by Scott McIntyre on Thursday, February 2, 2012
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Iowa’s community hospitals generate more than 136,000 jobs that add nearly $6.2 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 $1.7 billion on retail sales and contribute more than $104 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 for the entire region,” said Kirk Norris, IHA president/CEO. “Just as no one provides the services and community benefits found at our 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 70,363 people and create another 65,783 jobs outside the hospital sector. As an income source, hospitals provide $3.9 billion in salaries and benefits and generate another $2.3 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 333,554 Iowa jobs, or more than one-fifth of the state’s total employment.
Complete information from the study, including economic impact data for each of Iowa’s hospitals, is available on the IHA website.
by admin on Wednesday, January 25, 2012
George C. Grape Community Hospital in Hamburg expects to qualify for several hundred thousand dollars in federal reimbursement for implementing and demonstrating meaningful use of a certified electronic health record (EHR). This reimbursement will be used to help cover the costs of acquiring the EHR system. The reimbursement is part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, which offers health care providers financial incentives for demonstrating meaningful use of an EHR system.
In the second half of 2010, Grape Community Hospital began planning to demonstrate meaningful use of a certified EHR by the year 2014 or 2015. The hospital quickly accelerated the timeline when offered the opportunity to beta test Healthland Centriq, an EHR system designed specifically for small community hospitals. CEO Mike O’Neal proposed the project to the board of directors in September 2010. The extensive project that included installing high-speed fiber, new computer hardware, installing and testing new software, staff training and new audit processes kicked off in early 2011 with a goal of achieving meaningful use before the end of the year.
“By working with Healthland as a beta partner we got to have input into the features of the final product, and because Centriq is certified for meaningful use we knew we could qualify for the federal funding to help cover costs,” said Craig Wells, the hospital’s IT director. “That was all the incentive we needed to take on an aggressive implementation schedule to get us to meaningful use in the first year of eligibility and help us quickly recoup the up-front costs of the project.”
During the software implementation phase of the project in May 2011, hospital workers pitched in with the rest of the community in an effort to hold back the Missouri River floodwaters. By early June 2011, washed out roads and highways had left the town virtually cut-off from surrounding communities.
Thirteen employees living in the flood zone had to evacuate their homes.
Employees at George C. Grape Community Hospital train on the new electronic health record.
Staff members commuting from Nebraska saw their travel time to work increase from 20 minutes to two hours each way. (IHA assisted 12 Grape Community Hospital employees through the IHA Hospital Employee Disaster Relief Fund.)
“While the floodwater didn’t physically impact our building or the town of Hamburg, the stress of the disaster took a toll on everyone in the community,” said Lynda Cruickshank, the hospital’s marketing and development director. “Every able member of the hospital staff volunteered to help people evacuate, or sandbag homes, or prepare food for other volunteers.
“The flood response would have been exhausting on its own, but our staff did whatever was needed to keep the EHR project on schedule as well.”
In July 2011, as floodwaters and road closings continued to cut off the town, the hospital mounted a major communications campaign to let people in surrounding communities know the hospital remained open and ready to serve their healthcare needs. This was also a key time for the hospital as it was going through a mandatory 90-day reporting period to prove that the staff was using the new EHR system as required to qualify for reimbursements.
“Completing our reporting period and attesting to meaningful use was a huge milestone and I can’t tell you how proud I am of what our team accomplished and overcame in the past year,” said O’Neal, the hospital’s CEO.
by Scott McIntyre on Thursday, January 12, 2012
An Iowa Health-Des Moines nurse checks on a newborn.
Miracles happen at hospitals every day. Nowhere is that more evident than on the obstetrics unit – where the babies are. This is not just where infants are born, it’s where families are made and enhanced. It’s where lives are changed in a way that is joyous and forever.
But there was no miracle for the twin girls born late last week and then found dead in the trunk of their mother’s car in Story County. Now their mother, Jackie Burkle, is facing murder charges. Few details have emerged about the case, but there is only real question: Why? What would lead a young woman to give birth and then allow – if not purposely bring about – the deaths of her infant daughters?
This is particularly frustrating for hospitals and the people who work in them, not only because they are mission-bound to protect lives, particularly the lives of children and other vulnerable people, but because there are laws – laws that hospitals advocated for – to help these mothers in distress and their babies.
Iowa’s “safe haven” law was put on the books in 2001. Under the law, which was strongly supported by IHA, unwanted babies age 14 days or younger can be surrendered at a hospital or even a nursing home. The law provides that the child’s parents will be immune from prosecution (assuming the child is unharmed), their identities will be kept private and the child will be cared for and eventually adopted.
Fourteen Iowa infants have been adopted under the law. But, sadly, at least a half dozen have died since then in circumstances similar to those playing out in Story County.
In response, IHA worked with the Iowa Department of Human Services (DHS) and former Iowa First Lady Mari Culver to produce television (see video below) and radio ads in 2007 that explained the law and promoted hospitals as safe havens. The ads ran that summer on television and radio programs that were popular with young people.
Maybe it’s time that a coalition of Iowa human and health services organizations (including hospitals) – as well as state agencies – figured out how to ensure that a minimal year-to-year effort is made to raise safe havens awareness. It may never be enough to keep these tragedies from happening, but safeguarding the lives of newborns deserves more than nothing.
by Scott McIntyre on Thursday, December 15, 2011
It wasn’t long ago that the Centers for Medicare & Medicaid Services was rather tight-fisted with data like that found in this new report, in particular numbers related to annual Medicare spending per enrollee. A few years back, when IHA was fighting to make the case that Medicare exploited low-spending, high-quality states like Iowa to subsidize states on the other end of the value spectrum, this information was as hard to find as a black cat in a coal crib.
Things have changed. Oh, Iowa is still low on Medicare per-enrollee spending, though we’ve moved from the bottom five to the bottom 10. But at least the data is there – and there’s plenty of it to mull over as the report covers two decades of health care spending by Medicare, Medicaid and the population as a whole. And though there are a lot of numbers, there are not a lot of easy answers about why the numbers are so different from one place to the next.
Here’s what the numbers tell us. First, states with relatively low per-capita spending tend to have younger populations that don’t “use” a lot of health care, like Utah (median age: 28.8; annual per-capita health care spending: $5,031). They also have another group that tends to use less care – the uninsured – like Texas (percent of population uninsured: 26 percent; annual per-capita health care spending: $5,934).
Iowa sits in the middle (28th) for per-capita health care spending at $6,921. This may seem surprisingly high, but it makes sense because Iowa is well insured (10 percent uninsured – only three states do better) and has a relatively large population of senior citizens (15 percent of Iowans are 65 years or older, the fifth highest rate in the nation). Massachusetts provides the perfect storm for pushing up health care costs: nearly everyone is insured (4.4 percent uninsured) and the median age is high (39). But most important is Massachusetts’ unrivaled density of medical providers; the state has one physician for every 189 people; in Iowa, there is one physician for every 479 people. No wonder Massachusetts’ per capita health care spending is $9,277 (the highest of all states and 30 percent more than Iowa).
Older people are more expensive to keep healthy than younger ones, which is why in nearly every state (Alaska is the exception) more money is spent on each Medicare recipient than on the typical resident. In Iowa, it’s about 22 percent more; in 18 states, it’s at least 50 percent more. Some of that difference can be explained by a relatively young total population that keeps per capita costs down in some states. However, while there are a lot of uninsured in Texas and the median age is 33 (it’s 38 in Iowa), that doesn’t completely explain why a Medicare patient costs nearly twice as much as a plain ole Texan, on average. It certainly doesn’t make sense in Florida, where the median age is 40 but a Medicare patient costs 66 percent more than everybody else.
What about Medicaid? Well, Medicaid doesn’t serve the same populations as Medicare – not exactly, anyway. Most significantly, many Medicaid recipients are children or young mothers, so you’d expect Medicaid costs per enrollee to be quite a bit less than Medicare and about the same as everybody else (or somewhat higher because many Medicaid recipients are dealing with chronic health problems). In Iowa, that’s exactly the case – the cost per Medicaid enrollee is 99.5 percent of the cost of a typical Iowan.
However, the real cost of taking care of a Medicaid patient is significantly higher – Iowa hospitals and physicians lose millions of dollars a year because of Medicaid underpayment. But it could be worse. California, which spends nearly $11,000 on each Medicare patient each year (ninth highest in the nation), spends only $4,569 on each Medicaid patient (the least in the nation).
Does that mean Iowa is spending too much on Medicaid? Only if you feel ok about scores of physicians refusing to be part of the program, effectively making millions of Medicaid patients uninsured. That is precisely what has happened in California, which is more than happy to take advantage of low-cost states like Iowa to pump up its Medicare spending, while strangling providers with ridiculously low Medicaid payments and thereby cutting off health care to millions of the state’s poorest and most vulnerable citizens.
“Wide variation” comes up a lot when discussing numbers like these and how much is spent on seemingly the same patient groups in different parts of the country. As this brief discussion shows, there are many factors to consider. Still, while the actual cost of providing health care may be more in Manhattan than Marengo, it doesn’t completely explain why a New York Medicare patient costs 31 percent more and a Medicaid patient costs 37 percent more than the same patients in Iowa.
It is complicated, but it starts with providing value and making value a strategic priority in every Iowa hospital. It’s about providing quality care, not just quantity care. And it’s about putting patients first.
by Scott McIntyre on Tuesday, November 29, 2011
“The Iowa Hospital Association is the organization that represents Iowa hospitals and supports them in achieving their missions and goals.”
That is IHA’s mission statement, and it’s a good one. Basically, IHA helps hospitals do what they need to do to meet the expectations of their communities by educating hospital staff, collecting data that helps hospitals plan and representing Iowa hospitals in Des Moines and Washington, D.C.
That last part means IHA is a lobbying organization, not unlike other lobbying organizations that work on behalf of farmers, builders, school teachers, school boards, restaurants, grocers, insurance companies, lawyers, newspapers and dozens of other industries and organizations, including many non-profits, from Boys and Girls Clubs to Ducks Unlimited to Easter Seals.
Some people don’t like lobbyists; one of those people may well be Dean Lerner. Which would be more than a little ironic, since the Department of Inspections and Appeals, the state agency Lerner used to run, has its own lobbyist.
Certainly Lerner dislikes IHA, leaving one to wonder if he doesn’t feel the same way about the hospitals that make up IHA’s membership and drive the Association’s lobbying priorities. For the record, that would be every hospital in the state.
It’s a little hard to tell just what Lerner’s mission is, even after several reads of his 650-word opinion in Sunday’s Des Moines Register. Well, maybe it’s not that hard, as Lerner concludes early on that “hospitals…have come to reflect the values of Wall Street,” though he doesn’t bother to explain what that means or how it has affected one of the highest quality, most efficient health care systems in the country.
But it is obvious Lerner doesn’t like that there are hospitals in West Des Moines (a city of nearly 60,000 people located in the fastest-growing region in the state that Lerner, nonetheless, describes as “nowhere”) even though these hospitals see nearly 2,000 patients each month – in just their emergency rooms.
He doesn’t like Iowa’s smallest hospitals, either, because the federal government has the temerity to pay these hospitals 1 percent more than their cost of care. Lerner doesn’t seem to mind at all that these hospitals are almost completely dependent on Medicare and Medicaid dollars for their survival and that, without the Critical Access Hospital Program, their buildings would remain best suited for medicine as it was practiced 50 years ago.
Maybe Lerner doesn’t realize that Iowa hospitals, particularly in smaller counties, are often the largest employer and always an economic cornerstone for a state desperate to attract and keep young, well-educated workers and their growing families. His position seems to be that these hospitals, and the communities they serve, should just get it over with and die.
He also apparently believes hospitals should not be tax-exempt, though, once again, does not say why. He doesn’t think Medicaid losses by hospitals should count as a community benefit, though it’s difficult to imagine a greater benefit to taxpayers than the $196 million hit Iowa hospitals take each year to keep the program afloat (not to mention $63 million lost to Medicare).
He doesn’t think a half billion dollars in charity care and another $67 million in additional health care services are enough. He doesn’t think $344 million lost to people who simply decide not to pay their hospital bills is enough. And he apparently has ready replacements for hospitals and the millions they expend supporting and improving the health of their communities through education, counseling, sponsorships and research that extend above and beyond day-to-day patient care.
If he does have a different idea, rest assured that it will come at the expense of the communities that hospitals serve, the same communities filled with Iowans who each year donate millions of dollars and thousands of volunteer hours to their hospitals. It is those communities and their representatives that drive each hospital’s mission – the mission that IHA represents and supports.
Because there is one thing Lerner does manage to make clear – he is still the dedicated former bureaucrat who would gladly add more layers of legislation, regulation and expense to health care, ultimately making nurses and physicians more accountable to the government than to their patients and communities.
That’s a mission Iowa’s hospitals will not support, and neither should the people of Iowa.
