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

Iowa News

Tensions still high five months into Medicaid privatization
Medicaid providers and recipients criticized the privatized management of Iowa’s Medicaid system at the state capitol Monday. Governor Terry Branstad says there is less waste, fraud and abuse when Medicaid is run by private companies. But critics contend that poor administration of the program by three for-profit managed care organizations is harming the quality of life of low-income and disabled Iowans. Primary concerns centered on late Medicaid reimbursement payments and higher administrative fees for providers. (Iowa Public Radio)

UnitedHealthcare official confirms Medicaid losses in Iowa
A representative for one of the insurance companies overseeing Iowa’s newly privatized Medicaid program said Monday the company has lost money during the system’s implementation, but declined to say exactly how much. UnitedHealthcare information a new quarterly that the company has lost money. The confirmation means all three insurance companies that run Iowa’s health care program for more than 500,000 poor and disabled residents have lost money in the initial months of implementation. (Des Moines Register)

Cherokee mental health keeps similar service numbers after two other Iowa sites close
More than a year after two of Iowa’s four mental health institutes shut down, the institute in Cherokee is operating similarly to how it had been in recent years. The state in July 2015 shuttered mental health institutes in Mount Pleasant and Clarinda. The closures, however, have not resulted in more patients being treated in Cherokee or the other remaining institute in Independence. The facility, which has treated patients for 114 years, has survived two possible cuts in seven years. (Sioux City Journal)

Continuing Care Hospital provides long-term care for Iowa’s critically ill
When it was time for 72-year-old Jim Herren to be discharged from UnityPoint Health-St. Luke’s Hospital, he wasn’t quite well enough to go home. So doctors transferred him to the sixth floor of St. Luke’s — to UnityPoint Health’s Continuing Care Hospital, a hospital within a hospital. The long-term acute-care hospital sees the “sickest of the sick,” said Elly Steffen, the administrator and CEO — those who no longer need to be in an intensive care unit but are not able to be transferred to a skilled nursing facility or back home. (Cedar Rapids Gazette)

National News

Christie boasts New Jersey Medicaid expansion success under Obamacare
Governor Chris Christie on Monday boasted the success of expanding the Medicaid program in New Jersey, arguing that 566,000 additional New Jerseyans have insurance coverage. It’s been three years since Christie announced he planned to buck his party and embrace President Obama’s Medicaid expansion under the Affordable Care Act. He was one of only a handful of GOP governors to embrace the changes. The state has cut $150 million in the pool of “charity care” money it reimburses hospitals for treating uninsured people since the law took effect in 2014. (

Birmingham hospital adds beds for opioid addiction
The Addiction Recovery Program at University of Alabama at Birmingham is adding beds and staff to better handle an influx of patients struggling with addiction to opioids and other IV drugs. The capacity will increase by 60 percent, from 10 beds to 16. The hospital has also added nurses and technicians to better serve patients in outpatient treatment. Patients typically spend a month in the inpatient program and two months on outpatient treatment. “We are trying to be out on the front of helping people,” said Teri Williams, administrative director of the addiction recovery unit. (

Hospitals try giving patients a dose of reality
At the Shriners Hospital for Children in Galveston, 13-year-old Deona Duke’s doctors gave her a virtual reality headset. Slipping it on, she was immersed in “SnowWorld,” an icy landscape where she got to lob snow at snowmen and igloos. The Texas hospital is one of the few trying out virtual reality to relieve pain. It’s still a new and experimental approach, but proponents of virtual reality say that it can be an effective treatment for everything from intense pain to Alzheimer’s disease to arachnophobia to depression. (Bloomberg Technology)

AHA legal analysis sees compliance risk in site-neutral rule proposal
The American Hospital Association (AHA) has renewed calls for the Centers for Medicare & Medicaid Services to delay implementation of the site-neutral provisions of the Bipartisan Budget Act citing potential risk for hospitals to run afoul of the Stark law and Anti-Kickback statute. The proposal has engendered controversy since its announcement, with physicians and hospitals taking opposing views on its merits. AHA Senior Vice President and General Counsel Melinda Hatton says the rule “puts the hospital community in an untenable position by creating unavoidable legal risks.” (Fierce Healthcare)

How health systems can tackle health disparities
After more than a decade of asking why factors such as race, ethnicity, income, gender and sexual orientation often correlate with worse health and health care quality for so many Americans, perhaps the biggest question is what can health care providers do about it. But some providers and researchers are also realizing that’s just the starting point, and the health care system needs to make deeper changes and take on new roles. Last week, the National Institutes of Health launched two centers that will study the impact of environment on a person’s health. (Modern Healthcare)

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Does this capture the Iowa “why”?

Even longtime Iowans might struggle to remember the “Iowa…A Place to Grow” slogan and its accompanying clover leaf-like symbol that Governor Robert Ray adopted more than 45 years ago. Now, what appears to be the last vestige of the campaign, a sculpture near the Statehouse, has been taken apart.

The “Iowa…A Place to Grow” marketing campaign continued for at least 20 years, maybe closer to 30. Because it wasn’t until 1999 that Governor Tom Vilsack unveiled “Iowa…Fields of Opportunity,” which is still seen throughout the state, most notably on welcome signs along the borders. That slogan may seem outdated in a state where fields are being replaced by suburban sprawl and gigantic data centers. But maybe that was and still is the point: fields of opportunity, fertile enough to keep growing with changing times (and massive tax incentives). Maybe “Fields of Opportunity” does a fair job of describing Iowa’s “why.”

The idea of capturing and promoting an organization’s “why,” its core reason for existing, stems from Simon Sinek’s bestselling book, “Start with Why.” Sinek’s central point is that while any organization (or member of that organization) can readily describe “what” they do and probably “how” they do it, very few can articulate “why.” That is, they can’t describe the thing that inspires the organization, those who work for it and those who support it.

Here is how Sinek explains it: “When an organization articulates their WHY and we believe it, then we go above and beyond to include their offerings in our lives. We embrace their beliefs, not because they’re necessarily better, but because they represent values that are important to us.”

As mission-oriented organizations, community hospitals are probably more attuned to their “why” than most other businesses. Yet that focus often gives way to the business of health care – the “what.” In fact, the hospital “what” is so engrained that there’s even a well-known axiom of the industry built around it: “No margin, no mission.”

Hospitals are unique in their communities, as is their mission. But that is changing, just as the very nature of health care delivery is changing. There are countless entrepreneurs and innovators that are pouncing on the opportunities these changes are offering, opportunities made all the more enticing as hospitals and other legacy providers are slow to move into these spaces.

Perhaps hospitals are just too big to be that nimble. Or perhaps there is a level of arrogance at work, a belief that hospitals – with their inherent positive and trusted image – are both too big and too beloved to fail. But critics (media, assorted ratings companies, politicians, advocacy organizations) and competitors (retail outlets, specialized clinics, Uber-like innovators) are lining up to contain, control and displace both traditional and emerging hospital roles – and the accompanying revenue.

To counter these challenges, Iowa hospitals must rally to their “why” and reaffirm their mission and vision with both clear words and visible actions. Even in these times of change and uncertainty, hospitals must be united in their values and the priorities those values create. Only then, when Iowa hospitals proclaim, “We Care About Iowa’s Health,” will our fellow Iowans nod in agreement and stand at our side.

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

Iowa News

Medicaid beneficiaries, providers speak out at hearing
Yesterday, a two-hour long hearing took place before the Legislative Health Policy Oversight Committee meeting in the afternoon — the first of two Medicaid managed care oversight meetings held by a joint, bicameral committee. Multiple health care providers warned legislators to be cautious of Department of Human Services data that suggest the majority of clean claims are being paid on time. Providers across the state have told legislators and media outlets that they have received late and inaccurate payments, some totaling hundreds of thousands of dollars. (Cedar Rapids Gazette)

Unpaid claims plague Medicaid providers under new system, DHS data shows
The Iowa Department of Human Services (DHS) released its inaugural IA Health Link report Friday, detailing data from managed care organizations in conflict with survey results from Medicaid providers distributed last month. In an effort to hear from Medicaid patients and providers, Democratic legislators organized a two-hour Medicaid listening post Monday morning at the Capitol in Des Moines so they could describe their experiences with the privatized Medicaid system since its April kick off. (Burlington Hawk Eye)

Insurance rate hikes approved for thousands of Iowans
More than 75,000 Iowans will see their insurance premiums rise next year. Iowa Insurance Commissioner Nick Gerhart has approved rate increases sought by four companies who provide health insurance in the state, Gerhart’s agency announced Monday. The increases include plans covered by Wellmark Blue Cross & Blue Shield, the state’s dominant health insurer. The rate increases vary from about 19 percent to 43 percent, depending on the carrier. All of the increases will go into effect starting Jan. 1 and only apply to Iowans who buy their own health insurance plans. (Des Moines Register)

Cops and jails are not the answer to mental health problems
When a person is experiencing mental health problems, he or she needs help from mental health professionals. Unfortunately, in this country in general and in Iowa in particular, the person answering the call for help often wears a badge and a gun rather than a lab coat. For a variety of reasons, including changes in state and federal rules, inadequate resources and a lack of enough people trained in the mental health professions, local police and sheriff departments are often called upon to address situations involving people with mental health issues. (Mason City Globe Gazette)

National News

Virginia governor sees Medicaid expansion as fix for $1.5 billion budget hole
Virginia Governor Terry McAuliffe suggested tapping the state’s rainy day fund and accepting more federal Medicaid money on Friday as a way to patch the state’s $1.5 billion budget hole. Raises for teachers and state employees — contingent on higher tax revenue — are already off the table. But the governor urged legislators to otherwise protect K-12 school funding. He also asked them to consider expanding Medicaid under the Affordable Care Act to capi­tal­ize on federal health-care dollars. (Washington Post)

How legislators are trying to ease California’s rural health care issues
California lawmakers are working through two proposals intended to help rural hospitals, providers and patients before they wrap up the state’s 2016 legislative session. One bill would require Medi-Cal to pay for patients’ transportation costs for medical appointments. The law is particularly intended to help rural patients in need of specialists. The second bill aims to authorize small, rural hospitals to hire physicians directly in order to make staffing more feasible and potentially reduce health care costs. The new law is necessary because there are too few physicians available in rural areas. (Healthcare Dive)

Mental health centers strive to get more Kansans into treatment
Community mental health centers in Kansas are doing more to get homeless people off the streets and into treatment, but limits on Medicaid coverage and a lack of rental housing have slowed their efforts. Kristen Whitney is service coordinator for the Cooperative Agreements to Benefit Homeless Individuals grant. She said Wyandot Center employees can reach out to people who are homeless, encourage them to accept treatment, help them locate a permanent apartment and meet with them weekly to smooth issues that may arise. But that still isn’t enough to meet everyone’s needs. (Kansas Health Institute)

Hospitals face OB-GYN shortage
Faced with a shortage of obstetricians and gynecologists (OB-GYNs) and nurse midwives, several states are considering proposals that advocates say would improve health care for women. But with the female population of the United States and number of babies born here projected to increase sharply over the next decade and beyond, scholars and medical organizations say more dramatic changes are needed to ensure that the medical needs of American women are met. (Columbus Dispatch)

Audits of some Medicare Advantage plans reveal pervasive overcharging
More than three dozen just-released audits reveal how some private Medicare plans overcharged the government for the majority of elderly patients they treated, often by overstating the severity of certain medical conditions, such as diabetes and depression. The Center for Public Integrity recently obtained the federal audits of 37 Medicare Advantage programs. These audits have never before been made public, and though they reveal overpayments from 2007 — money that has since been paid back — many plans are still appealing the findings. (Iowa Public Radio)

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

Iowa News

Medicaid managers’ spending on Iowans varies greatly
The three private companies managing Iowa’s Medicaid program are spending significantly different amounts on care for the hundreds of thousands of poor or disabled people they cover, a new report shows. Amerigroup spent an average of $402 per adult member per month, 13 percent more than the $357 spent by UnitedHealthcare and 47 percent more than the $273 spent by Amerihealth Caritas, the report shows. The report, released Friday, covers the first three months of private administration. Governor Terry Branstad hailed it as evidence that the change working. (Des Moines Register)

Iowa pushes to the limit what it can recover from Medicaid beneficiaries
Barb Lewis of Iowa City, who is among the 13 percent of Iowans who live in poverty, discovered this year that the state is more aggressive than most in trying to recover after death any money spent on health care costs. Here, assets can be seized from estates by the government to pay for the cost of any care paid by Medicaid. Lewis said that wasn’t clear to her until after she paged through a booklet sent this spring by AmeriHealth Caritas, one of the three private providers who now manage Medicaid for the state. (Des Moines Register)

Iowa sheriffs at the front lines of mental health crisis
Many people in Iowa’s jails — as many as one-third — do not belong there, state law enforcement officials say. Too many people are jailed when what they really need is mental health care. The state’s mental health care system is plagued, law enforcement officials and mental health advocates agree, by a lack of access because of a shortage of beds and a lack of available mental health professionals. Iowa also lacks a unified mental health care model that involves hospitals, law enforcement and the community. (Mason City Globe Gazette)

Backlog of mental health evaluations causes delays in criminal proceedings
Law enforcement officials said it’s not uncommon that criminal suspects can’t be committed right away. The Iowa Medical and Classification Center in Coralville has 18 beds to serve all of the state’s 99 counties, and those beds are always full. The center’s forensic hospital primarily serves people facing criminal charges who have been ordered to either receive competency evaluations or treatment to restore competency for continued criminal proceedings. (Dubuque Telegraph Herald)

More traveling doctors make for healthier rural hearts
Rural patients with heart disease often have limited access to specialized care because most cardiologists practice in cities, so even routine office visits can be difficult and time consuming. But a new study from the University of Iowa finds that the use of visiting consultant clinics in rural hospitals staffed by traveling cardiologists greatly increases access to cardiology care. The study notes that rural cardiology care is especially important because rural populations are generally older and more at risk of developing heart disease. (Iowa Now)

National News

Alabama lottery bill dead for special session
Alabama voters won’t have their say on whether to allow a state lottery. A proposed constitutional amendment to allow a lottery died last week in the Alabama Senate. The BP bill was the other major issue for the special session, which Gov. Robert Bentley called to address problems with the state budget. The lottery was the governor’s proposal to boost funding for the budget, especially Medicaid. The governor said today’s vote rejecting the bill was a vote against the children and others who depend on Medicaid, about one million Alabamians overall. (

Mental health first aid: How New York City is fixing the system
In New York City, about one-in-five people are believed to have depression at any given time. Less than 40 percent get treatment. Chirlane McCray, New York City’s first lady, is trying to tackle the issue head-on. She is spearheading an initiative to improve access to mental health services in New York City. It entails boosting the number of people who can treat disorders like depression and anxiety, and partnering with agencies like public schools and the New York Police Department to reach people who might otherwise go untreated. (Kaiser Health News)

Orlando Health, Florida Hospital won’t bill Pulse shooting victims
Orlando Health and Florida Hospital will not bill survivors of the Pulse nightclub massacre for out-of-pocket medical expenses, officials announced last week. Instead, the hospitals will write off an estimated $5.5 million or more in care. Orlando Health President and CEO David Strong said. “The pulse shooting was a horrendous tragedy for the victims, their families and our entire community,” Orlando Health President and CEO David Strong said. “This is simply our way of paying that kindness forward.” (Orlando Sentinel)

How community health workers are transforming health care
Health care systems are trying to improve patient outcomes and reduce costs by ensuring high-risk patients receive preventive care and comply with medical orders. But oftentimes patients have obstacles in their lives clinicians are unaware of that keep them from engaging with the health system. Enter the community health worker (CHW), an emerging resource that is becoming a critical part of the integrated care team. CHWs are being dispatched to the front lines of care delivery by primary care practices, health systems and insurers to better understand patients’ socioeconomic circumstances. (HealthLeaders Media)

Hospital surprise: Medicare’s observation care
Hospitals provide observation care for patients who are not well enough to go home but not sick enough to be admitted. The care may seem just like what an admitted patient receives. But surprises can arise over billing because Medicare considers this outpatient care. So instead of Medicare picking up most of the bill, patients usually also have copayments for doctors’ fees and each hospital service, and they have to pay whatever the hospital charges for any routine drugs the hospital provides that they take at home for chronic conditions. (Kaiser Health News)

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

Iowa News

Branstad’s Medicaid dog-whistle
Governor Terry Branstad’s Medicaid privatization looks to be collapsing under its own weight. Yet, Iowa’s governor can only skewer the messenger. Branstad lashed out Monday at editorial writers and critical lawmakers. Huge savings are being realized after three private companies usurped control, Branstad said. “Fraud and abuse” is down, he pledged. Yet, unsurprisingly, Branstad failed to cite a single figure to support his claims. Nor could he. More than 500,000 Iowans and hundreds of service providers are experiencing the real-world effects of Branstad’s rush-job. (Quad-City Times)

Keokuk County Medical Clinic opens its doors
The Keokuk County Medical Clinic, an affiliate of Keokuk County Health Center (KCHC), began seeing family care patients upstairs in the new clinic last week. They will continue to work on renovations and updates to the space. Matt Ives, KCHC CEO, feels that expanding upstairs will lead to more health care options after the current renovations are completed and the clinic is settled in. Ives reiterates that primary care for the community comes first, but other options are possible with the new space. (Sigourney News Review)

Better care, better efficiency at Spencer Hospital
During a meeting this week, the Spencer Hospital Board of Trustees focused on increasing quality of care and reducing costs. Jim Potvin, regional director for Avera Medical Group, updated the board on how the Accountable Care Organization (ACO) demonstration has effected the clinics. “This essentially is a three-year demonstration project and essentially what it’s doing is giving us an opportunity to use a type of alternative reimbursement model that folks anticipate will be more widely used in the future,” Hospital President Bill Bumgarner said. (Spencer Daily Reporter)

Iowa City native helms a documentary about former NFL player with ALS
Iowa City native and Hollywood film producer Mary Rohlich hasn’t been in Iowa City since 2004. She’s fixing that this week when she comes to town for a screening of her critically lauded documentary “Gleason,” which follows former NFL player Steve Gleason as he and his family come to grips with his diagnosis of ALS. It will also serve as a fundraiser for the University of Iowa Hospitals and Clinics — a portion of all proceeds will go to treatment and research of ALS. (Iowa City Press Citizen)

Volunteers can make a big difference
Public-spirited people who make time in their lives to support worthy causes help make any town a better place to live. In that regard, the large and dedicated cadre of volunteers at UnityPoint Health – Trinity Regional Medical Center is an especially noteworthy example. Trinity celebrates the efforts of these praise-worthy individuals with an annual Volunteer Recognition Event. That important tribute took place Tuesday at Fort Frenzy. The roughly 75 volunteers honored had each helped make visits to the hospital complex easier for patients. (Fort Dodge Messenger)

National News

Controversial parts of Kentucky Medicaid plan remain
Governor Matt Bevin’s administration unveiled its long-awaited plan to reshape the state’s Medicaid program Wednesday, and while it restores some benefits Bevin proposed be cut two months ago, it retains the most controversial components of the governor’s approach to overhauling the federal-state health plan for low-income and disabled Kentuckians. Taking aim at the Medicaid expansion launched by his predecessor, Bevin said he wants to create a different program that includes more cost-sharing by consumers and brings the state’s soaring costs of Medicaid under control. (Courier Journal)

Texas owes the Medicaid program $57.8 million, report says
Texas received nearly $58 million from the federal Medicaid program for health services that did not qualify for reimbursement — and it may be asked to return part of the money. Payments made to six facilities were calculated in a way that did not meet federal and state requirements, according to an audit released by the Department of Health and Human Services. The Centers for Medicare & Medicaid Services said it will be reviewing the report and working with the Texas Health and Human Services Commission to come up with a solution. (Dallas Morning News)

How artificial intelligence could help diagnose mental disorders
People convey meaning by what they say as well as how they say it: Tone, word choice and the length of a phrase are all crucial cues to understanding what’s going on in someone’s mind. When a psychiatrist or psychologist examines a person, they listen for these signals to get a sense of their wellbeing, drawing on past experience to guide their judgment. Researchers are now applying that same approach, with the help of machine learning, to diagnose people with mental disorders. (Atlantic)

The life-changing magic of choosing the right hospital
There’s an exceedingly simple way to get better health care: Choose a better hospital. A recent study shows that many patients have done so, driving up the market shares of higher-quality hospitals. “Our results fit with the view that hospitals’ reputations spread through social networks of patients and doctors influencing the decision over where to seek care,” Adam Sacarny, one of the study’s authors, said. Rather than clinical quality, which is hard to perceive, patients may be more directly attuned to how satisfied they, or their friends and family, are with care. (New York Times)

Study looks at policy options to contain high prescription drug costs
According to a study published recently in the Journal of the American Medical Association (JAMA), the most realistic short-term strategies to address high U.S. prescription drug prices include enforcing more stringent requirements for the award and extension of exclusivity rights; enhancing competition by ensuring timely generic drug availability; providing greater opportunities for meaningful price negotiation by governmental payers; generating more evidence about comparative cost-effectiveness of therapeutic alternatives and more effectively educating patients, prescribers, payers and policy makers about these choices. (JAMA)

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