“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.

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.

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.

Up to that time, nothing formal had been done to publicize the law.  With information and assistance from IHA, hospitals put up signs and promoted the law with their local media when it was first passed.  But, except for that summer nearly five years ago, no money has ever been allocated by the Legislature to keep the public aware of safe havens.

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.

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 (28^th) 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.

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.

The co-chairs of the Joint Select Committee on Deficit Reduction have announced that the committee has failed to come to an agreement on a deficit reduction strategy.  The bi-partisan, bicameral committee, formed by the Budget Control Act, was charged with reducing the national deficit by at least $1.2 trillion.

The committee’s failure to reach an agreement means automatic spending cuts totaling $1.2 trillion, to be split between defense spending and non-defense programs, will become effective in January 2013.  Under this across-the-board cut, hospitals face a 2 percent reduction to Medicare payments over nine years (2013 to 2021).  Medicaid cuts are, however, exempt from the cuts.

Congress will now take the time to determine the next steps for deficit reduction.  Some are calling for the cuts to be repealed or delayed further, though the president has already threatened to veto any attempts to do so as a means to encourage continued Congressional action on deficit reduction.

IHA strongly opposes the cuts to hospitals as not only are they incredibly arbitrary, but hospitals have already committed to more than $155 billion in Medicare cuts to help finance the health care reform law.  By simply piling on more and more cuts, hospitals are finding themselves unable to expand critical services and are unable to create jobs with so much financial uncertainty, adding additional pressure to the economy.  IHA will continue to work with Iowa’s Congressional Delegation on this issue.

Future HCAHPS respondents...and they could be from anywhere.

“I think the focus needs to be on what staff, physicians and leaders can do to improve the patient experience instead of the ‘throw up your hands’ approach and blaming patients for being more difficult,” said David Brandon, CEO of The Finley Hospital in Dubuque.  “You cannot have an ‘opt-out’ culture if you’re going to succeed in creating an exceptional patient environment.” 

Both Sioux City and Dubuque are in multi-county hospital referral regions (HRRs) that rank in the top 20 nationwide for patient satisfaction.  The HRR around Mason City ranks at the top.  Meanwhile, out of nearly 300 HRRs, Manhattan is dead last and Cleveland is 237^th. 

“Where many CEOs fall down is they see this as a fluff kind of thing,” said Greg Paris, CEO at Monroe County Hospital in Albia, who received IHA’s hospital leadership award in 2007 in part for his work to pull that hospital’s patient satisfaction scores out of the basement.  “What they don’t realize is that satisfaction is directly related to quality outcomes, financial results and employee engagement.”

But, he added, “Smiles and singing don’t drive satisfaction.” 

Paris talks about how using key words reduces patient anxiety, which improves compliance with care plans and leads to better outcomes.  Hourly rounding (“I hear large hospitals gasping,” Paris laughed) reduces patient falls by 50 percent.  Checklists reduce errors.  Discharge calls save lives because one in six patients has an adverse health event after they go home.  Lower employee turnover means fewer mistakes and less harm to patients. 

But shouldn’t getting the highly touted care at Cleveland Clinic or NYU be enough?  The better question – the one really being asked through HCACHPS and Hospital Compare – is why not expect high-quality care and a first-class patient experience?  Anyone who has made use of the Iowa Healthcare Collaborative’s “Iowa Report” will see Iowa hospitals are uniformly committed to both. 

“Yes, we need to have the right facilities and evidence-based strategies in place, but more than anything else it is the never-ending commitment to create a culture that holds service in the highest regard,” said Brandon.  “Without the right culture, the strategies and facilities alone will not allow you to meet the expectations of your patients.” 

And because of the growing amount of publicly available data, hospitals cannot depend on just their word-of-mouth reputations or referrals.  “The next generation will pick their hospital based on outcomes and experience, not just by where their doctor sends them,” noted Paris.

One is a standard in Iowa law that exempts from property taxation any religious, educational or charitable institution.  The other is a federal regulation that exempts organizations from taxes on revenue if that organization provides community benefits that the government otherwise would have to provide or, at the time of application for tax exemption, don’t exist in the community.   

Each standard involves evaluation by regulators – the Internal Revenue Service for community benefit and the Iowa Department of Revenue for charitable status – and both have had extensive and consistent scrutiny by the courts.  The Register noted that hospitals pay significant sums in property taxes and in addition to that, some make payments in lieu of taxes to support police and fire protection. 

A nurse from Lucas County Health Center teaches a free "anytime CPR" class in Chariton.

Iowa hospitals supported mandatory reporting of community benefits in federal law because of their practice of doing so prior to this mandate.  Iowa hospitals continue to support the community benefit standard for the express reason that an assessment of community need is driven by its demographics and by the needs and priorities identified by community members.  The capacity, opportunity and definition of community benefit is different in a community of 1,500 than one modestly or significantly larger.  It’s certainly different when that institution exists in Des Moines or Chicago or Los Angeles. 

As the Register noted, opinions of policymakers and policy wonks differ on the question of what should be included in the definition of community benefit or whether a flat percentage mandate should be required.  Iowa Senator Charles Grassley supports inclusion of Medicaid payment shortfalls in an analysis of community benefit.  In 2010, Iowa hospitals’ net losses from Medicaid equaled nearly $200 million.  Uncompensated care, that care which was not classified as charity but which otherwise had no identifiable source for payment, equaled $340 million in 2010. 

So, what should be the appropriate ratio for calculating community benefit?  The Register took a very narrow view and used charity care divided by total expenses.  Hospital expenses consist of labor costs, infrastructure costs in delivering patient care as well as expenses unrelated to patient care.  Why not net patient revenues?  Perhaps because it supports a conclusion exactly opposite of the position promoted by the Register.   

Using the analysis of charity care plus Medicaid losses plus uncompensated care, Iowa hospitals provided 11.2 percent of net patient revenues for community benefit.  Using the same inputs and expenses for the denominator as the Register does shows Iowa hospitals allocated 10.2 percent of expenses for free care. 

In a country with a stagnating economy, it’s tempting to toss out simplistic solutions that rarely account for all the policy considerations at play let alone consider the implications for an industry that has a $6 billion impact on Iowa’s economy and provides nearly 70,000 jobs.  The important thing to know is that Iowa’s hospitals believe in and live up to being accountable to the communities they serve.

Regulators demand a lot from health care providers and it does impact care for patients – but that impact is not always positive.  One study found that for every hour of patient care, there is at least 30 minutes of paperwork.  In some settings, the ratio is one-to-one: one hour of paperwork to every hour of patient care. (The Obama administration recently announced steps it was taking to reduce regulatory red tape hospitals face.)

Does this mean hospitals are against regulation?  Absolutely not.  Hospitals recognize and honor the need for consistency, guidance and accountability because, in the end, providers and regulators are seeking the same thing: the right care for every patient, every time.  As David Vellinga, CEO at Mercy Medical Center-Des Moines, recently wrote: “While these processes can be burdensome at times, we at Mercy understand they are important parts of continuously improving quality — necessary steps in the journey toward perfect care.” 

The work to comply with regulations, inspections and surveys is no less for a smaller hospital.  “At times it is difficult to look beyond the minutia of regulations to see the intent,” said Sharon Taylor, who serves as the compliance officer at Burgess Health Center in Onawa.  “However, the intent of the majority of regulations is to be sure that treatment, payment and health care operations are delivered to our patients in a safe and effective manner.” 

Another reality is that nearly every hospital employee is affected by regulations and has a role in knowing and complying with them.  To prevent infections, housekeeping staff need to know that different cleaners must be used in different rooms and situations and they need to know how to use those cleaners safely and effectively.  Plant operations staff need know where hand gel dispensers can be mounted to comply with fire regulations.  And all staff are routinely trained on patient safety and privacy regulations. 

But, despite the hard work of staff, mistakes do happen.  “Employees come to work to do a good job, they don’t come with the intention of making a mistake or breaking a regulation,” Taylor said.  “Sometimes it is the processes that are put into place, because of regulations, that cause mistakes to happen and sometimes mistakes are just that, a mistake. While this doesn’t make it right and is certainly not an excuse, the people working in health care are after all humans.” 

More and more, hospitals – often in partnership with inspectors and surveyors – are looking closely at those processes, looking for opportunities to reduce problems and mistakes. “Over the years surveyors have changed their perspective to a more collaborative team approach,” said Michelle Burford, who manages compliance at Fort Madison Community Hospital.  “In my experience they often welcome questions.  They share suggestions they have learned from other organizations across the country.” 

Though it is enormous, the amount of regulation placed on hospitals is, for the most part, well intended. Most hospitals see its advantages and, in fact, practically all hospitals voluntarily seek other outside assessments that ultimately create more work but also improve health care.  “Mercy has proactively added to the number of survey processes by seeking and achieving accreditations and certifications for many services,” noted Vellinga.  “Mercy wants our patients and communities to understand the extensive efforts under way every day to scrutinize our facilities and services, find opportunities for improvement, and make changes to ensure we do everything right, every time, for every patient.” 

That is the goal of all health care providers – and it should be the goal of those who regulate them.  Just as hospitals examine and re-examine their processes in quest of improvement, hospital regulators should be careful as well, making sure whatever further demands they place on providers are both necessary and effective.

Jeb Hensarling (R-TX) and Patty Murray (D-WA)

The Joint Select Committee on Deficit Reduction, commonly referred to as the “super committee,” held its first public hearing in Washington, D.C. this week and focused on examining the history and drivers of the nation’s “debt and its threats.”   The hearing began with the announcement that the committee’s official website is now up and running and is expected to be a good resource to monitor the committee’s progress.  The committee called one witness to testify during the hearing:  Dr. Doug Elmendorf, director of the nonpartisan Congressional Budget Office (CBO).  The committee asked Dr. Elmendorf to testify about the scope of the budget and financial issues facing the nation.  Ultimately, the committee must decide whether and how revenues and spending cuts play out as it grapples to determine the role Congress wants the federal government to play going forward. 

Dr. Elmendorf explained that according to CBO analysis, changes in taxes and spending that would widen the deficit today but narrow it later in the decade would be the most effective combination of policies to solve the budget crisis.  This would work best if the policy approaches are specific, enacted into law and widely supported so observers believe that the fiscal restraint would truly take effect. 

Additionally, Dr. Elmendorf explained that the rising cost of health care and the aging population make solving the budget crisis today different than during any other time in U.S. history.   The number of Medicare beneficiaries is expected to increase by one-third in the coming decade.  Dr. Elmendorf stated that to address today’s deficit concerns, Congress must deviate from past solutions in at least one of the following ways: 

• Raise federal revenues significantly above their average share of gross domestic product (GDP).   According to CBO analysis, over the last 40 years, revenues have averaged about 18 percent of GDP.  Currently, revenues make up about 15 percent of GDP.  In the past, when the federal government has balanced its budget, revenues were approximately 19-21 percent of GDP. 
• Make major changes to the sorts of benefits provided for Americans when they become older, like Medicare. 
• Substantially reduce the role of the rest of the federal government relative to the size of the economy. 

Committee member Max Baucus (D-MT), chairman of the Senate Finance Committee, asked Dr. Elmendorf what changes in tax policy would stimulate the economy most.  Dr. Elmendorf referenced a January 2010 CBO report that examined a set of alternative tax cuts and explained that CBO found that reductions in payroll taxes are one of the more powerful levers, followed by expensing of investment costs and then broader reductions in income taxes. 

The super committee must make many difficult decisions under a very tight timeline.  While the committee technically has until November 23 to present its recommendations to Congress, as a practical matter it only has until the beginning of November to make those decisions.  This is because CBO and legislative counsel need several weeks to accurately “score” the committee’s recommendations and turn them into legislative text for a congressional vote. 

Another complicating factor adding to the committee’s work is the jobs initiative brought forward by President Obama earlier this month.  As the president rolled out his plans to create new jobs, he asked the super committee to find a way to pay for the bill.  So while the committee is hashing out ways to reduce the national deficit by at least $1.2 trillion, it must also find an additional $450 billion to pay for and help move the president’s jobs initiative forward. 

IHA continues to engage Iowa’s congressional delegation and monitor progress of the super committee carefully.  Given that Medicare and Medicaid comprise more than 20 percent of all federal spending, some policymakers are advocating for reductions in Medicare and Medicaid payments for hospital services as part of deficit reduction options, even though hospitals already are absorbing more than $155 billion in Medicare and Medicaid payment reductions.  Additional reductions would not only harm the ability of hospitals to care for patients, but could result in lay-offs of hospital workers at a time when the hospital sector is one of the few positive contributors to job formation. 

Of key concern for rural states like Iowa, some policymakers are also suggesting payment cuts to small, rural hospital programs and policies and in March of this year, CBO offered a budget-cutting option that would eliminate the Critical Access Hospital (CAH), Sole Community Hospital (SCH) and Medicare-Dependent Hospital (MDH) programs.  The March CBO option to eliminate these special rural hospital programs and policies would have a devastating effect on Iowa and Iowans’ access to health care.  Ninety-two of Iowa’s 118 community hospitals are classified by Medicare as Rural and 82 of these Rural Hospitals are also classified as CAHs.  Six Iowa Rural Hospitals are classified as MDHs and seven are classified as SCHs.  IHA does not anticipate elimination of the CAH program, for instance, but reductions to all programs including rural add-ons will be considered by policymakers.   

The super committee was created last month through the passage of the Budget Control Act that raised the nation’s debt ceiling and prevented the first-ever federal financial default.  The committee is a bipartisan, 12-member group chaired by Senate Democratic Conference Secretary Patty Murray of Washington and House Republican Conference Chairman Jeb Hensarling from Texas.  The committee is charged with presenting Congress recommendations by Thanksgiving that would reduce the national deficit by at least $1.2 trillion. 

If the committee fails to produce the recommendations or Congress fails to adopt the recommendations by December 23, then an automatic spending cut of $1.2 trillion split between defense spending and non-defense spending would take effect January 2013.  Under the automatic trigger, hospitals and other providers would receive reductions in Medicare payments of up to 2 percent, an estimated $43 billion in cuts to hospital payments alone; the 2 percent reduction would impact CAHs.  CAHs would continue to receive payments of 101 percent of cost as provided under current law, but the 2 percent reduction would occur during the cost-settlement process. 

Many are pushing for the committee to be very transparent as it continues its deliberations, but there is concern that the many of the upcoming meetings will be closed to the public.  The committee has not announced the date of its next public meeting.