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

Iowa News

Branstad: State might expand Medicaid if ‘assurances’ came attached
At his press conference on Monday, Governor Branstad seemed to indicate he might be amenable to accepting some form of expansion if it came with “assurances” that the feds wouldn’t renege on funding commitments in the years to come. “That is one of the things we’re willing to consider, provided there’s assurance that if the federal dollars are reduced that Iowa taxpayers don’t get stuck,” Branstad said. When pressed on this point, the governor emphasized that he was committed to finding a compromise that could pass both the Republican House and the Democratic Senate, but that he wasn’t making any specific offer to lawmakers. (Des Moines Register)

Plug the Medicaid gap
The biggest issue is what to do about health care services for the poor. If they’re maintained, the state’s debt will pile up. If they are continued but Medicaid providers aren’t paid, or if services to Iowans in need are cut, it likely would increase demand on hospital emergency rooms for charity care — which comes at a much-higher cost. And that also is something federal Medicaid officials frown upon and may spark a federal penalty. Those aren’t great options for the state’s budget or the Iowans who truly need Medicaid services at a time when more people can’t afford or access insurance coverage. Take care of this now, or pay more later. The choice is clear.  (Cedar Rapids Gazette)

Iowa lawmakers ponder special session for Medicaid debate
The debate is over whether to expand Medicaid or to approve an alternate proposal offered by Gov. Terry Branstad. Democrats, who control the Senate, have advocated on behalf of Medicaid expansion; Republicans, who hold a majority in the House, prefer Branstad’s plan to revamp an expiring program for low-income Iowans. Democrats say their plan would provide better coverage to more people. Branstad says the cost of an expansion is unsustainable and argues his plan would ensure better health results. (Omaha World-Herald)

Making sense of it
It’s unlikely many people needing medical treatment will download and sift through the massive spreadsheets just to shop around for health care providers. The Robert Wood Johnson Foundation is working on a project to make the Medicare data more accessible, according to a Department of Health and Human Services news release, but even that would present only a limited billing snapshot — leaving aside the cost of care for patients with private health insurance, or no insurance at all. True transparency also would include information about quality of care, and control for regional cost differences, two other important considerations. (Cedar Rapids Gazette)

National News

Medicaid opposition underscores states’ health care disparities
Republican opposition in many statehouses to expanding Medicaid next year under President Obama’s health care law — opposition that could leave millions of the nation’s poorest residents without insurance coverage — will likely widen the divide between the nation’s healthiest and sickest states. With nearly every GOP-leaning state on track to reject an expansion of the government health plan for the poor, the health care law’s goal of guaranteed insurance will become a reality next year mostly in traditionally liberal and moderate states. These states already have higher rates of health coverage. (Los Angeles Times)

Medicaid expansion would help Ohio’s veterans
There’s one more group of Ohioans who showed support for Medicaid expansion but are too often overlooked — our veterans. Right now in Ohio, there are approximately 52,000 veterans who have no options for health care. Many of them served our country during times of peace or have a disability unrelated to their service, pushing them into a dangerous gap where they are not eligible for federal Veterans Affairs benefits. Members of the Ohio National Guard or the military services’ reserves who were not called up for federal active duty may fall into this same gap. This is not satisfactory: They served when we asked and asked for nothing in return. (Cleveland Plain Dealer)

Legislator overreaches with claim that Medicaid expansion drives deficit
House Speaker Weatherford defended his key role in blocking federal money to help insure more low-income Floridians by pointing to the effect of all that extra health care spending on the national deficit. There’s no doubt the federal Medicaid expansion will cost money. Weatherford’s commentary, however, is vague. He ignores nonpartisan research showing the cost of expanding Medicaid coverage is offset by other parts of the health care law. At the same time, saying Medicaid expansion will “drastically” enhance the deficit is unproven. (Tampa Bay Times)

Romney health reform law did not increase hospital use, costs
Massachusetts’ 2006 healthcare reform law, signed by former Gov. Mitt Romney and often considered the model for President Barack Obama’s Patient Protection and Affordable Care Act, did not cause increases in hospital use or costs, according to a report from U.S. News & World Report. The findings are based on a new study led by Amresh Hanchate, PhD, an economist with the Veterans Affairs Boston Healthcare System, and presented at an American Heart Association conference. Massachusetts’ law included an individual mandate clause similar to the 2010 PPACA, under which Massachusetts residents would face a penalty — a minimum of $1,200 per year — if they did not acquire health insurance by a certain date. (Becker’s Hospital Review)

Belleville Memorial Hospital takes on nation’s largest insurer
Belleville Memorial Hospital and UnitedHealthcare are moving toward a showdown next month over hospital and physician reimbursement rates. If an agreement cannot be struck, Memorial and its physicians group will no longer be in the network of the nation’s largest insurer. Such contract disputes are becoming increasingly common as insurers and health providers vie for scarce health care dollars in a sluggish economy. The contract talks between Memorial and UnitedHealthcare have simmered for the last couple of years, but they turned potentially volatile in recent days as the two sides began to squabble publicly. (St. Louis Post-Dispatch)

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

Iowa News

Medicaid proposal too bitter a pill for 27 states
Obamacare opponents argue that the fact that pro-expansion governors’ political philosophies range from the most conservative to the most liberal underscores that opting in or opting out has more to do with each state’s interests. Three GOP governors with Democratic legislatures — in New Jersey, New Mexico and Nevada — swallowed hard and called for taking the federal money. Possible 2016 presidential candidate Gov. Chris Christie of New Jersey, a vocal critic of Obamacare, said taking advantage of its Medicaid provisions will “help keep our hospitals financially healthy and actually save New Jersey taxpayers money.” (Des Moines Register)

Will Medicaid decisions be reflected in elections?
The Urban Institute’s John Holahan predicts purple politicians who rejected the Obamacare Medicaid expansion, such as those in Ohio and Florida, will be vulnerable to voter backlash as the perks of Medicaid expansion become obvious in the Northeast, West Coast and other states. Red state politicians who rejected the plan likely won’t feel voter wrath, but “the fact is that people in those states will still be paying federal taxes that are going to other states,” Holahan said. (Des Moines Register)

Iowa Lutheran is first Iowa hospital certified for quality management
UnityPoint Health – Des Moines announced Thursday that Iowa Lutheran Hospital in Des Moines has achieved ISO – 9001 certification, making it the first hospital in the state to achieve the internationally recognized quality designation. The hospital group said it is seeking the certification for its other three Greater Des Moines hospitals – Iowa Methodist Medical Center, Blank Children’s Hospital and Methodist West. The global quality designation is more well-known to American manufacturers, who have long used the program as an indicator of quality assurance for their suppliers.

UI Hospitals trying to knock down health barriers
University of Iowa Hospitals and Clinics physician David Elliott has learned that almost anything can become an excuse for not getting a colonoscopy. Whether the hospital is too confusing or it’s too difficult to find nearby parking, Elliott has heard them all. “People don’t aspire to get a colonoscopy,” he said. (Iowa City Press-Citizen)

Swaddling out, sleep sacks in for babies
Baby blankets are now a thing of the past at Mercy Medical Center in Cedar Rapids. Instead, Mercy Birthplace is replacing them with baby sleep sacks. A sleep sack is a wearable blanket that’s kind of like a baby version of a Snuggie. Mercy Medical Center Director Linda Klein says the whole point of this is to keep babies safer. “The sleep sack is one piece and the two wings just wrap around the side of the baby to keep them nice and safe,” Klein said. Experts say there is a real movement to remove every item from the crib — and a loose blanket could be one of those items that can hinder breathing. Eighty-seven infants died from SIDS last year in Iowa. (KCRG)

National News

Obamacare: 3 years in, it faces steep challenges
The Affordable Care Act is sure to survive the latest vote by the House of Representatives Thursday to repeal it — since the Senate doesn’t plan to take it up and President Obama would veto a repeal bill if it somehow reached his desk — but the administration’s signature legislative achievement still faces serious perils ahead. Americans have a dimmer view of the health care law now than they did when Obama triumphantly signed it three years ago, according to monthly tracking polls by the Kaiser Family Foundation. (Washington Post)

Hospital charges and the need for a maximum price obligation rule
The release of average charges for common procedures in more than 3,000 U.S. hospitals last week by the Centers for Medicare and Medicaid Services elicited divergent reactions. On one hand, it was front-page news for most of the major newspapers: “Hospital Billing Varies Wildly, Government Billing Data Shows,” was the headline in the New York Times. The article went on to speculate that these new data would likely “intensify a long debate over the methods that hospitals use to determine their charges.” On the other hand the data were “old hat” to most health policy analysts. (Health Affairs)

Medical robot lets off-site doctors work quickly to diagnose patients
On any given day inside Mercy San Juan Medical Center’s neuro-intensive care unit, a 5-foot-6-inch-tall robot with a computer screen can be seen roaming the halls. The robot, named RP-VITA (Remote Presence Virtual Independent Telemedicine Assistant), is equipped with videoconferencing capabilities so doctors can beam in when there is an emergency. “Before, you couldn’t see the patient when an important decision needed to be made,” said Dr. Alan Shatzel, a neurologist at the Mercy Neurological Institute. “This has proven to be tremendously valuable.” (Sacramento Bee)

Seeking calm on the cancer ward
When people choose to have their leukemia treated aggressively, it’s a big commitment, more so than for almost any other cancer. With this therapy — three days of the drug daunorubicin, which comes in a reddish color so distinctive that one of my patients, a former chemist, used it in his professional life as a dye for plastics, and seven days of the drug cytarabine, which is infused continuously over 168 hours — we offer them the chance to be cured of a disease moving like wildfire with a stiff breeze behind it at the height of drought. (New York Times)

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

Iowa News

Mental health system transition progresses in Wapello County
The Wapello County Board of Supervisors met Tuesday evening discussing the next steps in the transition from a county-based mental health delivery system to a regional system consisting of three regions. Wapello, Appanoose and Davis Counties are the three counties. Regionalizing adult mental health and disability service systems was encouraged by the Department of Human Services and is now state code. Wapello County Supervisors unanimously approved the proposal on the agenda Tuesday night, to receive technical assistance from the DHS to guide them through the process. (KTVO)

Lawmakers won’t block closing of $26 million prison mental health unit
State lawmakers won’t stand in the way of Gov. Terry Branstad’s plan to shut down a 200-bed prison mental health unit at Fort Madison that opened 10 years ago at a cost of $26 million. A public safety budget deal signed Wednesday by Iowa House and Senate negotiators includes no money to keep the Clinical Care Unit open at the Iowa State Penitentiary, said Sen. Tom Courtney, D-Burlington, chairman of the Senate Justice System Appropriations Subcommittee. “They can keep it open if they want, but the governor is going to close it,” Courtney said. (Des Moines Register)

New initiative helps patients prevent return trip to the hospital
A new initiative is helping keep people out of the hospital in Sioux City. The Siouxland Care Incentive is a new program focusing on education for patients and getting them the services they need when they leave the hospital. The partnership brings together Siouxland Aging Services, Mercy Medical Center, Unity Point – St. Luke’s, Siouxland Community Health Center, and the Winnebago Tribe of Nebraska. The goal of the program is to keep patients from being re-admitted to the hospital within 30 days of discharge, thus lowering health care costs. (KTIV)

National News

Expanding Medicaid would help in fight against breast cancer
More than 1.5 million Ohioans are without health insurance and many women choose to delay or forego breast-cancer screenings because they can’t afford it. Many of these women will end up with late-stage cancers, and the cost of their treatment is significantly more than when the cancer is caught earlier. This affects every Ohioan, as those with private insurance end up paying more to cover the uncompensated costs absorbed by hospitals, as well as public funds used to help cancer patients. (Columbus Dispatch)

Hospital billing too complex
Hospitals deal with more than 1,300 insurers, each having different plans with multiple requirements for hospital bills. Decades of federal regulations have made a complex billing system even more complex and frustrating for everyone involved. What hospitals charge rarely reflects what they are actually paid by the government or private insurers. Nearly all of a hospital’s payments are set either by the government, which pays less than the cost of caring for patients, or through negotiations with private insurance companies. (USA Today)

Former nurse, hospital executive Tavenner confirmed to lead CMS
Marilyn Tavenner is no longer the acting administrator of the Centers for Medicare & Medicaid Services. On Wednesday the full Senate confirmed Tavenner as the administrator in an overwhelming 91-7 vote. Seven Republicans, including Senate Minority Leader Mitch McConnell (R-KY), voted against the nomination although no one spoke in opposition. Tavenner is the first CMS head to gain congressional approval since 2004 when Mark McClellan, nominated by then-president George W. Bush, was confirmed. (HealthLeaders Media)

Oklahoma law reflects divide over end-of-life issues
Supporters say the Oklahoma law will prevent doctors from acting against the wishes of desperately ill patients and their families who want the battle for life to continue. Critics counter that it will inhibit doctors from discussing the full range of options to patients near the end of life, raising the likelihood that they will undergo invasive, costly and often futile medical interventions with the pain and risks those procedures entail. At the other end of the spectrum from Oklahoma, the Vermont legislature this month passed a bill legalizing physician-assisted suicide. Oregon and Washington have similar laws, the result of ballot initiatives approved by voters. (Kaiser Health News)

It’s National Hospital Week.  In Iowa and across the nation, hospitals are always ready to care.  Hospitals serve communities large and small as well as entire regions by providing health, healing and hope 24 hours a day, every day.  No matter where they are located, hospitals are unique assets to the communities they serve, providing not only health care, but economic vitality and community benefits that no other institution or agency can match.  In countless ways, hospitals and the caring people they employ (more than 70,000 in Iowa alone) improve our lives and our quality of life.

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

Iowa News

Branstad points to special session on health-care dispute
Gov. Terry Branstad signaled Tuesday that he believes the issue of expanding health care coverage for low-income Iowans is too complicated to fix now and he favors calling lawmakers back into special session later this year once a bipartisan accord can be forged in the split-control Legislature. “As far as I’m concerned, there won’t be a special session,” said Sen. Jack Hatch, D-Des Moines. “All of our work will be done here now, it has to be completed…We see daylight between the Republicans and the governor’s plan. His financing is unacceptable to Republicans and to local governments and to local mental health agencies and providers.” (Waterloo-Cedar Falls Courier)

Iowa lawmakers, governor settle on $6.5 billion budget
Leaders in the split-control Legislature and Gov. Terry Branstad have agreed upon the overall spending level for the fiscal 2014 budget year – a key development that should begin the process of shutting down the 2013 legislative session. Democrats were adamant that the 2013 regular session not adjourn without an agreement to expand health care coverage to needy Iowans but GOP negotiators said the impasse between a Medicaid expansion or Branstad’s Healthy Iowa plan might require more work in special session to resolve. (Sioux City Journal)

Sioux City chosen for federal pilot program for high-risk Medicare patients
The federal Centers for Medicare and Medicaid Services recently announced Sioux City as the sole city in Iowa to win funding for a Community Care Transition Program, according to a release from the city.  The Siouxland Care Transitions Initiative was included in the fourth round of program approvals. It will be one of 102 pilot programs nationwide aimed at reducing readmissions to a hospital within 30 days of discharge, resulting in lower health-care costs and better outcomes for patients. (Sioux City Journal)

Infection control measures at Clarke County Hospital
Clarke County Hospital has significantly kept infection rates down by using a multi-prong approach. Strategies designed to reduce the spread of infections at the hospital include containment and isolation, hand hygiene, environmental cleanliness, and enforcement of employee health. Masks, gloves and other personal protective equipment are located at all entrances and available to anyone needing or wanting extra protection. These supplies provide a physical barrier to airborne viruses and other bacteria that can be dispersed from a sneeze or cough. (Osceola Sentinel-Tribune)

Fort Madison hospital celebrates 25^th anniversary
Fort Madison Community Hospital CEO Jim Platt talks about the hospital’s 25th anniversary at its current location along Highway 61 on the city’s west side. The complex has more than doubled in size over the last quarter century with the list of expansions including an urgent care facility, a medical clinic, a women’s enter, a wound center and an outpatient rehab center. Platt says it is actually one of the smallest projects, though, that stands out to him. (Tri-States Public Radio)

Preventive procedure: women agree with Jolie
Women who have inherited a “mutated gene” are five times more likely to be diagnosed with breast cancer. Tuesday, movie star Angelina Jolie announced she tested positive for the gene, and chose to undergo a preventive double mastectomy. “For those women who may be more on the fence as to what they want to do, what they don’t want to do, and those that judge women for making the decision, it makes them realize that this isn’t something crazy” said Pati Berger, a nurse and genetic coordinator at John Stoddard Cancer Center in Des Moines. (WHO-TV)

National News

Hospitals prepare to crimp services in Medicaid opt-out states
With 15 U.S. states opting out of President Barack Obama’s Medicaid expansion, hospitals that treat poor and uninsured patients are asking the government to delay $64 billion in planned funding cuts. Medicaid funds to hospitals with a disproportionate share of low-income patients will be cut 50 percent, or $14.1 billion, from fiscal 2014 through 2019, according to draft regulations to be published in the Federal Register tomorrow. The American Hospital Association wants to delay by two years the start of the cuts for Medicaid and for $49.9 billion in reductions by Medicare, the health program for the elderly and disabled. (Bloomberg Businessweek)

Ideology blinding Medicaid opponents
Research is clear, the uninsured who have less access to care are diagnosed with preventable conditions later, have worse outcomes from chronic conditions and are more likely to die prematurely than those with insurance. As an example, a week ago a local North Country HealthCare physician called me to ask what we could do for her uninsured patient who had a fractured ankle and needed surgery. The patient was told she had to pay $3,600 to get the surgery (the rest of the cost would have to be paid off after surgery) and didn’t have the money for this. Presumably her future ability to walk and work was at stake. Is this the situation we want people to endure? (Arizona Daily Sun)

Let the patient revolution begin
Partnering with patients must be seen as far more than the latest route to healthcare efficiency. It’s about a fundamental shift in the power structure in healthcare and a renewed focus on the core mission of health systems. We need to accept that expertise in health and illness lies outside as much as inside medical circles and that working alongside patients, their families, local communities, civil society organizations, and experts in other sectors is essential to improving health. Revolution requires joint participation in the design and implementation of new policies, systems, and services, as well as in clinical decision making. (British Medical Journal)