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

Iowa News

Did politics taint Iowa Medicaid bid process?
A private company that ultimately won a contract to help manage Iowa’s $4.2 billion Medicaid program asked two former state lawmakers for assistance in determining who was on the committee that would be evaluating the bids and how it might influence their decisions, according to evidence presented in court on Thursday. That company, WellCare, also sought information and received a response from a key member of Gov. Terry Branstad’s staff during a so-called “blackout” period when bidders were prohibited from making contact with state employees about the project, the documents show. (Des Moines Register)

Uninsured children numbers drop in Iowa
Thanks to expanded health coverage opportunities, there are 6,500 more Iowa children with health insurance. A new report from the Georgetown University Center for Children and Families says that’s a 21.9 percent drop in the number of uninsured children in just one year. Charles Bruner, director of the Child and Family Policy Center in Des Moines, says the change is in large part due to entire families enrolling for coverage. (Public News Service)

Community engagement essential for mentally healthy campus
Early in high school, Katie Kovacovich struggled with anxiety, depression, and self-harm. By her senior year, she had gone to counseling, talked with her parents, and felt prepared for the next step. She said the transition to campus for her first year at Luther College in Decorah was relatively painless. “To speak to the Luther community, they do a fabulous job of integrating students in their first year and pushing community and pushing involvement,” she said. (Iowa Public Radio)

Mumps surfaces in Dubuque area
Health officials have confirmed a case of mumps in southern Grant County and said more reports are under investigation. Meanwhile, northeast Iowa and northwest Illinois largely are free of the disease, though multiple cases have been confirmed in each state. Jeff Kindrai, director of the Grant County Health Department, would not disclose the name or location of the Grant County patient due to privacy concerns. He said county officials are investigating five other unconfirmed reports of the disease and hope to get test results back this weekend or early next week. (Telegraph Herald)

Whooping cough found in Fairfield
A dangerous illness has been found in Fairfield, but it can be fought here in Wapello County. Pertussis, more commonly known as whooping cough, has occasionally been fatal in Iowa children. “It is very contagious,” said Vicki Haney, R.N., a staff nurse at Wapello County Department of Public Health. “We don’t want it here in Wapello County.” She said she has not seen any whooping cough reports from Ottumwa. But Jefferson County did confirm the presence of the illness. (Ottumwa Courier)

National News

Obama administration campaign will publicize healthcare subsidies
The Obama administration on Thursday said that it would wage a national advertising campaign to counter a perception among people with low incomes that health insurance under the Affordable Care Act was not affordable. The television advertisements say that most people who sign up for insurance at can “qualify for financial help to make coverage more affordable,” with images showing that people who work in restaurants and at other low-wage jobs can slash their premiums with such assistance. (New York Times)

Can selling insurance to patients transform health care?
On the sixth floor of the historic Puck Building, in SoHo, are the headquarters of Oscar, a two-year-old startup that sells health insurance to individuals. The office, like the building’s Shakespearean namesake, has a certain playfulness: the walls double as chalkboards, kegs of beer round out the kitchen, and the names of the conference rooms refer to famous Oscars, including one called Bluth, after the “Arrested Development” character. “We want to introduce people to the idea of great health insurance,” announces a credo printed on one wall. (The New Yorker)

CMS issues rule, information request for monitoring access to care in Medicaid
The Centers for Medicare & Medicaid Services has issued a final rule requiring states to submit plans to monitor access to care for Medicaid beneficiaries, and establishing new review procedures for proposed rate changes in the Medicaid fee-for-service program. According to a CMS factsheet, the Access Monitoring Review Plans must provide for state reviews of five “core services”: primary care, physician specialists, behavioral health, pre- and post-natal obstetrics (including labor and delivery), and home health services. (Centers for Medicare & Medicaid Services)

CMS says claims are processing normally under ICD-10
The Centers for Medicare & Medicaid Services said that “claims are processing normally” following the Oct. 1 transition to ICD-10. CMS released data from Oct. 1 through Oct. 27 for Medicare fee-for-service claims that were submitted, rejected and denied, and the results are consistent with data prior to ICD-10. “The data CMS released today indicate claims are being received and passing the first round of edits at rates similar to pre-ICD-10 levels,” said George Arges, senior director of the American Hospital Association’s health data management group. (Centers for Medicare & Medicaid Services)

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

Iowa News

Branstad’s Medicaid privatization is a reckless gamble
In his blind, headlong rush to privatize Medicaid and hand billions of public dollars over to a group of for-profit corporations, Gov. Terry Branstad has tripped over his own feet every step of the way. His initial mistake was in failing to secure the necessary federal approval for privatization. In fact, the feds have yet to approve of the arrangement, despite the fact that full implementation is just nine weeks away. (Des Moines Register)

Ownership change in works for Covenant, Sartori and Oelwein hospitals
Hospitals affiliated with Wheaton Franciscan Healthcare in Waterloo, Cedar Falls and Oelwein may have a new owner early in 2016 — and be affiliated with a larger hospital network across the state. The Wheaton Franciscan Sisters announced Thursday they intend to form a new relationship for their Iowa hospitals and services located in Waterloo, Cedar Falls, and Oelwein, including Covenant Medical Center, Sartori Memorial Hospital and Mercy Hospital of Franciscan Sisters in each city, respectively. (Waterloo-Cedar Falls Courier)

Mary Greeley leader named 2015 Iowa Lean Champion
The Iowa Lean Consortium has named Karen Kiel Rosser, vice president and quality improvement officer for Mary Greeley Medical Center in Ames, as the 2015 Iowa Lean Champion. The award was created to honor a leader who has made significant contributions to lean practices or led a “lean journey” for 10 or more years. The award was presented today at the ILC’s annual fall conference. (Des Moines Business Record)

New Mercy Medical Clinic opens inside Hy-Vee store
Mercy Medical Center is opening a new Quick Care Clinic inside a Hy-Vee store in West Des Moines. “We are excited to collaborate with Hy-Vee to expand health care services in West Des Moines as an extension of the missions of both organizations to promote healthier communities,” said Wael Haidar, chief physician executive at Mercy. “This convenient new Quick Care Clinic location allows patients to easily access medical treatment with minimal interruption in their daily routine.” (KCCI)

UnityPoint breaks ground on $25M Ankeny medical park
Aiming to keep pace with Ankeny’s rapid growth, UnityPoint Health is building a $25 million medical park on the suburb’s burgeoning north side. The hospital operator broke ground last week on the facility at Northeast 36th Street and Ankeny Boulevard, vowing to bring medical services spread throughout Ankeny under one roof. Scheduled to open in late 2016, the medical park will offer family medicine, urgent care, physical therapy, a diagnostic center and a pharmacy. (Des Moines Register)

National News

Rethinking the Critical Access Hospital
The ongoing crisis confronting critical access hospitals across the nation has prompted a rethinking of the most cost- and resource-effective roles they can play in care delivery for rural America. The Kansas Hospital Education and Research Foundation, a think-tank attached to the Kansas Hospital Association, is in the midst of a “paper test” with five CAHs that volunteered for the study. They’re trying to determine the viability of transitioning away from the traditional 24/7, inpatient and emergency care model and toward a more proactive “primary health center” care model which focuses on prevention, community and population health, and access to primary and urgent care. (HealthLeaders Media)

The health care industry’s relationship problems
To fix health-care delivery, you must also fix health insurance. This entails a whole host of changes, from aligning financial incentives to improving customer service to making better use of technology. Fundamentally, though, it comes down to redefining the dynamics of the patient-insurer-provider triad: building a stronger relationship between patients and insurers, and turning the reimbursement tug-of-war between insurers and providers into a partnership. (The New Yorker)

Low-income elderly reject California managed care experiment
A large share of low-income elderly Californians have opted out of a statewide managed care experiment because they feared losing their doctors and were reluctant to make any changes to their health care, according to survey data released Tuesday by the Field Poll. California is in the middle of a three-year pilot project aimed at nearly 500,000 of the state’s most costly patients – so called “dual eligibles.” The beneficiaries receive both Medicare, the health insurance program for seniors and the disabled, and Medicaid, or Medi-Cal in California, which provides coverage for the poor. (Kaiser Health News)

CDC reports increase in fentanyl-related overdoses
The Centers for Disease Control and Prevention and the Drug Enforcement Administration are investigating recent increases in overdose fatalities related to fentanyl, a synthetic opioid 50 to 100 times more potent than morphine, according to a CDC advisory this week. Most of the more than 700 fentanyl-related overdose deaths reported to DEA since late 2013 were attributable to illicitly-manufactured fentanyl mixed with heroin or other diluents, the agency said. The advisory includes recommendations for public health departments, health care providers, law enforcement and others to improve detection of fentanyl outbreaks and expand naloxone. (Centers for Disease Control and Prevention)

Senators urge FTC to investigate saline solution makers
A bipartisan group of U.S. senators yesterday urged the Federal Trade Commission to investigate possible illegal collusion by saline solution manufacturers. “Since the saline shortage began in late 2013, suppliers are reported to have increased their prices by 200%-300%,” Sens. Richard Blumenthal (D-CT), Mike Lee (R-UT), Amy Klobuchar (D-MN) and Orrin Hatch (R-UT) said in a letter to FTC Chairwoman Edith Ramirez. “This equates to increased annual costs to individual hospitals in the range of hundreds of thousands to millions of dollars. One health care expert has claimed that this could make the saline solution shortage the most expensive drug shortage in U.S. history. (Office of Senator Orrin Hatch)

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

Iowa News

Second company in Medicaid trial accused of withholding data
A second for-profit company in line to take over management of Iowa’s annual $4.2 billion Medicaid program did not initially disclose important details about its recent involvement in litigation, investigations or terminated contracts, according to evidence and testimony presented during a court hearing Tuesday. That company, UnitedHealthcare, received a one-point reduction in the state’s scoring process after responding to a request for more information about a contract terminated in other states. (Des Moines Register)

Helping children hear better
A large-scale longitudinal study, the first-of-its-kind in the nation, followed children ranging in age from six months to seven years old who experienced mild to severe hearing loss. The Outcomes of Children with Hearing Loss study, conducted by researchers at the University of Iowa, Boys Town National Research Hospital, and the University of North Carolina at Chapel Hill, examined the impact of early identification and intervention on children with hearing loss. (University of Iowa)

Local program highlights Lead Poisoning Awareness Week
C-R Hazard Hunters” is a partnership between the city of Cedar Rapids and Linn County Public Health. They helped Jennifer Minney and her family get rid of lead paint they found shortly after moving in. Grant money from The Department Housing and Urban Development has done lead abatement in more than 400 properties so far. Minney says having her home lead-free is a relief. (KCRG)

National News

Hospitals face payment cuts at outpatient sites in budget
Hospitals could see some Medicare payments reduced as part of a U.S. budget agreement, a change that may reduce the incentive for hospitals to buy more outpatient facilities. The deal, brokered with the Obama administration by outgoing Republican House Speaker John Boehner, lowers payments for care delivered at hospital-owned outpatient centers, but only at newly opened or acquired ones. (Bloomberg)

Premiums for key marketplace silver plans rising an average of 7.5%, HHS says
Premiums will increase an average of 7.5 percent for the second-lowest-cost silver insurance plan to be offered next year in the 37 states where the federal government operates health marketplaces, according to an analysis by the Department of Health and Human Services. The HHS report, released late Monday, focuses on the monthly premiums for the second-lowest silver plan, also called the benchmark, which is used by the Internal Revenue Service to calculate tax credits to help pay for the premiums. (Kaiser Health News)

Walgreens to buy Rite Aid for $9.4 billion
Walgreens Boots Alliance Inc. agreed to buy Rite Aid Corp. for about $9.4 billion, in a move that would create a drugstore giant at a time when companies in nearly every corner of the health-care industry are seeking to gain advantage from bulking up. Walgreens agreed to pay $9 a share in cash for Rite Aid, offering a 48% premium to Rite Aid’s closing price Monday. Rite Aid’s stock rose 43% to $8.67 Tuesday after The Wall Street Journal reported on the deal talks. (Fox Business)

Hospitals doing better job promoting breast-feeding, CDC says
U.S. hospitals have made significant improvements to breast-feeding support programs in recent years, providing better help to new mothers, federal health officials reported Tuesday. Nearly twice as many hospitals have adopted most of the Ten Steps to Successful Breastfeeding initiative, a global standard for hospital support of breast-feeding before, during and after a new mom’s hospital stay, the officials said. (HealthDay)

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titanic-pictures-5622Like the Titanic speeding toward that fateful iceberg, the future of Iowa’s Medicaid program will be disastrous if the state continues on its present course toward privatized care.

The Iowa Hospital Association (IHA) opposes the state’s plan because it seeks to reduce Medicaid costs by restricting access to health care services and reducing reimbursement to providers through claims denials and requirements for prior authorization. Merely copying what 40 other states have pursued unsuccessfully is not new or innovative. It simply hands the reins of Iowa’s second largest insurance program to four out-of-state companies, along with a half a billion dollars of Iowa taxpayer funding.

Research of publicly funded managed care in both Medicaid and Medicare clearly demonstrates that minimal to no savings occur through the private management of these programs. In fact, spending for private management actually increases the cost of these programs in markets that are efficient utilizers of public resources. Iowa is such a market, as shown by the state’s low average cost per Medicaid enrollee and its low Medicaid administrative costs (among the lowest in the nation, in fact).

The current administration and Iowa hospitals agree that Iowa has been an innovator in its management of Medicaid. Just this year, the federal Centers for Medicare & Medicaid Services (CMS) approved a $40 million implementation grant for Iowa to continue work on the State Innovation Model (SIM) initiative, a multi-payer Accountable Care Organization (ACO) model that resulted from an 18-month collaborative plan design phase. The plan was approved by CMS and envisioned a long-term goal of advancing the significant progress made after the state expanded Medicaid to create the Iowa Health and Wellness Plan, which provided health insurance to more than 150,000 newly eligible Iowans.

The first five years of ACOs have yielded cost savings in both the private insurance market and the public sector (with Medicare) that have already eclipsed decades of experience with privatized Medicaid managed care. Moving to privatized Medicaid is a divergence that will inhibit, not improve, further opportunities for innovation.

One way Medicaid innovation is at work today is through Integrated Health Homes (IHH), which coordinate care for Iowa adults and children with serious mental health issues. Along with mental illness, these patients typically have three or more chronic health conditions, often leading to trips to the emergency room (ER) and hospitalizations, making their health care very expensive.

Managing care for such complex patients, who interact with many parts of the health care system, is always difficult and often fragmented. However, the health homes’ team-based approach addresses those issues by training providers, tracking patients and sharing information among providers, resulting in fewer ER visits and hospitalizations, reduced cost to Medicaid and a better quality of life for these Iowans.

So what is the future for these forward-looking programs under the state’s Medicaid managed care plan? The truth is, no one seems to know. The state is moving so fast and awarding contracts so quickly, those kinds of questions have been left unanswered. This is why there is grave concern among Iowa hospitals and other health care providers that these innovative and effective programs will simply be run over in the rush to implement privatized managed care.

The vast majority of Iowans are not on Medicaid, but the 560,000 who are in the program are among the state’s most vulnerable and least represented. We should all be concerned about their health care, not to mention what happens to the taxes that pay for it. There is no solid evidence from other states that privatized management will improve the health of Medicaid recipients, provide better access to care or save money.

Those in charge of the state’s fast-track plan for Medicaid privatization seem to rely on no one noticing the perils ahead. Iowans who care about their neighbors and holding our government accountable should prove them wrong.

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

Iowa News

Iowa DHS: Medicaid director’s private email ‘improper’
Iowa’s Medicaid director had improper communications with an insurance company worker and former lawmaker during a critical review period that ended with the for-profit company being selected to help privatize the state’s $4.2 billion annual Medicaid program, the state acknowledged in court Monday. Iowa Department of Human Services Director Chuck Palmer insisted in court that those communications with former Rep. Renee Schulte had no bearing on Iowa’s selection of four companies that are in line to manage the state’s Medicaid program. But the three companies challenging the state’s selection say it’s just one of many examples of nepotism, improper review and even illegal actions taken by the state in a flawed and “haphazard” process. (Des Moines Register)

UnityPoint Marion clinic expanding
UnityPoint Clinic Family Medicine and Urgent Care in Marion needs more space. The outpatient medical facility, which opened in 2009, is adding 6,000 square feet to better accommodate growing demand for services. The clinic has family medicine, urgent care, X-ray, ultrasound, digital mammography, laboratory and outpatient physical and occupational therapy services. “We want to provide adequate access for patients,” said Dr. John Roof, UnityPoint clinic vice president and medical director. (Cedar Rapids Gazette)

Genesis opens airport station
Travelers at the Quad-City International Airport can receive health information while relaxing in the new Genesis CarePort at the Airport. Genesis Health System debuted the new passenger lounge area Monday as the airport celebrated the send-off of a new Washington, D.C., flight. Located in the terminal near the gift shop, the casual lounge provides two Genesis computer kiosks for passengers. (Quad City Business Journal)

New twist on chiropractic care at Mercy – Des Moines
A Kansas City-based chiropractic practice that has begun franchising locations around the country will open its first Iowa location in Des Moines next month. But rather than leasing a retail storefront, the chiropractic clinic will be located at Mercy Medical Center – Des Moines campus to coordinate care and share referrals with Mercy physicians. The hospital-based chiropractic clinic approach was pioneered in the Midwest by chiropractor Jason Moss, an Iowa native and University of Iowa graduate who launched KC CORE in Kansas City in 2008. (Des Moines Business Record)

National News

Preserve the 340B program and protect vulnerable patients
The exorbitant cost of prescription drugs threatens access and affordability for millions of Americans who need life-saving medications. That is why the 340B Drug Pricing Program, which provides discounts on drugs to some health care providers who serve large numbers of low-income and uninsured patients, is so critical. The program constitutes less than 2 percent of the pharmaceutical industry’s $374 billion in U.S. sales, but the pharmaceutical industry wants to scale it back or eliminate it. (The Hill)

Ask candidates: How can Virginia save its rural hospitals?
Virginians have a General Assembly election next month that could have life-or-death consequences in their communities. Virginia’s hospitals are in a world of hurt — particularly in rural areas, where about half already were operating in the red in 2013 and the financial forecast is all gloom. As in: The financial outlook for all Virginia hospitals is a steady decline — from 4.5 percent operating margins in 2014 into negative territory; possibly to minus 0.2 percent by 2022, one study found. Who will save them from cutting services and perhaps, in rural areas, finally closing? (Roanoke Times)

How will Louisiana pay for Medicaid? Lawmakers review options
Senate Finance Committee members meeting Monday (Oct. 26) to discuss the cost of the state’s Medicaid program have more than the current costs of the program to worry about. The meeting is expected to address the state’s options when it comes to controlling costs. But beyond costs, there’s also a potentially threatened revenue source that has been hanging over the future of the Medicaid program that could require more urgency. It’s known as the Disproportionate Share Hospital payment, which helps hospitals pay for the treatment of uninsured patients. (New Orleans Times-Picayune)

Emergency physicians: High-deductible plans delay care
Seventy percent of emergency physicians say they routinely see insured patients in the emergency department who’ve delayed care because they can’t afford high deductibles and copays, according to survey results from the American College of Emergency Physicians. In addition, 73 percent of emergency physicians say they’re seeing increased numbers of Medicaid patients who’ve delayed care because they can’t find a physician in the narrow network provided by their health plan. (HealthLeaders Media)

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