 grant to help prevent substance abuse in connection with natural disasters and to treat flood survivors who are struggling with substance abuse or other issues. (November 7, Muscatine Journal)

Local medical team returns from Kenya
Michele Burnes, a physician’s assistant at the Urbana Family Medical Clinic and at Virginia Gay Hospital, and Sharon Dieter, a nurse at Virginia Gay Hospital, recently returned from Kenya, where they were part of an eastern Iowa team working at a medical clinic founded by Spanda, Inc., a non-profit organization founded by Cedar Rapids optometrist DeAnn Fitzgerald.  (November 11, Cedar Valley Daily Times) 

McDonald house, Miller provide needed support
Brenda Miller’s job goes beyond fund-raising and administrative work. As executive director for the Ronald McDonald House, she often lends an ear to family members who need to talk or celebrate a milestone in their child’s life. She also works with a 26-member board of directors and manages a staff of four people.  (November 11, Des Moines Register) 

Construction begins on new VA Clinic
It’s official – and being Veterans Day, the time and place were only fitting. On behalf of the U.S. Dept. of Veterans Affairs, members of the VA Central Iowa Health Care System formally announced the future opening of its third Community Based Outpatient Clinic Wednesday at the former Econo Foods building in Marshalltown.  (November 12, Marshalltown Times Republican)

State workers debate merits of givebacks
Unions in Iowa so rarely give up the hard-fought provisions locked into their contracts that some state employees are warning fellow workers not to do it now – even if it means 479 of them will be laid off.  (November 12, Des Moines Register) 

U.S.  Headlines

Making health care better
The crisis behind the health care debate is about one thing above all: the scattershot nature of American medicine. The fee-for-service payment system – combined with our own instincts as patients – encourages ever more testing and treatments. We’re not sure which ones make a difference, but we keep on getting them, and costs keep rising. Could the evidence-based medicine practiced at Intermountain Healthcare could be the cure for American health care?  (November 8, New York Times Magazine)

An interview with Dr. Donald Berwick
Dr. Berwick about the dynamics of the health overhaul debate. He says that most of the focus has been on cutting costs and finding the money to cover the uninsured. But often lost in the legislative tussling is a third, just as important goal: Improving the quality of care.  (November 12, Kaiser Health News) 

U.S. health care sector is a fairly green giant
According to the first estimate of the sector’s carbon footprint, the healthcare industry emits less than its share of the gases that promote global warming, compared to its size in the economy. Hospitals, nursing homes, drug companies and the rest of the sector contributed 8 percent of U.S. emissions. Hospitals are the biggest offenders, a finding that may motivate more of them to audit their energy usage and plant rooftop gardens – as one big Chicago hospital has done.  (November 11, Associated Press) 

Doctors embrace social networking
Doctors around South Florida and the rest of the country are using the social networking tools to bring patients’ families and the general public into operating rooms, sometimes sharing step-by-step medical procedures. They favor the real-time updates and videos as a way to reduce the fear factor of surgeries and educate people about the realities of certain procedures, especially new ones.  (November 11, Miami Herald)

The medical industry grumbles, but it stands to gain
The business world found plenty to complain about as it assessed the House bill that would make sweeping changes in the healthcare system and extend insurance coverage to millions more Americans. Insurers do not like the provision to create a new government-run insurance program. Drug makers oppose billions of dollars in rebates they would have to give to the government over 10 years. Medical devices are not happy about the proposed 2.5 percent tax on their products.  (November 8, New York Times) 

Current ‘death panel’ uproar echoes decades-old controversy
It was early summer. A senior federal health official wrote a memo suggesting that living wills – documents that can convey patients’ wishes about when to end life support – could help curb health-care costs. The memo leaked to the media. By August, a New York Times’ column said the official ‘likes euthanasia.’ Sound like this year’s angry August? Well, this story unfolded in 1977.  (November 10, Kaiser Health News) 

Dutch view of choice in U.S. care: it’s limited
The health system in the United States may be twice as expensive as those in Europe, and the population may be less healthy, but at least Americans have access to many more choices of doctors and insurers. Right?  No, says Ab Klink, the Dutch health minister.  (November 9, New York Times)

Iowa Headlines

In Iowa, Knoxville Hospital and Clinics was listed among the best hospital blogs.  The blog penned by Todd Linden, CEO of Grinnell Regional Medical Center, is also listed, and so is IHA’s blog. 

As for Nurseblogger…well, we’re not exactly sure who or what this is, although it seems to have something to do with helping nurses earn their bachelor’s degrees.  But they do seem to know health care and good hospital-related blogging when they see it.

The eight hospitals participating in the demo project used a central hospital in Duluth to review all medication orders after rural hospital pharmacists were off duty.

According to the report funded by the Agency for Healthcare Research and Quality and appearing in the American Journal of Health-System Pharmacy, pharmacists at the hub hospital identified potential drug problems for patients in the rural hospitals n more than 700 occasions in the first 20 months. Researchers compiling the report suggested that the ARPOE system played a large role in providing safer patient care than if no pharmacist had been available to review orders.

As health IT continues to assist hospitals in providing better care, similar networks such as this may prove to be effective in assisting critical access hospitals who need help or additional resource.

[via AHRQ]