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IWIRC Midwest Network Announces Member Success

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From Jeanne M. Goche, MA, JD, Chair, IWIRC Midwest Network:

We are proud that our IWIRC Midwest Network Member, Leslie Behaunek, is becoming a full-time law professor at a prestigious law school. Congratulations, Leslie!

She will be joining the faculty at Drake University Law School this fall in a tenure-track position, teaching Torts and related upper-level courses. She is a legal Rock Star who has been teaching and mentoring young lawyers for years.

Leslie will be strengthening the IWIRC connection with bankruptcy and commercial law students. In fact, Leslie has already played a foundational recruitment role as chair of the IWIRC Midwest Membership Committee and member of the Mentoring Committee.

Photo Caption: Leslie is front and center, pictured with Kristina Stanger, former IWIRC Midwest Network Chair and Shareholder at Nyemaster Goode, P.C., where Leslie will remain Of Counsel.

Financial Advisory M&A Advisor Award

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M&A Advisor has announced that Jeanne Goche, MA, JD, and the financial advisory firm Solutions in Health Care Management will be honored at its 19th annual Distressed Investing and Turnaround Awards on March 24- 25 in Palm Beach, Florida. 

Goche is among a group of attorneys and health care advisors being honored for their work in the category of Healthcare/Life Sciences Deal of the Year (UNDER $1B). 

The award recognizes Goche’s work in the Tabor Manor Care Center Chapter 11 Reorganization in 2024.  Goche served as the patient care ombudsman, effectively assessing the quality of care for the Bankruptcy Court during a period which included a Covid-19 outbreak.

Goche is the President and CEO of Solutions in Health Care Management, a financial advisory specializing in the health sector.  Serving in various roles, her practice is devoted to revitalizing healthcare organizations.

Others participating in the case and being honored include Jeffrey Goetz at Iowa law firm Dickinson, Bradshaw, Fowler & Hagen, PC; Petersen Law PLLC; Cutler Law Firm, PC; Gibbins Advisors, LLC; Tabor Manor Care Center, Inc.; and Whitfield & Eddy, PLC.

The team’s work was among hundreds of nominations submitted for these prestigious awards and was judged by an independent panel of industry experts.

M&A Advisor was founded in 1998 to publish insights and intelligence on mergers and acquisitions, and is the premier organization of M&A, Turnaround, and Finance professionals.

2023 American Bankruptcy Institute (ABI) Health Care

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Jeremy Johnson of the big city Polsinelli law firm (city mouse) and I from a small-town health care turnaround advisory (country mouse) both:

1.     Are attending the 2023 American Bankruptcy Institute (ABI) Health Care; and
2.     Have been named ABI Journal Coordinating Editors of the “Intensive Care” segment.

We look forward to seeing our fellow bankruptcy professionals in Nashville next week and would love to hear of your interest in writing for “Intensive Care.” 

Some of the Hard Truth Behind Rural Hospital Closure Risk

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Despite all the attention on rural hospital closure risk, the hard truth is that many rural hospitals are keeping up with the increasing challenges.

Another truth is that in the financially troubled hospital, operational and financial management is often in a state of confusion.  Restructuring professionals have long noted that basic processes and operations are typically in confusion at any troubled organization.

The good news is there is hope for the struggling rural hospital that reaches out for help from workout professionals.
The Iowa State Association of Counties (ISAC) has given me the opportunity to talk with Iowa’s rural leaders about opportunities for long-term hospital sustainability at its annual conference this week in Des Moines, Iowa.

Thank you ISAC staff!

IWIRC’s 20th Annual Spring Conference

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Tirzah Roussell, bankruptcy lawyer at Dentons Davis Brown, and I will represent the Board for the Midwest Network of the International Women’s Insolvency and Restructuring Confederation (IWIRC Midwest) at IWIRC’s 20th Annual Spring Conference in Washington, D.C., April 19 – 20, 2023.

Krystal Mikkilineni, our current Midwest Network Board Chair and also a bankruptcy lawyer at Dentons Davis Brown, is a superb role model in realizing IWIRC networking and professional development goals.
It’s a privilege to support her.

Learn more about IWIRC here. 

Dave Muhs, CFO at HCHC, featured in HFMA journal

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Congratulations to Dave Muhs, CFO at Henry County Health Center (HCHC). This Iowa hospital leader is featured in the recent Health Care Financial Management (HFMA) journal - a recognition that is well deserved.

Full article.

Stop Hospital Bankruptcy by Finding the Cash

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With the pandemic, inflation, staffing shortages, etc., many rural and community hospitals are struggling.

The good news is, many organizations ARE meeting the challenge, and others can, too.

For an overview of cash management issues often found in the financially troubled healthcare organization, please see my article in the American Bankruptcy Institute (ABI) Journal:

“What’s Different About the 13-week Cash-Flow Analysis in a Troubled Hospital?”
Read the article here. 

Some of the Hard Truth Behind Rural Hospital Closure Risk

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Trumpeting concern at the starting gates of 2023, healthcare policy experts are reporting that 600 rural U.S. hospitals – or 30% of them – are at risk of closing in the near future. Over 200 of these hospitals are said to be at immediate risk of closure.

There are many reasons for this including the end of pandemic funding, patient volume instability, extraordinary inflation, lack of Medicaid expansion, staff burnout, and the overwhelming task of hospital management without the personnel bench depth of a larger system.

While the hospital environment is tougher than ever, the truth is some rural hospitals are meeting the challenge.

Another truth is that in the financially troubled hospital, operational and financial management is often in a state of disruption. Restructuring professionals have noted such disruptions are common in troubled companies across all industries.

The good news -- there is hope for the struggling rural hospital that reaches out for help from workout professionals. Read about Schoolcraft Memorial Hospital here:

https://www.solutionsinhealthcaremanagement.com/overall-hospital-system-work

Stats: https://www.beckershospitalreview.com/finance/631-rural-hospitals-at-risk-of-closure-by-state.html

Texas A&M webinar: USDA resources for rural healthcare providers

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The United States Department of Agriculture (USDA) has excellent resources for rural healthcare providers. Since attending a Texas A&M webinar about this, I've also had success in networking with helpful local and state USDA representatives.

To watch the webinar click here.
 

Nearly 190 rural hospital closures since 2005

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With so many rural hospitals and nursing homes on the brink financially, it seems there is a gap between the specialized professional help available and the stabilization services they can afford. This week Becker’s reported that nearly 190 rural hospitals have closed since 2005. The list of closures was compiled by the University of North Carolina’s Cecil G. Sheps Center for Health Services Research in Chapel Hill. I would love to have conversation - does this gap exist? Contact me if interested.

Handing over the keys

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A phrase was used at the recent healthcare industry conference held by the American Bankruptcy Institute (ABI) - perhaps with a touch of frustration:

“They want to hand over the keys.”

This gave me a nice opportunity to note that when a healthcare organization wants to have the bankruptcy professional take over management, it’s time to call my firm.

Solutions has been taking the keys for troubled healthcare organizations for years. We can stabilize operations and improve cash while the other bankruptcy professionals do their legal and high-level finance work.

Don’t let your community nursing home or hospital close. There is hope.

Learn how you can take action to assure your community nursing home and/or hospital survives and thrives through this challenging time.  

2022 American Bankruptcy Institute (ABI) Health Care Program

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This week I’ll be educating health care bankruptcy professionals that there is hope for rapid improvement in the cash-on-hand status and overall financial performance of most financially troubled hospitals and nursing homes. 

While this may be hard to believe in these pandemic and inflationary times, my experience indicates it is true.  So that’s what I’ll be talking about as I network at the 2022 American Bankruptcy Institute (ABI) Health Care Program in Nashville, October 27 and 28.

For more articles and case studies on this topic, click here. 

Board Service Announcement: Women's Insolvency & Restructuring Confederation (IWIRC), Midwest Network

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It's an honor to serve as the new Secretary/Treasurer of the International Women's Insolvency & Restructuring Confederation (IWIRC), Midwest Network. I am thankful to have benefitted from this group and look forward to supporting other women in return. Learn more. 

NRHA announces support for the ICAN Act

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It's not much of an exaggeration to say that Advanced Practice Registered Nurses (APRNs) are saving health care in rural America. The recent support announced by the National Rural Health Association (NHRA) for H.R. 8812, the Improving Care and Access to Nurses (ICAN) Act, is commendable. If this bill is passed, it will broaden the services available from APRNs under Medicare.   Read official letter.

Can This Hospital Be Saved? Signs of Restructuring Potential 

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Thank you to the Healthcare Committee of the American Bankruptcy Institute (ABI) for recently publishing my article, “Can This Hospital Be Saved? Signs of Restructuring Potential.” The article discusses the severe financial strain of the health care industry now that Covid-19 pandemic funding is ending.

It suggests the organizations able to survive will have maintained a core staff of clinicians providing high-quality care. Current financial ratio performance will also impact survival options, including age of capital such as IT and clinical equipment.

For more articles and case studies, click here. 

Don’t let your community nursing home or hospital close. There is hope.

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Learn how you can take action to assure your community nursing home and/or hospital survives and thrives through this challenging time.

As is common in stressed organizations, gaps often appear in day-to-day operations. These gaps can lead to lost revenue and weakened expense management. With the pandemic and current inflation, the health care industry is particularly stressed. Click here to learn more.
 

Nursing homes continue to struggle as they address inflation and staff gaps at this later stage of the pandemic

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Read the case study here.
 

Jeanne's response to Fierce Healthcare's article: "Hackers shifting focus to small hospitals, clinics and tech companies to siphon off patient data, report finds"

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Even the smallest organization can protect themselves from cyberattacks. Fierce Healthcare reports that small healthcare organizations are being targeted. If you have not already done so, now is the time to take steps with your IT team to address this issue.

Read Fierce Healthcare Article.
 

Solutions client recognized for success in leadership

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Congratulations to Chuck Nelson at Marshfield Medical Center-Dickinson, Iron Mountain, on his recognition from the Michigan Hospital Association (MHA). It is wonderful to see another of my hospital turnaround clients evolve in long-term sustainability.

Read Full Article.
 

AHA: "Speed up 340B payment correction"

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Thanks to the American Hospital Association (AHA) for supporting fast adjustment on the recent 340B payment correction ruling from the U.S. Supreme Court.

This opportunity is one of many that critical access hospitals (CAHs), as well as other safety net hospitals, can use to improve their cash positions.

Read Full Article.
 

Congratulations to Schoolcraft Memorial Hospital leadership on a successful CEO transition!

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This evolution is markedly different than my entry there as the transitional CEO a few years ago.

At that time the entire top management team had left suddenly and there wasn't operating cash sufficient to cover future payrolls.

Over the next several months, Solutions staff covered the leadership departures and improved all financial operations, resulting in the organization's first positive operating income in years.

It's wonderful that the new CEO, Andy Bertapelle, will be able to support the high-quality care at Schoolcraft with his experience as a medical provider. It's also lovely that he's from the Schoolcraft area.
Best wishes to everyone at Schoolcraft, including CEO Bob Crumb upon his retirement!

Read the Article. 

Becker's Hospital Review: US Supreme Court overturns $1.6B 340B payment cut 

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This is fabulous news for financially troubled healthcare organizations participating in the 340B program.

Read the Article. 

Jeanne Featured by DCCS Consulting after Finishing Assignment with Stand-Alone Senior Living Campus

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It’s great to be featured by DCCS Consulting now just as I've completed stabilizing my first stand-alone senior living campus.

The campus consisted of a nursing home, independent living, and assisted living. While I have stabilized these types of services previously, this work has only occurred in association with a hospital.

DCCS notes my experience as a transitional CEO/CFO/COO (effectively CRO), sometimes working in dual c-suite capacities.

The profile goes on:
“Jeanne is a stabilizing and collaborative influence with a proven track record of financial turnaround while minimizing job elimination and maintaining high performance in the quality of care.

“Jeanne respects the special role healthcare serves in distinctive local cultures having retained endangered health care services for several communities and guided them to strategic redirection and long-term sustainability.”

Thank you DCCS Consulting!

The complete profile is available here. 
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Registration is now open at Texas A&M:

This time for the most requested learning topic at the Texas A&M Center for Optimizing Rural Health (CORH) - Service line implementation.

COHR and I are providing a free webinar on this topic Tues, May 10, 2022, from Noon – 1 PM, Central Time.

The webinar will cover key concepts in service line development and implementation with special consideration for rural health care.  The items addressed will include market research, financial analysis, budgeting, and staffing.

To register and learn more about the webinar, go to: https://tamu.zoom.us/meeting/register/tJ0lceitrz8tHtUzZcK0sBlg479FsfsvDy5Y

To learn more about COHR at Texas A&M, go to: https://optimizingruralhealth.org/

This work is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS).
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2022 Statewide Supervisors Meeting 

Educating County Supervisors about the potential to improve county hospital financial performance continues as a priority. Sometimes, a supervisor doesn’t even realize the county may hold financial responsibility for a failing county hospital.

Earlier this year, I worked the 2022 Iowa Statewide Supervisors meeting. This conference provided an unexpected opportunity to network with county lenders as well as more than 150 supervisors serving counties in public office. Thank you to the Iowa State Association of Counties for hosting this event. 
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Jeanne’s involvement teaching the Management of Healthcare Organizations in the Doctorate of Nursing Practice program at Bradley University, Peoria, Illinois

It was profound.  Left me speechless.  For a brief time, I had a close-up look at the work and dedication of nurses on the frontlines of care across the country.

They were my students in Bradley University’s online Doctorate of Nursing Practice program.  Thanks to Dr. Mark Brown, I had the opportunity to teach Management of Healthcare Organizations for the program this winter.

One student was a bit late to the course because of a snag getting back to the U.S. from her self-funded health care mission trip to Africa. Read full article.
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Access Full Webinar: Leadership for New Line Managers and Executives in Rural Health Care Organizations

The Center for Optimizing Rural Health at the Texas A&M Rural and Community Health Institute recently posted a leadership webinar I presented as part of its grant from the Health Resources and Services Administration (HRSA, part of the U.S. Dept. of Health and Human Services).

You may access slides and the webinar here.


 
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DCHS Joins Marshfield Clinic Health in Northern Michigan officially

Friends and colleagues at Dickinson County Healthcare System (DCHS) have informed me that DCHS has officially joined the Marshfield Clinic Health System.

As the DCHS Board Chair has noted, my work with the local team in stabilizing DCHS financials laid the foundation for bringing this world-class organization to the Michigan Upper Peninsula.

Read the news article.
 
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Webinar: Leadership for New Line Managers and Executives in Rural Health Care Organizations

Some of us are being placed (tossed??  thrown??  hurled??) into our first management or executive roles as we see health care staffing shortages worse than ever.  If you’re in your first management job, this is the free webinar you need.

Sponsored by the U.S. Health Resources and Services Administration (HRSA) via the Texas A&M University Center for Optimizing Rural Health, I will be presenting effective and practical management tips you can start using immediately.

Register Now.
 
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DCHS closer to joining Wisconsin-based health system

Another Dickinson County Healthcare System (DCHS) Board Member recently called me in thanks for my work with the local team in stabilizing DCHS financials. This laid the foundation for the new partnership with Marshfield Clinic.

It's wonderful the high-quality care provided in Iron Mountain will continue.

Read the full article on MSN. 
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Successful Fall 2021 Revenue Cycle Management Certificate Program Completed at Bradley University 

Thank you to Bradley University, Peoria, IL, and Angela Settles, Director, Center for Professional Excellence, in supporting completion of the Fall 2021 Revenue Cycle Management (RCM) Certificate Program.

We had another excellent class of health care professionals who used course concepts to design RCM projects with return-on-investment for their employers.

I enjoyed teaching this group of students and, as usual, learned a lot from them.

The students liked stretching their thinking with Bradley University Professors Bond, Brown, Mills, and Weinzimmer on marketing, customer service, data analysis, building engagement, and collaboration.

They also received cutting-edge information on revenue cycle management and the use of artificial intelligence from Shawn Steffen, Senior Director, Revenue Cycle, Mercy Medical Center.    

Finally, thanks go out to Laurie Hurwitz, Senior Vice President for Revenue Cycle at OSF Healthcare.  Not only did Laurie support the class by presenting an overview of revenue cycle, she also sent several students through the program.

Happy Thanksgiving, Everyone!!
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Webinar: Managed Care Contracting for Rural Health Care Organizations

It’s my pleasure to provide a free webinar on managed care contracting for the Texas A&M University Center for Optimizing Rural Health (CORH) as part of its grant from the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS).

The webinar is open to all and will cover the basics of managed care contracting in rural health care.

In financially troubled health care organizations, I find the institutional knowledge about these contracts has often been lost.  Unfortunately, this means no one is seeing that the organization is getting paid as it should for services provided.

Learn how to fill this gap for your organization by attending “Managed Care Contracting for Rural Health Care Organizations,” Tuesday, November 16, 2021, 12:00 Noon, CST.

Here are the links to learn more and register:

CORH Website with Webinar Information: https://optimizingruralhealth.org/event/managed-care-contracting-for-rural-health-care-organizations/

Webinar Registration Link: https://tamu.zoom.us/meeting/register/tJcsd-2vpjkpGddAsq-2Z2hu0HaX8zA0Tdhm
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Congratulations to Marshfield Clinic and Dickinson County Health System

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This one I will never forget.

It was a closed session with the Dickinson County Health System (DCHS) Board. I sat across the table from the new leaders who had returned to the Board to save the place, including current board chair Margaret Minerick, long-time community business owner.

A big-time consultant told them the 50-bed county hospital in the rural Upper Peninsula (UP) of Michigan would have to file for bankruptcy and lay off about 80 people. This was just before the holidays. I watched the concerned eyes of the new Board members as they turned to me, the girl from the Iowa cornfields who runs hospitals.

“What can you do, Jeanne?” they asked.

Not having seen the financials or done an onsite assessment yet, but based on my experience turning health care organizations, I said, “Well, I can’t guarantee success as I’m not familiar with your situation, but I’ll give it the ol’ college try.”

That began our huge turnaround that produced positive margins and the building of cash reserves without a major layoff at Christmas, or ever, actually. This turn became the basis of refinancing by the United States Department of Agriculture (USDA) and continued success by the Board, the permanent CEO, Chuck Nelson, and local consultant Dennis Smith.

Now, DCHS leadership has taken this success and its existing strong clinical care to join forces with the outstanding Marshfield Clinic Health System based in Marshfield, WI. This move will make DCHS the hub of high-quality health care in the UP.

Congratulations to Marshfield Clinic Health System and Dickinson County Healthcare System!

Read the news story here.
 

Revenue Cycle Management Certificate Program -

In-session update October 2021

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Wow.  Today’s Revenue Cycle Management Certificate Program session at the Bradley University Center for Professional Excellence is one of the highlights of the course.

Shawn Steffen, MHA, Senior Director of Revenue Cycle, Mercy Medical Center, Cedar Rapids, IA, is leading the entire day teaching implementation of best practices and the use of artificial intelligence (AI) in revenue cycle management.

The students also reported on their projects intended to provide an ROI for their employers and they are inspiring.  The course requires that the students work with their management leaders to assure the projects are positive and effective contributions to their organizations.

Student interaction with Shawn has been wonderful.  The students are like sponges soaking in best practices in revenue cycle management as well as the use of artificial intelligence (AI).

Thank you again to Bradley University and the Healthcare Financial Management Association (HFMA) in making this highly effective educational experience possible. 

We are having a grand time in Peoria while also including the virtual students online!​​​ 
 

Revenue Cycle Management Certificate Program -

In-session update September 2021

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Thank you, Bradley University Center for Professional Excellence, for creating the Revenue Cycle Management Certificate Program.  I just finished teaching my sessions providing an overview of health care finance (the Twitter version!), and an introduction to data analysis and best practices.

Also, thank you to the Healthcare Financial Management Association (HFMA) for partnering with us in using its fantastic revenue cycle information and providing continuing education credit for the students.

The best parts of the course are yet to come:

Read Full Article. 

Jeanne Featured by DCCS Consulting

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It’s great working with DCCS Consulting professionals CEO Dave Capone, COO Debbie Linnes, and Steve Grace, Transition Services.

I’m pleased they are featuring me as a leader in health care transformation available for assignment through their firm.

DCCS notes my experience as a transitional CEO/CFO/COO (effectively CRO), sometimes working in dual c-suite capacities.

The profile goes on:
“Jeanne is a stabilizing and collaborative influence with a proven track record of financial turnaround while minimizing job elimination and maintaining high performance in the quality of care.

“Jeanne respects the special role healthcare serves in distinctive local cultures having retained endangered health care services for several communities and guided them to strategic redirection and long-term sustainability.”

Thank you DCCS Consulting!

The complete profile is available here.

Enrollment now open:
 
Revenue Cycle Management Intensive -
Begins September 16, 2021

Bradley University

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Revenue Cycle Management (RCM) in health care organizations has changed drastically the last 20 years and if your organization is financially troubled, the probability is high you’ve missed the RCM memo. Enroll Here.

Here’s what’s happened:
It used to be that Medicare made a change or two per year in claims processing and they were later slowly mimicked by other payers.

Read Full Article. 

Vaccine Mandates in the Health Care Workplace: A Legal Analysis for Employers

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Recently, I was recognized as a major contributor for an American Health Law Association (AHLA) book, Vaccine Mandates in the Health Care Workplace: A Legal Analysis for Employers by Denise M. Hill, MPA, JD, Associate Professor of Practice in Public Administration at Drake University, Des Moines, Iowa.

Read Full Article.

Troubled Rural Health Care: Considerations for Our Communities

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Originally Published in Iowa Lawyer, October 2020

Many rural health care organizations were struggling long before this year’s coronavirus pandemic.  Nationally, 168 rural hospitals have closed since 2005, 126 of these closing since 2010.¹  In 2020, eight hospitals have closed already.²

Iowa communities have generally seen their health care organizations maintained the last several years, although many are in precarious financial condition.  Of the 118 Iowa hospitals, 44 were shown to have ended the last fiscal year with negative balances.³  According to the Guidehouse Rural Hospital Sustainability Index, 12 – 17% of Iowa’s rural hospitals are at high risk of closing without improvement in their financial situations.⁴
The role hospitals play in Iowa is immense, providing more than 78,000 jobs and last year creating nearly $8 billion in overall economic impact.⁵  Losing several Iowa hospitals would have a devastating impact on Iowa communities still consumed with a pandemic, wind storms, and drought. Read Full Article.
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