Certificate of Need

Iowa has one of the highest quality, lowest cost health care systems in the United States. And at the heart of that system are 118 community hospitals that stand ready, day and night, to serve everyone, regardless of their ability to pay. A significant reason for health care excellence in Iowa has been state oversight of institutional health care services through the Certificate of Need law.

Iowa’s Certificate of Need regulations were first enacted in 1977 for the express purpose of providing for the orderly and economic development of health care services, thereby avoiding unnecessary duplication of services, controlling the growth of overall health care costs and ensuring the stability of community hospitals. Since that time, these regulations have been re-examined multiple times and each time the same conclusion was reached: Iowa needs Certificate of Need.

As the name implies, Certificate of Need ensures that new medical services are truly needed at the community level. This is important because new facilities (including nursing homes, ambulatory surgical centers and hospitals, among others) must have sufficient patient volumes to support proficiency among medical staff and ensure high-quality care. The same applies to existing facilities, yet without Certificate of Need, new, for-profit facilities would spring up all over the state and deplete patient volumes across the board.

Not only would this compromise the quality of care for everyone, but these new facilities would target lucrative lines of medical service while not providing emergency care, charity care and other unprofitable services that are at the core of the community hospital mission. If Iowa’s community hospitals are left with only unprofitable services and only care for complicated patients who are on Medicaid or uninsured, their ability to survive and continue providing high-quality, community-focused care to everyone will be jeopardized.

In fact, repeal of the law in other states has led to hospitals closing. Furthermore, nearly all of these states have instituted a different review process that is highly politicized.

One of Iowa’s greatest strengths is its health care system. Not only do Iowa’s health care providers deliver excellent, accessible and efficient care, but health care employs more than 200,000 people, injecting some $11 billion into the state’s economy. More than 71,000 of these workers are employed by hospitals, which alone have an economic impact of $4.3 billion.

Certificate of Need, which exists in 36 states, not only ensures the stability of these major employers and economic engines, but it also supports the collaborative spirit that fosters communication and cooperation among Iowa health care providers, which, again, leads to better health care for everyone.

Today, with the uncertainties surrounding the future of the Affordable Care Act (Obamacare), Iowa’s Medicaid program and even Medicare, the constancy of Certificate of Need is more important than ever. During this time of significant change in the health care industry, the stability provided by this law allows hospitals to more confidently plan and respond to the needs of the communities they serve.

In all parts of the state, Iowans depend on their community hospitals being there all day, every day. That level of access and preparedness is jeopardized by those who would significantly change or repeal Certificate of Need.


Kim Gau
Chief Executive Officer

The Robot Has A Name!

Community members and school groups took  turns at controlling Guttenberg Municipal Hospital’s new surgical robot and learned more about the options for robotic surgery at an Open House.

The surgical team chose the winner of the Name the Robot contest. Our new robot’s name is RAHMA which means compassion, submitted by Kailey Dempster.

Thank you all who submitted entries and attended our program.

Dr. Mansfield with Kailey and RAHMA.



Strategic Partnership Task Force Update- February 3, 2017

Guttenberg Municipal Hospital


February 1, 2017

Dear Board, Physicians, Employees and City Council Members,

Guttenberg Municipal Hospital’s (GMH) Strategic Partnerships Task Force (Task Force) is pleased to provide this fourth stakeholder update on our process and progress. As a reminder, the members of the Task Force are:

  • Bill Allyn, Task Force Chair and Board of Directors Vice Chair
  • Russell Loven, Mayor
  • Karen Merrick, Board Member
  • Andrew Smith, MD

Our Recent Work

In our last update to you, we described an interview process we would be using to learn more about six potential partner organizations and identify a smaller subset of these organizations to invite for on-site presentations to the Task Force in March. After an initial conversation with our consultants from ACCORD LIMITED, one of the original 6 organizations withdrew from consideration; ACCORD then completed interviews in early January with the following five potential partners:

  • Gundersen Health System
  • Mayo Clinic
    • Mercy Health Network
    • UnityPoint
    • University of Iowa Hospitals and Clinics

On January 24, members of the Task Force met with the GMH Board to share key findings from the recently completed interviews. The Board then deliberated with the Task Force and decided Mercy Health Network, UnityPoint Health, and University of Iowa Hospitals and Clinics should be invited for more in-depth conversations in March. While all five of the original organizations are outstanding health care systems, the Board’s selection of the three systems came down to several key considerations including:

  • The degree to which local residents already rely on these systems for health care not available at GMH and its affiliated clinics;
  • The flexibility these systems offer in terms of potential partnership models;
  • The broad range of support and services these systems can provide to rural providers like GMH; and
    • The specific support they can provide in recruiting new physicians to our

Of course, we still have much to learn about each organization and the value they might bring to health care in Guttenberg. The presentations planned for March will provide the opportunity to do just that.


Providing Additional Education and Securing More Input

The Task Force believes that it will be helpful for all key stakeholders, including themselves,to receive some additional education about trends in rural health care as we all prepare for the potential partner presentations . Therefore, we have invited Greg Boattenhammer,past Senior Vice President, Government Relations, with the Iowa Hospital Association, to conduct three group sessions here at GMH on February 2th. There will be separate sessions for: GMH Managers; GMH Board, Task Force and City Council; and GMH Physicians, with discussions tailored for each group. Each session will explore the challenges facing rural health care providers and how our peers have been responding. More detail will be available soon on the times for these educational sessions.

We will also be using these same sessions to get additional input on the most important questions to ask and issues to explore with each of the three potential partner organizations. Pam Knecht, President and CEO of ACCORD LIMITED,will be attending each session to facilitate discussions regarding specific questions that should be asked of each partner. These educational and input sessions continue our commitment to you-to seek your input and advice as we move through our process. Our goal is to leave no stone unturned-to learn all we need to know to make the best decisions for our future.

Responding to Questions from Our Stakeholders

Recently, many of you have asked for more information about why GMH should consider partnership now. In this update, we explore three important (although not the only) reasons.

Reason #1: Physician Recruitment

Physicians are the backbone of our health care system although it is increasingly difficult to recruit physicians to practice in smaller, rural areas like ours. Health care systems across the country are vying for the best and brightest physicians to serve their communities. A partnership with a larger organization provides expertise and resources to support GMH physician recruitment. With the right partner, we will have access to a broader pool of physician candidates and are more likely to “stand out” as these candidates consider their options. In March, we will explore this topic in more detail with the potential partners to learn as much as we can about how specifically each organization can help us with recruiting outstanding physicians to our community.

Reason #2: Better Models of Care Delivery

Quality health care requires close cooperation and integration across the entire system of care. Patients deserve easy access to all the care they need, a seamless and coordinated experience, one medical record, and a comprehensive medical team centered on their needs and supported by constant, effective communication. Delivering on this promise is one of the major reasons we consider partnerships. Especially as our population ages and chronic conditions become more prevalent, we cannot do it alone.A partner can help us to offer more specialties locally, support investment in new clinical services and medical technology,and fill in our continuum of care by adding services such as home health, long term care and hospice.


Physicians across the nation are challenged to keep up with shifting demographics and changing disease patterns, new payment models, increasing expectations from policy-makers; regulators, patients and their families, and constant innovation in treatments and technology. Such challenges are especially acute for rural providers, who are asked to do even more for their patients without the infrastructure and support available in larger communities. A relationship with a strong partner offers the potential for enhanced support to GMH-affiliated physicians. During our in-depth conversations with the potential partners in March, we will explore the specific ways in which each organization could help our affiliated physicians with their patient care needs; for example:

  • The specialists each system would bring to our communities to see patients close to home;
  • The remote support (e.g.,by telephone or telemedicine) they would offer to primary care physicians who practice here;
    • The systems they have for easy transfer of patients when care is needed that is not available at GMH;
    • The clinical support tools and continuing medical education resources they make available to community

Economies of scale also are possible through partnership, providing access to innovation and technology that we could never afford on our own. One example is telemedicine where our doctors work with specialists who are in another location. Through video and electronic monitoring devices, multiple physicians can “see” and treat a patient together, increasing the likelihood of an accurate diagnosis and decreasing the need for anyone to travel.

Reason #3: Financial Realities

Health care providers across the country face ongoing challenges to do more with less. Payments from all sources continue to be squeezed as we face the prospect that  recent coverage expansions under the Affordable Care Act (Obamacare) will be scaled back. Added to this are the recent ruling by the Centers for Medicare and Medicaid Services (CMS) that a portion of the historical payment that GMH received would no longer be provided, and the unique financial challenges we face because of our small sca le. Partnerships with the right partners can help GMH navigate future financial challenges-supporting our growth, helping us to participate in a wide range of insurance plans and products,and assisting in risk and expense management. As we explore potential partners and partnership models, we are especially interested in learning more about:

  • The resources that partners could provide to support the growth of local These,in turn, would bolster our revenue base and allow us to invest even more in new services and treatments;
  • Opportunities with the potential partners to participate in new insurance plans and products;
  • The extent to which the partners could help us to “weather the storm” if we were to experience periods of financial l



    • The economies of scale that we could achieve together and the likely savings to GMH from participating in shared system services such as group purchasing.

Improving Our Community’s Health

Change is a constant in today’s world and health care is no exception. Scientific breakthroughs and technological advances create new treatment options and offer new hope. Alternative settings of care enhance access and convenience and new health plan options sharpen our focus on prevention, wellness, and value for dollars spent. While these are only a fraction of the changes impacting health care today, they all are part of a larger story. Across the country there is a movement to innovate in all aspects of health care:to look at new ways of doing things and to explore new relationships and partnerships for greater impact. GMH must be part of this movement and for the best of reasons-to improve the health and wellness of our communities. We encourage your ongoing participation and input as we explore the potential value of partnerships (benefits relative to costs) for GMH and the people we serve.


Bill Allyn

Strategic Partnerships Task Force Chair and Board of Directors Vice Chair

Robotic Surgery Arrives in Guttenberg

Guttenberg, IA — A new era of surgical care has begun in Guttenberg with the arrival of a computer-enhanced, or “robotic,” surgery system at the hospital. Guttenberg Municipal Hospital in Guttenberg, Iowa has joined the ranks of some of the leading hospitals in the country – including The Mayo Clinic, Johns Hopkins Hospital, Memorial Sloan-Kettering and the Cleveland Clinic Foundation – that have invested in the da Vinci Surgical System’s equipment.

Computer-assisted technology – FDA-approved for laparoscopic procedures since 2000 – has been revolutionizing the way hospitals perform minimally invasive surgery.

Guttenberg Municipal Hospital CEO Kim Gau views the acquisition as a major step forward for patients and their families as well for surgeons who practice at Guttenberg Municipal Hospital.

“This computer-enhanced surgical system will allow us to improve our patients’ experience, help our surgeons take the next leap forward in perfecting their craft and will keep the health-care provided by Guttenberg Municipal Hospital at the leading edge of medical science” said Kim Gau.

The da Vinci Surgical System allows a surgeon to use a special console with hand and foot controls to manipulate tiny robotic arms and an endoscope (a 3-D camera eye) to perform intricate surgical procedures that are beyond the current limitation of human performance.

Because surgeries performed with the da Vinci robot allow a surgeon to make small cuts versus having longer, open incisions, recovery time is dramatically shortened and patients can return to an active lifestyle much more quickly from most procedures. Other benefits include reduced pain, less anesthesia during surgery, a lower risk of infection, less blood loss and need for transfusions and reduced trauma to the body.

Dr. Daniel Mansfield, General Surgeon, will be the first physician to perform procedures with the robotic-assisted system at the hospital. His first procedure is scheduled for this week.   “Bringing robotic surgery to the community of Guttenberg offers another option for surgical patients.  Robotic surgery offers our patients a faster recovery, smaller incision area, less pain and scaring.” Dr. Mansfield said.  “It also allows surgeons more precision and flexibility that what can be achieved through traditional surgical methods.”

The hospital will host an open house and “Name the Robot” contest in January 2017. More details about this event will be posted on the hospital’s website at and on the Guttenberg Municipal Hospital Facebook page.

“Although the da Vinci Surgical System is not a new invention, patients will no longer have to travel outside the region for the highest standards in treatment” said Kim Gau.  “This was a mission-driven decision by the GMH board. We see this technology as essential to improving the overall patient experience by helping people recover faster and with less pain.”



About Guttenberg Municipal Hospital Guttenberg Municipal Hospital is a nonprofit, municipal 25-bed Critical Access Hospital led by an elected five person Board of Directors. As a Critical Access Hospital, Guttenberg Municipal Hospital is committed to delivering the best outcome for every patient, every time with acute, skilled, observation and hospice inpatient services. In addition, Guttenberg Municipal Hospital operates the area’s Level IV Community Trauma Center, provides general medicine and surgical services as well as obstetric and newborn services.

Guttenberg Municipal Hospital is an affiliate of UnityPoint Health Finley Hospital and a rural affiliate of UnityPoint Health as a member of the UnityPoint Health Community Network. UnityPoint Health is recognized as one the nation’s most integrated health systems in the Midwest.