The 127 hospitals participating in the Iowa-based Hospital Engagement Network (HEN) prevented potential harm to more than 4,300 patients in 2013 and reduced health care costs by more than $51 million, according to data released today by the Iowa Healthcare Collaborative (IHC), which administers the network.
Among other improvements, participating hospitals reduced early elective baby deliveries (which can increase complications) by 90 percent; catheter associated urinary tract infections by 44 percent; adverse drug events by 28 percent; central line-associated blood stream infections in intensive care by 24 percent; surgical site infections by 24 percent; patient falls by 23 percent; and avoidable re-admissions by 11 percent.
This work has taken place as part of the federal Partnership for Patients initiative, with the goals of reducing harm by 40 percent and hospital readmissions by 20 percent. The program has helped the hospitals develop the infrastructure, expertise and organizational culture that will support further improvements for years to come. The Iowa HEN, which includes12 hospitals in Illinois and Nebraska, has accelerated improvement across the state and patients are benefiting every day from the spread and implementation of best practices.
In addition to reducing costs, the Iowa HEN reduced the time that patients spent in the participating hospitals by 17,758 days. It’s estimated that at least 32 lives were saved because of the HEN.
“Through the HEN program, Iowa hospitals and their 71,000 employees are ensuring that patients are safer when they are in the hospital and less likely to return to the hospital, all of which reduces the cost of care,” explained Tom Evans, M.D., IHC CEO. “In many ways, Iowa was already a leader in these measurements, but our hospitals have taken up the challenge to do even better – and they are succeeding.”
“Iowa physicians and hospitals are committed to raising the quality and safety bar in all parts of the state,” said IHC Board Chair Jeff Maire, D.O., of Mercy Surgical Affiliates in Des Moines. “Through that commitment we are increasing value and bending the cost curve for all health care consumers.”
The story goes that Andrew Jackson, as the nation’s seventh president, once set out a huge block of cheese to encourage ordinary Americans to visit and interact with the White House. As folklore, the story is mostly homage to Jackson’s down-home, populist image: raised in the Carolina backwoods; self-taught country lawyer; first elected representative of Tennessee to the U.S. House; national hero who defeated the British at New Orleans during the War of 1812.
There is some truth to the cheese story. In 1835, a wheel of cheese four feet in diameter and two feet thick was created by a New York dairy farmer, part of a collection displayed at a local patriotic gathering, which culminated with the largest wheels being shipped to leaders in Washington, D.C. The biggest, weighing some 1,400 pounds, found its way to the White House.
President Jackson supposedly distributed some of the cheese to friends and colleagues, but by 1837 the wheel was largely intact and still in the White House. Two years of aging and the accompanying odor pushed Jackson and his staff toward a solution, which led to a public reception where, reportedly, 10,000 visitors devoured the cheese in two hours.
The big block of cheese story, then, is more about symbolism than actual history. In addition to bringing even more color to Jackson’s already flamboyant personal story, the idea of inviting and feeding thousands of citizens inside the walls of the world’s most powerful residence reinforces how we, as Americans, view our relationship with those who govern – “of the people, by the people, for the people.”
For IHA, that relationship is put into action daily through continual advocacy efforts and comes to a head each year at our Legislative Day. For more than 20 years, IHA has invited hospital leaders and advocates to come to Des Moines, learn about the issues affecting their hospitals and share their concerns with legislators at the seat of state government, the Iowa Capitol.
Far from being merely symbolic, these personal interactions are truly affective in advancing the Iowa community hospital agenda. One-on-one conversations with legislators by hospital representatives who have come from all corners of the state make a real impression – and they make a real difference.
Time and again during last year’s Medicaid expansion debate, legislators from both sides were heard to say, “This is what my hospital is telling me.” Obviously, much of what legislators were hearing was communicated via e-mails, letters and phone messages, so imagine the impact of a face-to-face conversation, particularly if it takes place on their legislative turf.
Make no mistake, however, perception does matter. The fact that IHA, year after year, is able to bring hundreds of voters representing every state Senate and House district to Legislative Day does not go unnoticed. The sight of busloads of hospital advocates pulling up to the Capitol serves as urgent notice to rookie legislators and a stark reminder to veterans: there are real people behind those e-mails, they care about their hospitals and they are a force to be reckoned with.
That force must be re-energized and reorganized each year. For that to happen, hospital leadership is needed. IHA is known and respected “on the hill” because behind our expert lobbyists are thousands of hospital leaders, employees, trustees and volunteers ready to spring into action.
On Wednesday, IHA will be asking hospital advocates to bring their passion to Des Moines. Be heard. Make a difference. And who knows, there may even be cheese…
Iowa’s community hospitals generate nearly 120,000 jobs that add more than $6 billion to the state’s economy, according to the Iowa Hospital Association’s latest Iowa hospital economic impact report. In addition, Iowa hospital employees by themselves spend more than $1.6 billion on retail sales and contribute nearly $99 million in state sales tax revenue.
“People are often unaware of the contributions that hospitals make to their local economies, including the number of people they employ, the significance of hospital purchases with local businesses and the impact of their employees’ spending and tax support for an entire region,” said Kirk Norris, IHA president/CEO. “Just as no one provides the services and community benefits found at community hospitals, there is also no substitute for the jobs and business hospitals provide and create.”
The IHA study examined the jobs, income, retail sales and sales tax produced by hospitals and the rest of the state’s health care sector. The study was compiled from hospital-submitted data on the American Hospital Association’s Annual Survey of Hospitals and with software that other industries have used to determine their economic impact.
The study found that Iowa hospitals directly employ 71,437 people and create another 48,553 jobs outside the hospital sector. As an income source, hospitals provide $4.2 billion in salaries and benefits and generate another $1.8 billion through other jobs that depend on hospitals.
In all, Iowa’s health care sector, which includes employed clinicians, long-term care services and assisted living centers, pharmacies and other medical and health services, directly and indirectly provides 307,402 Iowa jobs, or about one-fifth of the state’s total non-farm employment.
Complete information from the study, including economic impact data for each of Iowa’s hospitals, is available on the IHA website at www.ihaonline.org.
“The more we lack the courage and the will to act, the more we condemn to death our brothers and sisters, our children and our grandchildren. When the history of our times is written, will we be remembered as the generation that turned our backs in a moment of a global crisis or will it be recorded that we did the right thing?”
Those are the words of Nelson Mandela, the globally revered African leader and statesman who died in December. Mandela was talking about the AIDS epidemic and, with regard to doing the right thing, his own failure to act and save lives.
Nelson Mandela was father to a reborn South Africa, a nation (the richest in Africa, in fact) previously ruled by a prosperous white minority while its black majority languished in racial oppression and poverty under the rule of apartheid. But before he was its father, he was South Africa’s prisoner. Convicted of sabotage and conspiracy to overthrow the government, he spent 27 years in prison.
While in their custody, Mandela spent years negotiating with the white rulers, who in the late 1980s were crumbling under international pressure and the threat of all-out civil war. Released in 1990, Mandela calmed calls for vengeance and gave the white government the cover it needed for an orderly retreat and a peaceful transfer of power, leading to Mandela’s election as president in 1994.
That same year AIDS became the leading cause of death for all Americans between 25 and 44 years old. Faced with 500,000 U.S. cases of AIDS, President Bill Clinton hosted the first White House Conference on HIV/AIDS in 1995. Two years later, U.S. AIDS-related deaths were in decline, but worldwide 16,000 people a day were contracting HIV.
As Mandela’s first presidential term was coming to a close in 1999, HIV/AIDS was the leading cause of death in Africa, yet Mandela had done virtually nothing about it. Many saw this as one of his greatest failures, but they also recognized that governing – including addressing a public health crisis – simply was not a priority or strength of this world-class liberator, peace-maker and nation-builder.
That’s part of the reason Mandela served only one presidential term. In addition to ensuring stability in South Africa’s infant democracy, that decision allowed Mandela to turn his still-substantial power and influence toward other priorities – and AIDS was at the top of his list.
At the 2000 International AIDS Conference in Durban, South Africa, Mandela said, “The challenge is to move from rhetoric to action, and action at an unprecedented intensity and scale.” Mandela did his part, establishing 46664, the music-led HIV/AIDS awareness campaign named for his prison number, and financing various HIV/AIDS projects through his foundation and children’s fund. As he grew older and more fragile, he rarely accepted opportunities to speak – unless he was speaking about AIDS.
In the end, Mandela did the right thing. His response to AIDS, though delayed, was a tribute to his reputation for compassionate coalition-building and a leadership style that embraced human frailty, including his own. As he was fond of saying, “Do not judge me by my successes, judge me by how many times I fell down and got back up again.”
Integrity, it’s been said, is doing the right thing when nobody is looking. As perhaps the most regulated industry in the nation, health care providers seem to always be trying to do the right things when everybody is looking. Maybe that’s why providers often find themselves facing stick-or-carrot proposals, because incentivization allows others to define right and wrong, while those at the other end can only react to the incentives.
For providers, the “others” often include governments, like the state of Maryland. Recently, that state’s Health Services Cost Review Commission (HSRC), which has held rate-setting authority for health care for more than three decades, and the Centers for Medicare & Medicaid Services came to an agreement with hospitals to limit spending growth while also reducing readmissions and hospital-acquired conditions.
The agreement formalizes the nationwide movement, led in many ways by Iowa providers, from volume to value. Maryland’s government hopes that setting a firm budget for each hospital – combined with the HSRC’s power to dictate hospital prices – will press down on health care spending, forcing hospitals to dedicate limited dollars to the most cost-effective care. At the same time, quality metrics seek to ensure care is appropriate, not just inexpensive.
While the Maryland agreement is garnering a good deal of attention, its goals are hardly groundbreaking. Health care providers from coast to coast have seen the writing on the wall that spells out the inevitable demise of the fee-for-service payment system and its perverse incentives that put volume ahead of value.
Far from turning a blind eye to this reality, Iowa providers have advocated for it for years, knowing that the state’s culture of primary-based, patient-centered health care is naturally value-based. Independent research, meanwhile, has shown Iowa providers to be efficient users of health care resources, again helping to keep costs in check.
Perhaps the clearest illustration of Iowa success is seen in the nearby chart, which shows the annual percent increase in total expenses for Iowa hospitals. From 2004-2008, that increase averaged 6.7 percent, but from 2009-2013, the average was less than 3 percent.
Iowa hospital quality metrics show a similar trend: 30-day readmissions down from 13.3 percent in January 2012 to 11 percent in April 2013; catheter-associated urinary tract infections down from nearly 2.5 percent to less than 1.5 percent; adverse drug events down from nearly seven per 1,000 patient days to about 3.5; early elective deliveries down from nearly 8 percent to less than .5 percent.
While some of these metrics are now under the watchful eye of the federal government, which has more recently created its own set of value-based incentives, the work in Iowa through the Iowa Healthcare Collaborative (IHC) predates those regulatory efforts by years. More important is the provider attitude in Iowa that led to IHC’s creation a decade ago by hospitals and physicians as a patient-focused organization dedicated to promoting a culture of continuous improvement.
This combination of culture, proactivity and verified results has created a provider-led health care revolution in Iowa that has placed this state’s health care system well ahead of the curve. Choosing integrity over incentives, Iowa hospitals will continue to lead – and everyone is invited to keep on watching.