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

Iowa News

Keep pressing for Medicaid oversight
Less than one month into a controversial new system and Governor Terry Branstad is ready to call the Medicaid privatization transition a success. Branstad and Lieutenant Governor Kim Reynolds the other day sent out a press release highlighting success stories about how the new system is “connecting patients with services to live healthier, happier lives.” Unfortunately, the news release from the governor’s office notwithstanding, the reviews are not all glowing. In many cases, managed care operators are frantically trying to put together documentation to keep services flowing. (Dubuque Telegraph Herald)

A few Zika-bearing mosquitoes could buzz into Iowa
Southern mosquitoes could buzz into Iowa this summer, but state experts don’t expect them to be a major carrier of the Zika virus. New maps from the Centers for Disease Control and Prevention show Iowa in the range of one of two mosquito species believed to carry the virus, which causes birth defects. The maps show the Aedes aegypti mosquito’s range petering out in Missouri, but they show the Aedes albopictus mosquito’s range extending through Iowa and into southern Minnesota. (Des Moines Register)

Experts lament lack of sex therapists, resources in Iowa
alking about sex is hard. Perhaps that’s why there are so few doing it professionally in Iowa. In fact, Denise Stapley is the only sex therapist in the state certified by the American Association of Sexuality Educators, Counselors and Therapists (AASECT), and she rarely accepts new patients. “I don’t want to be the only one in Iowa,” Stapley said. “I turn people away all the time … There’s more need than I can manage in my practice.” (Cedar Rapids Gazette)

Mumps confirmed in Howard County
Regional Health Services (RHS) of Howard County has confirmed one case of mumps in Howard County, as of April 25. Mumps is a contagious disease caused by a virus. It spreads easily through coughing and sneezing. There is no treatment for mumps, and it can cause long-term health problems. The Iowa Department of Public Health suggests the best thing to do as a treatment is quarantine until all signs and symptoms have dissipated, as well as making sure immunizations are up to date for the patient and those with whom they are in contact. (Cresco Times Plain Dealer)

Iowa Regent Mary Andringa to resign
After just one year serving on the state’s nine-member Board of Regents, Mary Andringa on Wednesday announced plans to resign, saying she “underestimated the time required to fully serve in this role given my pre-existing commitments and responsibilities.” Governor Terry Branstad appointed Andringa last March, and she began serving on the board May 1, 2015. Her term would have expired April 30, 2021. Her resignation is effective Saturday. (Cedar Rapids Gazette)

National News

U.S. health care prices are all over the map, new study finds
Health care prices are all over the map in the U.S., a new study finds. It digs deeply into the crazy pattern of health costs across the U.S. and shows there is very little consistency. The report from the Health Care Cost Institute finds prices for the same procedures vary by sometimes huge amounts — even within the same state. “Prices for medical services varied more than threefold in certain instances,” the team wrote in the report, which was published in the journal Health Affairs. (NBC News)

This medical center looks and feels like an Apple store
The University of Minnesota Health Clinics and Surgery Center in Minneapolis, which opened earlier this year, was inspired by the Apple Store, designed to be more experience than ambulatory site. It’s a $165 million risk, to be precise. But the bet is that the approach will increase patient satisfaction and staff efficiency, all with a design footprint that’s smaller than other academic medical centers with similar patient loads and staffing levels. (Stat)

Quadriplegic regains movement via brain signals
An Ohio man with quadriplegia has used his own hands to pick up a bottle, swipe a credit card and play a video game with the help of technology that routes signals from his brain to his muscles, researchers reported in a study Wednesday. Other paralyzed people have used their brain signals to command computers and robotic arms. But this “marks the first time a person living with paralysis has regained movement by using signals recorded from within the brain,” study co-author Chad Bouton of the Feinstein Institute of Medical Research told reporters Tuesday. (USA Today)

HHS acts to help more ex-inmates get Medicaid
Administration officials moved Thursday to improve low Medicaid enrollment for emerging prisoners, urging states to start signups before release and expanding eligibility to thousands of former inmates in halfway houses near the end of their sentences. Health coverage for ex-inmates, “is critical to our goal of reducing recidivism and promoting the public health,” said Richard Frank, assistant secretary for planning for the Department of Health and Human Services (HHS). Advocates praised the changes but cautioned that HHS and states are still far from ensuring that most people leaving prisons and jails are put on Medicaid and get access to treatment. (Kaiser Health News)

CDC reports on trends in racial and ethnic health disparities
Racial and ethnic differences in life expectancy, infant mortality, female cigarette smoking, flu vaccinations for seniors and health insurance coverage narrowed between 1999 and 2014, according to the Centers for Disease Control and Prevention’s (CDC’s) latest annual report on the nation’s health, which features a special section on health disparities. “Results indicate that trends in health were generally positive for the overall population and several graphs illustrate success in narrowing gaps in health by racial and ethnic group,” the report notes. (CDC)

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

Iowa News

Knoxville Hospital & Clinics opens new main entrance
Knoxville Hospital & Clinics officially opened its new main entrance and reception area April 26. This marks the completion of the $15 million modernization and expansion project. The new main entrance includes a canopied drop-off area. “We really wanted this main entrance to serve as a grand welcoming for our patients, visitors and guests,” said Kevin Kincaid, Chief Executive Officer. “We’ve brightened up the space and added special touches to provide a welcome and open, friendly environment.” (Knoxville Journal Express)

UnityPoint to help students explore careers
A new program at UnityPoint Health – Trinity Regional Medical Center will allow students to explore careers in health care. The Health Careers Program provides regular student visiting sessions and connects them with health care professionals. “We decided to organize this program in a way that we’d have structured and organized learning experiences for any upcoming juniors and seniors who want to be a part of the program,” said Katie Cole, UnityPoint provider recruitment and retention specialist. (Fort Dodge Messenger)

Iowa Donor Network brings awareness to organ donation
There’s 120,000 people on the organ transplant list in the United States, and 600 of those are Iowans. Iowa Donor Network celebrates April as Donate Life Month. It’s a time to bring awareness to that number and talk about ways to reduce it to zero. “We’re just trying to get people to do two things. One find out about what it means to be a donor, educate themselves or learn from us about the process of donation, and then two hopefully go out and register if they’re not already a registered donor in Iowa,” Public Outreach Manager Tony Hakes said. (KCRG)

Lullaby Lane a heartfelt project
Those who have experienced the unimaginable pain of having a child lost to miscarriage may soon be comforted in an especially caring way. The Leadership North Iowa class, consisting of up-and-coming business people, completes a community impact project every year. This year the class, part of the Mason City Area Chamber of Commerce, is raising money to build Lullaby Lane in Elmwood Cemetery, a prayer walk leading through Lullaby Land, the area of the cemetery where children are buried. (Mason City Globe Gazette)

National News

Southeast Michigan health systems reverse trends, reap profits
Southeast Michigan health systems last year battled double-digit increases in drug prices and historically low rate increases from commercial and government payers to post the highest profit margins in several years, according to top system executives. Aiding their efforts to improve profit margins have been double-digit declines in uncompensated care, which includes charity care and bad debt, due primarily to Medicaid and private health insurance expansion that added more than 1 million people in Michigan to insurance rolls. (Modern Healthcare)

The rural care health access crisis
Often prohibitive cost to patients isn’t the only health care crisis in the United States, as many people in this region know all too well. In rural areas, mostly poor ones, the crisis isn’t just about the affordability of medical care, but about having access to it at all. In emergencies, that can be literally a life-or-death issue. Yet all across the country, rural hospitals are finding it hard, and sometimes impossible, to stay open. (Columbus Ledger-Enquirer)

Data sharing may be essential to hospital efforts to improve community health
Data sharing may be essential to hospital strategies to identify high users and improve community health, according to a study published online by the Journal of American Medical Association (JAMA) Internal Medicine. The study examined patterns of hospital use by patients with more than five emergency department visits to Maryland hospitals in calendar year 2014, and the share of hospital admissions received by the most used hospital in each zip code. (JAMA Internal Medicine)

New tools help patients make tough decisions in the ER
In the emergency room (ER), patients may expect doctors to call all the shots about tests and treatments. But increasingly, ER physicians are asking patients to participate more in critical decisions about care, such as whether to opt for surgery or undergo a scan with radiation exposure. Now, to help patients and families weigh the evidence and compare risks and benefits, hospitals are developing so-called shared decision-making aids tailored to emergency situations. (Wall Street Journal)

CMS releases MACRA proposed final rule
The Centers for Medicare & Medicaid Services (CMS) released on Wednesday the proposed final rule for the Medicare Access and Children’s Health Insurance Program Reauthorization Act of 2015 (MACRA). It establishes the merit-based incentive payment system which consolidates components of the physician-quality reporting system, the physician value-based payment modifier and the Medicare electronic health record incentive program for eligible professionals. MACRA removes the sustainable growth rate formula, which cut Medicare payments for services, and replaced it with a 0.5 percent year-over-year increase in the physician fee schedule. (Healthcare Dive)

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

Iowa News

The future is here: Robots in the hospital room
The recent edition of River to River highlights how different medical robots work and the pros and cons of working side-by-side with machines to provide patient care. For example, tele-stroke carts help doctors treat patients remotely, allowing physicians like Dr. Enrique Leira, with the University of Iowa Hospitals and Clinics, to connect with doctors and patients in rural communities. Dr. Brian Wilson is a gynecological surgeon with Spencer Hospital and he performs surgeries with the assistance of a robot. (Iowa Public Radio)

Dubuque health care costs rank among lowest in country
Dubuque’s health care costs are among the lowest in the country, and patients using Medicare and private insurance plans are both benefiting from the savings. Patients in Dubuque who are on Medicare pay the fifth-lowest health care rates in the U.S., according to an analysis of per-capita costs in 306 health care markets. For those on private insurance plans, the Dubuque market has the ninth-lowest rates in the country. (Dubuque Telegraph Herald)

Mercy Dubuque’s AirCare 3 set to save lives in the tri-states
“It could potentially mean the difference between life and death,” AJ Topliss, a flight nurse with Mercy Dubuque’s AirCare 3 said Tuesday. “More so, we’re there for the time sensitivity of it, trying to get them to that doctor for the definitive care that’s needed.” AirCare 3 is part of the University of Iowa Hospitals and Clinics system, which also has helicopters in Waterloo and Iowa City. This helicopter will transport patients from Mercy to UIHC or other facilities (some even out of state) to receive more specialized care. (KWWL)

Hospital offers help to sexual assault victims
Sexual assault affects one in five women and one in 71 men nationally. In eight out of 10 cases, the victim knew their attacker. And that’s just the tip of the iceberg, since sexual assault is believed to be a widely underreported crime. In April – Sexual Assault Awareness Month – the Sexual Assault Nurse Examiners team at Methodist Jennie Edmundson Hospital has placed brochures in local clinics, sent letters to area emergency medical services programs and hospitals and posted flyers at Jennie. (Council Bluffs Daily Nonpareil)

Iowa more ready than most for disasters
How prepared is Iowa when it comes to dealing with a natural disaster or public health scare? According to a study by the Robert Wood Johnson Foundation, it’s more prepared than most. The National Health Security Preparedness Index tracks the nation’s progress in preparing for, responding to and recovering from disasters and other large-scale emergencies. Overall, the state scored 6.8 out of 10 for overall preparedness. The national average was 6.7. (Cedar Rapids Gazette)

National News

As medical programs strive to crank out rural physicians in Missouri, the shortage grows
Missouri is part of a troubling national pattern of insufficient health care in rural counties. According to the National Rural Health Association, only about 10 percent of physicians practice in rural parts of America, while about 25 percent of citizens live in rural America. In Missouri, 80 percent of the state is designated as a health profession shortage area, according to a 2014 special report by the Missouri Hospital Association. That means one in five Missouri residents has limited access to primary medical care, dental or mental health providers. (Columbus Missourian)

Oregon putting $10 million into rural health care efforts
State Senator Alan Bates and Representative Nancy Nathanson, along with Oregon’s rural hospitals announced Tuesday the inclusion of $10 million in the state’s recent budget to fund projects designed to help ensure the sustainability of rural health care. The projects were developed during an exhaustive listening tour and process conducted in a partnership between the Oregon Health Authority, the Oregon Office of Rural Health and the Oregon Association of Hospitals and Health Systems. (KTVZ)

Best Practices: Customizing transitional care for North Carolina Medicaid patients
Health care organizations are increasingly trying to crunch data to find patients who are at risk of being hospitalized and returning to the hospital soon after going home. But finding them doesn’t mean they’ll all respond to the same kinds of interventions. A not-for-profit group that works closely with the North Carolina Medicaid agency has developed a data-driven transitional-care program intended to connect the right patients with the resources that are most likely to work. (Modern Healthcare)

White House unveils major effort in health career opportunities
The Obama administration this week announced a new initiative to expand job opportunities in the health care sector. The privately-led Health Careers Pathways Initiative (HCP) builds on a framework developed with a $19.6 million Labor Department grant for job-driven training at the community college level. More than 50 organizations are participating in the HCP, which grew out of a White House meeting where officials and health care executives convened to discuss the impact of community college grants on companies. (Healthcare Dive)

Administration says new rules for Medicaid plans will improve service for enrollees
The Obama administration tightened rules Monday for private insurance plans that administer most Medicaid benefits for the poor, limiting profits, easing enrollment and requiring minimum levels of participating doctors. For consumers the most visible change may eventually be quality ratings intended to reflect Medicaid plans’ health results and customer experiences. But the sweeping regulation, the biggest for Medicaid managed care in a decade, changes many aspects of how UnitedHealthcare, Aetna and other large contractors who administer care for some of the most vulnerable patients do business. (Kaiser Health News)

telemedicine-childrenTelemedicine – connecting health care providers and patients via computer or smart phone for diagnosis and treatment – has been making it easier, and more cost-effective, to “see” the doctor. Using a camera-enabled computer or smart phone, patients with common health concerns can get some diagnoses without leaving their homes. Emergency room doctors and nurses are able to communicate with their peers in larger trauma centers via computer, as well.

Now a new University of Iowa study, published recently in the journal Pediatrics, shows that parents with children on the autism spectrum are able to have a specialist address challenging behavior in these children by interacting over the computer, too – and at less than half of the cost of receiving similar care in person.

“A lot of kids who are on the autism spectrum have significant problems with behavior,” says Scott Lindgren, Ph.D., professor of pediatrics in the Stead Family Department of Pediatrics at University of Iowa Carver College of Medicine and lead author of the study. “These kids may have trouble following directions, or have problems when there are changes in their schedule or routine. They also don’t always have good enough communication skills to be able to explain to someone why they’re getting upset or having a meltdown.”

Parents are often frustrated, Lindgren says, because they don’t know how to communicate with their child to find a way to prevent or stop a meltdown. What adds to frustrations, he says, is that many Iowa families live in areas where services for children on the autism spectrum may be hard to come by.

“There are a limited number of professionals with the training and expertise needed to work with these children, which means a lot of families can’t get access to the services they need,” Lindgren says. “That’s the situation we have in Iowa.”

With the availability of telemedicine, he says, families with limited access – particularly those in rural settings – will be able to connect with their provider without causing a big disruption to their child or their family.

Additionally, the study showed that total costs for treating a child for challenging behaviors was cut from nearly $6,000 per child to just over $2,100 through the use of telemedicine – or telehealth, as it is often called. Cost savings were seen in various areas, including travel expenses and staff hours that were saved when no travel was involved.

Lindgren

Scott Lindgren, Ph.D.

In the study, Lindgren, who is co-director of the UI Children’s Hospital Autism Center, and David Wacker, Ph.D., professor of pediatrics in the Stead Family Department of Pediatrics at UI Carver College of Medicine, along with other UI colleagues, examined whether these families could be served by using telehealth to train parents to use applied behavior analysis (ABA), a common intervention for children with autism spectrum disorder (ASD).

The group studied 107 children ages 21 months to 6 years old with ASD or other developmental disabilities and who were treated between 1996 and 2014. The children were divided into three groups: 52 kids treated between 1996 and 2009 who had a behavior consultant come to their home; 23 children treated between 2009 and 2012 whose parents went to a clinic near their home to be coached via telehealth; and 32 children who were treated between 2012 and 2014 as part of a trial in which their parents were trained in functional communication training (FCT), a type of ABA treatment, via telehealth coaching at home.

Researchers found that not only are specialists able to successfully train parents to use ABA procedures using telehealth, and at a fraction of the cost, but they are also able to provide the training to families in outlying rural areas who might otherwise not have access to care.

“When we were starting to do this with telehealth a few years ago, a lot of people said there’s no way to work with children with autism without seeing them in person,” Lindgren says. “Usually the way they had been managed was that the family would come to the hospital and see Dr. Wacker and he’d evaluate the children.” Behavior analysts were then sent out to the home to work with the family, Lindgren says.

As telehealth services evolved, he says, families would go to one of 14 regional clinics around the state and be coached by a behavior consultant via an internet connection between the hospital and the local clinic. It saved families from having to drive to the hospital, but it still involved leaving the home and disrupting the child’s routine.

With the most recent approach of using in-home telehealth, parents and consultants could connect via a computer at home, which often gave consultants a glimpse into where the child was most comfortable and where most challenging behavior occurred. The parents would then receive coaching in functional communication training at home.

“This coaching is more than having a casual talk with families,” Lindgren says. “It’s setting up a variety of situations in which problem behavior may occur, and helping parents find ways to address problems constructively, and to better understand why that behavior is occurring. For 90 percent of the kids we evaluate, we can find a social reason for what that child is doing.”

Lindgren said he’s been pleased with the results of the consultations via telehealth – and so have been families.

“It’s been impressive to me to see how well this works in different settings,” he says. “Almost all of the parents do well enough in this training to be able to help their kids a lot. And that reduces stress on the family and helps kids succeed in school and in life.”

Other UI researchers involved in this study include Kelly Pelzel, Ph.D., Todd Kopelman, Ph.D., and John Lee, BA.

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

Iowa News

Senator Amanda Ragan on Iowa’s HHS Budget
On Sunday, Senator Amanda Raga (D-Mason City) made comments on the Senate floor regarding the proposed Health and Human Services (HHS) budget. This year’s general fund target for HHS, agreed to by the Iowa House and Senate, is just $4 million over last year’s budget, and increase of only 0.2 percent. In her comments, she encouraged the Senate to vote to include strong oversight for Medicaid managed care. (KIOW)

Iowa House OKs bill on mental health prescriptions
The Iowa House has approved legislation that would allow specially trained psychologists to prescribe medication to mentally ill people in the state. The Republican-majority chamber voted 72-22 Monday for the legislation, which would allow licensed psychologists to complete additional coursework and training to prescribe medication typically offered by psychiatrists and others. (Associated Press/KWWL)

Minnesota partnership a potential solution for Iowa medical cannabis law
A potential partnership with a neighboring state may be the most likely expansion of Iowa’s limited medical cannabis law this year. Advocates have spent months pushing state lawmakers to expand Iowa’s medical cannabis program, which permits Iowans to possess cannabidiol, a medicinal byproduct of the marijuana plant, to treat children with epileptic seizures, but the law does not provide access to cannabidiol in the state. (Cedar Rapids Gazette)

UnitedHealth quits Iowa Obamacare marketplace
Iowans who want to buy subsidized health insurance under the Affordable Care Act (ACA) will no longer be able to choose a policy from the country’s largest carrier. UnitedHealthcare will no longer sell individual health insurance policies in Iowa, the state insurance division announced Monday. This doesn’t affect the tens of thousands of Iowa Medicaid recipients who recently were enrolled in UnitedHealthcare plans to replace Medicaid coverage. (Des Moines Register)

National News

85 percent medical-loss ratio in final managed Medicaid rule
The Centers for Medicare & Medicaid Services (CMS) has finalized a long-awaited rule that will overhaul managed Medicaid, which has not been updated in a decade. The sweeping 1,425-page rule, which was proposed last May, caps insurer profits, requires states to more rigorously supervise the adequacy of plans’ provider networks, encourages states to establish quality rating systems for plans, allows more behavioral health care in institutional settings and promotes the growth of managed long-term care. But the CMS deferred to state control for several issues. (Modern Healthcare)

North Carolina mental health agencies announce workforce-development collaborative
Three of North Carolina’s Medicaid mental health organizations announced last week that they’ll be jointly launching a workforce-development initiative to offer training resources to frontline professionals who provide services to people with disabilities. Classes offered will include frontline supervision and management, employment services, personal assistance and caregiving and recovery community and inclusion. (North Carolina Health News)

Kansas hospitals wary of budget cut option
One of the governor’s options to patch a hole in the state budget includes a $35 million cut from the Kansas Department of Health and Environment, a move a hospital group says could harm its members. Medicaid already has lower reimbursement rates than Medicare and private insurers for many procedures, said Cindy Samuelson, spokeswoman for the Kansas Hospital Association. Hospitals often take a loss when treating Medicaid patients, she said. (Kansas Health Institute)

Breaking the system: State budget battles gut health care for the most vulnerable
Even as the White House touts the Affordable Care Act’s successful coverage of nearly 20 million people, residents across the country are struggling to access and afford healthcare and social service programs.State legislatures are seeing shrinking revenue because of tax cuts and low energy prices. North Dakota and Texas, which rely on oil tax revenue, are facing huge budget shortfalls. Medicaid, a large part of most state budgets, is one of the first places to make cuts. (Modern Healthcare)

Hospitals test putting psychiatrists on medical wards
Some leading hospitals have begun placing psychiatrists and other mental health professionals into medical units to identify psychological problems early in a patient’s stay. Mental health professionals working on the front lines with medical doctors improve care and help reduce the time patients need to stay in the hospital, studies suggest. Some practitioners also say the approach might cut the likelihood patients will need to be readmitted. (Wall Street Journal)