Despite health care competition, Corridor providers agree on shared issues

Competition among health care providers is often fierce, but leaders of some of the Corridor’s largest medical institutions have plenty of common ground on the largest issues they face.

And they concurred on many of those persistent issues during updates presented at the Corridor Business Journal’s annual Health Care Symposium Feb. 8 at the Hyatt Regency Coralville Hotel & Conference Center.

Among the most overarching challenges mentioned by the leaders of UnityPoint – St. Luke’s Hospital, Mercy Cedar Rapids, Physicians’ Clinic of Iowa and University of Iowa Hospitals & Clinics:

• Low reimbursement rates from government payors;
• The “war for talent,” from doctors and nurses to technicians and executives, including higher wages for those workers;
• Iowa’s aging population, with more complex medical conditions and longer lengths of inpatient hospital stays;
• Market disruption spurred by competition and the addition of new medical facilities;
• The soaring costs of medical equipment and supplies; and
• Staff physical and psychological burnout, particularly in the wake of the COVID-19 pandemic.

Still, there are unique challenges and areas of focus for the Corridor’s primary health care organizations, and leaders of each of those organizations provided organizational updates for about 130 attendees at this year’s symposium.

Denise Jamieson, University of Iowa Vice President for Medical Affairs

Access to care is among the biggest challenges facing largely rural states like Iowa, said Dr. Denise Jamieson, MD, MPH, University of Iowa Vice President of Medical Affairs and Tyrone D. Artz Dean of the Roy J. and Lucille A. Carver College of Medicine.

Dr. Jamieson highlighted maternal care as a particular area of concern in rural areas.

“In Iowa, we have a maternal health crisis,” she said. “Labor and delivery units are closing, particularly in rural areas, and we need to come up with a sustainable way to address that.”

The number of deliveries at University of Iowa Health Care has nearly doubled in recent years, and is projected to reach nearly 4,000 deliveries this year, Dr. Jamieson said.

“I was really taken by the fact that there was one rural hospital who said that they had closed their labor and delivery unit a year or two ago, and then in the last year, they had more than 10 pregnant women in labor show up in their emergency department,” she said. “That just shows the dire consequences of not having labor and delivery units open across the state.”

As part of supporting obstetrics programs across the state, Dr. Jamieson said it’s time to consider new models of care, such as telehealth programs for everything from prenatal visits to complex medical conditions – all in an effort to keep patients locally.

Another key aspect of maternal care is trying to make delivery safer, said Dr. Jamieson, who has practiced in obstetrics for 26 years.

“We know that a major cause of maternal mortality is postpartum hemorrhage, and a lot of that occurs shortly after birth,” she said. “So we have a simulation program where we go out and train labor and delivery units how to respond to postpartum hemorrhage, because you can do a lot of that by simulation … even simple things like (making) sure you have the right medications and the right devices on a hemorrhage cart, and that everybody knows where the hemorrhage cart is – that's the kind of thing that saves lives. And unless you practice, when it actually happens, you're not going to be ready.”

Dr. Jamieson also touched on the University of Iowa’s vital role in training new health care practitioners, as well as an ongoing focus on research – noting that Iowa is one of only two or three states with rising cancer rates.

“We need to figure out how to screen for cancer, how to detect cancer early, how to treat cancer, and which cancers do need to come to University of Iowa Health Care as the state's only comprehensive cancer center,” she said. “Some cancers can be treated very appropriately locally. Trying to coordinate across the state to ensure that everybody's getting the right care at the right time, in the right place, is critically important.”

Finally, Dr. Jamieson addressed concerns from other providers, including some in the private sector, that UI Health Care is infringing on private enterprise in the Corridor.

“There's a lot of work to do here, a lot of patients across the state,” she said. “I think our role is relatively unique because we are a state institution. We do have an obligation to support health care efforts across the state, and we want to work collaboratively. We are here to support.”

As an example, she contrasted the closed medical staff at UI Health Care’s university campus, meaning that providers have to be on the UI faculty to practice, with the new Downtown Campus at the former Mercy Iowa City facility, which has an open medical staff.

“Some of you may disagree with me, but from my perspective, this is not a highly competitive medical environment,” she said. “We have so many patients to take care of. I think we can all figure out ways to work together to ensure that we put the patients first and that they’re getting access to the highest quality of care.”

Casey Greene, UnityPoint Health – St. Luke’s

St. Luke’s Hospital in Cedar Rapids faces staffing shortages and challenges with access to resources, but is committed to quality of care and strategic initiatives, said Casey Greene, UnityPoint Health – St. Luke’s Market President.

Mr. Greene, who assumed his new role in August 2023 after former UnityPoint Health – Cedar Rapids President and CEO Michelle Niermann was named Chief Operating Officer (COO) for UnityPoint’s East Division, said St. Luke’s is part of a larger UnityPoint system that stretches from Sioux City to Meriter Hospital, a joint venture with the University of Wisconsin-Madison. The entire system has about 30,000 health care associates, and Cedar Rapids represents UnityPoint’s third largest market, behind Des Moines and the Quad Cities.

In Eastern Iowa, UnityPoint employs about 4,000 workers at facilities including the Jones Regional Medical Center in Anamosa, the Abbe Center for Community Mental Health, the Helen G. Nassif Transitional Care Center on North Council Street, and the Surgery Center, a joint venture between UnityPoint, PCI and other community partners.

The Nassif Community Cancer Center, located at the PCI Medical Pavilion in downtown Cedar Rapids, is another key UnityPoint venture, Mr. Greene said. And the Nassif Heart and Vascular Center at the main St. Luke’s facility is in the midst of an expansion project. The first phase, completed in 2023, added a second electrophysiology lab, and the second phase, set for completion this year, includes a new vascular and interventional radiology lab for services such as imaging and biopsies, aneurysms and revascularization.

A third phase, set for 2024 and 2025, will add a large hybrid operating room for structural heart issues, including defects, disorders, and heart valve repair and replacement via catheter.

UnityPoint also has three behavioral health inpatient units within the main hospital, including units for adolescents, adults and an older adult geriatric unit – all meeting a critical need in the state, Mr. Greene said.

“We don't have nearly enough behavioral health beds in the state,” he said. “You all know that just as well as I do. But it's certainly a challenge, and we’re committed to serving that population here in Eastern Iowa.”

Mr. Greene also highlighted the new off-site UnityPoint emergency room, set to open in August at 3301 Armar Drive in Marion.

“We've been hesitant to add an off-off site ER here, because of potential costs from a payer perspective and a patient perspective,” he said. “But there’s simply a demand for this type of facility. It’s something we've added to decompress our on-campus (emergency department). We're landlocked there – not a lot of room to expand – so this allows us to decompress our ED and meet those wait times that we have expectations for.”

Nathan Van Genderen, Mercy Cedar Rapids

Mercy Medical Center is distinguished in the local health care marketplace by three key attributes, according to Executive Vice President and CFO/COO Nathan Van Genderen:

It operates as a nonprofit, it’s governed by a local board of directors, and – hearkening back to its founding in 1900 by the Sisters of Mercy and Sister Catherine McAuley – it operates as a faith-based Catholic institution.

“We open our meetings with prayer, and we talk about different faiths,” Mr. Van Genderen said. “You don't have to be a Catholic or a Christian – we are open to all faiths. It's a pretty cool thing to be part of an organization like that.”

Mr. Van Genderen specifically outlined the financial challenges Mercy Medical Center has faced in recent years. He said the organization relied on $30 million to $35 million in cash flows before the COVID-19 pandemic, but that amount decreased significantly after the pandemic due to a lack of staff, leading to increased costs and challenges in providing services.

As a result of those staff shortages, at the height of the pandemic, Mr. Van Genderen said the hospital was paying traveling nurses as much as $275,000 per year.

“And the problem was, it wasn’t concentrated in specific areas,” he said. “So are you going to reduce services across the board, or are you going to make the investment and then try to work your way out of it?”

The hospital is now using fewer “travelers,” Mr. Van Genderen said, and the rates have dropped to a degree, but despite efforts to reduce costs, capital investments and raises for staff have continued to provide challenges, especially in the face of limited increases in reimbursement rates from government payors.

On the employee front, Mr. Van Genderen emphasized the importance of being the employer of choice by investing in well-being programs for employees, including physicians, and highlighted the need for support programs to help employees maintain a work-life balance and avoid burnout.

He also outlined Mercy's efforts to address the labor shortage by partnering with local educational institutions to develop a pipeline of talent, as well as offering tuition assistance to employees.

The November 2023 opening of Hallmar Village in Marion, a partnership between Mercy and Presbyterian Homes, brought a new level of services for aging adults, including dementia support and research, and the Jewel and Jim Plumb Heart Center, opened in July 2023, offers cutting-edge cardiac care in a purpose-built setting with a design that pays visual homage to Mercy’s deep Catholic roots.

Finally, Mr. Van Genderen updated the progress on Mercy’s new off-site emergency room at 3701 Katz Dr. in Marion. Set to open in November 2024, it will join its Hiawatha facility as the hospital’s second off-site ER.

Eric Dalton, Physicians Clinic of Iowa

Physicians Clinic of Iowa CEO Eric Dalton took great care to differentiate PCI from the other large-scale health care providers in the Corridor.

“We’re not a hospital, and we’re not a system,” he said. “And despite our differences, or competition at times, we have a lot of similarities in many respects.”

In the 1990s, an era characterized by consolidation and the acquisition of many local providers by larger hospital systems, PCI was formed in 1997 by a group of eight specialty practices seeking to remain independent.

Being physician-owned, PCI has maintained a hospital-neutral business model, Mr. Dalton said. “We’re not large, but we’re busy, especially from an ambulatory surgery perspective,” he noted. “We see a lot of patients and we perform a lot of tests. We like to refer to ourselves as a hospital without beds. Patients often refer to us as a one-stop shop.”

PCI now comprises more than 60 physicians, 25 physician assistants and nurse practitioners, 20 ancillary providers and over 400 total providers in two medical pavilions, performing more than 600,000 ancillary procedures per year.

Patients come from Linn County and more than 15 other counties across Eastern Iowa, Mr. Dalton said, and 70% of patients are referred by other providers. PCI also has eight hospital and clinic outreach locations, from Maquoketa and Vinton to Sumner and Prairie du Chien.

PCI’s “medical mall” concept is designed to create a high-touch, high-tech patient care environment, Mr. Dalton said. The group’s growth strategy revolves around a number of goals, including creating partnerships with business entities and providing competitive compensation and benefits, all while remaining independent.

PCI has experienced a number of successes in its short history, Mr. Dalton said, from surviving the challenges of COVID-19 and OSHA to staffing challenges and physician recruitment, while maintaining high patient satisfaction scores.

“When it comes to a level playing field and competing, we proudly feel that we can provide the care that's necessary in Cedar Rapids, without that potential encroachment,” he said. “That's a challenge, but it's also an opportunity for us to step up our game.”

In the future, Mr. Dalton said PCI plans to address physician burnout and competitive compensation, pursue strategic expansion through growth of new service lines, stress staff and tenant recruitment and retention, and continue to pursue new partnership opportunities. He also noted PCI is in talks with some Johnson County physicians who want to remain independent in the wake of UIHC’s acquisition of Mercy Iowa City.

Bradley Haws, University of Iowa Hospitals & Clinics

Bradley Haws just began his tenure as Chief Executive Officer of the University of Iowa Hospitals and Clinics in November, but had previously served as UIHC’s chief financial officer and associate vice president for UI Health Care from 2018 to 2021.

“I’m thrilled to be back here,” he said, “and I really view the role that I have as a dream job.”

One of the first tasks facing Mr. Haws upon his arrival was the integration of the former Mercy Iowa City, now known as the Downtown Campus, into the UIHC system, a process officially completed in late January.

Approximately 1,000 Mercy Iowa City staffers transitioned to UIHC, including about 65 medical providers, Mr. Haws said, estimating that 97% of former Mercy staffers and providers were retained in the transition.

“The chief medical officer who's there now said the other day ‘there's an optimism here that I haven't seen in three years,’” Mr. Haws said. “So we feel like we've at least gotten off on the right foot there.”

Mr. Haws emphasized the importance of preserving Mercy’s unique culture and values while adapting to changing needs. He also highlighted the potential for collaboration between the downtown and main campuses, recognizing the strengths and weaknesses of each institution while providing a unified approach to health care delivery and research.

“We really feel like there's a great legacy on that (Mercy) campus,” Mr. Haws said. “We don't view it as ‘let's take it over and make it like we are.’ We feel like there's a great legacy, a tradition and a spirit there that we want to learn from and grow.”

Mr. Haws also stressed that Mercy Iowa City should help address capacity issues for the main UIHC system.

The ongoing construction of UIHC’s new $525 million campus in North Liberty is providing another expansion of services, including an additional emergency room and 40-50 beds for orthopedics, gynecology, and other services.

UIHC is planning to evaluate services to consolidate or move between the main UI campus, the Downtown Campus, and North Liberty campus to optimize capacity and access, and to continue discussions with physicians on utilizing downtown campus capacity for surgical cases and other needs, while maintain the open medical staff model at the Downtown Campus for community providers.

Finally, Mr. Haws provided an overview of the Carver College of Medicine’s Rural Iowa Scholars Program (CRISP), designed to address the increasing physician shortage in rural areas of the state. Under the program, medical students who commit to stay in Iowa after graduation receive tuition forgiveness. A total of 12 students are currently enrolled, Mr. Haws said.

“I wish this program were better and bigger,” he said. “Students come to our medical school precisely because they want to be part of this. They can go get residency training anywhere in the country. But if they come back to Iowa after the training and they go to these rural counties, they get their tuition forgiven. What a great way for us to commit providers that will help those facilities provide the services that they so desperately wanted.”

The symposium concluded with a presentation from Amy Wadstrom, president of Vivid Clear Rx, a Hy-Vee subsidiary founded in September 2020 that offers Pharmacy Benefit Management (PBM) services to Hy-Vee’s 88,000-plus employees, as well as to employers looking to maximize their employee benefits spending.