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.

According to the IHA DATABANK Program for January-December 2009, 79 percent of all surgeries were performed on an outpatient basis compared to 73 percent in 1998.

Percentage of surgeries performed on an outpatient basis by hospital type:

• Critical Access = 88 percent
• Rural = 82 percent
• Rural Referral = 81 percent
• Urban = 76 percent

Contact Perry Meyer at IHA with any questions.