Repeal and replace – not so fast


More than 290,000 Missourians have health coverage through the Affordable Care Act or Obamacare.  In the months leading up to the recent presidential election, the ACA was a sticking point for both sides.  President elect Donald Trump repeatedly called the ACA a disaster and promised to repeal and replace the law.

Repeal and replace makes for a good platform but is easier said than done.

President elect Trump’s stance on the ACA has changed a bit since the election.  His position has softened and he’s said publicly that he’s willing to retain certain aspects of the law and replace or eliminate specific portions.  Specifically, Trump has said that he hopes to keep protections for people with pre-existing conditions and to allow children to stay on their parents plans until their mid-twenties.

Republican members of Congress have been trying to repeal the law for years but they haven’t had the votes to do so, until now.  Republicans hold majorities in Congress and there will be a Republican President in January.  It will be interesting to see if repeal continues to be a priority or if prior discussions of repeal were posturing and rhetoric.

A complete repeal, without a replacement plan, would have severe implications on the health care delivery system and may cause the system to unravel all together.  I don’t foresee that happening.  Instead I would suspect that bits and pieces of the law are changed.  Trump is pro business so opportunities for insurance providers to sell across state lines may come into play.  An increased emphasis on health savings accounts might also be a priority.

I would suspect that Medicaid reform will be a priority at both the state and national level.   One way Medicaid could be reformed would be to switch to a Medicaid block grant system.  Trump hinted at using Medicaid block grants during his campaign.  A block grant system would allow for the federal government to disperse Medicaid funding to states and then states could create eligibility requirements.

Campaigns are full of promises and campaign promises, more than any other, are meant to be broken.  The ACA is the law of the land and the health care system has adjusted and is functioning according to rules.  A total repeal will be difficult and without a suitable replacement it could be disastrous.

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Renovation timeline


Here’s an info-graphic that Leslie Lower put together to help illustrate the timeline of current renovation activity at GVMH.  New construction is complete but there’s a lot of renovation activity occurring.  As you can see the coming months will allow services to expand and move into renovated space.  As with all construction activity the timelines are “projected” and are subject to moving.  Once this round of renovation is complete and services vacate space a new round of renovation will begin.  Thank you for being patient as we work to improve facilities to better serve our patients and community.  GVMH is better because of you!

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Award winning Quality at GVMH

Quality Billboard

Golden Valley Memorial Healthcare named recipient of the 2016 Missouri Quality Award

 COLUMBIA, Mo. – The Excellence in Missouri Foundation announces Golden Valley Memorial Healthcare, located in Clinton, MO as the 2016 recipient of the Missouri Quality Award. This marks the second time that the organization has received the award.

A not-for-profit healthcare delivery organization, Golden Valley Memorial Healthcare (GVMH) consists of a 56-bed hospital, a home health service, outpatient services, and four physician clinics located in west central Missouri. GVMH also operates provider and outpatient clinics in Warsaw, Windsor, and Osceola, Missouri.

A 2013 recipient of the Missouri Quality Award, GVMH is guided by the Golden Path to Success, or “GPS”. GVMH uses a robust strategic planning process to align its goals and action plans around 5 Pillars of Excellence: People, Service, Quality, Financial, and Growth. A focus on performance excellence and organizational learning is embedded in the GVMH culture, and is reinforced through a series of processes designed to assure the achievement of its mission, “to provide exceptional health and wellness services with friendliness and compassion” to Henry County and the surrounding areas.

Located near Truman Lake, Golden Valley Memorial Healthcare provides rural residents with big city services, while living up to the community slogan, “Great People, by Nature.” Specialty clinics, state-of-the-art medical equipment, nationally recognized food “room service”, walk-in clinics, and Home Health services ranked among the best in the nation, and complement excellent inpatient, outpatient, emergency and rehabilitation services. GVMH provides a great place for patients to receive care, a great place to work, and a great place for physicians to practice.

 About the Missouri Quality Award (MQA): The MQA is the official state recognition for excellence in quality leadership. Modeled after the prestigious Malcolm Baldrige National Quality Award, the MQA is recognized as one of the strongest state-level quality award programs in the country.

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It’s almost over


I’m typing this particular blog the day prior to election day.  When many of you read it the suspense will be gone and our country will have elected either our first female president or a Washington outsider.  I don’t know about you but the end could not have come soon enough for me.  It seemed to me that this election, more than any other I can remember, was divisive.  No matter the winner, the first order of business needs to be spanning the gap and pulling both sides together.

The second order of business needs to be addressing one of our countries biggest concerns.  A recent study by the Kaiser Family Foundation showed that 63% of the public is concerned that the government is not doing enough to lower prescription drug prices.  Another concern is related to what’s going on with employer sponsored health plans.  Much has been made of premium increases in the exchange but there are far fewer people enrolled in the exchange than those covered by employer sponsored plans.

Employer sponsored health plans rose an average of just 2.4% in 2016 and are expected to rise another 4.1% in 2017.  Anytime increases are kept below double digits it’s a win but there’s more to the story.  During the same period of time drug costs rose an average of 10%.  Employer sponsored plans are holding premium increases at a modest level by shifting more and more people to high deductible plans, last year more than 29% of people in an employer sponsored plan had a high deductible and that number is predicted to go higher this year.

The Affordable Care Act, Obamacare, has done a good job of decreasing health care costs and the table is set for costs to continue to decrease in the years ahead.  Hospitals and other health care providers have been forced to reduce cost and deliver more affordable care.  The pharmaceutical industry has not had the same pressure.  The new president will need to work with both parties to develop a system that encourages drug manufacturers to deliver products at a price patients and insurance providers can afford.

“We’re stronger together” and “Make American great again” were the two major candidate’s slogans in this election let’s hope compromise and the greater good become a legacy as opposed to an empty campaign promise.

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Drug costs keep going up

medsA lot has been made about EpiPen prices increasing by 1,100 percent in recent months.  EpiPen is life saving allergy medication that has a one year expiration date.  If someone has a severe allergy to bee stings or peanuts an EpiPen may be the difference between life and death.  EpiPen controls the market because there are very few competitors that provide auto-injectors like the EpiPen.  When you control the market and you provide a life saving drug, you can set the price wherever you want and people are going to find a way to buy.

Although the EpiPen price increase seems excessive, it is reflective of what’s occurring throughout the pharmaceutical industry as a whole.  A recent report from the Bureau of Labor Statistics found that prescription drug prices grew 7.3 percent from September of 2015 to September of 2016 which is the highest rate of growth since 1992.  The American Hospital Association recently released a report on trends in inpatient hospital drug costs.  The study found that average annual inpatient spending on pharmaceuticals increased 23 percent between 2013 and 2015.  On a per admission basis the spending grew by 39 percent during the same period.  The spending was driven by increased cost and not by increased admissions because during the same period, hospital admissions decreased.

Hospitals like GVMH are working hard to reduce cost and the federal government is putting a lot of pressure on hospitals to become more cost conscious.  The growth in drug costs isn’t sustainable because during the same time frame as referenced above hospital rates only increased 2.7 percent.  As hospitals divert more money to pay for medications provided to patients it limits their ability to invest in other services that would benefit their patients and the communities they serve.

Back to EpiPen, it may be there was an endgame in mind when Mylan, the manufacturer of EpiPen imposed the price increase.  Mylan has applied the have the EpiPen added to the federal list of preventive medical services.  The list currently contains thing like wellness visits and birth control and anything on the list must be provided by insurance companies and federal payers like Medicare and Medicaid at no cost to recipients.

If EpiPen gets added to the list the cost will shift from consumers to the government and insurance companies.  Ultimately the cost would be absorbed by tax payers and anyone paying a premium to have commercial insurance.  The consumer will still be paying but without any real knowledge of sticker price and Mylan will be out of the spotlight.  It’s a  sneaky way to drive profits and a way to do so when no one is watching.


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Survivor and an inspiration



It’s Breast Cancer Awareness Month and there’s been a recurring theme on the blog this month – I’ve been able to share the stories of people who dealt with breast cancer with dignity and determination.  I first shared this story three years ago and to this day Courtney is an inspiration for me.  Courtney is one of the kindest, most positive people I have the honor and pleasure of associating with.  Here’s the blog I posted three years ago this month.

This is the link to a You Tube video. The video is 2 minutes and 14 seconds long. The last 20 seconds are the best and if you watch you’ll get to see one of my hero’s and one of the most inspirational people I know.

God Bless You Courtney, you amaze me every day and your strength, faith and courage are an inspiration to us all!

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Chrissy’s Story 2016: Breast Cancer Awareness Month


October is Breast Health Awareness Month and that means it’s time to once again share “Chrissy’s Story”.

Chrissy Wilson shares her story of being diagnosed with breast cancer at age 28, her story is awesome and I could have never done it justice. Without further ado, in her own words, here’s Chrissy’s story:

It all started with me touching myself! Here’s the story…One evening while in the shower I decided to do a self breast exam. I’m not sure why, I’ve done self exams in the past but I wasn’t good about doing them regularly, I’d probably read about them in a magazine earlier in the day. When I crossed my right breast I had shooting pain and I could feel 3 knots. I felt the left side and it seemed fine. I’d never felt knots in my breast before but as I said I wasn’t good at doing the exam on a regular basis so I asked my husband, Jeremy, to feel them. If anyone knows how my breasts feel, it should be him! After feeling the knots himself he suggested that I see my family doctor who referred me for a mammogram. At this point cancer was the farthest thing from my mind for a number of reasons. 1) It could never happen to me 2) I’m too young and there’s no family history 3) I had read, probably in the same magazine that recommend the self breast exam, that breast cancer isn’t painful.

I was anxious about my first mammogram, afterall, I was only 28 years old at the time and I had no reason to have a mammogram before. I was worried that it would be painful, truth is it didn’t hurt a bit, maybe that was because I didn’t have much to hurt, who knows. That same day, after my mammogram, it was recommended that I have an ultrasound but again, no big deal because I was told my breasts were dense since I was young. I soon started to worry a little. I was sitting in a hallway with a gown on watching other women leave after their mammograms and I started to wonder “why aren’t they having an ultrasound, they look young, aren’t all young breasts dense”.

I sat and waited in that hall so long that Jeremy, who was in the waiting room asked the receptionist if I’d left the building. If I knew what was ahead of me, trust me, I would have left that building! After my ultrasound I was told I would need a biopsy. I asked them if they thought it was cancer and that moment, for some reason, I knew the answer even though they said they were 99% sure it wasn’t.

On November 15, 2006 I was diagnosed with breast cancer, stage II Invasive duct carcinoma to be exact. I was given two options, a lumpectomy or mastectomy. I chose the mastectomy; in fact, I chose to have a bilateral mastectomy even though the cancer was only on one side. I felt that they came as a pair so they should go as a pair!

On December 12, 2006 I had both breasts and 7 lymph nodes under the armpit removed. One lymph node was involved and my cancer was found to be estrogen and progesterone receptor positive which means the cancer grows from these hormones. After the surgery I began chemotherapy and had to do eight rounds, Cyclophoshamide with Doxorubicin the first 4 treatments followed by Taxol last 4. I lost my hair and my breasts, but I never lost HOPE.

Over an 11 month time span I had 3 major surgeries; mastectomy, breast reconstruction, and hysterectomy and with the hysterectomy I had my gall bladder removed because at this point my feeling was “If I don’t need it, take it out”. I also had two procedures to place and remove a port used for blood draws and chemo administration.

At the time I was diagnosed, my sons were 9 and 5 years old. These two children saw more in a year than most see in a life time. I never once tried to keep anything from them. I believe what they saw and experienced has made them stronger and helped them become who they are today. People tell me how strong I am, but really it’s my family who’s strong. They’re the ones that got me through this. I could have never done it on my own.

I deal everyday with what breast cancer has taken from me. I’m going through menopause due to my hysterectomy and the anti cancer drug, Aromasin, I now take. I have Osteopenia (bone loss) which is a side effect of the Aromasin and I have to take Boniva for the bone loss. As a result of the removal of my lymph nodes I struggle with Lymphedema which causes swelling and pain in my right arm and hand. I have man-made breasts, minus the nipples. That’s right, no nipples, a mastectomy really does take it ALL. Breast cancer took a lot from me, but it DID NOT TAKE MY LIFE AND IT DIDN”T TAKE MY HOPE!!!

This was my journey and I’ve decided to take the bad and turn it into a positive. I tell my story because someone reading this may someday hear “You have Cancer”. Just like you I thought “it will never happen to me”.

My hope is my story will encourage you to do your self breast exams and get regular mammograms, it could save your life. – Now go touch yourself!!!

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