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Hey Iowa, Nice Job Being a ‘Least-Stressed’ State!

More and more often, other states are catching on to the great things we have going on in the Hawkeye State1! Our state and communities continue to receive many national accolades from various publications, many of which are quite flattering, such as:

A recent national benchmark ranking, coming from WalletHub, suggests that Iowa is the fourth LEAST-stressed state when compared to all other states (including the District of Columbia). Iowa’s placement follows only (in order), Minnesota, North Dakota and Utah. For comparison purposes, Iowa was the third least-stressed state in 2017 (Minnesota and North Dakota were No. #1 and No. #2, respectively). There appears to be something magical about the upper Midwest.

To determine the rankings, WalletHub compared the 50 states (and D.C.) across four dimensions (and 38 relevant metrics). The four dimensions were:

  1. Work-related stress (7 metrics)
  2. Money-related stress (10 metrics)
  3. Family-related stress (6 metrics)
  4. Health- & safety-related stress (15 metrics)

As we know, stress is related to both external and internal factors that affect each of us. Sometimes we are unaware of how stress can impact our health. External factors may include our job, relationships with others, our home, other physical environmental situations, challenges, difficulties, and expectations we are confronted with on a daily basis. How we respond to, and deal with, the external stress-inducing factors affects our nutritional status, emotional well-being, overall health and fitness levels, and the amount of sleep we get. Each of us deal with stress differently, but if we are not careful, it can wreak havoc on our personal (and professional) lives.

For each of the four dimensions mentioned above, the state of Iowa ranked as having the 16th least work-related stress, sixth least money-related stress, fifth least family-related stress, and third least health- & safety-related stress. Metrics that relate to the work-related dimension, the lowest scoring of the four dimensions, include:

  • Average hours worked per week
  • Average commute time
  • Average leisure time spent per day
  • Job security
  • Unemployment rate
  • Underemployment rate
  • Income growth rate

The economy can have a big influence on this particular dimension. Iowa has a very low unemployment rate (2.9% in 2017), a factor that causes employers to struggle with finding qualified workers in jobs difficult to fill. According to the Iowa Workforce Development, the weekly wage increase in 2016 was below two percent (2017 data will be available very soon), showing that wages are depressed.

Iowa Healthiest State Initiative

To help Iowa avoid resting on its’ laurels, a wonderful ‘movement’ occurring in Iowa is the Iowa Healthiest State Initiative (HSI). Executive Director Jami Haberl, and her team are working to make a meaningful difference in how Iowa communities and employers can improve the daily lives of how we live, work and play. One HSI approach attempts to address the stresses we face in our environments, and will annually monitor this stress through our resiliency. Resiliency is an often-used term that describes the ability to overcome challenges of all kinds – such as trauma, tragedy, personal crises, everyday problems – and our ability to bounce back stronger, wiser and healthier. If you are not aware of the HSI resources, please check them out here.

Receiving national accolades are wonderful, but these don’t just happen out of sheer luck. It takes hard (and smart!) work and perseverance, coupled with the belief that implementing new initiatives and approaches to positively impact our communities and those living in it will be best for all of Iowa. 

As the saying goes, “Prepare and prevent, not repair and repent.”

Let’s keep it up, Iowa!

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1Sorry Cyclone fans, but the official state nickname for Iowa is ‘The Hawkeye State.’  Honestly, I’m trying to be as impartial as possible!

Healthcare Patients Want ‘Good Value’ for the Money

Cost +Quality = Value

…we are now entering into a new era in healthcare that appears to alter our behaviors toward the care we are receiving…

Similar to national data, Iowa spending on healthcare and insurance premiums has risen at historically lower rates in the last three years. However, according to the Kaiser Family Foundation, only three percent of Americans said health costs are “going up slower than usual,” and 52 percent said costs are “growing faster than usual.”  The other 35 percent say costs are about the same.

The amount that Iowans with employer-based health insurance pay for premiums has risen 167% in the last 14 years, while Iowa weekly wages have risen about 40%* and general inflation 43 percent. As we know, our incomes are suppressed by increasing health premiums, which certainly impact take-home pay and, ultimately, our capability of making consumption trade-offs for other priorities, such as food, shelter, education and retirement savings.

In addition to the premium cost, Americans are asked to pay increasingly more of the medical care they seek, through higher deductibles, copayments and out-of-pocket maximums. With lower-relative income, finding the financial resources to pay is problematic for many employees, causing them to put off receiving care or incur more medical debt.

In a recent Wall Street Journal article, Drew Altman, president and CEO of the Kaiser Family Foundation, wrote that Americans with health coverage care about:

  • Their premium costs, or the share of premiums they pay if they have employer coverage;
  • Their deductibles and other forms of cost-sharing, especially when deductibles have been rising steadily;
  • Their drug costs;
  • Whether they can go to the doctor or hospital they want without having to pay more;
  • The hassle and red tape in healthcare and health insurance. People care about getting information to be informed about their health and make smarter insurance and healthcare decisions;
  • Seniors care a lot about Medicare and sometimes vote on this issue.

Most people would agree to this list.

However, Mr. Altman then mentioned that “Americans don’t care as much as experts do about improving quality and eliminating unnecessary care. In general, people think that quality is good and they want more care not less.”

Perhaps this was true in the past, but we are now entering into a new era in healthcare that appears to alter our behaviors toward the care we are receiving. One prime example is a recent study that says cost is not the most important determinant of the care we seek – it is quality. From this report, when patients are provided hospital safety score grades and cost information together, they will choose safer hospitals 97 percent of the time, REGARDLESS OF COST.

Of course, this may also depend on WHO pays…the patient or a third party.

Making sure that such report cards reflect the most relevant performance measurements will be extremely important – if not critical – to the patient. Unfortunately, we don’t have this luxury at the present time. A March article on the Johns Hopkins Medicine website reports that national rating systems on the quality and safety of hospitals are too confusing because each will stress different measures from each other – sometimes providing a wide variation of grades on the same hospital (study source: Health Affairs).

In my blog last August, I wrote that the Urology Department at Cleveland Clinic received a top score by the U.S. News & World Report, yet received the lowest possible score by Healthgrades for prostatectomy outcomes. This type of reporting will only serve to confuse the general public before seeking care.

As healthcare delivery and payment initiatives continue to morph, look for quality and safety measurements to emerge with the cost component. The convergence of reliable safety and quality information with ‘real-time’ cost information can eventually catapult the healthcare industry into the 21st century.

Until then, many hurdles must be successfully cleared in order to achieve the desired value we all want.

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*2014 data from the Iowa Workforce Development is not yet available, and therefore, excluded.

Seriously…Cleveland Clinic?

Sweeping Dirt Under RugHarvard, Yale, Princeton and Stanford – all are very prestigious universities.

Likewise, the Mayo Clinic, Johns Hopkins and Cleveland Clinic – are all are very prestigious medical facilities, right?

Having a stellar reputation takes years (and generations) to build, whether it’s institutions of higher learning, healthcare organizations or law firms, etc. Being ‘prestigious’ comes with many flattering adjectives like: celebrated, trusted, respected, prominent, great, important, imposing, influential, renowned, and exalted.

The Cleveland Clinic has enjoyed this elevated stature for years. But, unfortunately in healthcare, it may be easier (and cheaper) to ‘buy’ an image of quality than it is to consistently perform quality care practices day in and day out – especially when the image is protected by suppressing information from state and federal authorities regarding safety practices.

Believe it or not, Cleveland Clinic was on a “termination track” with Medicare between 2010 and 2013 (19 total months) for more than a dozen inspections that occurred due to patient complaints. Cleveland Clinic was threatened to lose its almost $1 billion annual Medicare reimbursements – quite a hit, even for a multi-billion dollar organization. After repeated Cleveland Clinic violations, the Centers for Medicare and Medicaid Services (CMS) took the unusual step to personally cite CEO Toby Cosgrove and the Cleveland Clinic Governing Board.

In June, Modern Healthcare reported that retired Air Force Col. David Antoon had accused Cleveland Clinic of withholding documents from federal authorities while the Clinic was being investigated for substituting Antoon’s authorized surgeon with a medical resident that resulted in a gross medical mistake. Mr. Antoon suffered serious disabling injuries resulting in the loss of his job as an airline pilot.

According to this article, and based on my correspondence with Mr. Antoon, the Cleveland Clinic hid important documentation from federal inspectors to avoid responsibility (and liability) for their derelict actions. If this can happen at a prestigious institution, you can be confident that it can happen anywhere.

As mentioned in previous blogs, Rosemary Gibson, senior advisor at The Hastings Center, did a splendid job of explaining in her book, “Wall of Silence,” how the ‘medical industrial complex’ in this country is conspicuously silent when it comes to medical mistakes that kill and injure millions of Americans.

U.S News & World Report recently published the ‘Best Hospitals Rankings’ and placed the Cleveland Clinic in the top position for Urology. In contrast, Healthgrades ranked Cleveland Clinic with the lowest possible score for prostatectomy outcomes; CMS data for Hospital Acquired Conditions (HACs) placed Cleveland Clinic in the bottom 7% of all hospitals with a score of 8.7 (scores ranging from 1- 10, with ten being the worst); and the independent Leapfrog Group gave the first ever “D” grade to Cleveland Clinic for patient safety. WDAF-TV (Kansas City, MO) recently reported that hospitals must pay US News to use the “Best Hospitals” logo in advertising. Many rating organizations charge hospitals to market their grades. So what can the public believe: “pay to play” advertising or independent reviews?

The Cleveland Clinic will continue to pay US News to market itself as evidence that they are a ‘prestigious’ medical organization, and yet quietly sweep the CMS action, and other independent negative reviews, under the rug.

Again, my point is simple. If this happens to the prestigious Cleveland Clinic, it can happen anywhere – and it does. Unfortunately, the Cleveland Clinic story is only the tip of the proverbial medical iceberg. The medical industry is unwilling and, quite frankly, unable to reform itself from within. Because of this reluctance, it is now time for the public to apply transparency measures. Our own lives may depend on it.

As the saying goes: “Fool me once, shame on you. Fool me twice, shame on me.” I think this easily applies to all of us who continue to allow the medical establishment to self-regulate with secrecy – resulting in unnecessary harm to unsuspecting patients.

I’d love to hear your thoughts.

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