Featuring hospital and health care headlines from the media and the Web.
Iowa ombudsman raises question over Medicaid oversight
Iowa Ombudsman Ruth Cooperrider raised concerns Wednesday that if the state privatizes its Medicaid system, it becomes unclear which office has the authority to investigate patient complaints. Currently, the Office of the Ombudsman can investigate any state agency, including the Department of Human Services. The organization receives and investigates complaints about delays or denial of services from patients enrolled in the state Medicaid program. (Des Moines Register)
Report cites Iowa in making case for Medicaid expansion
Iowa and Missouri share a border, but the states have taken very different approaches to Medicaid expansion. Iowa has expanded it while Missouri has not, costing that state’s hospitals money and harming the quality of life for its residents, according to Families USA, a not-for-profit group based in Washington, D.C., that pushes for access to health care. (Cedar Rapids Gazette)
Hospitals provide a pulse in struggling rural towns
(Beatrice, Nebraska) has lost a lot of the energy of its heyday…But it has yet to lose its economic pulse, thanks in large measure to the Beatrice Community Hospital and Health Center, housed in a sprawling new building of concrete and green glimmering windows on the outskirts of town. The hospital has become an economic anchor for the area. (New York Times)
The prognosis for U.S. health care? Better than you think
Bernard Tyson, chairman and chief executive of Kaiser Permanente—the $56 billion non-profit health insurer and hospital operator—is more optimistic about America’s healthcare system than he’s ever been. That’s saying something, given that the fate of the Affordable Care Act hangs in the balance pending a Supreme Court ruling due in June. He paints a mostly rosy picture of the modern, efficient health system he sees in America’s future—though he did note a few pain points that stand in the way. (Fortune)
Report: Obamacare ruling would disproportionately affect small businesses
Small businesses are among the most vulnerable to steep cost increases in health care coverage if the Supreme Court rules against ObamaCare, according to new data from the Urban Institute. In addition to the 7.5 million people who could lose their insurance subsidies if the Obama administration loses the case, nearly 3.5 million people on small-business plans would also face “substantially” higher premiums, Linda Blumberg, senior fellow for the Urban Institute, will tell a Senate panel on Wednesday. (The Hill)
Future of MinnesotaCare remains uncertain
The future of a health care program for low-income Minnesotans is at stake in the debate over how much the state should be spending in a year of a budget surplus. The Minnesota House passed a bill Tuesday night that funds the health and human services department. It would eliminate MinnesotaCare, a health care program for people who earn too much for medical assistance but can’t afford private insurance. (St. Cloud Times)
ONC brief describes positive trends in hospital EHR adoption
Hospital adoption of technology with advanced functionality increased significantly. “Fewer hospitals are using Basic EHRs without Clinician Notes” and “[h]ospital adoption of Comprehensive EHR systems has increased eleven-fold since 2009.” A vast majority of acute care hospitals (97 percent) possessed a certified EHR technology in 2014, increasing by 35 percent since 2011. (National Law Review)
Lynda Douglas thought she had a deal with Tennessee. She would adopt and love a tiny, unwanted, profoundly disabled girl named Charla. The private insurance companies that run Tennessee’s Medicaid program would cover Charla’s health care.
Douglas doesn’t think the state and its contractors have held up their end. In recent years, she says, she has fought to secure essential care for Charla.
“If you have special-needs children, you would not want to be taking care of these children and be harassed like this,” Douglas said. “This is not right.”
Across the country, state Medicaid programs, which operate with large federal contributions, have outsourced most of their care management to insurance companies like the ones in Tennessee. The companies cover poor and disabled Medicaid members in return for fixed payments from taxpayers.
That helps government budgets but sets up a potential conflict of interest: The less care these companies deliver, the more money they make. Nationwide, such firms had operating profits of $2.4 billion last year, according to regulatory data compiled by Mark Farrah Associates and analyzed by Kaiser Health News.
In an attempt to manage that tension, Washington regulators are about to initiate the biggest overhaul of Medicaid managed-care rules in a decade. Prompted by the growth of Medicaid outsourcing and concerns about access to care, the regulations are expected to limit profits and set stricter requirements for quality of care and the size of doctor networks.
“We want the enrollees to have timely access to integrated, high-quality care,” James Golden, who oversees Medicaid managed care for the Department of Health and Human Services, told a group of insurance executives in February.
Tennessee Medicaid contractors — operated by BlueCross BlueShield of Tennessee, UnitedHealthcare and Anthem — are among the most profitable Medicaid plans in the country, according to data from Milliman, a consulting firm.
State officials point to data on quality and survey results as evidence that the companies are doing a good job while allowing the state to spend far less on Medicaid than predicted. In a survey last year, more than 90 percent of customers using TennCare, as the program is known, said they were very satisfied or somewhat satisfied, officials note.
TennCare Director Darin Gordon worries that new federal rules could hinder states from improving Medicaid quality while controlling costs. “Don’t hamstring us,” he said.
But doctors and patient advocates say state savings and insurer profits come at the price of inadequate physician networks, long waits for care and denials of treatment. Answering another question in the survey, 30 percent of adults said the quality of their TennCare care last year was fair or poor.
More than half of Medicaid beneficiaries in the nation now receive coverage from managed-care companies. That shift helped prompt inquiries by the HHS inspector general last year that found widely varying state requirements for access to doctors and poor information for members on where to find them.
Policy experts believe that the proposed rules, expected soon, will set stricter standards.
In Tennessee, where TennCare’s member-per-doctor ratio for primary care is one of the worst among states that have such rules, views diverge sharply on whether those rules are necessary. Many, like Lynda Douglas, say the system is far from adequate.
Douglas, 69, knew that she wanted to adopt Charla a decade ago, as soon as she took the girl for foster care from the state. Charla’s problems include cerebral palsy, a badly curved spine and frequent seizures. She is 16, cannot speak, weighs less than 80 pounds and loves Barney the dinosaur.
Douglas, who lives about an hour east of Nashville, was grateful that TennCare contractors sent daytime nurses to monitor Charla’s seizures and maintain a tube that delivers medicine or nourishment eight times a day.
Then, more than a year ago, UnitedHealthcare reduced the nursing to one hour a day, even though Charla’s condition hadn’t improved. Douglas protested with the help of the Tennessee Justice Center and a pro bono lawyer and won. But TennCare appealed. It took two more rounds of adjudication before a judge ruled in Douglas’s favor late last year.
The managed-care companies “are making a mint down here,” Douglas said. “They’re getting rich at the expense of the kids. This is not right.”
UnitedHealthcare made an operating profit of $236 million last year on revenue of $2.8 billion in its Tennessee Medicaid business, according to state filings. Anthem’s operating profit for TennCare came to $53 million on revenue of $946 million. BlueCross’s operating profit for TennCare was $121 million on revenue of $1.8 billion. Those results do not include expenses for taxes, depreciation and other items not directly related to health coverage.
“Our care teams worked with the family and with [Charla Douglas’s] physicians and other providers to assure that her services were appropriate,” UnitedHealthcare said in a statement. The plan followed TennCare’s contract and care guidelines, it said.
Gordon, the TennCare director, rejects suggestions that managed-care networks are inadequate or that contractors deny needed care.
TennCare members sometimes have trouble seeing specialists, but so do patients in commercial plans, he said. Like many state Medicaid directors, he wonders how HHS can publish network rules for 50 states with widely varying geographies and health systems.
He also doesn’t accept that Medicaid plans need rules that limit profits and force them to spend a minimum portion of revenue on medical care. Written the wrong way, the standard could discourage spending on coordinators who improve care quality at decreased cost, he said.
“Yeah, we’re a little concerned,” he said. “There are some things that we think may have adverse effects.”
Featuring hospital and health care headlines from the media and the Web.
Poll: Iowans reject Branstad’s plans for Medicaid, closing MHIs
Gov. Terry Branstad’s plans to save money by privatizing Medicaid and closing state mental health institutes in Mount Pleasant and Clarinda are strongly opposed by a majority of Iowa voters, according to a national opinion research firm. A survey by Public Policy Polling of 1,219 Iowa voters found that only 22 percent of Iowa voters back Branstad’s plan to hire private managed-care companies to run the state-federal Medicaid health insurance program for low-income Iowans. Fifty-two percent are opposed. (Des Moines Register)
Cedar Rapids and Iowa City agencies’ merger comes ahead of switch to managed care
Two of Eastern Iowa’s largest mental health agencies plan to merge to save money in preparation for the state’s switch to managed care. The board for the Community Mental Health Center for Mid-Eastern Iowa, commonly known as Iowa City Community Mental Health Center, voted last night to join the Abbe Center for Community Mental Health in Cedar Rapids. (KCRG)
Cedar Rapids MedQuarter names executive director
Philip Wasta will oversee the MedQuarter, a 50-block district that includes Mercy Medical Center, UnityPoint Health-St. Luke’s Hospital, and Physicians’ Clinic of Iowa. “The commission unanimously selected Phil from a quality pool of candidates because we all believe he has the ability to very quickly jump-start district development,” Ted Townsend, chairman of the Medical Self-Supporting Municipal Improvement District Commission, said in a news release. (Cedar Rapids Gazette)
Mental illnesses most common hidden diseases at colleges
Nancy Reasland has seen it in her 20 years as Cornell College’s student health services director in Mount Vernon. Students with mental illness struggle when academic pressures get high, adding to their stress levels. “That switch from high school to college is big in a lot of ways,” she said. “Sometimes in high school, the parents are very involved in helping the student with time management, helping the student with medication schedules, just kind of running interference.” (Des Moines Register)
Physician burnout heavily influenced by leadership behaviors
Physician burnout is prevalent throughout the U.S. health care system—experienced by nearly half (46 percent) of physicians, according to data published in JAMA last year. But effective leadership appears to alleviate it, according to new research from Mayo Clinic and published in the April issue of Mayo Clinic Proceedings. In 2013, nearly 3,000 physicians and scientists across Mayo Clinic’s three campuses in Arizona, Florida and Minnesota responded to a survey about their wellbeing in the workplace. (HealthLeaders Media)
Senators warn Medicare appeals system ‘buckling under its own weight’
The Senate Finance Committee is demanding more attention on the growing backlog of Medicare appeals claims, which federal officials are continuing to blame on a lack of funding. The Office of Medicare Hearings and Appeals is receiving a record number of appeals, with the processing time for each claim more than quadrupling over the last five years to an average of 550 days. (The Hill)
Dallas Fire-Rescue program helps reduce 911 calls by frequent EMS users
Assistant Chief Norman Seals said the Mobile Community Healthcare Program, which treated its first patient a year ago, has successfully helped cut the amount of calls from some of those frequent fliers from more than two a month to almost none a month. Rather than simply responding to emergency calls, paramedics regularly visit the patients at their homes to teach them to care for themselves — and to use the 911 system properly. (Dallas Morning News)
ApplePay added to InstaMed medical payment system
Healthcare payments manager InstaMed on Monday said it added ApplePay to its payment methods, the first health care company to integrate Apple’s big bet on mobile payment technology into its service. The news means patients will be able to use Apple smartphones enabled with ApplePay at healthcare providers, payers or online to pay medical bills. (Healthcare Finance News)
Patients who text message just prior to surgery end up needing less pain medication
When someone goes in for surgery, even if it’s minor, it can be scary and unsettling. Pain medication will be administered regardless, but a new study shows that the social support a patient experiences by text messaging before a procedure can reduce the need for supplemental pain relief – even if it’s texting a stranger. Researchers at RTI International, Cornell University and LaSalle Hospital (Montreal, QC), recently published a study in Pain Medicine that indicated the influence mobile phones have in the clinical setting. (MedCity News)
Featuring hospital and health care headlines from the media and the Web.
Des Moines teen takes break from caring for others to enjoy prom
Ruth Phaviset has spent most of her young life taking care of others — beginning with her mother, who died after years of health problems when Ruth was 15. Sometimes Ruth cares for younger family members. Other times the 18-year-old tends to nursing home residents as a certified nurse assistant and volunteers at a hospice, talking with patients and their families. (Des Moines Register)
Robins man donates blood, platelets 800 times
Pete Bischoff, a 68-year-old Robins resident, donated platelets for the 800th time, making him a 100-gallon donor. Bischoff said he donated for the first time in 1966 when he was in the Army and stationed in Germany. “They said whoever donates gets a three-day pass and a $25 savings bond,” he said. “I thought to myself, well who wouldn’t do that?” Since then, he’s donated to UnityPoint Health-St. Luke’s Hospital, Mercy Medical Center’s blood bank and the Mississippi Valley Regional Blood Center Lindale Crossing Donor Center. (KCRG)
U.S. to set tougher standards for companies running Medicaid
Lynda Douglas thought she had a deal with Tennessee. She would adopt and love a tiny, unwanted, profoundly disabled girl named Charla. The private insurance companies that run Tennessee’s Medicaid program would cover Charla’s health care. Douglas doesn’t think the state and its contractors have held up their end. In recent years she says she has fought battle after battle to secure essential care to control Charla’s seizures, protect her from choking and tube-feed and medicate her multiple times a day. (Kaiser Health News)
Hospitals offer to share in cost of LA Medicaid expansion
As Louisiana struggles with budget troubles, private hospitals are offering lawmakers a way to draw down more federal health care dollars for patient care , but only if the money is used to expand coverage through the Medicaid program. Legislation filed by House leaders would let the state tap into a voter-backed plan that allows hospitals to pool their dollars and use that money to attract new federal Medicaid money to compensate them for their care for the poor. (Associated Press/Washington Times)
Kansas rural hospitals struggle to stay afloat
There are a lot of small, rural hospitals in Kansas. Without them, many Kansans would have to travel long distances for care. What’s more, in many small towns, the hospital is one of the largest employers — making it vital to the local economy. But declining populations, combined with changes in the way hospitals are paid for their services, are making it more difficult for many small hospitals to survive. (KCUR)
Obama proposes Medicare be given right to negotiate drug prices
Embedded in President Obama’s budget request to Congress is a paradox. He proposes a major new initiative to develop drugs tailored to the genetic characteristics of individual patients, but he expresses deep concern about the costs of such specialty medicines for consumers and for the Medicare program. He has asked Congress to let Medicare officials negotiate prices with drug manufacturers — a practice explicitly forbidden by current law. (New York Times)
How is the doctor-patient relationship changing? It’s going electronic
Thanks to technology, Gary Sullivan enjoys a new kind of relationship with his doctor. If he wakes up with a routine health question, the 73-year-old retired engineer simply taps out a secure message into his doctor’s electronic health records system. His Kaiser Permanente physician will answer later that day, sparing Sullivan a visit to the clinic near his Littleton, Colo., home and giving his doctor time to see those with more urgent needs. (Washington Post)
Featuring hospital and health care headlines from the media and the Web.
Mental health forum gives residents a chance to voice concerns about closing facility
The Mount Pleasant Health Institute is scheduled to close, leaving one less option for mental healthcare in southeast Iowa. But a group of lawmakers and community leaders are pushing to save it. Democratic Senator Rich Taylor says the facility is an important resource for Southeast Iowa and if it closes, it could put the people who need care the most back on the streets. (WGEM)
Des Moines physician forms fundraiser to help Nepal earthquake victims
Emergency relief agencies are already on the ground in Nepal but a metro doctor is planning a way Iowans can help from home. Mercy Medical Center-Des Moines physician Dr. Richard Deming is organizing a fundraiser for relief agencies. Deming said once he heard the news of the massive earthquake, he was tempted to fly to Kathmandu to help treat victims. Instead, he said the country needs more financial assistance. (WHO-TV)
UnityPoint Sioux City official chairs national panel
Mike Schmidt, director of Business Health & Rehabilitation Services at UnityPoint Health – St. Luke’s, has been appointed to a three-year term as president for the National Association of Occupational Health Professionals Advisory Board, or NAOHP. NAOHP provides continuing education, training and communications resources to enhance the health and safety of employees. Employers receive resources on work injury care, screening service recommendations, and equipment information. (Sioux City Journal)
Q-C women are project engineers on Genesis building job
Both Lauren Wiest and Bo Weber knew at a young age that they wanted to grow up and build something. They just didn’t imagine it would be one of the largest construction projects in Davenport history. Weber, 27, and Wiest, 26, are two of the engineers working on the $138.5 million construction and renovation project at Genesis Medical Center along East Rusholme Street in Davenport. The young women are engineering school graduates of Iowa State University in Ames, and both of them chose engineering as a career after growing up in the Quad-City area. (Quad-City Times)
Ankeny medical startup raises $2.5 million
An Iowa-based investment fund is backing an Ankeny startup that has entered the growing market of telehealth and remote monitoring of patients. The startup, 1Comm Medical, has raked in $2.5 million in an investment round led by Next Level Ventures, officials with the company and investment fund told The Des Moines Register. Started about two years ago by a group of four partners, 1Comm has developed a cloud-based portal to remotely connect doctors and nurses with patients testing their blood at home. (Des Moines Register)
Hospitals pursue patient perspectives for better care
Jane Maier was among a select group of patients invited in early 2012 to help Partners HealthCare, Massachusetts’ largest health system, pick its new electronic health record system — a critical investment of close to $700 million. The system, which is now being phased in, will help coordinate services and reshape how patients and doctors find and read medical information. The fact that Partners sought the perspective of patients highlights how hospitals increasingly care about what their customers think. (USA Today)
Nursing homes starting to supplant hospitals as focus of basic care
The notion that a hospital remains the safest place for old patients dies hard. Many families still believe their aging relatives belong in a hospital when they’re ailing. But 20-plus years of research have documented the risks of hospitalization for older adults, particularly those frail or ill enough to need nursing home care. (New York Times)
Insurers take first steps to change how WI doctors, hospitals are paid
A nationwide initiative to make the fragmented and costly health care system more efficient could affect the more than 340,000 people in Wisconsin enrolled in Medicare Advantage plans. Most probably are unaware that anything has changed. But there’s a chance their care could be more coordinated, adhere more closely to clinical guidelines and cost less because of the initiative. Humana and UnitedHealthcare — two of the largest health insurers that offer Medicare Advantage plans — are striking agreements with what are known as accountable care organizations. (Milwaukee-Wisconsin Journal Sentinel)
Health systems rush to partner with booming retail clinic market, report says
Health systems have formed more than 100 partnerships with retail health clinics, according to a new study published by the Robert Wood Johnson Foundation and Manatt Health, as consumer interest in easy-access, lower-cost care is changing the market. The bulk of the estimated 1,800 retail clinics are owned by pharmacies and big-box retailers, with the six largest being CVS MinuteClinic, Walgreens Healthcare Clinic, Kroger Little Clinic, Walmart Retail Clinics, Target Clinic and RiteAid RediClinic, according to the study. (Healthcare Finance News)
A hospital is already giving Apple Watch to its patients
The Apple Watch began arriving in homes and businesses across America on Friday. And in New Orleans, one doctor immediately strapped it to his patient’s wrist. “We need to fundamentally change behavior,” says that doctor — Richard Milani. “And the Apple Watch has the potential to [do] it.” Milani is the Chief Clinical Transformation Officer at Ochsner Health System, and overseeing what the hospital calls a first-of-its-kind trial: Giving Apple Watch to patients who struggle with high blood pressure. (Forbes)