On June 16-17, the Iowa Hospital Association hosted its summer leadership forum: Reform and the Road Ahead. Conference objectives were to discuss the current MedPAC recommendations regarding health care payment reform, how scale matters in health care and what the impact of the current U.S. economy will have on the entire health care industry.

The following video is the second in a two-part series of interviews conducted with a couple of the forum’s esteemed speakers. IHA had the chance to speak with David Swenson, Associate Scientist, Department of Economics at Iowa State University. Swenson provides his unique perspective on where the country is at in the current economic recession and how it may affect the economics of health care in the near future.

Part one of the series was posted last week and featured Herb Kuhn, President and CEO of the Missouri Hospital Association (Jefferson, MO), who discussed his thoughts on how health care reform will impact states like Iowa and Missouri.

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

On June 16-17, the Iowa Hospital Association hosted its summer leadership forum: Reform and the Road Ahead. Conference objectives were to discuss the current MedPAC recommendations regarding health care payment reform, how scale matters in health care and what the impact of the current U.S. economy will have on the entire health care industry.

The following video is the first in a two-part series of interviews conducted with a couple of the forum’s esteemed speakers. IHA had the chance to speak with Herb Kuhn, President and CEO of the Missouri Hospital Association (Jefferson, MO), on how health care reform will impact states like Iowa and Missouri.

Part two of the series will be posted next week and will feature David Swenson, Associate Scientist, Dept. of Economics at Iowa State University. (Update: click here for part 2)

YouTube link: http://www.youtube.com/watch?v=nWSOlXI7qiA

President Obama will hold the first in a series of “tele-town hall” meetings today with seniors across the country.  The president, joined by Secretary of Health and Human Services Kathleen Sebelius, focus on the upcoming $250 rebates for seniors on Medicare who fall into the so-called prescription drug “donut hole.”

Due to a flawed formula, many who use the Medicare Part D prescription drug program do not receive the needed level of benefits leaving them on the hook for much of hte cost of prescription drugs.  The health care reform bill included rebates to beneficiaries affected by this and hopes to offset some of the cost.

The president will also take questions from seniors across the country as well as discuss efforts to combat senior scams and fraud in advance of the first mailing of the rebate checks.  An estimated four million seniors nationwide will receive rebate checks.

The event will be broadcast on C-SPAN and can be seen from the following locations in Iowa:

National Council on Aging
Iowa City Johnson County Senior Center
28 South Linn Street
Iowa City

Alliance for Retired Americans
Machinists Hall
2000 Walker
Des Moines

Alliance for Retired Americans
Black Hawk Labor Temple
1695 Burton Ave
Waterloo

Alliance for Retired Americans
IBEW 405
1211 Wiley Blvd. SW
Cedar Rapids

Cedar Falls Senior Center
528 Main Street
Cedar Falls

Buchanan County Senior Center
400-5th Avenue
Independence

Marshall County Senior Center
20 ½ E. State Street
Marshalltown

Kimball Ridge Senior Center
2101 Kimball Avenue
Waterloo

Researchers at the Dartmouth Atlas of Health Care are reacting to a recent New York Times article with pointed criticism.  Principal scientists Elliott Fisher and Jonathan Skinner said they are “disappointed” in the article’s attack on the veracity of Dartmouth Atlas data, which has been widely cited and highly influential with regard to health care reform.  

The two scientists go on to point out several factual errors and misrepresentations in the article.  Among the errors: the Times claims Dartmouth data does take into account quality of care; Fisher and Skinner show that the atlas does indeed contain quality data.  The article also claims that “neither patients’ health nor differences in price are fully considered by the Dartmouth Atlas”; the scientists respond that risk adjustments are included in their studies.  As for price, they point out that because their investigations focus on actual measures of utilization, price adjustments are not necessary, though fully price-adjusted expenditure data is also available on the Dartmouth Atlas Web site, just the same. 

Rather than the Times article, which cites “critics” of Dartmouth’s work but fails to present any substantial criticism (or at least none that can hold up to scrutiny) and Skinner and Fisher describe as “superficial,” the researchers urge readers to take the time to read their initial but very thorough responses to the reporters’ questions, which the Times posted as a sidebar. 

In an article that ran in the Dartmouth campus newspaper, Fisher reiterated that the Dartmouth Atlas findings – essentially, hospitals that spend more on high-intensity health care “are less likely to deliver safe and effective care” – remain largely undisputed in the scientific community.  

“All of this research and all the findings they cite [in the Times’ article] are consistent with ours,” Fisher said. “The Times is not helping advance the public’s understanding of what’s going on.” 

Fisher went on to say that the potential remains to save “about 20 to 30 percent of health care spending” if more hospitals engage in “better performance measures, greater accountability and payment systems that reward improved performance.”

Like the scientists at the Dartmouth Atlas, IHA and Iowa’s hospitals are committed to understanding variations in health care delivery for the purpose of ensuring access to high-value health care.

 The New York Times, meanwhile, appears less interested in improving health care and more interested in creating controversy where there is none.

Under the tab of “why didn’t we think of that” comes news that Dartmouth College is establishing the “Dartmouth Center for Health Care Delivery Science.”  The center’s basic mission is to show how health care can be improved without increasing costs and how costs can be lowered without impacting quality. 

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.