Iowa hospital leaders applaud Gov. Reynolds’ proposal to improve rural health care access

DES MOINES — Hospital leaders gathered Tuesday at the Iowa Capitol to show support for Iowa Gov. Kim Reynolds’ proposal to improve access to high-quality health care in rural Iowa and address the state's shortage of health care professionals.

Reynolds has proposed legislation — House Study Bill 191 — that would consolidate state loan repayment programs and more than double the investment to $10 million.

The governor also has directed the Iowa Department of Health and Human Services to partner with UI Health Care and Broadlawns Medical Center in Des Moines to secure $150 million in federal money to train a projected 115 new medical residents at 14 hospitals across the state.

Once fully implemented over four years, 460 new physicians would be trained in Iowa, the governor’s office projects.

The initiative aims to increase physician retention and strengthen health care access.

“Where a doctor does residency is often where a doctor chooses to practice,” Broadlawns Medical Center CEO Proctor Lureman told reporters during a news conference with Reynolds and other health care officials.

Reynolds also has proposed to unbundle Medicaid maternal rates and invest $642,000 to increase Medicaid reimbursement rates for maternal care. That includes $420,000 to increase reimbursement to OB/GYNs and primary care physicians for complex cases. She also proposed increasing rates for certified nurse midwifes and adding doula services as a covered Medicaid benefit.

The governor emphasized the importance of regional partnerships and centers of excellence to enhance rural health care services.

Iowa has established five Centers of Excellence across the state, four of which are focused on maternal health care.

Reynolds said Iowa Health and Human Services will seek federal approval to provide more Medicaid rate flexibility to encourage regional collaboration between health systems, with a focus on creating access to specialty care in rural areas.

“On average, Iowa mothers are only an 11 mile drive from a birthing hospital. But not all of those hospitals can handle complex or high risk pregnancies,” Reynolds told reporters during the news conference.

Kevin DeRonde, CEO of Mahaska Health Partnership in Oskaloosa, said the hub-and-spoke model of the centers of excellence helps meet the needs of health care providers and patients, and has led to increased births, expanded fertility services, and improved patient safety and recovery outcomes.

The program also has expanded echocardiogram services and provides cholesterol screens for farmers, DeRonde said.

Shelly Russell, CEO of Mitchell County Regional Health Center in Osage, thanked Reynolds for inviting hospital leaders to the table “to consider innovative ways that we can work together to resolve our workforce shortages and improve access to care.”

“When residents are trained here, they are more likely to stay in Iowa and practice in our communities,” Russell said. “Additionally, the governor's proposal to increase the state's investment in loan repayment and recruitment programs will provide critical financial incentives for physicians and nurses to work in rural areas.

“Building the health care workforce pipeline is critical in rural Iowa. So is reimagining how we work together to serve our communities.”

She said the regional health center partners with system affiliates as well as neighborhood counties on a variety of services.

“This regional approach to care delivery has worked well for us,” Russell said. “It's simply not possible for each community to provide every service locally, but when rural health care providers partner regionally, essential services remain within proximity for the populations that we serve. This type of model helps keep quality care in rural areas viable and sustainable.”

Iowa ranks 44th in the nation for patient-to-physician ratio per 100,000 population. The nation also is experiencing a significant physician shortage estimated at 64,000 physicians.

Iowa has the fewest OB/GYNs per capita of any state, according to the American College of Obstetricians and Gynecologists, and is one of five states with the highest losses of access to obstetric care over the past 13 years.

“The well-being of working families and rural communities depends on access to high quality health care,” Gov. Reynolds said. “Iowa has a strong foundation to build on, but we need more medical professionals, including specialists, in every part of the state. This program will mean over 460 new physicians over four years being trained here in Iowa. That’s a game changer for rural communities and every part of the state.”

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