July 2009

Grinnell Medical Associates welcomes Wendi L. Beck, PA-S, to the practice. She joins Roy Doorenbos, MD, and Clayton Francis, MD, on the second floor of the Ahrens Medical Arts Building. She begins Aug. 10 at the private practice as well as joins the Grinnell Regional Medical Center’s Medical Staff.

Beck recently graduated from the University of Iowa Carver College of Medicine with a physician assistant advanced degree. She completed a one-year practice rotation at six different hospitals as part of her physician assistant training, which covered pediatrics, family medicine, emergency medicine, psychiatry, long-term acute care, gynecology, and surgery. She also elected to have a rotation in specialty areas of radiology, EKG interpretation, and cardiology. Her undergraduate bachelor’s degree was received at Simpson College in biology.

As a physician assistant, Beck is a licensed healthcare professional who practices medicine under the supervision of a physician. A physician assistant provides a broad range of healthcare services that are traditionally performed by a doctor. In general, a PA can provide approximately 80 percent of the services typically provided by a family physician.

“We feel Wendi will be an excellent addition to our practice,” Francis says. “Her familiarity with GRMC, staff, and the community will enable her to quickly earn trust of patients and staff.”

Beck worked at GRMC from January 2005 to April 2007 as a patient care tech in medical/surgical units and as a nursing technician in ICU. She grew up in Brooklyn and graduated from BGM High School. She was one of the GRMC Auxiliary Scholarship recipients in 2007 and 2008 as she completed her bachelor’s degree and physician assistant degree.

“When I worked at GRMC, two physician assistant positions were being hired and I had hoped that I would be able to return to GRMC,” explains Beck. “I love the community and the employees. It’s like a comfort zone to return to a familiar place.”

Beck enjoys reading, scrapbooking, and along with her husband, Jon, she spends time in the outdoors fishing and hunting.

To schedule an appointment with Grinnell Medical Associates, call 641-236-2500.

The New Sharon Memorial Clinic and Grinnell Regional Medical Center announce the addition of Diane Nutter, ARNP, as a primary healthcare provider for area residents. Nutter will begin seeing patients on August 3 in the clinic, located at 302 S. Park St. in New Sharon.

Nutter brings more than 15 years of experience as a nurse practitioner and registered nurse to the position. Prior to joining the GRMC medical staff, Nutter provided family/primary care at the Truman State University Student Health Center, in Kirksville, Mo. She also served as a nurse practitioner at Quincy Medical Group, Rural Health Affiliate, in Lewiston, Mo., and Hays Medical Center, in Hays, Kan.

“I was inspired by the TV show ‘Mash’ to be an army nurse or doctor when I was young,” Nutter says. “I really wanted to be a doctor but was talked out of it. I received a biology degree from Northeast Missouri State University. I did a few odd jobs and decided to go back to my passion and become a nurse practitioner. I enjoy caring for people and having fun with what I enjoy. My approach to medicine is to treat people how I want to be treated – with respect and quality care.

I’m compassionate and realize it’s not realistic to try to change behaviors overnight. I work with my patients to figure out their problems and together make progress to healthy behaviors.”

Nutter received a bachelor’s of science in nursing at Culver-Stockton College and Blessing-Rieman College of Nursing, Quincy, Ill, and a bachelor’s degree from Northeast Missouri State University, Kirksville, Mo. She earned a master’s degree in nursing with a family nurse practitioner certificate from Fort Hays State University, Hays, Kan.

Nurse practitioners have an advance academic and clinical degree and can manage the majority of patients’ healthcare needs. NPs promote a holistic approach to healthcare and emphasize the overall health and wellness of their patients. Nurse practitioners are qualified to provide primary care diagnosis and treatments to patients and prescribe medications, order tests, and manage chronic conditions.

“Diane brings a genuine compassion and love of small towns that I believe the residents of New Sharon will find refreshing and sincere,” explains Todd C. Linden, GRMC CEO and president. “Diane is the type of provider who wants to be a part of the patient’s life and know the family. She’s a real gem. We’re very pleased she has decided to make New Sharon her home and practice location.”

The Nutter family will move to New Sharon, including husband, Rich, and six-year-old daughter, Rubi. When not busy with her practice and family, Nutter enjoys photography, reading, coaching softball in the summer, music of all kinds, traveling, and training the family dogs.

To schedule an appointment at the New Sharon Memorial Clinic, call 641-637-4046.

Grinnell Regional Medical Center released its 2008 annual report, “Your Hospital, Our Story,” to the public. The 2008 report can be found online at www.grmc.us.  It is the first online annual report for GRMC, strengthening the organization’s commitment to the environment and to saving paper, printing, and postage costs.

Within the online video and text report, GRMC’s main accomplishments and advances in 2008 are highlighted, along with a financial performance summary, optimal healing practices, new medical staff, and advocacy efforts to correct unfair Medicare payment.   

While providing some of the highest quality, lowest-cost medical care in the nation, GRMC still struggled with a $3.1 million loss from operations for 2008.  Reimbursement challenges, decreasing numbers of patients, the rising need for charity care, and more people having difficulty paying their medical bills all contributed to this loss. GRMC’s total operating revenue was $74,754,158 however deductions such as commercial insurance and government insurance discounted rates, charity care, and bad debt reached $33,370,454. This generated a net revenue of $41,383,740, which is a $2.9 million reduction from the previous year.

Total expenses were $44,452,868 in 2008. GRMC reduced expenses by $1.8 million to counter the revenue challenges; however, it wasn’t enough to close the $3.1 million gap in operations budget.

Community members contributed to the medical center in exceptional ways with last year’s record-setting annual fund drive of more than $313,000 from 1,148 donors. GRMC also received nearly $600,000 from other sources such as memorials, gift annuities, fundraisers, and estate distributions. Along with grants, these donations help to upgrade needed medical equipment, renovations, and other ongoing programs. This support helps bridge the widening gap between revenues and expenses.  

Optimal healing created an environment of health and harmony at GRMC last year. Our medical center is a leader in the nation for offering integrated therapies to patients. USA Today (June 2008) featured Anne Stephens, an acupuncturist at Postels Community Health Park, GRMC’s integrated therapies clinic.

 “Success came in different forms this year. We made some serious changes due to financial challenges, but we still recruited eight healthcare providers, reached out to neighbors affected by natural disasters, and gave outstanding care to our patients. You cannot assign a numerical value to those successes,” says Susan Witt, chair of GRMC’s board.  

Ongoing community programs and benefits supporting the optimal healing environment to area residents included the Women’s Health Focus, Community Care Clinic serving those without healthcare insurance, Senior Education Program, GRMC Baby Fair, distributing bike helmets to third graders in the area, community blood screens, donations to more than 10 area schools funded by the sports physical at area clinics, Relay for Life support, infant/car seat safety checks, and the Green Health initiative.

“In national studies, Iowa ranked second best in the nation for highest quality, lowest cost, and best access in healthcare. GRMC’s costs are below the national average, yet we still only receive 67 percent of our costs in caring for Medicare and Medicaid patients, representing nearly two-thirds of our patients. Considering the national average for Medicare reimbursement is about 90 percent, rewarding inefficient healthcare in other states is an injustice that must be addressed this year in healthcare reform,” says Todd C. Linden, GRMC president and CEO. “It is simply unacceptable to be paid almost $7 million less than we spent taking care of these patient populations, and expect we can shift those costs to the rest of our patients.”

The 2008 GRMC Annual Report, “Your Hospital, Our Story,” can be viewed online at www.grmc.us. If you have any questions, please call the public relations office at 641-236-2593.

Grinnell Regional Medical Center this week reduced work hours for all staff in an effort to cut costs.

“We want to retain all our valued employees. One of our goals has been to preserve jobs during our financial challenges. The idea behind this move is to avoid layoffs so employees will still be here when the economic situation improves. We see this as a shared sacrifice during this economic crisis. By holding on to our staff, we believe we will be in better shape than hospitals that have used the philosophy of layoffs,” says Todd C. Linden, GRMC president and CEO.

 GRMC patient admissions have decreased this year—in large part because many patients are not seeking elective procedures due to the national recession. For the past several years patient volumes have also decreased because of the difficulty recruiting physicians in several key specialty areas. Orthopedics, general surgery, and internal medicine are special focus areas for GRMC physician recruitment.

“There are national shortages of physicians in these specialties, which makes it more difficult to recruit. And we are looking for extraordinary candidates to match the quality of physicians we currently have on our medical staff,” Linden adds.

“The amount of bad debt and number of people needing financial assistance are higher than they have ever been,” says Jack Fritts, GRMC vice-president and CFO. “During the month of May, the medical center lost almost $400,000—which was incredibly disappointing after seeing a positive margin in April. June volumes were not as low as May and we will make budget, but we continue to see poor reimbursements from Medicare, Medicaid, and private insurers. As we planned ahead for the next few months, we knew we had to act decisively to prevent additional large monthly losses.”

Susan Witt, GRMC board chair, explains that “GRMC is experiencing the perfect financial storm – lower patient volumes, the worst Medicare payment in the country, and a poor economy adding to bad debt and charity care. Even our largest private insurance payor, Wellmark, only increased payment rates this year one half of one percent.  Obviously, our supply costs, utilities, drugs and equipment costs were substantially more than that. It really only leaves cost cutting as a means to reduce the losses and our biggest expenses are staff related. Yet our employees are our most valued resource so we are trying to be very careful cutting in this area.” 

GRMC administration and department leaders will reduce their work hours by 20 percent until Sept. 12. All other staff will work 10 percent less. Some staff members have chosen to work even less in an effort to help more. In August, GRMC leaders will review the medical center’s needs and make decisions about the need to continue this.

In the past year, GRMC had already made a number of cost reductions, such as eliminating GRMC’s match to employee’s retirement benefits as well as enforcing a hiring freeze for non-essential positions. In addition, more than 60 employees voluntarily reduced their hours in September 2008. Year-to-date, GRMC has reduced expenses more that $2 million compared to the same time last year, largely through not replacing vacated positions.

“Our relationships with our employees are important to us. By making these changes together, we intend to protect staff from more difficult changes for as long as possible. These changes will help us weather the storm together and carry out our mission in a manner that meets the standard of excellence we expect from each other and ourselves for our patients,” Linden says.

Witt adds: “The staff at GRMC does a fantastic job of providing high quality and compassionate care every day. The board is so proud of what they have accomplished under an extremely difficult set of circumstances caused largely by external forces. The board appreciates the sacrifices that have been made so the mission of service to the community remains strong.”

 “With national healthcare reform underway and more Medicare cuts likely, GRMC leaders anticipate the need for additional cost-containment measures in the future, especially if patient census does not increase,” Linden says. “We are grateful for a committed and supportive community, board, medical staff, auxiliary, and group of employees. When it comes to healthcare, it is all about the people and we have great people. Together we will get through this.”

Grinnell Regional Medical Center’s board of directors has approved an affiliation agreement that will make GRMC the 30th Iowa affiliate hospital of Mercy Health Network based in Des Moines.

“We look forward to a mutually beneficial relationship with Mercy Health Network. It’s taken a lot of planning and research to get here, and I appreciate the work of our task force on this effort. We’ve really studied the benefits that might come from various relationships and the GRMC board believes the type of affiliation offered by Mercy will benefit GRMC patients for years to come without taking away local control of our hospital,” says Susan Witt, chair of the GRMC board of directors and a member of the task force that began looking at the merits of a system affiliation about a year ago.

Established in 1998, the Mercy Health Network was founded on the belief that the existence of rural healthcare facilities throughout the state is the key to providing readily accessible high quality healthcare to all Iowans. Affiliate hospitals benefit from the added value of collaborative initiatives, programs, and support services. The affiliation between GRMC and Mercy will become effective July 1, 2009.

“On behalf of the entire Mercy family, I am pleased to welcome GRMC to Mercy Health Network,” says David H. Vellinga, president and CEO of Mercy Medical Center—Des Moines and Mercy Health Network. “I am confident that this new affiliation will be positive for both GRMC and Mercy. Together, we will learn from one another and share best practices to provide the highest quality health care available and, equally important, to continue to improve the health and well-being of the people who live in the communities we serve.”
 
GRMC Physician Support

Members of GRMC’s medical staff indicated their support of an affiliation agreement with Mercy Health Network when they voted in favor of the relationship at their monthly medical staff meeting on June 16.

Several different reasons exist for why physicians support a connection with Mercy, says Clayton Francis, MD, president of the GRMC medical staff. GRMC physicians found Mercy’s practice of leaving specialty referral decisions to the patient and the patient’s primary care provider important. Another benefit, he adds, will be access to best practice and quality ideas from dozens of Iowa hospitals that are also part of the Mercy network.

“On one hand they will provide us with support. On the other hand, GRMC will remain independent, allowing us to make our own decisions. This is important because we want to do what is good for the local community and not have that control elsewhere. Our physicians and allied health professionals are all part of this community. We live here. We work here, and we use the hospital, too.  We know what the community needs,” Francis says.

Benefits of Affiliation

“Patients coming to GRMC will not see any dramatic changes resulting from the affiliation, such as a new name or different people interacting with them,” says Todd C. Linden, GRMC’s president and CEO. “GRMC will remain an independent community hospital, yet through the affiliation we will enjoy access to opportunities like group purchasing, computer services, and physician recruitment expertise.”

Under the proposed agreement, GRMC will contract services and share best practices with all of Mercy network hospitals. GRMC also will continue its business relationships with other healthcare organizations and visiting specialists. The agreement allows GRMC physicians to make referrals for specialty care for their patients not only to Mercy, but also to any hospital or provider that can help a patient the most.

“One of the many reasons the proposal from Mercy was attractive to us was that it does not call for a change of ownership or a merger. The GRMC board of directors will continue to govern the medical center while also receiving guidance and advice from Mercy and its other affiliates when we ask for it. It doesn’t get much better than this: we get the benefits of being part of a system and yet remain independent,” Witt says.

Another attractive feature of the agreement is that Mercy offers a 90-day out clause at any time. “This shows Mercy’s commitment to continuously provide value for the fee we pay to be part of their network,” Linden says.

Affiliation Goals

Mercy Health Network was one of four organizations the board considered for affiliation. The board had a number of goals as it reviewed affiliation options. Those included finding a partner to help with physician recruitment and medical staff development; quality, safety and service initiatives; access to specialized expertise such as electronic health records and legal services; and being part of a larger purchasing pool for supplies, medications, and equipment.

“This year, GRMC is in a better financial position than it has been in the past two years. We believe the affiliation holds promises for helping GRMC continue to regain our economic stability. Essentially, the opportunities that exist for us through Mercy can help make GRMC fiscally stronger as we continue to struggle with insufficient Medicare and Medicaid reimbursement and the need to recruit more specialists,” Linden says. “In addition, the affiliation will allow us to establish networking relationships that will ensure the medical center will offer the best practices and highest quality to our patients.”

Mercy Health Network is an integrated system of member hospitals and other health and patient care facilities united through various relationships. The network already includes 11 owned hospitals, 29 affiliated hospitals, 98 physician clinic sites, and more than $1 billion in annual revenues. While Mercy Health Network provides integrated financial and management services to operate network facilities, it does not own or control the majority of its affiliates.

GRMC and Mercy leadership will hold an open forum at 6 p.m. on Monday, July 6, in the Tomasek Conference Center at GRMC. The public is invited to come and meet Mercy leaders and learn more about the affiliation.