Iowa Public Radio Interview

I, along with HMP (Health Management and Policy) research collaborator Dr. Peter Damiano, were special guests on an episode of Iowa Public Radio The Exchange recently, discussing changes that will be occurring in healthcare with the reform that was recently passed. To listen, click the link below.

http://iowapublicradio.org/audio/theExchange/te100413.mp3

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.

Aiming Higher for Excellence in Healthcare

Every two years, The Commonwealth Fund provides their State Scorecard, ranking all states according to 38 common benchmarks such as access to care, quality of care, costs, and health outcomes.

In 2009, Iowa tied with Hawaii for second place, the highest ranking for a state in the upper Midwest. This was also our ranking in the 2007 scorecard. The following is what is known as the Top Quartile.

1. Vermont
2. Hawaii/Iowa
4. Minnesota
5. Maine/New Hampshire
7. Massachusetts
8. Connecticut
9. North Dakota
10. Wisconsin
11. Rhode Island
12. South Dakota
13. Nebraska

“Leading states consistently outperform lagging states across indicators and dimensions; public policy and public-private collaboration can make a difference.”

“Some states in the Upper Midwest (e.g. Iowa, Minnesota, Nebraska, North Dakota, and South Dakota) achieve high quality at lower costs. Although these states are exceptions to the rule, they provide examples for other states to follow in pursuit of both goals.”

Interestingly enough, many of these states (Iowa, Minnesota, Nebraska, North Dakota, and South Dakota) provide some of the highest quality care at a lower cost. I’ve been beating the drum for years about the inequities in the Medicare reimbursement system. These states are setting the example for the rest of the nation in healthcare reform. There are wide geographical disparities in payment and if it holds, there is a provision in the recently passed House (H.R. 3200) that will call for review for rural healthcare providers to modify our reimbursement structure.

Hopefully, the term “tweener hospital” will be a thing of the past someday. What the future holds for healthcare and specifically for hospitals, remains to be seen.

A Crystal Ball for Healthcare Reform

The internet, the talk shows, and the newspapers are full of stories about healthcare reform. The pundits and the experts are batting around proposals and various solutions related to healthcare. There is some allure to throwing our current healthcare system out and starting over. Realistically, that just isn’t possible.

I’ve said it before: reforming healthcare is like peeling an onion. There are layers under layers, under layers that must be addressed before anything that looks like reform can be useful. Medicare, Medicaid, private insurance, personal responsibility, preventive and public health emphasis, physician payment, medical liability, pharmaceuticals and medical device manufacturers, single-payor system, tax credits, electronic health records, fee for service, pay for performance…these are just a few of the issues being addressed. Each is complicated at best on their own, but extraordinarily so when trying to fit them all together into one cohesive package.

Last week I attended a meeting in Cedar Rapids with Senator Grassley on the topic of healthcare reform. It is the committee he serves as ranking minority member (and former chair), the Senate Finance Committee, that is currently shaping the debate. He hopes for a bipartisan approach to this monumental task; I share that hope. He is pushing for all involved parties to have some skin in the game; that also makes sense to me. Finally, he noted we must not have government making decisions about individual healthcare issues; another ideal I share.

Several years ago when I was on the American Hospital Association board of trustees, we started discussing healthcare reform. More recently, the AHA set out a framework for change which includes the following five tenants: healthcare coverage for all; paid for by all; focus on wellness; most efficient affordable care; highest quality care; and best information. These principals and ideals seem like a great place to start.

We’re hearing that there should be some healthcare reform legislation crafted this summer to be ready for the President before Congress takes a recess in August. It’s entirely possible that we will have a different sort of healthcare system by the end of the year. My crystal ball is certainly no clearer than anyone else’s, but it is clear to me we will have some big changes by year end. The question is, will it be meaningful reform or just window dressing…

It could be a very hot summer in Washington.

The postings on this site are my own and don’t necessarily represent GRMC’s positions, strategies, or opinions.

Bringing D.C. to DSM

I had the opportunity to attend the President’s Forum on Health Care Reform in Des Moines on March 23. This forum was one of four held throughout the country to gather ideas and input on what folks want to see in healthcare reform.

Sen. Tom Harkin, Rep. Leonard Boswell, Gov. Mike Rounds of South Dakota, and Nancy-Ann DeParle, the Obama administration’s health care reform advisor, were all present at this forum, moderated by Iowa Governor Chet Culver.

Tackling healthcare reform is a monumental task. There are so many layers that are interconnected. Accessibility, cost, insurance coverage, Medicare, Medicaid, facilities, and more…it’s hard to know where to begin.

Rep. Boswell made two opening comments…one about the inequity of Medicare payment between states, with Iowa at the bottom of the list and one about the Medicare tweener hospital issue that affects GRMC, seven other Iowa hospitals, and about 400 community hospitals across the country. It was great to hear our Congressman tell our story to another audience. He actually handed our advocacy materials on this issue to the new Healthcare Reform Leader in the Whitehouse, Ms. DeParle.

I feel hopeful that the beginnings of reform will happen this year and that the tweener issue will be addressed. Senate Finance Committee leaders Sen. Grassley and Sen. Max Baucus, (D-MT) are in the best position to make sure our legislation moves forward. Both have gone on record in support of fixing the unfair Medicare payment system and the situation it has created for tweener hospitals like GRMC.

I’m gearing up for another visit to Washington, D.C. in a few weeks for the annual meeting of the American Hospital Association along with several of our board members. Many of you shared some incredible stories about your experiences with GRMC for a publication I’m taking to my meetings with Congressional leaders during that time. Thank you for taking the time to do this. My intention is to put names, faces, and the words of real people who appreciate what is available at GRMC in front of these decision-makers to illustrate why communities like ours need a strong and healthy hospital.

In the meantime, I keep telling GRMC’s story to make a change for the better.