Choosing Health

If we as a healthcare organization are truly committed to improving the health and wellbeing of our community, I believe we have to start with ourselves. It’s about setting an example for health and wellness.

For many years we have embraced the concept of creating a healthy workforce through a program called “I Choose Health.” Its focus is to encourage GRMC employees to live healthier lives.

GRMC has a self-insured health plan. This simply means that all our covered employees and their family members either pay the bill with a co-payment or deductable or GRMC does. When we reduce the number of health claims submitted, we reduce the cost for covering our employees and their families. That in turn reduces the cost for GRMC to deliver our services. Through our incentives we have been successful in bending the cost curve for healthcare coverage at GRMC. There has not been a substantial increase in health insurance premiums in three years. We had a minimal increase of 3 percent from 2009, well below the Iowa market standard of 17 percent. Additionally, we saw a 9 percent decrease in blood lipid levels from 54 percent in 2008 to 45 percent in 2009.

However, it is clear more can be done, so this year we took a bold step with I Choose Health.

If employees choose to participate in this program, they can continue to enjoy our excellent health coverage at the same costs in 2011. To participate, employees and covered spouses are required to get appropriate annual screenings and a physical, keep an exercise log, not use or make a concerted effort not to use tobacco, and reduce the harmful effects of stress in their lives. If they choose not to participate, their co-payments and deductibles go up significantly.


Of course there are health issues we don’t have much control over, such as an accident. However, there are ways we can take personal responsibility to improve our health to possibly avoid health conditions. We can take responsibility for what we do to maintain a healthy weight through exercise and food choices. We can get the appropriate screenings and an annual physical to detect early signs of illness. We can refrain from using tobacco. We can learn to manage our stress levels. These are choices we all make. Simply put, it costs less if we all take better care of ourselves and the costs our employees pay for their coverage should reflect these efforts.


We have gone to great lengths to make it easy for our employees to take this personal responsibility for improved health. The great thing is the benefits go beyond lower healthcare costs. In fact, the real benefits are an improved health status and greater enjoyment of life. That is the real prize. If a hospital cannot be the leader in helping to create the healthiest workforce, who will? Our responsibility is to keep our costs for the delivery of quality healthcare the lowest possible including our benefit costs. Our vocation is to help our most vital resource, our employees, live the highest quality of life possible. That is something to celebrate.

The President, The Past, and the Future

On Thursday, my 16-year-old son, Grant, and I stood for several hours waiting for President Obama to address a couple thousand Iowans in the old Fieldhouse on the campus of the University of Iowa. While we waited, I reminisced about watching the 1980-81 Hawkeye Final Four basketball team in that very building. I explained to Grant that as a lowly freshman at UI, I had a ticket right behind a pilar on the second level. I could not even see the center of the court!

I also remembered how loud it could get in there when the crowd cheered. Perhaps that is what the most powerful man in the free world wanted for his first public rally after signing the healthcare reform bill earlier this week. The President started his speech by noting that his NCAA tournament bracket was busted by the Kansas-upsetting Northern Iowa Panthers! A cheering crowd erupted when the University of Northern Iowa President stood up holding a purple and yellow jersey. (As a proud parent of UNI daughter/student, Coco, I felt the Panther pride as well.)

In my last blog entry I mentioned how the passage of healthcare legislation this week was historic. The President came to Iowa City because it was nearly three years ago when he was in Iowa City kicking off his campaign with a major focus on healthcare as a primary goal. Coco was among a group of about 300, largely students, on hand back then caught up in the vision Barrack Obama had for universal healthcare.

I have to admit I got caught up a bit in the hoopla of the Presidential visit. It was all there: long lines, secret service officers, a throng of press, the large American flag, the singing of the Star Spangled Banner, the Presidential Seal, and, of course, those words of introduction: “Ladies and Gentlemen, the President of the United States!” The President, playing to the audience, introduced one of his military escorts, a past strong safety on the University of Iowa Hawkeye football team. Obama certainly knows how to rev up a crowd.

On to the speech: It was a carefully crafted sales pitch about all the many good things about the reform package. It is clear the President believes he has delivered on one of his biggest campaign promises. Whether you like the legislation or not, it was an amazing feat by President Obama and the leadership of the Democratic Party to get this legislation passed.

Although I have some concerns about the bill, I also am excited about the fact we have finally pushed through some “tweener” relief for middle-sized rural hospitals like Grinnell Regional Medical Center (as noted a couple days ago in this blog). There is also clearly the beginning of a new approach to Medicare payment, one focused on “value.”

The hoopla didn't end for me with the speech. During the event a man standing in front of Grant and me fainted. After helping him to the floor, we were relieved to see several physicians and nurses standing in all directions and happy to come to his aid. He was taken by paramedics for further treatment, but appeared to be OK much to our relief. A couple years ago, I administered CPR with a surgeon to an elderly man while standing in line at an airport. Fortunately, we revived him, and he also appeared to be OK as emergency personnel took him to the hospital. I was glad this fellow did not need that kind of help on Thursday. Although not expecting someone to need healthcare at the rally, it was poignant given that the central focus of the President’s message was healthcare.

I want to extend a special thanks to Congressman Boswell for inviting me to the speech. It was fun to have the opportunity to listen to the President talk about something dear to my heart: the delivery of high quality and affordable care to all in need. Now all we have to do is make this legislation do the trick…I am sure there will be nothing to it!

Historic Healthcare Reform, Indeed

There really is no other way to put it. The healthcare reform signed into law by the President is indeed historic. Whether or not you like the legislation, there is no doubt that it will clearly affect Americans for many years to come.

Obviously, we are a long way from being done. The reconciliation bill is being debated in the Senate. Several states across the country are filing lawsuits saying the legislation is unconstitutional. The process of writing the rules will crank up soon, and each of these will continue the process started with the stroke of the President’s pen. The talk show hosts, the political pundits, politicians, and coffee shop patrons are buzzing about the history-making legislation that we will continue to learn more about in the coming days and weeks.

Although it seems anticlimactic at this point (given all the rhetoric on both sides of the political aisle and the size of this bill), I want to celebrate a major component of the bill. After several years of advocating for “tweener” hospitals, we finally have some legislation that improves the very inequitable Medicare payment levels for middle-sized rural hospitals like Grinnell Regional Medical Center. We have been fighting for the people we serve and I want to acknowledge the Iowa Congressional delegation for their efforts to make sure “tweener” reform was written into the bill and stayed in the bill. This issue had bipartisan support. I especially I want to thank the staff in the offices of Senators Grassley and Harkin and Congressman Boswell for their tireless work on this issue. The Iowa Hospital Association and the American Hospital Association also worked hard to deal with this issue. It was a team effort to bring some fairness to these payment levels so that GRMC and “tweeners” across the country can better meet the needs of the seniors who depend on us.

I don’t know for sure what the true impact of healthcare reform will be for America. I do know that after literally dozens of trips to Washington, D.C., pleading the case for making Medicare payment a little more fair for GRMC and other middle-sized rural hospitals, we finally have a victory. The winners are the Medicare patients and the healthcare providers who provide the high quality care they deserve.

Historic Healthcare Reform, Indeed

There really is no other way to put it. The healthcare reform signed into law by the President is indeed historic. Whether or not you like the legislation, there is no doubt that it will clearly affect Americans for many years to come.

Obviously, we are a long way from being done. The reconciliation bill is being debated in the Senate. Several states across the country are filing lawsuits saying the legislation is unconstitutional. The process of writing the rules will crank up soon, and each of these will continue the process started with the stroke of the President’s pen. The talk show hosts, the political pundits, politicians, and coffee shop patrons are buzzing about the history-making legislation that we will continue to learn more about in the coming days and weeks.

Although it seems anticlimactic at this point (given all the rhetoric on both sides of the political aisle and the size of this bill), I want to celebrate a major component of the bill. After several years of advocating for “tweener” hospitals, we finally have some legislation that improves the very inequitable Medicare payment levels for middle-sized rural hospitals like Grinnell Regional Medical Center. We have been fighting for the people we serve and I want to acknowledge the Iowa Congressional delegation for their efforts to make sure “tweener” reform was written into the bill and stayed in the bill. This issue had bipartisan support. I especially I want to thank the staff in the offices of Senators Grassley and Harkin and Congressman Boswell for their tireless work on this issue. The Iowa Hospital Association and the American Hospital Association also worked hard to deal with this issue. It was a team effort to bring some fairness to these payment levels so that GRMC and “tweeners” across the country can better meet the needs of the seniors who depend on us.

I don’t know for sure what the true impact of healthcare reform will be for America. I do know that after literally dozens of trips to Washington, D.C., pleading the case for making Medicare payment a little more fair for GRMC and other middle-sized rural hospitals, we finally have a victory. The winners are the Medicare patients and the healthcare providers who provide the high quality care they deserve.

Reconcilation...Really?

I think the term “reconciliation” is an interesting one to describe what’s going on in Congress these days. Seems like there should be some reconciling in Washington today. Both parties have contributed historically to the difficulty in getting to issues that will create significant and beneficial reform. For example, we need healthcare reform, but at this point it is hard to imagine that Congress will find any middle ground—or reconciliation—to get us to there.

I recently heard governance guru Jamie Orlikoff say “…no one can afford healthcare today. Government can’t afford it, companies can’t afford it and individuals can’t afford it.” He went on to cite a New England Journal of Medicine article that indicated a full 30 percent of current services delivered in America are clinically unnecessary—that represents 5 percent of the United States’s gross domestic product. The reasons include duplication of testing, defensive medicine, differences in training, financial incentives to do more than needed, etc.

Seems to me Congress should put their full effort toward working on ways to eliminate this waste. Things like wellness, malpractice reform, and reducing fraud all will help, but the big one must be payment reform. The incentives today are all wrong. Orlikoff argues we have to focus on “value” and not “volume” regarding the payment if we ever hope to get the cost under control.

Of course, as someone who leads a “tweener” hospital in a state with some of the lowest government reimbursement rates in the country, I would agree. When your costs are already well below the national average and your reimbursement is around 62 percent of cost, it’s hard not to feel like the government is getting pretty good value. Medicare spends a paltry $5,232 per beneficiary in Grinnell annually. That’s a full 36 percent below the national average. Yet our state consistently ranks among the highest states in the U.S. on quality measures. The sooner we move to a value-based approach the better, from my point of view.

As the Democrats feverishly work to find a way to get the Senate Health Bill passed, I worry there is not enough focus on “value” in the current legislation. Ensuring more Americans have access to health insurance is of course a priority. However, more access to the current wasteful system will break the bank…maybe for good. Again, simply consider our little hospital as the test case. If this bill goes forward (even with a minor tweak to improve payment for tweeners), Medicare payment will decrease some half a billion dollars nationally. Today we already have to pass the massive losses from current Medicare patients onto others. Even if everyone has access to insurance, the cost curve is not bent and we end up just expanding our current problem. Hospitals and healthcare providers will need to increase the price of care to everyone not on Medicare just to survive.

Conventional wisdom would suggest that politically it is anathema to reduce benefits to seniors and/or raise taxes. So all that’s left is cutting Medicare payments to hospitals by $500,000,000 and expanding access to the uninsured. In 2009, some of the nation’s most well-known and established hospitals closed their doors. With this new plan, many more hospitals would be forced to close and local access to healthcare will be lost. The federal deficit will double and the system along with our economy could well collapse.

As a registered Independent voter, it is my hope that this bill isn’t forced through Congress right now. I would far prefer that the two parties “reconcile” their differences by doing what’s right: Make the system simpler; pay for value; incent personal responsibility and wellness; reform malpractice; and then we can afford to dramatically expand access to all Americans.

Healthcare vs. “Sick” Care

“Since both in time and importance health precedes disease, so we ought to consider first how health may best be preserved, and then how one may best cure disease.” – Galen, 170 AD

This is one of my favorite quotes and one I often referred to concerning healthcare. GRMC provides a refuge for people in need of medical care. Our goal is always to heal people to their best possible health after an illness or injury. I am proud of the quality of care our team works hard to offer the communities we serve.

GRMC is in the “quality-of-life” business, in that our own personal health and wellbeing dramatically impacts our everyday lives. As the quote from Galen puts it, preserving health in the first place should be the number one priority.

Unfortunately, the healthcare system in this country has really been more of a “sick care” system. Too much emphasis has been on mending bodies after health has left them. We have shielded folks from the true cost of healthcare through the proliferation and misuse of health insurance. The personal responsibility for maintaining optimal health has not been incented in the system. Although a growing number of Americans are health conscious, it is hard to deny the obvious epidemic of poor health. Really troubling is the rise of childhood obesity, for example.

So what can be done to be more proactive in preserving health? I believe community hospitals can be a catalyst for health improvement and the quality of life for our citizens. In March 1997 with the help of Claude Ahrens, GRMC built the Paul W. Ahrens Fitness and Rehabilitation Center in the heart of our campus. It was our first really visible commitment to preventive health. Over the years we have built on this initiative with integrative health services at the Postels Community Health Park and Fly High Fitness Studio in downtown Grinnell for all our group exercise activities such as yoga, aerobics, Spinning®, and now Zumba®.

I truly cannot predict what the future of acute care medicine is going to look like for rural hospitals in America, but I do know our survival depends upon staying relevant to the community. People understand the importance of an easily accessible emergency department in their community for urgent healthcare after a car accident or with the onset of a heart attack. But hospitals are often considered only a place to go to be “fixed” when something is broken.

As hospitals, we can become more skilled in helping people stay healthy in the first place. If we can do this well, community hospitals will continue to be vital to the wellbeing of the community.

Stay tuned to future blog entries on health improvement topics, such as how we are working to strengthen our health coverage for our employees and our vision to create the healthiest community in America, a project we call “The Heart of Grinnell.”