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Grading Iowa Hospitals and Physicians – A ‘Silent Voice’ No More

PR Report Card Visual Option (1)Today, we issued our press release on the Iowa Employer Perceptions of the Iowa Healthcare Provider Community. The results come from our 15th annual Iowa Employer Benefits Study©. This section of the study reveals compelling information that is both fascinating and relevant to Iowa employers – and to the entire state of Iowa. This type of study is a first of its kind in Iowa – perhaps in the country! 

We’ve also just released our “Voices for Value” white paper which provides a comprehensive look at Iowa employer perceptions of the Iowa healthcare marketplace. I am very proud that the Iowa Association of Business and Industry (ABI) is the sole sponsor of this paper, as they have represented the “Voice of Iowa Business Since 1903.”

For the last 30 years, I have been keenly involved with employer-sponsored health insurance in Iowa. During most of that time, I assisted employers with evaluating and obtaining health coverage on behalf of their employees. As employers know, the complexities of health insurance requires a great deal of their time and effort each year to assure the ‘appropriate’ health coverage offering to their employees. This is an often-overlooked cost that is not factored into the health premiums paid by employers. Nonetheless, it is a necessary process that requires frequent employer attention.

Year-after-year, our annual studies indicate that Iowa employers continue to receive premium increases that exceed the inflation rate. In fact, since 1999, the annual Iowa single premium increased by 171 percent while the family premium increased by 158%. Despite these meteoric increases, Iowa employers continue to pay more than their ‘fair share’ of the premium costs – about 80 percent of the total single premium and about two-thirds of the family premium.

So why ask Iowa employers to assess hospitals and physicians within their communities? It’s quite simple. Employers play an enormous and critical role in funding the private insurance system. Unfortunately, when assessing the value received from the healthcare providers, they have been a relatively silent and diluted voice on how this investment is being used.

A silent voice?  Yes, but no longer.

Iowa employers were asked on a 10-point scale, where 1 is “failing” and 10 is “excellent,” to assess 11 key performance measures. Employers reported that both hospitals and physicians within their communities are either ‘average’ or ‘below average’ on most measurements. However, two measurements that are most worrisome to employers, resulting in dismally low grades, are “Keeping Cost Reasonable” and “Cost Transparency.” Iowa employers feel that hospitals are a grade away from failing on both measurements, as they received grades of D-minus and D-plus respectively. Physicians were graded slightly better at D and C-minus, respectively. Based on the escalating premiums employers continue to pay each year, it is not surprising that employers are in a foul mood on cost issues.

 Grading Hospitals - Voices for Value

Grading Physicians - Voices for Value

Iowa Hospitals and Physicians - 'Voices for Value'

Trusting Hospitals and Physicians

One last assessment measurement is the “Level of Trust” employers have with hospitals and physicians within their communities. Specifically in healthcare, trust is perhaps the most important measurement used to gauge the effectiveness of the services provided to the population. In this measurement, hospitals received a tepid B-minus from employers, while physicians received a mid-B.

The other grades given to hospitals and physicians are considered to be underperforming, particularly relating to measurements on patient care and the perceived outcomes received from patient care. More about these grades in later blogs.

One final comment regarding how employers graded their health providers. When asked to evaluate health providers, employer assessments come from ‘perceived’ attitudes about the various measurements being asked within the survey. Clearly, we need to know a great deal more on how our healthcare providers can meet the expectations of a key healthcare payer – the employer.

This particular survey provides a solid baseline on employer perceptions. Based on these results, future healthcare provider community assessments will be required. 

I invite your comments regarding the grades employers assigned to both hospitals and physicians.

To learn more about this and other survey results, we invite you to subscribe to our blog.


  1. Dave,

    A great job as always on this. Did you note any differences in metropolitan vs. rural areas or differences in regions of the state? If you can say, are there any systems in the state that seem to be getting it right that can be modeled?

    • David Lind says

      Thank you, Maurie! Yes, the results are EXTREMELY interesting when looking at the results using five regions around the state. I plan on sharing some of this information in future blogs, so stay tuned! As former U.S. Rep. Tip O’Neil (MA) commented in the past, “Politics is all local.” So too is health care. I also have results on a county-by-county basis which is an eye opener…especially in our larger urban locations. Frankly, I find much of this information very troubling. We have so much work to do in learning more and finding ways to improve quality (and value) in our delivery system! The work has only begun!

  2. Excellent findings. Information like this is well overdue. Clearly, Iowans deserve more transparency from their medical providers. I suspect the trust factor will only increase once the low scoring issues are addressed. Great stuff.

    • David Lind says

      Thank you, Andrew! I work with an excellent research organization, Data Point Research! The journey has just begun on this topic.

  3. Mark Runquist says

    David, I have heard many stories of patients not knowing how much services cost ahead of time – and even physicians having no clue what the differences might be between similar drugs, or even the same drug in different dosage rates. Obviously, from this report, that is a widespread problem. Does Obamacare have any provisions to make more transparency?

    • David Lind says

      Thank you, Mark. I believe that relying on ‘Obamacare’ to fix the health care ‘system’ on cost transparency will be minimal to a certain extent. With health care, real change will come from within, and this will only happen when enough ‘voices’ are raised to make a tsunami of change from those who seek care from our health care providers. With growing government regulations, we typically experience both intentional and unintentional consequences that result in an even more disfunctional health care ‘system.’ We need to drive the right kind of behaviors from health care providers in the future, and cost transparency is definitely a must!