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

Iowa News

Court says Wellmark must pay claims for life-saving drug
An appeals court says Iowa’s largest health insurer improperly refused to pay claims for expensive life-saving drugs for patients with a rare blood disease. The court ruled Tuesday that Wellmark Blue Cross and Blue Shield searched for reasons to deny millions of dollars in claims for drugs used to treat hemophilia, an inherited condition in which patients suffer excessive bleeding. (KCCI)

Community Foundation awards grants to Broadlawns, United Way
The Community Foundation of Greater Des Moines has awarded a leadership grant of $250,000 to Broadlawns Medical Center Foundation for renovation of the hospital’s mental health care area. The grant also will expand the number of inpatient beds to the maximum allowed by the hospital’s license. (Business Record)

Flu deaths despite light activity
Three Iowans have died from influenza this season, but the overall activity involving flu-like illness remains light. The mild weather may be a contributing factor, according to Patricia Quinlisk at the Department of Public Health. The health department’s latest flu report shows no influenza outbreaks in Iowa long-term care facilities so far in this season. Four schools have reported ten percent or greater absenteeism due to flu-like symptoms. (Iowa Public Radio)

Iowa’s Population Grows
Iowa’s population grew at a modest rate to 3.12 million this year, but the growth rate trailed behind the national rate. The U.S. Census Bureau released new estimates Tuesday showing state and national populations as of July 1. Iowa’s population grew by 14,418, or 0.5 percent, over last year’s total of 3.11 million. The national population grew 0.8 percent to 321.4 million between last year and this year. Iowa remains 30th in population among the states. (KGAN/Associated Press)

National News

How regulations changed reimbursement in 2015, outlooks for 2016
Reimbursement in 2015 saw impacts from the Centers for Medicare & Medicaid Services (CMS) and additional changes in everything from ICD-10 to new joint bundled payments regulations, new sepsis regulations and new discharge requirements. Three experts explain what they see as the most pertinent regulation changes for 2015 and impacts ahead for 2016. (Healthcare Dive)

Best Practices: Paramedics deployed as care navigators
Former paramedic Matt Zadavsky long believed that there was a broader role for his profession beyond simply responding to emergencies. In line with a 1996 National Highway Traffic Safety Administration report, he envisioned a system in which paramedics functioned as navigators, steering patients to the most appropriate care setting to reduce use of hospital emergency departments. But he encountered resistance. (Modern Healthcare)

Nurses develop tool to reduce readmissions
Nurses at California Hospital Medical Center in Los Angeles took matters into their own hands when it came to trying to reduce 30-day readmissions. A nurse committee developed a form that nurses fill out when patients are admitted to the med/surgical unit-the unit with the highest readmission rates-to determine which patients are at high risk for readmission. (Fierce Healthcare)

No easy task: End-of-life talks between doctors, patients
Nationally, impetus is growing for patients and doctors to embrace end-of-life conversations. Starting January 1, Medicare will reimburse doctors who spend time with patients discussing their end-of-life care. It’s not always easy for doctors to broach the topic. About 89 percent of Americans say doctors should discuss end-of-life care issues with their patients, but few – about 17 percent – say they’ve had that conversation, according to a September 2015 survey by the Kaiser Family Foundation. (Sacramento Bee) users hit 8.2 million
A late surge of insurance applications and automatic renewals pushed the number of people using to 8.2 million through December 19, federal officials said Tuesday. Some 71 percent of the site’s enrollees—around 5.8 million—had coverage renewed, and 29 percent—or about 2.4 million—had been first-time buyers. Federal officials have seen a flurry of activity around a December 15 deadline to buy or switch existing coverage that would take effect January 1, and offered a two-day extension to accommodate the late crush on the site. (Wall Street Journal)

More than half of patients can’t access electronic health data
Despite widespread adoption of electronic health record (EHR) systems by providers, consumers continue to be frustrated by their inability to access their digital health care information, according to a new survey. A survey of more than 500 U.S. consumers planning to enroll in a 2016 health plan found that 53 percent can’t access all of their health data electronically and 60 percent indicated they are unsure or do not have all of their health data stored in EHRs. (HealthData Management)

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

Iowa News

WellCare to Iowa: Don’t count us out just yet
A company whose multi-million dollar contract to help manage Iowa’s Medicaid program was terminated last week has asked Iowa to continue to do business with it until a judicial review is completed. An administrative law judge in November recommended WellCare’s contract — which was originally to begin January 1 — be terminated because of the company’s alleged failure to disclose fraud that resulted in three of its former executives sentenced to prison and a so-called “integrity agreement” with the federal government. (Des Moines Register)

More than 730 babies born at Finley in 2015
More than 730 babies have been born at UnityPoint Health-Finley Hospital in 2015, the highest number in 66 years. Hospital staff have delivered 733 babies so far in 2015, according to a press release. That’s the most in a calendar year since 1949, when 794 babies were delivered at the hospital. (Dubuque Telegraph Herald)

Cedar Rapids pediatrician to retire after 40 years
After four decades of caring for children and their families, Dr. Kenneth Anderson is hanging up his stethoscope. The Cedar Rapids pediatrician is retiring at the end of the year and moving to the Des Moines metro area with his wife, Kathy, to be closer to family. Those who know him say he’s mentored doctors, been a strong advocate for children and helped countless parents who have come into the UnityPoint Health-Cedar Rapids pediatrics clinic. (Cedar Rapids Gazette)

Oelwein double-lung transplant recipients recover together
Recovering from an organ transplant takes a physical and emotional toll, but two Oelwein patients are recovering together at Mercy Hospital. Since 1988, less than 130 Iowans have undergone lung transplants. This year, two Wheaton Franciscan Healthcare patients form a friendship from their former hardship. (KWWL)

National News

Disturbing trends in physician burnout and satisfaction with work-life balance
Recent data analyses reveal the disturbing decline in well-being of contemporary U.S. physicians. This trend has captured the attention of not only affected physicians and researchers but also physicians’ patients and the general public. Physicians who remain in practice while burned out show higher propensities for making medical errors and diminished quality of medical practice and professionalism. Worse still, patients of depleted physicians are less compliant with physicians’ care plans. (Mayo Clinic Procedings)

Virginia health alliance works to boost care, lower costs
Mary Washington Healthcare and area doctors have joined together in a new program to improve healthcare and lower costs. The Mary Washington Health Alliance, as it’s called, is helping MWHC and about 400 independent doctors coordinate patient care, share best practices and provide follow-up for high-risk patients. “Its goal is to respond to changes in the health care industry,” said Travis Turner, the alliance’s vice president of clinical integration. (Free Lance-Star)

What post-acute providers need to know about value-based care
As newer care delivery models evolve and emerge amid health care’s transition from volume to value-based care, post-acute care (PAC) providers have a vital role to play, according to a new TrendWatch report from the American Hospital Association. The increased proliferation of alternative payment models that involve shared risk among hospitals, PAC providers and insurers means PAC providers must understand factors such as geographic PAC spending variation. (Fierce Healthcare)

Patient-as-consumer dynamics reshaping health care markets
Markets typically function smoothly when buyers and sellers share equal information about price and value and can equally compete to sell or purchase a product. Yet, the U.S. health care system typically hasn’t resembled this idealized marketplace. An employment-based health care system means consumers can’t easily move their transaction to a more competitive offer. However, there are signs the health care market is becoming more transparent and flexible as cost pressures prompt employers, insurers, and consumers to rethink strategies. (Healthcare Dive)

Obama administration’s proposed insurance reforms incite industry backlash
The Centers for Medicare & Medicaid Services faces a daunting task in finalizing its rule for the 2017 health insurance market. The agency received more than 500 comments this week, many of which demand the rollback of provisions intended to help consumers. Every corner of the industry, from health insurers and hospital associations to consumer advocacy organizations and trade groups, submitted comments on the proposed rule. (Modern Healthcare)

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

Iowa News

Branstad claims Medicaid transition will be ready March 1
Barring further legal entanglements, the state will be ready to shift management of its $5 billion Medicaid program to three private health-care companies on March 1 — one company shy and two months later than the original plan — Governor Terry Branstad said Monday. Despite the setbacks of the past week, Branstad said he is confident the program will be ready March 1, although he repeatedly had said the same about the original January 1 start date. (Quad City Times)

Medicaid delay makes some Iowa kids’ coverage uncertain
The two month delay in Iowa’s effort to privatize management of Medicaid means that most of the 37,000 children enrolled in a special health care program must transition to a new insurance carrier January 1. But some of those children may face situations where their doctors don’t accept their new insurance carrier. That possibility was revealed Monday as part of a public meeting where several lawmakers expressed “deep concerns.” (Des Moines Register)

Appetite for Medicaid contracts on display in WellCare’s Iowa battle
Iowa’s decision to boot WellCare from its new Medicaid managed-care program has roiled tensions in the state. It also shows how fiercely insurers will fight to secure a big-ticket source of revenue. Late last week, Iowa’s Department of Administrative Services terminated its Medicaid contract with WellCare, a publicly traded insurer based in Tampa, Fla. WellCare, which is planning to fight the decision, says the losing bidders derailed its contract by combing through the voluminous bid materials to find a lapse that led state officials to rescind the award. (Modern Healthcare)

Iowans invited to shape state health plan
The Iowa Department of Public Health has begun development of the most comprehensive health needs assessment ever undertaken by the department. A statewide effort designed to help Iowans live longer, healthier, more productive lives will be outlined in the Healthy Iowans: Iowa’s Health Improvement Plan 2017-2021. (Mason City Globe Gazette)

Speaking about the unspoken: New service will be available in Southwest Iowa
Individuals with mental health needs will soon have a new service available in the Southwest Iowa (SWIA) Region. The Mental Health and Disabilities Services SWIA Region has been working hard over the last 18 months to build crisis stabilization services to support individuals who are experiencing a mental health crisis and their families. The newest crisis service will begin January 4 in Clarinda. (Daily Nonpareil)

National News

Bedside point-of-care tests speed up care, improve outcomes
To improve healthcare delivery and cut down on outcomes disparities, hospitals must increase their use of bedside point-of-care (POC) testing, according to Executive Insight. POC testing allows providers to make diagnoses in varied settings in which the patient is present, such as doctors’ offices, ambulances, hospitals or at home, and holds the advantage of significantly speeding up the care process without hurting care quality, according to the article. (Fierce Healthcare)

Push on to make transparent medical record the national standard of care
Perched on an exam table at the doctor’s office watching the clinician type details about their medical problems into their file, what patient hasn’t wondered exactly what the doctor is writing? As many as 50 million patients may have a chance to find out in the next few years, following the announcement this week of $10 million in new grants to expand the OpenNotes project, which works with medical providers to expand patient access to clinician notes. (Kaiser Health News)

Colorado hospital reinvents its ED, slashes wait times and costs
A bigger emergency department (ED) won’t be better unless delivery of care transforms along with the facility expansion, according to the head of the University of Colorado Hospital emergency department. The university hospital created groups of eight to 10 providers to quickly examine three core functions: quality, operations and process improvement. The larger, redesigned ED increased volume by 53 percent, cut total treatment time by more than 40 percent and virtually eliminated the number of patients leaving without being seen. (Fierce Healthcare)

Kansas City hospitals using innovative cancer treatments
Kansas City is a proud leader in a plethora of categories: barbecue, baseball, museums and jazz included. Now one could argue adding cancer treatment to that list. North Kansas City Hospital, KU Hospital and Saint Luke’s all appear to be leading the pack in how to not only discover certain types of cancer, but treating them as well. (KSHB)

ER doctors say federal rules could raise patients’ out-of-network bills
Two professional organizations representing emergency doctors warn that a new federal rule could lead to higher out-of-pocket costs for consumers when they need emergency care outside their health plan’s network of providers. But consumer advocates and health policy experts say the groups’ proposed solution doesn’t adequately protect consumers. Emergency services providers say they are in a tough spot because federal law requires them to treat anyone who comes through their doors, whether or not they have insurance or can afford to pay. (Kaiser Health News)

Another close call for the ACA one of many pivotal legal events impacting health care
2015 will be remembered as the year the U.S. Supreme Court narrowly saved the Affordable Care Act (ACA) for the second time. But there were other court rulings that also will have a lingering impact on health care. In their June opinion in King v. Burwell, Chief Justice John Roberts and five other justices upheld the legality of the law’s insurance premium subsidies in all states, averting an insurance market meltdown. (Modern Healthcare)

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

Iowa News

Feds right to tell Iowa to go slow on Medicaid plan
The Centers for Medicare & Medicaid Services (CMS) told the state to slow down the transition to managed care, delaying implementation until March 1. Governor Terry Branstad has been pushing to shift Medicaid management to four private companies by January 1. Some people doubt Iowa will be ready by March 1. Some organizations, notably the Iowa Hospital Association, oppose privatization of Medicaid management altogether. (Burlington Hawk Eye)

What the Medicaid managed care delay means
Thursday’s news that implementation of Medicaid managed care will be delayed two months left many Iowans asking the same thing — what does this mean for my health care coverage? The state will continue operating its fee-for-service system for several months, the Iowa Department of Human Services says. That means Medicaid enrollees can continue to see their providers and use their Iowa Medicaid cards, while the state continues to reimburse providers at current rates. (Cedar Rapids Gazette)

Medicaid delay will reduce Iowa savings by $14.3 million
A decision by federal officials to delay Iowa’s Medicaid privatization by at least 60 days will result in $14.3 million in lost savings for the state budget this fiscal year. Iowa policymakers said Friday they haven’t determined yet whether the lost money will be made up through state budget cuts, by withdrawing cash from the state’s reserve funds or through other measures. (Des Moines Register)

Official terminates WellCare contract
Friday brought a second blow to Governor Terry Branstad’s plan to move its $5 billion Medicaid program to managed care. A state official said the bid from WellCare of Iowa — one the four companies awarded contracts — should be “disqualified and the subsequent contract … terminated.” Earlier in December, the Iowa Department of Human Services said that if the state decides to toss out WellCare’s contract, Iowans put on a WellCare plan will be reassigned to one of the three remaining managed-care organizations. (Cedar Rapids Gazette)

National News

Rural health crisis: Four ways hospitals can beat the odds
Rural health care is caught in a full-blown crisis. The rural hospital sector desperately needs more workers, even more so than the health care sector at large. In addition, federal funds are at risk in states that failed to expand their Medicaid programs under the Affordable Care Act. As a result, up to 30 hospitals may close in states such as Kentucky and Kansas. Despite these obstacles, many rural and community providers have found innovative ways to survive and, in some cases, thrive. (Fierce Healthcare)

Massachusetts hospitals are dealing with a growing number of mental health patients
A new report reaffirmed longstanding concerns by Brockton, MA-area nurses, state legislators and mental health advocates about the burden that local hospitals face, boarding people who require proper behavioral health treatment while they wait for those services to become available. Mental health advocates and state legislators have said in recent years that the state lacks an adequate amount of inpatient mental health care beds. (WCVB/Enterprise)

Coloradans will put single-payer health care to a vote
On a brisk morning in Denver recently, an ambulance pulled up in front of a downtown office tower. “I think the patient is going to make it,” Dr. Irene Aguilar said as a team rolled out the gurney. This wasn’t a medical emergency, but rather a bit of political theater. The gurney held several big boxes of signed petitions to be delivered to Colorado’s Secretary of State’s office. The group ColoradoCareYES gathered enough signatures — more than 100,000 — to put a single-payer health system on the ballot next fall. (Iowa Public Radio)

President signs omnibus including ‘Cadillac’ and medical device tax delays
President Obama on Friday signed the 2016 Consolidated Appropriations Act into law. The Senate had voted 65-33 to pass the $1.1 trillion omnibus spending bill earlier Friday after it had cleared the House easily. The bill provides $622 billion in tax breaks, including delays to the Affordable Care Act’s Cadillac tax and medical device tax. With the tax now delayed two years, the government will lose the estimated $91 billion in revenue the tax would bring during the next decade. (Healthcare Dive)

FTC increases action on hospital mergers
The Federal Trade Commission’s (FTC) recent efforts to block three hospital merger proposals in Illinois, Pennsylvania and West Virginia are under a challenge by the affected health care systems in those three states. On Friday, Chicagoland’s Advocate Health Care and NorthShore University HealthSystem jointly announced that they will fight the FTC, shortly after the commission announced that it was taking action to block the merger. (HealthLeaders Media)

Most states fall short on infectious-disease preparedness
A majority of states remain ill-equipped to effectively respond to an infectious-disease outbreak, according to the Trust for America’s Health (TFAH). The findings raise concerns as the numbers of health care-acquired and sexually-transmitted infections continue to rise. “The country’s interest in infectious diseases tends to ebb and flow,” said Jeffrey Levi, TFAH executive director. “When there’s a new, scary threat like Ebola last year, there’s a major ramp-up. But once there’s a sense that the outbreak is contained, we fall back to a place of complacency.” (Modern Healthcare)

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

Iowa News

Feds tell Iowa: Delay Medicaid privatization by 60 days
Federal administrators have ordered Iowa to wait at least 60 days before shifting its Medicaid program to private management. The delay, announced Thursday, will affect 560,000 poor or disabled Iowans who receive health care under the $4 billion program. Gov. Terry Branstad has been pushing to transfer Medicaid management to national, for-profit companies on Jan. 1. (Des Moines Register)

Medicaid privatization gets messy in Iowa
In Iowa about 600,000 people get medical care through Medicaid, the public-health program for the poor and disabled. That includes more than a third of the state’s children. Doctors currently bill Iowa’s Medicaid program directly for their services, but starting next year, the state will move all of its Medicaid patients onto managed-care plans offered by four private insurers. It’s been a complicated handoff. The change was originally planned to take effect Jan. 1. With two weeks to go, the federal Centers for Medicare & Medicaid Services, which oversees state programs, deemed Iowa “not yet ready” in a letter to the state on Dec. 17. (Bloomberg)

Mercy opens family caregivers center in Cedar Rapids
A center that supports people who provide care to loved ones is now open in Cedar Rapids.
Today, Mercy Medical Center hosted a ribbon-cutting for the center next to the hospital on Eighth Avenue Southeast. The center pairs each caregiver with a volunteer coach, who works with a family to develop a plan with the resources available. (KCRG)

Early literacy support is a win for all
As a primary care pediatrician at Blank Children’s Hospital in Des Moines, I’m thrilled with strong, bipartisan support for the Every Student Succeeds Act (S. 1177), which was signed into law by President Barack Obama on Dec. 10. The bill seeks to ensure the provision of a quality education for all children, and notably recognizes the importance of pediatric early literacy promotion. (Des Moines Register)

National News

Kaiser’s bid to start a medical school: ‘A game changer’
News that Kaiser Permanente plans to launch its own medical school is drawing cheers from local sources familiar with medical education and the changing health care industry. In a surprise move, Kaiser said Thursday morning it plans to open a nonprofit “national school of medicine” in an undisclosed Southern California location in 2019. (Sacramento Business Journal)

CIO of health care giant drives the need for speed
In mid-July, on Johnson & Johnson’s second-quarter earnings call for 2015, Group Worldwide Chairman Sandi Peterson outlined some of the critical IT initiatives that would help the $74 billion company compete — and win — in the rapidly evolving world of digital health care. Included in her remarks was a simple statement: “We are at a tipping point where technology is becoming the medium through which healthcare can become a more effective and efficient system.” (CIO)

Doctors see patients taking a greater role in their own care
The practice of medicine has moved away from a paternalistic model toward one of collaboration between doctor and patient. This has happened as the information age, propelled by the Internet, has plunged us into an ocean of health information. In the past, doctors may have been happy with passive patients who followed orders and didn’t ask questions. Today the most innovative medical programs recognize that such an approach does not promote optimal health outcomes for patients. (Chicago Tribune)

Pharma CEO’s arrest a sign of health sector ills
Fraud charges against Turing Pharmaceuticals boss Martin Shkreli are a symptom of the sector’s ills. Healthcare has been prone to financial finagling, but the recent boom created more opportunities for misconduct. With good times fading, the excesses suddenly stand out like a sore thumb. Controversy has long been Shkreli’s calling card. He made his name publicly criticizing biotechnology stocks whose value his hedge fund bet would drop. Then he switched tactics, founding two biotech companies himself. (Reuters)


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