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Featuring hospital and health care headlines from the media and Web from October 24-30.

Iowa Headlines

Soldiers see childbirth thanks to technology
Freedom Calls Foundation sets up 2,000 “virtual” meetings among soldiers overseas and their families back home. About 10 percent of these conferences involve births.  Recent calls involved Iowans and Iowa hospitals.  (October 29, Sioux City Journal)

Maquoketa hospital to renovate former skilled nursing unit space
The former long-term skilled nursing unit at Jackson County Regional Health Center will be renovated to make way for the hospital’s physical therapy unit, cardiac rehab and the fitness center and diabetes education center.  (October 28, Quad-City Times)

Montgomery County Memorial Hospital

Montgomery County Memorial Hospital

Red Oak hospital gets recognized
A hospital in the southwest Iowa town of Red Oak is being recognized as the number-one hospital in the state for patient satisfaction. Montgomery County Memorial Hospital public relations director David Jennings says the Center for Medicare & Medicaid Services now requires hospitals that receive the Inpatient Prospective Payment System to report the results of a standardized survey of patients about their hospital stay.  (October 27, Radio Iowa)

Health care forum voices concerns, solutions
No subject was off the table. In fact, several panelists pointed out that it is not health care that needs reforming so much as access to medical care and the insurance industry that dictates decisions on care and prohibits pooling across small businesses, industries and even state lines.  (October 28, Sioux City Journal)

Regional medical district coming to Cedar Rapids
A new regional medical district is coming to Cedar Rapids. The city of Cedar Rapids, St. Luke’s Hospital, Mercy Medical Center and Physicians Clinic of Iowa are all entering a cooperative venture. It will be located along 10th Street SE in Cedar Rapids, running between the two hospitals. There are a number of medical facilities in that area already, but this would be an effort to develop more, and hopefully attract patients from around the region.  (October 27, KCRG)

Sister preserves “Legacy of Mercy”
Sister Mary Elizabeth Burns has been a member of the Sisters of Mercy for 63 years, So when the Estherville, Iowa, native began writing a history of the Sisters’ health care heritage in Iowa, Michigan and Indiana, she knew much of this history from personal experience. It still took 10 years of on-and-off research, however, before her book, “Beyond Measure: A Legacy of Mercy,” could be completed — and published earlier this year.  (October 29, Sioux City Journal)

Task force tours fourth Iowa mental institute
After touring the fourth of the four state mental health institutes Monday, a task force of Iowans will now spend a few weeks figuring out what to do next.  The Iowa Mental Health Institute Task Force will make a report to the director of the Iowa Department of Human Services, which runs the four mental health institutes, about the impact that closing an institute would have on the community and patients.  (October 27, Des Moines Register)

U.S.  Headlines

It’s alive! End-of-life counseling in health bill
The Medicare end-of-life planning provision that 2008 Republican vice presidential nominee Sarah Palin said was tantamount to ‘death panels’ for seniors is staying in the latest Democratic health care bill unveiled this week. The provision allows Medicare to pay for voluntary counseling to help beneficiaries deal with the complex and painful decisions families face when a loved one is approaching death.  (October 29, Associated Press)

Massachusetts nurses my join big union
Unionized nurses in Massachusetts are moving toward affiliating with their counterparts in California and more than 20 other states to create the largest nurses union in US history, a 150,000-member powerhouse that would lobby lawmakers for higher staffing levels and an overhaul of the nation’s health care system.  (October 29, Boston Globe)

Can “bundled” payments help slash health costs?
Under the “bundled” payment approach being tested by Medicare, the program makes a single reimbursement for all the hospital and doctor care for heart and joint procedures, rather than making separate payments to the facility and physicians. Such combined payments are getting close attention during the healthcare debate as a way to encourage hospitals and doctors to work together to hold down costs and improve care.  (October 26, USA Today)   

Photo by San Francisco Chronicle

Photo by San Francisco Chronicle

A prescription for success: don’t bother nurses
Striving to reduce interruptions that lead to mistakes, teams of nurses at the different hospitals came up with a variety of methods – often surprisingly low tech – to alert others they were administering medications. The strategies included everything from wearing brightly colored vests or sashes to establishing “quiet zones” or making announcements at key points in the day when medications are being administered.  (October 28, San Francisco Chronicle

Who picks up the tab for health reform
Beyond the contentious battle over the public insurance option, there’s a huge fight over another question: Who will pay to cover the uninsured? It’s safe to say doctors will give up the least, pharmaceutical and medical device makers will fall somewhere in the middle, and insurers will be the big losers. The 85% of citizens with insurance of any kind should probably assume that most costs levied on other parties to health reform will be passed along to them through higher premiums.  (October 22, Business Week)

Innovations in health care delivery
Sometimes lost in the big health care debate over how to insure more people, more efficiently, are some of the smaller innovations that offer surprisingly significant improvements in care and cost.  This series of reports focuses on some of those innovations.  (October 27, Wall Street Journal)

In China, too, health care system in disarray
Over the past five years, the Chinese government has tried to provide coverage to more of its 1.4 billion people. But even people covered by a minimal health insurance program are often left with big hospital bills and must pay for most outpatient services and medication. In addition, more than 300 million people do not have any health insurance. The gap in the quality of care also has been steadily growing.  (October 28, Washington Post)

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Source: Air America via Google Images

Source: Air America via Google Images

U.S. House Speaker Nancy Pelosi (D-CA) along with House Democratic Caucus members have unveiled a 1,990 page “draft” health care reform bill, H.R. 3962.  This is the first time that all three House committees, (Ways & Means, Energy & Commerce and Education & Labor) bills have been released in their combined format.

According to a released statement, the bill will provide coverage for 96 percent of Americans and is deficit-neutral.  The bill also includes a mandate on individuals to carry health insurance as well as a mandate for employers to offer health insurance.  Failure to do so will trigger tax penalties for both individuals and businesses.

The bill includes a “public health insurance option.”  The public plan will be available alongside private health insurance plans all contained in the bill’s proposed national “health insurance exchanges.”  The public option would pay hospitals and other providers at rates negotiated with the U.S. Department of Health and Human Services and does not carry a state “opt-in” or “opt-out” provision. 

As an additional option, the legislation includes the alternative insurance “co-op” plans that permit states to enter into agreements to allow for the sale of health insurance across state lines when the state’s legislature agrees to such compacts.  Grants are also awarded to help states with this endeavor.

IHA is continuing to review the legislation and additional impacts on hospitals.

A detailed summary is available for download here.

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An Iowa hospital is in the national spotlight this afternoon in an Associated Press story focusing on “medical homes.”

The story focuses on Dr. Don Klitgaard and his colleagues at Myrtue Medical Center in Harlan and their use of the medical home model, which focuses on primary care and coordinating the care of patients at that level:

Put primary care doctors like Klitgaard on the front end, the theory goes, and they could make sure patients see the right specialists, avoid duplicative tests, get proper medications and prevent the worst complications of chronic illness, such as diabetes-related blindness.

The problem is, health care payment systems, including Medicare and Medicaid, don’t line up with the Medical home model:

Klitgaard is wondering if Congress will do enough for primary care doctors, the ones expected to carry out the transformation. Medicare, the government health program for seniors, doesn’t pay for the care coordination, monitoring, and coaching of patients that are part of his model.

The practice model at Myrtue is nothing new, at least in Iowa.  It is one of the reasons why Iowa spends far less on Medicare patients than nearly all other states, yet retains extremely high quality of care, as the Commonwealth Fund noted in its most recent report.

Unfortunately, while Iowa’s practice model limits wasteful tests and visits to multiple specialists, keeps patients out of hospitals and ICUs and promotes hospice care, the model in other hospitals in many other states tends to do quite the opposite.  The result forces Iowa to effectively subsidize the wasteful ways of those hospitals.

The good news is stories like this one, which notes that the medical home model is getting more and more attention from Congress and the White House.

The other good news is that Iowa hospitals and practitioners are ready to show the world how and why the medical home model works.  On-point in that effort is the Iowa Healthcare Collaborative, the organization founded by IHA and the Iowa Medical Society to advance health care quality in Iowa and beyond.  IHC has developed a comprehensive medical home model toolkit.

And Dr. Klitgaard?  He happens to be the co-chair of IHC’s medical home model workgroup.

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Senate Majority Leader Harry Reid (D-NV) announced at a press conference that the Senate combined health care reform bill will include a public option with an “opt-out” option for states.  Under this scenario, individual states would have the ability to opt-out of offering a government-sponsored insurance plan as part of the health insurance exchanges that would also be created under the bill.

In order to pass, Reid will need all 58 Democrats and two Independents to vote for the provision.  It has been speculated that at least two Democrats, and one Independent have not yet committed their support.

Other reports indicate that this is the first of many “test” provisions that will make it to the Senate floor for debate.  First is the above mentioned “state opt-out,” if that fails then a “state opt-in,” and next a public plan “trigger” proposal is also on the table whereby a public plan would be triggered in a state where mandated health coverage cost reduction goals are not achieved.  Reid announced that the Senate bill will now be sent to the Congressional Budget Office to receive a total cost as well as coverage estimates.  Throughout last week Senate leaders were working to combine both bills resulting from Finance and Health Education, Labor and Pensions.

IHA supports increasing health care coverage to as many citizens as possible, but maintains concerns that a public health insurance plan would reimburse hospitals at Medicare rates.  Medicare rates are generally much lower than private insurance payments, and Iowa ranks near last in Medicare reimbursements contributing to hundreds of millions of dollars in payment shortfalls each year.

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Among more than 71,000 employees, Iowa hospitals have countless examples of amazing people doing outstanding work.  Each year, IHA honors some of those employees as Iowa Hospital Heroes.  In the coming weeks, IHA will share the stories of our 2009 Iowa Hospital Heroes.  Below is our Hero for this week:

Nancy EdlerNancy Edler
Registered Nurse
Iowa Lutheran Hospital, Des Moines

A registered nurse at Iowa Lutheran Hospital for 34 years, Nancy Edler loves nursing and her patients love her.  Nancy is well respected by co-workers, physicians, patients and families and is a resource for many.  She demonstrates great teamwork and has a “can-do” attitude. Very often staff comment that “the shift goes more smoothly because Nancy is working.” 

She is always willing to pitch in and help her peers, encouraging and mentoring new nurses as she enthusiastically shares her expertise with co-workers.  Nancy is known for helping peers with difficult IVs, lab draws or with patients who become critically ill. She is always available to help if a co-worker is suddenly overloaded, often helping with new admissions. 

For five years Nancy has volunteered in the community every Thursday at her church’s free health clinic with Dr. Nick Palmer. She does these things because she can, because she loves her role and because it is the right thing to do.

When Iowa Lutheran Hospital needed space to recover patients from the cathertization lab, Nancy volunteered to help initiate this new program on 3 East.  She was one of the first nurses to work in the new recovery area and she developed a friendly relationship with all of the staff on 3E. She would often volunteer to work extra shifts on 3 East when the floor was short-staffed.  

Nancy rarely takes time off. She has worked extra many times when the hospital was short staffed or because a co-worker needed the time off. Nancy does not shy away from work.  She will stretch and take that one last patient when everyone else is busy. 

This is the kind of hero Nancy Edler is. She is dedicated, compassionate and truly works toward the best outcome for every patient every time.

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