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Iowa Department of Public Health

Top Flex Activities

Program Area: Support for Quality Improvement

Iowa's goals are to improve patient safety in critical access hospitals (CAHs) and the community by:

  • Ensuring all health care providers and eligible patient populations receive their influenza vaccinations
  • Provide technical assistance (TA) workshops and consultation site visits to improve hospital staff and patient vaccination rates and provide online vaccination data reporting system reports (in addition to other data reports)

These goals will be measured by the percentage of CAH staff vaccinated, the percentage of eligible patient population vaccinated and the percentage of CAHs reporting on influenza vaccination rates.

Please share a success story about reporting quality data or using quality data to help CAHs in your state improve patient care.

Floyd Valley Healthcare, part of Avera Health, was one of the hospitals recognized at the 2016 National Rural Health Association’s Critical Access Hospital Conference as a Top 20 CAH. The hospital, with an average daily census of about 10, is located in Le Mars, Iowa, which claims to be the Ice Cream Capital of the World and is northeast of Sioux City.  

Quality and patient perspectives are only a portion of the measures considered in the CAH ranking methodology. Upon review of the Medicare Beneficiary Quality Improvement Project (MBQIP) data, these were likely strong contributors to Floyd Valley’s success. A Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) five-star hospital, Floyd Valley Healthcare performs with excellence across every MBQIP domain and has also been a strong participant and performer in the Centers for Medicare & Medicaid Services (CMS) Partnership for Patients program. 

When asked for the most powerful factors that drive Floyd Valley’s success, 18-year Administrator Mike Donlin described a healthy culture of teamwork and devotion to patients that impacts everything from the pristine appearance of the campus to excellence in billing and medical records. The culture is one where leaders respect and encourage staff and provide the resources needed to do their jobs well. Donlin stated, “For the whole management team, no one pushes back on investing in quality. We count it as a given and a part of the minimum of what our community expects of us.” He added that the work of quality is ongoing. “Nothing is sustainable without effort.”

Beyond embracing Avera’s proactive quality and patient safety stance, Dolin also points to the power of partnerships to extend the reach of excellence into every aspect of patient care. The hospital collaborates with its principal affiliate Avera Health as well as nearby UnityPoint Health on joint quality and patient safety projects. It is active in the Iowa Hospital Association’s Hospital Improvement and Innovation Network (HIIN) and participates in a Medicare Shared Savings Program Accountable Care Organization (ACO). “We seek participation in everything we can to prepare for what’s coming down the pike in terms of value-based purchasing. It is dangerous to rely on the present payment system,” Donlin stated.

Program Area: Support for Financial and Operational Improvement

In the area of financial and operational assessments, the Iowa Flex Program will:

  • Conduct three meetings with identified CAH cohorts in high need of financial and operational assistance to help prepare CAHs for new payment and delivery models
  • Track the number of CAHs in need of financial and operational assessments that show improved financial and operational performance
  • Track the number of targeted CAHs that attend regional meetings

Program Area: Support for Population Health Management and Emergency Medical Services Integration

In the area of population health management and emergency medical services (EMS), Iowa will:

  • Provide a statewide CAH population health management needs assessment
  • Evaluate CAH and county level community health assessments to determine needs related to health access, disease prevention, causes and treatments
  • Track the number of CAHs completing or revising health needs assessments

Please provide information about any efforts to assist CAHs/communities and partner organizations in the transition to value-based care.

The Iowa Flex Program has contracted with consulting experts to advise Iowa CAHs and their communities on what value-based care is and how the transition will impact the health care system.

Please provide information about network activities in your state to support Flex Program activities.

The Iowa Flex Program subcontracted to a technical expert to promote and improve the reporting of quality of care data by CAHs.

Please describe how your state Flex Program has enhanced its use of data in the past year.

The National Organization of State Offices of Rural Health (NOSORH) and iVantage recognized Iowa for having 102 hospitals reach top quartile performance status in Quality, Outcomes, Patient Satisfaction and Financial Strength compared to all acute care hospitals in the nation!

Program Statistics

Type of Organization State Government
Staffing 2.4 FTEs
Number of CAHs 82
Website URL None provided

Flex Program Staff

Megan Hartwig
State Office Director, Iowa
(515) 499-4467

State Office Director since June 2016

Katie Jerkins
Interim Flex Coordinator, Iowa
(515) 423-2690
Merrill Meese
EMS Regional Coordinator, Iowa
(515) 344-2793

Specialty Areas / Background

  • EMS system development
  • EMS service program rule compliance
  • Incident management; Incident Commander on Iowa Homeland Security and Emergency Management Division All Hazards Incident Management Team 2005-present

EMS Regional Coordinator since 1998

This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UB1RH24206, Information Services to Rural Hospital Flexibility Program Grantees, $1,100,000 (0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.