Hospitals and hospital leaders across the state are celebrating significant milestones on their calendars in recent days, but there is a particularly notable occasion that IHA would like to recognize: the 5^th anniversary of the Iowa Healthcare Collaborative (IHC).

In 2005, through the visionary board leadership of the Iowa Medical Society (IMS) and IHA, a new organization was formed:  A hospital and physician-led statewide collaborative, the first of its kind, with a mission to facilitate exceptional health care quality and safety for all Iowans.  Financially supported by IHA, IMS, major health systems both within and on the borders of Iowa and community partners, IHC truly is a major “collaborative” effort.  

Recently, IHC held its annual conference with the theme of “Leading Transformation.”  This is a very appropriate moniker as we recognize many accomplishments by Iowa hospitals and physicians worthy of celebration:

• In 2010, here is a sampling of what the numbers show for Iowa hospital implementation of bundles of best practice defined by the Institute for Healthcare Improvement nationally.  (In each case, fewer than 20 percent of Iowa hospitals had implemented when first measured in 2006.):

                   - 62 percent have fully implemented rapid response teams.

                   - 84 percent fully implemented the acute myocardial infarction (AMI) care bundle.

                   - 84 percent fully implemented the surgical site infection bundle.

                   - 76 percent fully implemented the methods to high alert medications.

                   - 79 percent fully implemented pressure ulcer care bundle.

                   - 90 percent fully implemented heart failure care bundle.

• Influenza vaccination of health care workers in Iowa hospitals has increased from 68 percent in 2007 to 91 percent in 2010, one of the top rates in the U.S.
• IHC has initiated a statewide hospital reporting of health care acquired infections for eight measures.  In the three years of voluntary reporting, the variation in coronary artery bypass graft surgical site infection has been cut in half, hysterectomy surgical site infections reduced by 25 percent and a dramatic seven-fold reduction in central line infections variation.  Iowa hospital averages best national averages in each category.  And improvement is already being shown in MRSA infection rates after only two years of reporting.
• Looking at Centers for Medicare & Medicaid Services indicators of quality in reporting, Iowa hospitals have improved from complying with the AMI bundle of services from 86 percent in 2005 to 94 percent in 2009; for pneumonia from 85 percent to 90 percent; and for surgical care from 73 percent to 90 percent.
• Iowa hospitals rank in the top 10 percent of states in the U.S. in each of the patient satisfaction measures.
• Iowa hospitals better the national average in the 30-day readmissions for AMI, heart failure and pneumonia.
• Iowa hospitals have shown steep declines over the last five years in deaths in low-mortality DRGs, accidental punctures or lacerations and central line-associated bloodstream infections.
• More than 50 percent of Iowa hospitals now employ Lean health care improvement to eliminate waste and improve efficiency.
• More than 250 medical professionals and hospitals have participated in the IHC efforts to deploy the “medical home” model of primary care across Iowa. 
• Thousands of Iowa hospital employees and physician leaders have actively participated in information sharing and collaboration through IHC-sponsored conferences and workshops.  A common theme: To be the best, learn from the best.

Impressive, but there is more work to be done.  Health care-associated infections need to be driven down to zero.  All Iowa hospitals need to deploy 100 percent of the clinical bundles of service (evidence-based medicine) as the medical care of the patient dictates.  Readmission rates are still too high.  Health care workers beyond Iowa hospitals need to be immunized for influenza.  Better coordination of patient care is a must.  And there is much inefficiency in the system still to be eliminated.

Milestones are important as markers on a long road and as reasons to pause for celebrating accomplishments.  More importantly, they remind us of the road ahead and the work needed to continue a productive and successful journey.

IHA has released results from its latest hospital community benefit survey, which show Iowa hospitals provided a total of $1.2 billion in community benefit.  Community benefits are activities designed to improve health status and provide greater access to health care.  Along with uncompensated care (which is made up of both charity care and bad debt), community benefits include such services and programs as health screenings, support groups, counseling, immunizations, nutritional services and transportation programs. 

IHA also includes hospital losses to Medicare and Medicaid in its community benefit report.  This is because those losses – more than $310 million in 2009 – impact the hospitals’ ability to provide community benefit. 

Providing community benefits is an essential mission of non-profit community hospitals (117 of Iowa’s 118 hospitals are non-profit) and it is also required under federal laws that cover these hospitals’ tax-exempt status.  However, those laws do not specify an “amount” of community benefit from each hospital. 

Instead, hospitals are given the flexibility to determine how to meet the specific needs of their individual communities through these programs and services.  IHA believes that flexibility is important because community needs vary, not only from hospital to hospital and community to community, but from year to year – even from month to month.  A one-size-fits-all approach to community benefit would negate that flexibility and undermine the ability of hospital boards, administrators and employees to react to community needs in a timely fashion – if at all. 

In the coming weeks, IHA will be sharing more about the unique programs and services Iowa hospitals provide to their communities.

The 2009-2010 flu season is coming to a close.  Except for localized cases in the Southeast, Maine and Hawaii, current H1N1 flu information from the Centers for Disease Control and Prevention indicates sporadic activity in most of the U.S. and no activity in Iowa and most of the Upper Midwest. 

Evaluation is underway and official reports will be published in the coming months, but one conclusion is obvious: the flu season was expected to be much worse than it actually turned out to be. 

Why? 

While the official and scientific response to that question is in the works, an interesting bit of data was provided by a recent post on the Gallup Web site.  Since September 2009, Gallup has randomly called 1,000 Americans a day and asked them, “Were you sick with the flu yesterday?”. 

For seven of the eight months between September and April, the percentage of people who self-reported flu symptoms was lower in 2009-2010 than during the 2008-2009 flu season.  The same was true for people who were asked if they had a cold the previous days.

So, surprisingly, on any given day fewer people were sick this flu season compared to that last one.  The reasons are complicated and, as noted, being figured out.

But at least partial credit for this decline goes to efforts to inform and educate the public about the flu, how to prevent its spread and, of course, constantly pushing people to get vaccinated, Gallup concluded.  People washed their hands, sneezed into their elbows, stayed home when they were sick and went out of their way to get their shots.  And they reminded their families and friends to do the same.

Hospitals played an important role in all of this.  Hospitals were not only a source of vaccine, but also a source of expert information that was disseminated to the community through a large corps of knowledgeable, trusted health care professionals. 

In most communities, no other entity – public or private – could have fulfilled the mission that hospitals did during the 2009-2010 flu season. 

Hospitals also increased their credibility in this potential crisis by setting the example – by diligently enforcing hygiene policies and pressing employees to get vaccinated.  This is why, nationwide, hospital employees had higher vaccination rates than all other health care workers – nearly 75 percent, versus about 50 percent for all other workers.  Hospitals that required vaccination had a 97 percent rate. 

Final results are still being tabulated, but expect Iowa hospitals to fall somewhere between 80 and 90 percent for their employee vaccination rates.  Not a bad result, but you can count on hospital leaders to be pushing their staffs to do better.

IHA’s latest economic impact report shows Iowa’s 118 hospitals are worth more than $6.1 billion dollars to the state’s economy.  It’s unusual to think of hospitals as economic powerhouses, but there is no denying their impact.  As the information below shows, hospitals are good for Iowa’s economic health: 

• In Iowa, hospitals now employ more than 74,000 people.  In most counties where there are hospitals, the hospital (or hospitals) are among the five largest employers – and often the number-one employer.  Even in major cities with multiple large employers, hospitals dominate.  In Des Moines, hospitals employ more people than Principal and Wellmark combined.  Hospitals in Davenport provide more jobs than even the gigantic John Deere plant.  In Council Bluffs, the Ameristar Casino is the city’s biggest single employer, but the combined workforces of the two local hospitals are much bigger. 
• These are not ordinary jobs.  Most hospital jobs require a college degree and/or specialized training and offer pay that is commensurate with that advanced education.  Because they each have a large workforce, hospitals are places where careers can be grown and leaders are created (and hospitals will typically assist employees who want to further their education).  This means hospitals are important weapons against Iowa’s persistent “brain drain,” because they are employers that attract young workers and families and help keep them in the community for the long-term. 
• Hospitals are more than the people they employ and the wages they pay as their economic impact ripples out into the community.  In Iowa, this multiplier effect creates thousands of jobs worth billions of dollars.  Hospitals buy products that support local businesses.  They support local charities and community programs with dollars, manpower and expertise that few other organizations can muster.  Hospital employees are a huge market that helps keep local dollars in the local economy.  They buy groceries, cars, fuel, homes and countless other products.  They also pay taxes that keep schools open, streets maintained and police officers on watch. 

IHA believes it is important to view hospitals through the economic lens, especially for our government leaders who control much of the revenue hospitals depend upon.  As those leaders make important economic choices (between supporting more casinos, for example, or protecting the Medicaid budget), they must remember that hospitals are a wise investment. 

Shortchanging hospitals means shortchanging Iowa’s economy and threatening its chances for future growth.

IHA has concluded a comprehensive information technology (IT) environmental assessment survey of Iowa hospitals, in accordance with the charge of the CIO/IT Director Workgroup.  Surveys were completed by 93 of the 117 community hospitals in Iowa.

Below are some selected results from the reporting hospitals:

• Ten Iowa hospitals have implemented a 100 percent electronic health record (EHR) system, while 69 hospitals are part paper and part electronic and 12 have not started implementation.
• Two-thirds of the hospitals reporting indicated the amount of capital needed to purchase an EHR system is a major barrier to full implementation.  Lack of adequate IT staff, resistance from providers and finding a system to match needs are also significant hurdles.
• Twenty hospitals have fully implemented computerized electronic systems in decision support for clinical guidelines and 49 have implemented for drug allergy and drug interaction alerts.

In looking at the entire survey results, significant progress is being made by Iowa hospitals in the deployment of EHR and other technologies. However, large barriers still exist for full-scale EHR deployment in Iowa hospitals, including lack of capital resources and physician resistance.