IHA Sends Letter to Register Publisher

The following was sent April 25 by IHA to Des Moines Register President and Publisher Laura Hollingsworth in response to the April 13 Register story, "Hospitals, regulators in battle over rules."

Dear Ms. Hollingsworth:

The Iowa Hospital Association recently found itself in the focus of the Register’s “investigative reporter,” Clark Kauffman.  With health care being a top issue throughout Iowa and the nation, IHA representatives are accustomed to being interviewed by reporters working in newspaper, radio and television markets of all sizes, both in Iowa and beyond.  Given IHA’s expertise in health care policy, we expect, welcome and actively seek, as we did this winter with every major daily newspaper in Iowa, media inquiries as opportunities to provide and clarify IHA’s position on these issues and assist members of the media in understanding and reporting on the inherent complexities of today’s health care environment.

Mr. Kauffman spent a number of hours interviewing myself and Greg Boattenhamer, IHA’s Senior Vice President of Government Relations, on topics related to IHA’s advocacy activity during the current legislative session.  In the wake of these interviews, both Mr. Boattenhamer and I felt Mr. Kauffman had more than enough detail on IHA’s perspective for Mr. Kauffman to provide a thorough and balanced report for the Register’s readers.  However, Mr. Kauffman’s article, which was published on the front page and above the fold of the Register’s Sunday, April 13 edition, was far from balanced.  In fact, it was almost completely devoid of IHA’s perspective and filled with incomplete and misleading information.  Specifically:

-- Mr. Kauffman wrote that the Iowa Hospital Licensure Board “approval is needed for most regulations pertaining to hospitals.”  The Iowa Board of Public Health has final say on these regulations, and the director of the Department of Inspections and Appeals always has the option to bring proposals to that board, no matter the opinion of the licensure board.  The job of the licensure board is to provide “real-world” implications of the many and often complex regulations that impact hospitals.  This is why the board is made up of experienced, professional administrators who, despite the insinuation of this article, put patients first.  Despite Mr. Kauffman’s assertion, the hospital licensure board has no veto authority over proposed rules.

-- Mr. Kauffman wrote that DIA proposed increasing the hospital licensing fee and IHA immediately opposed it.  This is not true. IHA supported and continues to support increasing the fee if DIA can provide a sound policy reason for the increase, for example, reducing the hospital inspection cycle from every three to four years to approximately two years or using the money for educating hospitals on compliance matters.  More importantly, and also explained to Mr. Kauffman, IHA worked to secure funding for additional inspectors at a time when DIA’s inspection cycle was at seven years.  As Mr. Kauffman was told, IHA has a track record of supporting the Legislature’s funding of additional hospital inspectors for this very reason.  Meanwhile, DIA’s response has been that an increase is needed because the current fee “sounds low.”

-- Mr. Kauffman wrote that the Hospital Licensure Board “is resisting” applying fines to certain violations in hospital-operated nursing homes.  He failed to explain, though it was explained to him, that DIA’s real objection has nothing to do with fines, but with the licensing of hospitals to operate long-term care units in the first place.

-- Mr. Kauffman wrote that IHA stopped supporting a bill to require background checks for hospital employees and the bill died, implying IHA opposed the bill and the Legislature followed suit.  IHA has in fact worked collaboratively with DIA to create this requirement and IHA never opposed the DIA bill.  In fact, this bill was resurrected the week prior to Mr. Kauffman’s article being published, yet Mr. Kauffman still laid claim in a subsequent article that it was his investigation that prompted this action.  IHA did tell Mr. Kauffman that language added by DIA forced IHA to take a neutral position on the bill, also a legislative distinction lost in Mr. Kauffman’s reporting.

-- Mr. Kauffman wrote that the Hospital Licensure Board “is resisting” DIA’s proposal to adopt 2006 American Institute of Architects construction standards for hospitals, but he fails to explain, though it was explained to him, why this is.  The fact is the board favors adopting the new standards with one exception:  a requirement for all hospital rooms to be single-patient rooms.  This requirement doesn’t make sense for many of Iowa’s small hospitals.  Mr. Kauffman wrote that 42 other states have adopted “some version” of those standards, meaning other states saw fit to amend the standards to meet their specific needs – exactly as Iowa’s licensure board has recommended for Iowa.

All of this information was provided to Mr. Kauffman through the course of his lengthy interviews with IHA officials, yet IHA’s perspective on these issues is virtually nonexistent in his April 13 article.  This reality was underscored when Register editorial writer Andie Dominick called IHA a few days after the article was published seeking “to get IHA’s side of the story” – something she apparently could not deduce from Mr. Kauffman’s article.  If a Register editorial writer was unable to formulate an informed opinion from Mr. Kauffman’s article, then where does that leave the Register’s readers?

As the length of this letter suggests, the issues Mr. Kauffman attempted to address are not simple, though in the context of the IHA’s legislative priorities, they are relatively minor issues.  Rather than focus on the issues chosen by the Register, IHA has lobbied for the past two years for an increase in hospital Medicaid payments in order to keep quality nurses and physicians in Iowa and to offset the rising costs of private health insurance.  Iowa hospitals now lose more than $150 million a year treating Medicaid patients – a far more substantive concern than an increase in licensure fees.  Additionally, health care providers saw no Medicaid payment increase in 2007, despite a statewide tobacco tax increase, which hospitals actively lobbied, to support health care programs and a movement to increase teacher salaries to the national average, (while underfunded Medicaid payments are part of the equation that puts Iowa nurse salaries among the lowest in the nation).

IHA has tried on numerous occasions to engage Register reporters on these and other issues that represent the core of IHA’s legislative advocacy, but no articles have been written.  Meanwhile, the Register uses print space to spell out the economic impact of the state’s airports and gaming industry, yet despite frequent communication from IHA, the Register has refrained from similar reporting on the health care sector, which is responsible for more than 20 percent of the state’s economy.  Similarly, the Register refuses to report on the fact that Iowa hospitals are national leaders for providing high-quality care at low cost, as a recent report from Dartmouth has documented.  Register health care reporters claim readers would not be interested in articles about such studies, even as flagship newspapers like the Wall Street Journal, New York Times, Boston Globe and USA Today provide lengthy coverage of the same report. 

In any case, Mr. Kauffman chose what to write about and thus was obligated to be thorough in his reporting.  Instead, he reported the story almost exclusively from the point of view of one source (as opposed to the supposed many “state regulators” and “state officials” cited, but not quoted, in the story) and then touched on each issue only to the degree that the information would paint a negative portrait of IHA and Iowa’s hospitals.

That negative tone permeates Mr. Kauffman’s article and the accompanying sidebar stories that from beginning to end imply IHA uses its influence to undermine the state and put patients at risk.  That implication is an affront to Iowa’s community hospitals, all of which are non-profit facilities that work continuously and cooperatively with state regulators and legislators to ensure the best possible care for patients.

For nearly 80 years, IHA has been committed to supporting the missions of Iowa hospitals, missions that have put people and communities first and led to Iowa having one of the finest health care systems in the nation.  Iowa hospitals depend on IHA and we take that mission seriously.  So we are understandably disappointed when the Register, “The Newspaper Iowa Depends Upon,” falls well short of that same level of commitment and seriousness by publishing articles that show little regard for journalistic standards of fair, balanced and thorough reporting.

That lack of professionalism undermines the Register’s credibility and its relationship with IHA, Iowa’s hospitals and, ultimately, the Register’s readers.

Sincerely,

Kirk Norris
President/CEO