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Featuring hospital and health care headlines from the media and the Web.

Iowa News

How does privatizing Medicaid save Iowa money?
I am concerned about the privatization of Medicaid Services in Iowa in general, and in particular the hiring of out-of-state companies to manage the mental health benefit program. I was even more concerned when the Register published that all three of the companies contracted have records of fraud or mishandling claims. I was also taken aback by the information that the previous management company received nearly 10 percent of the total Medicaid budget for managing. (Des Moines Register)

The heroin epidemic: ‘Worse than a sickness’
Heroin’s new hold into Cedar Rapids slipped in quietly, according to one emergency department doctor. UnityPoint Health-St. Luke’s Hospital’s emergency department already has treated more heroin overdoses during the first half of this year than in all of 2014 — 20 from January to June 2015 compared with 19 in 2014. It treated only nine in 2010. (Cedar Rapids Gazette)

Some schools working with parents to address mental illness
When a student’s mental health care requires more than a typical school counselor can provide, where do schools turn? In the Pleasant Valley Community School District in Eastern Iowa, they turn to a professional counselor contracted to work with students in need. “It’s a great partnership,” Pleasant Valley Assistant Superintendent Brian Strusz said. “It’s a win-win for everybody.” (Cedar Rapids Gazette)

A decline in dentists
Iowa’s dental work force looks very different from it did 18 years ago — with far more women practicing and the average age of working dentists steadily climbing. That’s according to new data in several issue briefs out by the University of Iowa’s Public Policy Center. The briefs laid out dentist-workforce supply trends in Iowa from 1997 to 2013 to help the UI’s College of Dentistry and Dental Clinics better anticipate potential shortages and focus retention and recruitment efforts. (Cedar Rapids Gazette)

National News

As health care shifts to homes, need for home health aides grows
Baby boomers, as they grow older and more infirm, will need more people like Antwannette Hill – home health aides, and personal care aides – jobs that overlap, with the latter often doing more housekeeping. The U.S. Bureau of Labor Statistics says both categories will be among the fastest growing in the next seven years, adding just over a million jobs. Aging baby boomers are driving the demand for more health services, but how that care is delivered is not just about demographics. It’s also about who can do it more cheaply, said labor economist Paul Harrington, director of Drexel University’s Center for Labor Markets and Policy. (Philadelphia Inquirer)

A new way to think about conflicts of interest in medicine
Does the source of funding affect study findings? The question is at the heart of a longstanding debate about financial conflicts of interest in medicine and what to do about them. That debate was recently reinvigorated by a three-part series of articles on the subject in The New England Journal of Medicine. But other potential sources of conflicts of interest in medicine have not been as closely examined. (New York Times)

Precision medicine, linked to DNA, still too often misses
Back in January, when President Obama proposed a precision medicine initiative with a goal of “matching a cancer cure to our genetic code,” John Moore could have been its poster child. His main tumors were shrinking, and his cancer seemed to have stopped spreading because of a drug matched to the cancer’s DNA, just as Obama described. This summer, however, after a year’s reprieve, Moore, 54, feels sick every day. The cancer — advanced melanoma like former president Jimmy Carter’s — has spread to his lungs, and he talks about “dying in a couple of months.” (Boston Globe)

Organ donation awareness increases after IndyCar driver Justin Wilson’s death
The Indiana Donor Network said they’re seeing increased attention in the wake of IndyCar driver Justin Wilson’s death. This week we learned Wilson was an organ donor and saved six lives. Still Thursday, flowers remained outside Gate 1 at the Indianapolis Motor Speedway, along with memorials and mementos for fallen IndyCar driver Justin Wilson. But Wilson’s legacy lives on through organ donation. (Fox 59)

FDA warns tobacco makers about label language
The Food and Drug Administration issued warnings to the makers of Natural American Spirit, Winston and Nat Sherman cigarettes, saying that the brands could not be marketed as “additive-free” or “natural.” In three separate letters made public on Thursday, the F.D.A. told the manufacturers of the brands that they did not have the agency’s approval to claim that their products were free of certain harmful substances, or that they posed less risk to consumers than other tobacco products. (New York Times)

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Featuring hospital and health care headlines from the media and the Web.

Iowa News

Skiff provides $1.5 million in community benefits
Skiff Medical Center provides $1,513,610 in community benefits to Jasper County, according to a recently completed assessment of those programs and services. That amount, based on figures from the 2014 fiscal year, includes $1,236,131 in uncompensated care and $252,858 in free or discounted community benefits Skiff specifically implemented to help Jasper County residents. (Newton Daily News)

Memphis company defends psych hospital plan
A Memphis firm vigorously defended its plans to build a 72-bed psychiatric hospital in the Quad-Cities, saying Thursday that it can co-exist with the existing hospitals — and that competition will be good for patients and the community. A representative of Strategic Behavioral Health LLC spent an hour briefing the Scott County Board of Supervisors, answering questions and rebutting some of the allegations Genesis Health System officials made earlier this week while asking board members to oppose the plan. (Quad-City Times)

Ankeny running short on ambulances, calls on Polk City for help
It’s clear to see that Ankeny’s population is on the rise. Ankeny firefighter and President of the IAFF 4814, said, “The city is growing at such a high right now. I think we are adding five people a day right now.” That growth is beginning to spread the city fire department dangerously thin. “In 2013-14 call volume went up 15 percent which is on par with population over the last few years so that’s not going to slow down,” said Wells. Earlier this month Polk City which has a mutual aid contract with Ankeny, was needed to respond to fifteen medical emergencies in just thirteen days, all in Ankeny. (WHO-TV)

Commit to be fit: It really is better to give than to receive
During our 2014 “Year in Review,” my mom asked each of us to come up with one word we would like to focus on for the new year. I remember straining my brain trying to come up with the perfect word. All these powerful words flashed in my mind: determined, focused, successful, willpower, motivated, strong, empower, perseverance. Each of my family members named similar — if not the same — words that I listed above. We ended with my youngest brother — and I’ll never forget it. His word was the total opposite of what the rest of us had chosen — and unlike anyone else, he didn’t give a lengthy reason of why he chose his word. He just simply said: “Others.” (Cedar Rapids Gazette)

National News

More than 80% of health care IT leaders say their systems have been compromised
Eighty-one percent of health care executives say their organizations have been compromised by at least one malware, botnet or other kind of cyberattack during the past two years, according to a survey by KPMG. The KPMG report also states that only half of those executives feel that they are adequately prepared to prevent future attacks. The attacks place sensitive patient data at risk of exposure, KPMG said. The 2015 KPMG Healthcare Cybersecurity Survey polled 223 CIOs, CTOs, chief security officers and chief compliance officers at healthcare providers and health plans. Sixty-six percent of the IT executives at healthcare plans who were surveyed said they were prepared to fend off attacks. (Computerworld)

Population health initiatives drive hospital collaboration
The push for patient-centered care and improving population health has led to increased collaboration among hospitals, according to a nationwide survey from the American Hospital Association (AHA). About nine in 10 hospitals collaborate with other hospitals and seven in 10 participate in a regional collaborative on these initiatives, according to the survey of more than 1,400 hospitals conducted by the AHA’s Research & Educational Trust and the Association for Community Health Improvement, in partnership with the Public Health Institute. (Fierce Healthcare)

L.A.’s westside mystery: Higher cancer rates in one zip code, longer lives in another
Two programs — one conducted by the University of Southern California, the other by best-selling “Blue Zones” author Dan Buettner — have revealed odd stats. While cancer rates are up in places like Beverly Hills and Pacific Palisades, the Beach cities (Hermosa, Manhattan, Redondo) are working toward longer-than-average life spans. (Hollywood Reporter)

RecycleHealth finds unused activity trackers new homes with underserved populations
Last year when Endeavor Partners published a study showing that a third of wearable activity tracker users consign their device to the sock drawer within six months, most people saw it as a fatal flaw in the activity tracker trend. But Lisa Gualtieri, an assistant professor of Public Health and Community Medicine at Tufts University, saw it as an opportunity. “You can recycle cellphones, you can recycle your glasses, you can recycle used tennis balls,” Gualtieri said. (Mobi Health News)

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Featuring hospital and health care headlines from the media and the Web.

Iowa News

Feds should stop Medicaid privatization
About 550,000 low-income Iowans rely on Medicaid health insurance. The program, administered by the state, has low administrative costs. It has held down spending by reimbursing providers modestly, reducing fraud and giving seniors alternatives to expensive nursing homes. Medicaid in Iowa spends less per person than the majority of other states, while still providing comprehensive coverage. Unfortunately, Republicans have never met a government program they didn’t want to privatize. And Gov. Terry Branstad is a Republican. (Des Moines Register)

Critics call Iowa’s Medicaid selection ‘haphazard’
Three competitors say Iowa erred in its selection of four other companies to manage the state’s $4.2 billion annual Medicaid program and are seeking a review that could throw Gov. Terry Branstad’s privatization efforts into a legal quagmire. The companies allege nepotism, cited alleged fraud or mismanagement among groups that were selected and a flawed review of competitive bid documents that one described as “haphazard, inconsistent, inaccurate, arbitrary and capricious.” (Des Moines Register)

Wellmark, Coventry double-digit rate increases approved
Iowa’s chief insurance regulator has approved double-digit premium rate increases affecting thousands of Iowans. The Iowa Insurance Division said Wednesday that Insurance Commissioner Nick Gerhart has approved increases requested by Wellmark Blue Cross & Blue Shield, Coventry Health Care and Gundersen Health Insurance. All of the rate increases are for policyholders holding individual health insurance plans. They will go into effect Jan. 1. (Des Moines Register)

Davenport council tables mental health resolution
After hearing from a nearly a dozen employees and board members of Genesis Health System as well as speakers supporting Genesis, the Davenport City Council unanimously tabled a resolution indicating a need for additional behavioral health services in Scott County during Wednesday’s city council meeting. The Memphis, Tenn.-based Strategic Behavioral Health LLC filed a letter of intent to seek state approval to build and operate a $14 million 72-bed psychiatric hospital in the county. (Quad-City Times)

National News

Accountable Medicare effort save another $400M
A rapidly expanding healthcare delivery system that rewards doctors and hospitals for working together to improve quality reaped $411 million in savings, the Obama administration said. The Centers for Medicare & Medicaid Services said Tuesday more than 350 accountable care organizations combined to achieve savings in 2014 as the government and private insurers move quickly away from fee-for-service medicine that rewards quantity of care to a value-based proposition that rewards quality and penalizes high costs. (Forbes)

Amputees decry Medicare payment overhaul for artificial feet
The Obama administration is trying to disentangle itself from another controversy over Medicare coverage. Amputees are protesting this time, fearing they’ll be denied the latest technology for artificial legs and feet. Medicare spending for those items soared in the last 10 years, even as the number of amputees declined because of improved diabetes care. That prompted scrutiny from government investigators. (Associated Press/KWWL)

Judge says Arizona Medicaid plan hospital fee constitutional
A judge ruled Wednesday that a hospital assessment that pays for the expansion of the state’s Medicaid program did not require a supermajority vote of the Legislature to be enacted and is therefore constitutional. The ruling from Maricopa County Superior Court Judge Douglas Gerlach comes more than 18 months after the expansion went into effect and means about 350,000 Arizonans who have gained coverage will continue to receive health care insurance. However, the decision will be appealed by the 36 Republican lawmakers who sued, said their attorney, Christina Sandefur of the Goldwater Institute. (Associated Press/Arizona Daily Sun)

School lunch study confirms: Kids don’t eat their vegetables
In a study published this week in Public Health Reports, researcher Sarah Amin determined that such waste has become heartbreakingly common since the U.S. Agriculture Department rolled out new requirements in the 2012 school year that mandated children who were taking part in the federal lunch program choose either a fruit or vegetable with meals. The USDA mandate — championed by first lady Michelle Obama — has been controversial. Some school officials worried that picky eaters would just throw the food away. Proponents said they should give kids more credit, that students would make the right choice with some nudging. (Washington Post/Cedar Rapids Gazette)

Cowboy robot doctor makes rounds at Nebraska Medicine
A new physician is reporting for duty at Nebraska Medicine – Nebraska Medical Center. Dr. Double, is part robot, iPad and Segway. In 2014, Nebraska Medicine acquired a DoubleRobotics remote telepresence device, nicknamed Dr. Double. “Telemedicine is an alternative delivery format that uses audio/video technology to bridge geographical barriers and remotely deliver the same standards of care as a patient would expect in an ‘in person’ setting,” explains Kyle Hall, telehealth program coordinator at Nebraska Medicine. “Dr. Double allows a remote user to drive the Internet-connected robot from anywhere else on the Internet, using a computer or an iPad.”

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Featuring hospital and health care headlines from the media and the Web.

Iowa News

Dubuque’s Finley Hospital appoints new chief operating officer
UnityPoint Health Finley Hospital in Dubuque announced Tuesday they’ve named Tim Ahlers as the new chief operating officer. Ahlers currently serves as CEO at Story County Medical Center in Nevada. He’ll start in Dubuque on October 5. Before working at the Story County Medical Center, Ahlers spent 10 years at Mercy Hospital in Iowa City. (KWWL)

UI bans use of e-cigarettes, other tobacco products
The University of Iowa expanded its campus-wide smoking ban to include smokeless tobacco and other tobacco products, including e-cigarettes and chewing tobacco. Campus and other university-owned buildings have been smoke-free since 2008 when lawmakers passed the Iowa Smokefree Air Act. According to the university’s website, the Tobacco Free Campus policy was enacted to help create a healthy campus and promote positive overall health and well-being. (KCCI)

Employers challenged to find qualified workers
Unemployment rates dipped last month in the Corridor despite the seasonal loss of jobs in education. Iowa Workforce Development on Tuesday reported the jobless rate in the Cedar Rapids metropolitan statistical area (MSA) was 3.6 percent last month, down from 3.7 percent in June. The number of residents employed in non-farm jobs dropped by 2,500 to 140,800 in July from 143,300 in June. Total employment dipped by 200 jobs from 138,500 in June to 138,200 last month. Educational and health services also recorded a seasonal loss of 300 jobs. (Cedar Rapids Gazette)

National News

‘Cowboy doctors’ and health costs
Who’s driving up U.S. health care costs? A recent study by Harvard professors and colleagues revealed that the culprits may be “cowboy doctors”—physicians who provide intensive, unnecessary and often ineffective patient care, resulting in wasteful spending costing as much as 2 percent of the nation’s Gross Domestic Product—hundreds of billions of dollars annually. The authors, including Eckstein professor of applied economics David Cutler and assistant professor of business administration Ariel D. Stern, found that physicians’ beliefs in clinically unsupported treatment procedures can explain as much as 35 percent of end-of-life Medicare expenditures, and 12 percent of Medicare expenditures overall.

FL Gov: Audits for 129 hospitals warranted
“This new special set of state audits will require the use of already scarce taxpayer resources,” said Linda Quick, president of the South Florida Hospital & Healthcare Association. “At the same time, the governor and legislature has cut the Agency for Healthcare Administration’s budget and insisted the state cannot afford to expand coverage for the uninsured or pay plans and providers what it costs to provide care and treatment to Medicaid beneficiaries. One can’t help but wonder, where are the funds for these audits going to come from?” (Palm Beach Post)

Could cameras in operating rooms reduce preventable medical deaths?
A surgeon in Toronto has built a “black box” that synchronizes a patient’s physical data with video and audio recordings of an operation, enabling doctors to review their work the same way athletes watch video of their performances. And he said he has lined up two U.S. hospital systems to take part in the first testing of the system. “If we don’t know what we’re doing wrong, we’ll never improve,” said Teodor P. Grantcharov, a professor of surgery at the University of Toronto. “This is what many other high-performance industries have been using for decades.” (Washington Post)

Survey highlights hospital approaches to population health
Hospitals are working with a wide variety of community partners to promote population health, according to a recent survey conducted by the American Hospital Association’s Health Research & Educational Trust and Association for Community Health Improvement with the Public Health Institute. About nine in 10 hospitals are collaborating with other hospitals and seven in 10 are participating in a regional collaborative, the survey found. Other common partners include public health departments, Chambers of Commerce, health insurance companies and community health centers. (American Hospital Association)

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money telescopeIowa’s march toward Medicaid managed care moved several steps forward last week, with the Department of Human Services (DHS) presenting the four winning bidders that will be contracted to manage health insurance coverage for one-sixth of the state population. Some may view the announcement as just another check-off in a long process, but it was in fact a significant milestone, even if in the public view, the news was low priority.

While IHA continues to give the state’s process the close scrutiny it deserves, public outlets that provided coverage more or less ran the DHS press release word-for-word with no dissenting voice whatsoever. The Des Moines Register was more thorough, including quotes from Democratic legislators who have been questioning Iowa’s Republican governor since his administration fired up the managed care machine in February. Nonetheless, the Register relegated the story to the bottom of page 4A, while it was nowhere to be found on the paper’s home page.

Given that Medicaid affects more than 560,000 Iowans, the lack of drill-down given to this monumental change is, to say the least, disappointing. It’s also perplexing, like an elephant falling into a pool yet making no splash.

How could half a million people’s health and well-being – their very lives, in fact – be so roundly ignored? If this doesn’t raise a question about Iowans’ compassion, it at least says something about the lack of representation for our neighbors who are poor and disabled. And, of course, that gap in representation will grow further as management of Medicaid shifts from our duly elected government to private, profit-driven, out-of-state companies.

And speaking of drill-down, just where are the questions about the promises of Medicaid managed care with regard to cost, access and quality? As noted, DHS’ rose-colored claims for each of these were as unchallenged as they were unsubstantiated.

For those willing to investigate, it’s not hard to find doubt. A 2012 report from the Robert Wood Johnson Foundation, which examined and summarized current and relevant research on the subject, has plenty of it.

Have states saved money with Medicaid managed care? “Peer-reviewed literature finds little savings from Medicaid managed care on the national level, but some states have been more successful than others.” However, “managed care is unlikely to significantly lower cost” for a number of reasons, including already low fee-for-service rates, high state administrative costs (at least on the front end) and the fact that states were using prior authorization, utilization review and other similar tools even before moving to managed care.

What about access? “Medicaid managed care can and sometimes does provide beneficiaries with improved access, but the scope and extent of such improvements generally are state specific and variable.” And quality? “There is scant literature that carefully examines the effectiveness of disease and care management programs administered by Medicaid health plans.”

Not quite ringing endorsements, especially when taken in the context of decades of other states’ experience with Medicaid managed care. What the report does conclude is that the best approaches are likely to be site- and group-specific. In other words, Iowa needs an “Iowa solution” for Medicaid, something Iowa hospitals have been pursuing, with measurable progress and benefit to patients, for years.

But exactly how is an Iowa solution supposed to come about, or continue moving forward, when the people running Iowa Medicaid are in Minneapolis, Tampa, Philadelphia and Indianapolis?

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