Iowa State Flex Profile

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 on-line 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 Critical Access Hospitals (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, Iowa 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 (such as financial improvement networks, CAH quality networks, operational improvement with CEOs or EHR workgroups): 

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

From the last Flex Program year, please describe a best practice you would like to share with other states: 

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

What type of organization is your Flex office housed in?: 
State Government
What is the number of full time employees (FTE) in your Flex office?: 
How many CAHs are in your state?: 
Do you have any hospitals interested in converting to CAH status?: 

Additional Information

Rural Health Plan: 

Flex Program Staff

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

State Office Director since June 2016

Amanda Ramierz
Flex Coordinator, Iowa
(515) 314-6912

Specialty Areas / Background

  • Managing and implementing state and federal grants
  • Flex Program coordination
  • SHIP coordination
  • 3RNet coordination
  • Administrator for legislated Rural Health Advisory Committee

Flex Coordinator since July 2016

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.