A Message of Appreciation and Hope to Our Nation’s Capitol

US Capitol on a bright blue spring day in Washington, D.C.

This was no ordinary trip to Washington, D.C. On many of my previous trips to the nation’s capital, my message was one of deep concern. I pleaded for a change in the way middle-sized rural hospitals like Grinnell Regional Medical Center receive reimbursement under the Medicare system.

This month’s trip to the Beltway found me with a skip in my step and a message of THANKS. We finally prevailed in getting the “tweener” issue addressed as part of this year’s historic and massive healthcare reform bill. For a description of the “tweener” issue, please see these past blogs.

Deep in the belly of the legislation lays a tweak of the Medicare reimbursement formula. The change will result in much needed relief from the unfair payment scheme we have experienced for many years. Beginning in 2011, GRMC should see about $750,000 in improved payment from the federal government for caring for our Medicare patients. That is truly welcomed news because we were paid $2.5 million below our costs for this care in 2009! This benefit will not only help GRMC. It will also help hundreds of other 25- to 50-bed hospitals across rural America.

Todd Reding, chair of GRMC’s Foundation Board Chair and a member of our Board of Directors, and Kyle Wilcox, a University of Iowa graduate student in health management and policy, joined me on the trip to the Hill. Our primary focus was to say thank you to both of Iowa’s Senators and to two of GRMC’s Congressmen.

Even though Sen. Charles Grassley (R-IA) did not vote in favor of the bill, we took the time to thank him. The reality is, the “tweener” payment improvement plan started in the Senate Finance Committee where he is ranking member. Michael Park, Grassley’s staffer for the committee focused on Medicare, was extremely helpful on this issue early in the process.

Sen. Tom Harkin (D-IA) championed this cause, too. In his important role as chair of the Health, Education, Labor and Pension Committee, he had a lot to say about healthcare reform. His staffer, Jenelle Krisnamoorthy, fought the good fight during difficult negotiations with delegations from larger states not interested in sharing scarce resources.

Rep. Leonard Boswell (D-IA) and his healthcare assistant, Katy Siddall, worked hard on the House side to make sure the Senate bill’s tweener language was not changed during reconciliation. Rep. Boswell also helped orchestrate a meeting with both our senators in 2008 to brainstorm ways to get “tweener” legislation moved ahead given their leadership roles in the U.S. Senate.

Todd Linden and Todd Reding presenting board
resolution of thanks and photo to Congressman Boswell

We also thanked our “adopted” representative, Bruce Braley (D-IA). The Congressman was born at GRMC, and his mother lives in nearby Brooklyn. Rep. Braley and his staffer, Mike Goodman, described to us their 2:30 a.m. victory in the Speaker’s office the day of the historic vote on healthcare reform. The victory? The start toward “value based purchasing” and the government recognizing the geographic variation in payment needs to be addressed in the Medicare system! Rep. Braley helped get $800 million dollars added to the reform package during reconciliation to prop up payment around the nation to the lowest reimbursed physicians and hospitals providing high quality care!

Todd Reding presented each of these leaders with a special resolution from the GRMC board expressing our appreciation for their efforts to bring a little equity into the Medicare payment system. Their efforts make it possible for us to continue to provide the care people deserve in Grinnell and other middle sized rural hospitals in Iowa and around the country. Todd also gave each of them a photograph taken after one of our Senior Education Center meetings. The picture includes many folks who helped communicate the need for change with our delegation over the years. This group of seniors is emblematic of the very people this legislation will help. (See photo and board resolution)

Of course, the fight is not over yet. A great deal of uncertainty exists in the overall healthcare reform bill. Potential potholes could detract from our future abilities to deliver the care people need. Yet, it was great to take time to pause, reflect, and give thanks for an epic battle to create some equity in the payment flaw that has plagued us over the past half dozen years.

Todd Reding with Jenelle Kristnamoorthy with Healthcare
Reform Bill which contains fixes for the “tweener” payment issue

Incidentally, it was Kyle’s first trip to Washington, D.C. What a great education for a young man just starting his career in healthcare leadership. In addition to meeting all of our Congressional delegation and their health staff members, he also heard some great presentations from the American Hospital Association, visited a few monuments and museums, peeked at the U.S. Constitution and Bill of Rights, and ate some great food. (For those concerned about costs, I should note that I paid for Kyle’s trip and split costs for my trip with the hospital, the American Hospital Association, and myself.) I also have to admit I felt just a bit safer wandering around Washington with Kyle by my side—this high school and college football standout still has some size on him!

Intern Kyle Wilcox extracting funds from the “US Senate Money Machine”

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

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.

You Never Know Who You Might Meet

While I was in Washington, D.C., recently, I had a few interesting moments.

The first night, I was waiting in the hotel bar waiting to meet other NRAC (National Rural Advisory Committee) members for dinner. Two people sat down next to me and were discussing restaurants in the area and they asked the bartender if he had heard of a particular hot spot. He had not, so they asked me and I reported that although I had heard of the restaurant, I had not dined there. It seemed to me that they were looking for recommendations, so I pulled out the list of about 20 restaurants the concierge had printed off for me and began to point out places where I had eaten in the past and which ones I thought they might enjoy. The gentleman then inquired about what I thought about the hotel and I said I thought it was a great place to stay. This is the hotel the government uses for the NRAC when we are in D.C. for this meeting. He smiled and told me he was glad to hear I liked the place, since he was the general manager! The hotel was the Sofitel, a French hotel. He then bought me a glass of wine and we had a delightful conversation until my colleagues arrived.

The next day, I was leaving the meeting room on the second floor and was invited into one of the elevators with the general manager and two other gentlemen. He greeted me and asked me how my dinner was the night before. I told him it was excellent and went on to say with a smile that we had eaten in his restaurant. The other men were speaking French. The elevator abruptly stopped and the control panel went dark. We were stuck! One of the men in the elevator with us was the French ambassador to the United States. He had just given a speech to the media down the hall from our meeting room. We engaged in a wonderful conversation about our new president and his popularity in Europe, French versus California wine (we agreed to disagree on which was better), and his take on the global economy. Meanwhile, the general manager nervously talked in French on his cell phone to his maintenance staff outside feverishly trying to open the door.

At one point the lights went off so all four of us powered on our cell phones to light up the elevator. I showed them a silly picture I had taken the day before of the U.S. Capitol when I was on the Hill meeting with staff members of our congressional delegation on building support for the legislation they have introduced on the “Tweener” Medicare payment issues. I explained I tried to take the roof off the Capitol to see if Mr. Obama was inside!



The maintenance staff opened the door about 40 minutes later and we were all pulled up and out of the elevator which had been stuck between floors. I saw the general manager again later that evening and he bought me another glass of wine with a twinkle in his eye and said although he had never been stuck in an elevator before, he was sure glad to have been in there since the ambassador was on board. I must admit, I was glad to have been there as well, because it is not everyday a country boy from Iowa gets to have a one-on-one conversation with an ambassador!

On my flight home from Washington, Karen and Jim Nussle were on the same flight. Unlike the French ambassador, I do know Jim pretty well going back to his days as the U.S. Congressman from northeast Iowa. We worked together on a number of rural health issues. He was a member of Congress that truly cared about rural healthcare, understood the issues, and was a strong voice. I had not had a chance to talk with him much since has appointment as the Director of the Office of Management and Budget. You know; the guy responsible for helping to draft the federal budget and responsible for managing the largest financial enterprise in the world…the U.S. Government! Basically he was the CFO for America. We talked between flights for about a half hour and I was just mesmerized as he talked about daily meetings with the President…sitting in Situation Room at least one day a week. He was in the room for every major decision made by the President over the last couple of years!

For a government wonk like me, the conversation was tantalizing. What was President Bush really like? How about Chaney? Jim was gracious and friendly as always and seemed to enjoy talking about it all in past tense. I asked if he was relieved to be out from what must have been overwhelming stress and a look of relief spread across his face. He did say it was absolutely fascinating…the understatement of the week!

You just never know who you might run into when traveling to our nation’s Capitol…for me it was a very memorable 24 hours.

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

This is YOUR hospital.

I'm going back to Washington, D.C. for the American Hospital Association annual meeting in April and I want to show our Congressional leaders the faces and names of people whose lives have been impacted by Grinnell Regional Medical Center.

Will you help?

Send a photo of yourself and a few lines about why GRMC is your hospital to: GRMC, attention Barbara Hansen, 210 Fourth Avenue, Grinnell, Iowa, 50112. Or email to info@grmc.us. We'll collect those we receive by March 12 and put them into a format that I can take and show to Members of Congress about why community hospitals like GRMC are vital.

We know that GRMC is your hospital. Now its time to tell your Members of Congress.

A Postcard from D.C.

On Wednesday, members of the delegation from Poweshiek County Economic Development (PowI-80) had meetings with Rep. Bruce Braley, Rep. Leonard Boswell, Senator Chuck Grassley, and Senator Tom Harkin.

Pictured here are the members of the group meeting in Senator Harkin's office. We are advocating for many issues of importance to Poweshiek County. Obviously, one of the biggest issues of the day revolved around President Obama's proposed economic stimulus package. The House of Representatives have passed the package and it now goes to the Senate.

The Senate Finance Committee have reviewed their version of the stimulus package. As you may know, our Senator Chuck Grassley, is the ranking member of that committee and Sen. Max Baucus (D-MT) is the chair of the committee. Over the past few years, both Senator Grassley and Senator Baucus have been working closely on rural hospital issues, including the unfair Medicare reimbursement system for tweener hospitals such as GRMC.

I am pleased that there is a provision in the package to provide assistance to Iowa's tweener hospitals. We are advocating that this and many other provisions of the legislation stay in the final version of the package that will directly benefit Iowa hospitals and the people who rely on them for their healthcare.

Please take a moment, and thank your U.S. Members of Congress and their hard-working staff, for all they do on behalf of Iowans.

We're doing more than keeping our fingers crossed that these provisions will make it to the final version--we're actually on The Hill telling the story for all of us. When I get back from DC later this week, I'll share more with you about what I heard and learned.