Grinnell College…One of America’s Great Liberal Arts Colleges

For the better part of the past decade, I have had the privilege of serving on the Grinnell College board of trustees. What a fabulous experience! Grinnell College is the rock of our community. GRMC has certainly benefited over the years—both tangibly and intangibly—through relationships with the college.

In early May, the college board held its spring meeting on campus. A special highlight of this meeting was the celebration known as Selah. Orchestrated by the college’s past board chair, Nord Brue, Selah offered a time to pause and take stock of the excellence that Grinnell College has been, currently enjoys, and will be in the future.

We especially enjoyed celebrating the “fourth” rebuilding of the college with outgoing President Russell Osgood. During the 12 years with Russell at the helm, the college has constructed many new buildings. As vice-chair of the buildings and grounds committee, I have enjoyed watching it unfold. A fine arts center, four new dorms, a major addition to the science building, a new campus center, and an athletic and fitness complex, along with several major renovations have all been accomplished in a fiscally prudent manner. We have also witnessed growth in the college’s academic and financial strength. This is a tribute to not just Russell, but also to the faculty, staff, board members, and students.

As Russell departs to teach around the world and return to the Osgood home in New England, we welcome the 13th Grinnell College president. Dr. Raynard Kington is the current deputy director of the National Institutes of Health. He holds a medical degree from the University of Michigan and an M.B.A. and a Ph.D. from the Wharton School of Business. We are excited about Dr. Kington and his family coming to Grinnell this summer to start his tenure at Grinnell. The GRMC medical community is looking forward to the opportunity to interact with Dr. Kington and his partner, Peter Daniolos, M.D. Dr. Daniolos is a child psychiatrist currently practicing at Children’s National Medical Center. He is also on the faculty at George Washington University.

I’d also like to share an interesting side note from the meeting. I am one of a few trustees on the board who is not an alum. At the student forum, we heard five outstanding presentations from student groups. The Scarlet and Black (the student newspaper), snapped a photo of me with several students after the presentations. The photo appeared on the front page of the newspaper with the caption “trustee Todd Linden ’85.” Although I received my undergraduate degree in 1985, it was from the University of Iowa. I have found myself hoping that my name will be called with the rest of the Grinnell College graduates this year. But I will not hold my breath. The S&B does not have that kind of authority!

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.

Bluestones Touch Our Hearts

This past week, Rebecca and Robert Bluestone touched a chord deep within my soul. Rebecca is an unbelievably talented silk weaver. Robert is an amazing classical guitar player. Rebecca is also an ovarian cancer survivor and cared for her mother during the last six months of her life after a breast cancer diagnosis. Robert was Rebecca’s caregiver during her life-saving treatment.

Their “Woven Harmony” project originated from a unique collaboration at the University of Iowa with Hancher Auditorium, the College of Public Health, and the Holden Cancer Center. A journey across Iowa, “Woven Harmony” included stops in Spencer, Algona, Des Moines, Grinnell, and Davenport. Over the past several weeks, Rebecca and Robert spent three days in each of these communities conducting workshops and performances. Using their “stringed instruments” of loom and guitar, they delighted audiences and inspired healthcare workers with the beauty of their art.

In Grinnell, they started at GRMC with two workshops attended by more than a hundred staff members. Of course, staff met their message of art and healing with enthusiasm and a kindred spirit. Art has been a part of GRMC’s optimal healing environment for many years. The Bluestones offered yet another example of how soulful music and exquisite visual art can enhance modern medicine.


Rebecca and Robert also provided workshops at the Grinnell Newburg High School and Grinnell College. More than 200 students experienced Rebecca and Robert’s artistry. During these presentations, the couple shared how the arts can add to the creative spirit that dwells within us all. The duo capped off their three days in Grinnell with an inspirational performance entitled “Celebrating Community” at the Voertman Theater. It was a special treat for me to have my son, Grant, (also a gifted guitarist) and my parents, Judith and Chuck, attend the performance with me. My mother is also a cancer survivor. With Mother’s Day coming up, it was extra special to enjoy the message and beauty of the Bluestones together.


Everyone who experienced Robert and Rebecca’s talent and compassion were inspired to care a little deeper, think a little clearer, and live a little richer. I look forward to future collaboration with this extraordinary couple on their mission to change the world. Thank you, Bluestones for touching my heart.


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

Taking the opportunity to look inside the department that looks inside!

This week I had a chance to visit our imaging department, often referred to as “radiology.” This department is certainly one of the “high tech” and very expensive departments at GRMC. It is truly amazing to see what amazing progress there has been over the years in the technology of looking inside our bodies. I watched an abdominal CT scan, upper GI, and Venus Doppler (ultrasound) study. One can’t help but be impressed with how clear the images are and the information now available to our physicians and mid-level providers in making diagnosis and treatment decisions.

As impressive as the machines are, it is the skilled and knowledgeable people working the machines that makes this also a “high touch” department. Obviously, patients and their family members are often worried about what might be wrong when going through these studies. They might be experiencing pain or drinking icky stuff that can also lead to anxiety. Some tests can take several hours. What I observed was a talented team of people working together to take expert pictures while doing so in a courteous and compassionate manner. I had a chance to spend time with Gina, Regina, Kathy, and Terry – all sensational members of the GRMC team!

One of the key members of the team is the radiologist. GRMC is blessed to have an excellent relationship with Iowa Radiology. Several of the radiologists from this large group of doctors based in Des Moines view our images daily for GRMC. Using something called PACS, they now “read” all the studies on computer and the x-ray film is a thing of the past. Literally minutes after the exam is completed a radiologist reviews the exam and is able to offer a report electronically to the referring physician and ultimately the patient. Really cool stuff.

I was reminiscing with one of the tech, who has been at GRMC for 18 years, about the days when stacks of films were piled in the radiologist offices waiting to be read. We would have to store the film and make copies for referring physicians or patients. Those certainly were not the “good old days”!

As we prepare to bring a new MRI unit into the department, it is great to look around the GRMC imaging department and marvel at what modern medicine is now capable of showing. It will be very interesting to see what the next 10 to 20 years will bring in our capabilities to look inside our bodies!

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

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

Adding the Executive Branch to the Portfolio

I have enjoyed the opportunity to serve on the National Advisory Committee on Rural Health and Human Services for the past two years. The committee advises the Secretary of Health and Human Services, currently Kathleen Sebelius, regarding rural health and human services issues. Physicians, nurse practitioners, academics, policy folks, retired bureaucrats, association types, and a couple hospital administrators among others serve on the committee. It is staffed by the Office of Rural Health Policy…a truly amazing group of folks. We meet three times per year – once in Washington, D.C. The other two meetings are field trips to rural America. We develop a two to three topic report annually for the Secretary on issues we believe are important to rural communities. We also write comment letters and white papers on issues of interest when time is of the essence.

When I was asked to serve on this committee, I thought it might be an interesting opportunity to get involved in the executive branch of government. Most of my work in the past has been on the legislative side of things. It has been interesting getting a better understanding of the depth and breadth of our government. I am continuously amazed how truly gigantic it really is.

The most recent meeting was in D.C. in late February. At the time, we thought we would be focused on healthcare reform as a done deal and what impact the new legislation would have on the rural areas of our country. We talked instead about bundled payments and accountability of care organizations, regulatory issues that affect rural health and human services issues, and stimulus funding for implementation of the electronic health record. We also spent time discussing the epidemic of childhood obesity, especially as it relates to rural America.

One of the highlights of this meeting was a discussion with Mary Wakefield, director of the Health Resources and Services Administration. What a ball of fire she is. And coming from North Dakota, she is someone who can really relate to the rural nature of our committee.

When I am in D.C., I try to make it to Capitol Hill. I met with staffers in both Senator Harkin and Grassley’s office as well as the health aide in Congressman Boswell’s office. I am always impressed with how bright and committed these folks are to doing the work to keep their bosses in the know on important issues facing their constituents. I’m preparing to head to Washington next week for more meetings with our elected officials.

I’m looking forward to thanking our leaders for their efforts to fix our Medicare “tweener” hospital challenges. After several years of advocating for “tweener” hospitals, we have some legislation that improves the inequitable Medicare payment levels for middle-sized rural hospitals like GRMC. So many of us fought for this change and I want to acknowledge the Iowa Congressional delegation for their efforts to make sure this was written into the bill and just as importantly stayed in the bill as it was written into law.

I digress…back to my committee work. It is easy sometimes to lose heart, given how slowly some things in government move. Yet, when one is able to influence the process by making sure we are telling the story of how legislation and regulation impact the people we are dedicated to serving, it can be rewarding. I remind myself that I am a member of a “special interest group,” that is, someone who advocates for the special interests of the patients and families we are privileged to serve. I believe government works best when “we, the people” get involved.

This is going to be a particularly interesting year for our committee, given the changes coming in the delivery of healthcare and human services, but also because the committee is coming to Iowa in September on one of its field trips. I can’t wait to show off our state to the rest of the committee.

(By the way…Jesse Jackson was on my plane ride home from DC to Chicago…you never know who you might run into. I didn’t get a chance to talk with him…he was riding up front!)

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

The Heart of Grinnell

For more than a decade, Grinnell Regional Medical Center has been a leader in promoting health improvement for our employees and the community. We continuously look for the best ways to encourage and provide opportunities for exercise. We have provided pathways for reducing or eliminating the use of tobacco. We have provided classes on proper nutrition and maintaining a healthy weight and we have looked for the best ways to help people manage the stress in their lives. We have also been a national leader in the provision of hospital-based integrated health, which has contributed to our success with improved health and healing.

A little over two years ago, working with a group of colleagues from Grinnell and some new friends from HeartMath®, we doodled on the back of a napkin a simple vision of a healthy community, something we call “The Heart of Grinnell.” The focus of this project is stress.

Stress has become epidemic in our society. Last year the Journal of the American Medical Association published an article about a study that indicated workplace stress was a greater risk for cardiovascular disease than smoking or high cholesterol. There is little doubt that stress and its effects is a major underlying cause of many chronic diseases that plague our society.

Until our discovery of HeartMath®, our focus was on recommending relaxation techniques to manage stress such as exercise, massage, yoga, therapy, prayer, and meditation. De-cluttering our lives can also impact our stress levels. The problem with most of these approaches to reducing stress is they occur after the fact, not in the heat of the moment or when stressful situations have taken control of our emotions. HeartMath® is a scientifically proven technique that has been developed to be an effective way to manage stress at the time stress is impacting us—just-in-time stress relief, if you will.

Stress is really caused by our emotional response to the environment around us. The toxic impact of stress affects us in many ways physically, emotionally and mentally. If unchecked, stress can impact our health, our relationships and our productivity. The techniques are based on the long-established connection between the mind, body, and spirit, recognizing that one’s state of mind impacts the body’s autonomic nervous system (ANS) that controls our breathing and heart-rate variability. HeartMath® provides the tools to lessen the physiological effects of stress.

GRMC received a $240,000 grant through the Centers for Disease Control and Prevention last year through efforts from Senator Tom Harkin. The concept of our project is simple: look for opportunities to teach the HeartMath® technique to as many community members as possible and then over time study the impact on the overall health of the community. Through the use of pilot projects at Grinnell College, police and firefighters, the Grinnell Newburg School District, Brownell’s, and the Grinnell Ministerial Association, we hope to demonstrate the healthful impact of effective stress management on overall community health status. From that point, the goal is to extend HeartMath® further into the community spurred on through the proven benefits of the pilot projects.

Seventy-five percent of all GRMC staff members have been trained in the HeartMath® technique and the initial impact has been very beneficial. The Institute of HeartMath® has hundreds of other studies which have proven the benefits of this technique, primarily focused on single organizations. What’s unique about The Heart of Grinnell project is its focus on the entire community.

We have discovered, when we are able to control our emotional response to the stressors around us, we often can maintain other healthy behaviors such as diet and exercise which sometimes suffer when we get stressed. So, HeartMath® has become a central focus in our overall health and fitness program.

Our vision to create optimal health in our community is the focus of The Heart of Grinnell project. Of course we are interested in improving physical health such as decreasing cardiovascular disease and diabetes, but we are also thinking about health in a much broader perspective. By decreasing the stress in our community can we improve productivity and relationships as well? So we intend to measure the number of domestic abuse calls to the police station, absenteeism in our employers, and test scores in our schools.

It is a bold initiative. We are excited about it. The more people exposed to HeartMath® and the amazing benefits of stress reduction, the more this vision is beginning to take hold.

We will keep you posted as our vision unfolds….