Featuring hospital and health care headlines from the media and the Web.
Obamacare repeal must not turn Iowa’s hospitals, citizens into victims
Congress should work to reverse hospital payment cuts that were reduced as part of the Affordable Care Act. The initial Obamacare cuts to hospital payments came through Medicare and Medicaid. That’s why millions who live in rural Iowa are relying on Congress to restore the hospital payment cuts that were made to help fund the passage of Obamacare. Without restoring these cuts, many local hospitals will be starved of hundreds of billions of dollars and will have no choice but to shut down critical services, putting the health of untold numbers of Iowa’s most vulnerable citizens at risk. (Newton Daily News)
County urges Medicaid management company AmeriHealth Caritas not to drop contract
The Johnson County Board of Supervisors is urging one of the three insurance companies that manage Iowa’s Medicaid program not to drop its contract with the county. The board is sending a letter to the company AmeriHealth Caritas in response to news last week that AmeriHealth would be changing its case management model, which could end contracts with current agencies — like Johnson County Case Management — and transition clients to in-house case managers. The move could impact the jobs of Johnson County’s 23 case management employees and more than 500 clients in the area who rely on those case managers for help accessing Medicaid services. (Iowa City Press-Citizen)
Like an angel coming to help: Osage family grateful for hospice services
Bob Frein’s eyes moisten when he speaks of the deep gratitude he has for the comfort hospice brought to him, his wife, Marlene, and their family more than a decade ago. Marlene was diagnosed with lung cancer and had grown worse, so the Freins contacted Hospice of North Iowa, who sent a representative to talk with the family. “The representative was like an angel coming to help us,” said Frein. “I was going downhill and the kids saw I was going downhill and so the hospice nurse, who came to our home went and talked with Marlene,” Frein said. Marlene knew it was time to go into the Mitchell County Regional Hospital’s hospice room. (Mitchell County Press News)
Hancock County Health System: Influenza widespread in Iowa
Influenza activity in Iowa is widespread, and, according to the Iowa Department of Public Health continues to increase. “Influenza activity has been identified in all six regions of the state,” said Denise Hiscocks, director of Hancock County Health System Community Health. “Just this week alone, the State Hygienic Lab confirmed more than 80 cases of influenza. The most common strain now is influenza A(H3).” (Britt News Tribune)
Connecticut hospitals launch TV ad to protest new tax proposal
Connecticut’s hospital industry launched a new television ad Thursday to protest Governor Dannel Malloy’s proposal to end nonprofit hospitals’ exemption from local property taxation. The commercial, developed by the Connecticut Hospital Association, opens by listing a variety of occupations and one common thread among the people in all of them: they all pay a price when taxes rise on Connecticut hospitals. “The proposed budget, with a scheme to let municipalities tax hospitals, has once again put hospitals and their services at risk,” said Jennifer Jackson, CEO of the hospital association. (CT Mirror)
House committee OKs involuntary hold plan for Kansans in mental health crisis
A bill that would allow treatment centers to detain Kansans in mental health crisis for up to three days moved forward Thursday after months of work to develop a compromise. A committee of law enforcement officers, treatment providers, mental health advocates and others met six times between legislative sessions to come up with a compromise bill that still fulfilled the original goal of providing short-term mental health care. Allowing crisis centers to hold patients for 72 hours will help reduce demand for beds at the state psychiatric hospitals. (KCUR)
Rural health providers head to DC to flex newfound political clout
In the past six years, dozens of rural hospitals around the US have discharged their final patients and turned out the lights, including three in North Carolina. And research shows there’s a persistent gap in life expectancy between rural and urban communities, with data showing that rural areas experience poorer health on almost every measure and have less health care infrastructure to support residents. More than 500 rural health care providers gathered last week in Washington, DC for the annual Rural Health Policy Institute, held by the National Rural Health Association. (North Carolina Health News)
GOP leaders provide new details about Obamcare repeal
House Republican leaders on Thursday presented to their members the most detailed look yet at their plan to repeal and replace Obamacare, though some key elements remain to be worked out. A packet distributed to lawmakers at the meeting and obtained by The Hill says the GOP bill will include tax credits, an expansion of health savings accounts, money for high risk pools to care for the sick and a major restructuring of Medicaid to cap federal payments. No dollar figures for any of the Republican proposals have been presented yet. Lawmakers said that is because the Congressional Budget Office is still analyzing the plan. (The Hill)
Trump administration is moving to reshape health insurance on its own
With congressional Republicans struggling to develop an Obamacare alternative, the Trump administration is taking steps on its own to loosen government regulation of the nation’s health insurance markets, a longtime conservative goal. Administration officials said the moves — which were detailed in proposed regulations released Wednesday — are necessary to stabilize Obamacare marketplaces that have been shaken over the last year by rising premiums and insurer exits. But the Trump administration’s moves to relax rules on insurers appear likely to shift additional medical costs onto patients by promoting higher-deductible health plans. (Los Angeles Times)
(This article was provided by Kaiser Health News.)
Yolanda Solar has battled a life-threatening disease for more than three decades. The disease nearly killed her last summer and Solar, a 73-year-old grandmother, was rushed to the hospital by ambulance.
When Solar was discharged one week later, she received bad news: She would have to wait until March to see a doctor.
Waiting seven months for treatment would be unthinkable if Solar had cancer or heart disease. But Solar suffers from severe depression, and waiting that long for help is typical — and potentially dangerous.
Although San Antonio has earned widespread praise for its success in keeping people with mental illness out of jail, patients here routinely wait months to see psychiatrists, who are in short supply across the country. The number of available psychiatrists who specialize in the care of the elderly or children is even smaller.
Without routine medical care, patients like Solar, who tried to kill herself in August with an overdose of pills, can quickly deteriorate. Many return to the emergency room. Some don’t survive.
But Solar was luckier than most.
Emergency room (ER) staff made an appointment for her at a transitional care clinic at the University of Texas Health Science Center at San Antonio, which annually treats up to 1,500 patients with serious mental illness until they can find regular care. The clinic helps the mentally ill avoid winding up in the ER, where round-the-clock activity and confusion is ill-suited to the needs of patients who are already agitated, suicidal or psychotic.
Communities like San Antonio are increasingly focused on reducing emergency room use by people with mental illness. In addition to being chaotic, emergency rooms are among the most expensive places in the health system to get urgent care.
Patients like Solar end up in the ER because they can’t find care in the community, and emergency rooms can’t legally turn anyone away. The mentally ill can be stranded in the ER for hours, days or even weeks with minimal treatment, because doctors deem them too disabled to discharge, but can’t find them an inpatient psychiatric bed, which would allow patients to get more intensive care.
More than half of emergency room physicians said their local mental health system has gotten worse in the past year, according to a survey of 1,716 members of the American College of Emergency Physicians, released in October. Seventy-five percent of ER doctors said on their last shift, they saw at least one psychiatric patient who needed to be hospitalized.
“The emergency department becomes the de facto dumping ground for all mental health patients,” said Gillian Schmitz, a San Antonio emergency physician.
The number of ER patients with a mental illness grew from 4.4 million in 2002 to 6.8 million in 2011, an increase of 55 percent, according to a 2016 study in Health Affairs. About 836,000 Americans a year go to the emergency room after harming themselves, according to the Centers for Disease Control and Prevention. Nearly 43,000 Americans committed suicide in 2014 — more than are killed annually in car accidents.
The American College of Emergency Physicians devoted much of its annual meeting in October to patients with psychiatric crises.
Everyone suffers when people with mental illness are stuck in limbo in the ER, Schmitz said. Other patients face longer waits for care and hospitals lose money. That’s because insurers pay emergency rooms only for their initial encounter with a patient, but not for time spent waiting for an inpatient bed.
“Every hour we are holding a psych patient,” Schmitz said, “is lost revenue that hospitals could be earning on other medical patients.”
Solar’s story also shows the progress that people with mental illness can make when they receive prompt and comprehensive care. She has not returned to the ER since beginning treatment in August.
Hospital staff scheduled her appointment at the transitional care clinic through a web-based computer system before she left the hospital. Like most patients, Solar was seen within a few days.
Solar now meets regularly with a psychiatrist, who manages her medications, and a counselor to discuss her fears.
A therapist visits her at home to help organize her medications, which include pills for high blood pressure and cholesterol. The visits are paid for through a Medicaid pilot program, which allows staff to provide extra services for up to five patients who are considered “high utilizers” of health care, or patients who are particularly costly to insurers because of repeat trips to the hospital or ER, said Megan Fredrick, the clinic’s program manager.
Patients with serious mental illness, which can cause cognitive changes similar to dementia, often need help with day-to-day tasks, said psychologist Dawn Velligan, project director at the transitional care clinic. Therapists help patients set alarms that remind them when to take their medicines. They work with patients on calendars and organizational skills, so that clients don’t miss appointments.
Through a type of therapy called cognitive adaption training, clinic staff teach basic skills, such as how to shop for groceries or take the bus to a medical appointment, Velligan said.
Only 2.5 percent of psychiatric patients seen at the transitional care clinic return to the ER within three months, compared to 10 percent of patients who aren’t seen at the clinic, Fredrick said.
Without the clinic’s help, Solar said, she would probably have considered suicide again.
“Sometimes, I get pretty, pretty, pretty depressed,” said Solar, who was raised by an alcoholic father. Her depression began, Solar said, during an unhappy marriage.
Yet for years, Solar suffered in silence. The first time she saw a psychiatrist was after her August suicide attempt.
Nationwide, more than half of people with mental illness go without treatment, according to Mental Health America, an advocacy group. The reasons are complex. Many people with mental illness don’t realize they’re sick, or that treatment can help. Some patients lack transportation or money to pay for care. About 17 percent of people with a mental illness in the U.S. are uninsured, according to Mental Health America.
“For many of our elderly Hispanic patients, this is the first time they’ve seen a therapist,” Cynthia Sierra, a clinic counselor. “You’re raised not to talk about your problems with strangers … You can carry years of burdens and trauma.
For all its success, the transitional care clinic can’t help everyone.
With an annual budget of $3.5 million — provided by a variety of grants and a fund for Medicaid demonstration projects — the clinic sees just a fraction of those who need help.
“We constantly have to beg for money,” Velligan said.
Although the transitional clinic accepts patients covered by Medicare, Medicaid or private insurance, it can’t accept most uninsured patients.
Psychiatrist Harsh Trivedi describes the program as a “Band-Aid” that fails to address the larger problem of inadequate care for people with mental illness.
“Unfortunately, creating these programs doesn’t actually solve the real access issues,” said Trivedi, chair of the American Psychiatric Association’s council on healthcare systems and financing.
Trivedi notes that the national shortage of psychiatrists means that even well-insured patients often have to wait for care. Although the overall number of physicians increased 14 percent from 2003 to 2013, the number of psychiatrists fell by 10 percent when adjusted for population growth, according to a July study in Health Affairs.
That shortage is projected to worsen over the next decade as large numbers of psychiatrists reach retirement age, said Trivedi, who is also the president and CEO of Sheppard Pratt Health System in Maryland.
Many psychiatrists have stopped taking insurance because health plans pay them too little to sustain a practice, Trivedi said.
To really help more patients, the country needs to rebuild the mental health system, investing both in outpatient care, more hospitals beds and supportive services, Schmitz said. Instead, states have been steadily slashing mental health budgets for years.
“As a society, we’re OK with the fact that someone with depression isn’t able to get care,” Trivedi said. “That double standard allows some of our most vulnerable people to end up in harm’s way.”
Featuring hospital and health care headlines from the media and the Web.
Youth flag football may not be safer than tackle
A new study from the University of Iowa (UI) Health Care has found that youth flag football may not be safer than youth tackle football. A team of UI researchers studied three large youth football leagues with nearly 3,800 participants comparing the number of injuries, severe injuries and concussions in players on flag and tackle football teams. Sports-related injuries are the leading cause of injury among children and adolescents. Results showed injuries were more likely to occur in flag football than in tackle football, however, there was no significant difference in the severity of the injuries between the two groups. (United Press International)
Small pacemaker brings big energy back to Iowa woman
It’s not every day you hear someone excited about chores, but 81-year old Trudy Hall of Ankeny has good reason. One year ago, Trudy was struggling to complete routine tasks around her home. Doctors quickly discovered the reason, and Trudy volunteered to be a test case for a medical device that had not yet been approved. “They told me that they had a brand new device, a pacemaker, and I thought, ‘oh my goodness,'” said Trudy. It was not just any pace maker-it was the world’s smallest pacemaker, about the size of a pill. The procedure was done at Mercy Medical Center West Lakes in Des Moines and because of the new Micra pacemaker, Trudy’s vitality is back. (WHO)
Man reunites with off duty officers, nurse who saved his life at the gym
Emotions ran high at Mercy Hospital in Omaha as Cory Kleindienst and his wife Kristine reunited with the men who saved Cory’s life at a metro gym. Omaha Police Officer Marc Van Sickle was also working out that day. He said, “I heard a female scream and I went to see what was going on. I saw Cory. He was laying down and he was blue and his hands were blue and his face was blue.” Bluffs Police Detective John Huey was also on the scene. “I saw that Marc was doing the chest compressions and thought right away, we’ve got to have an automated external defibrillator (AED).” A nurse, also at the gym grabbed a nearby AED. They used it to shock Cory back to life. (WOWT)
State approval of increased hospital beds in Florida could end this year
Certificate of Need (CON) has been a heated topic in Florida for years. But Senator Rob Bradley, who is sponsoring a repeal bill in the Senate, say the rules limit competition. “Repealing CON could create a two-tiered health system in Florida,” said Clint Shouppe, who represents BayCare Health System. “One for patients with good-quality insurance and one for Medicaid and charity care patients.” Hospitals offset the costs of charity care patients and low Medicaid rates with patients who have private insurance. And Shouppe said he worries new hospitals could open intending to treat only those whose health plans can pay full price. (Tampa Bay Times)
Montana legislator says hospital prices are out of control
Alarmed by rising health care costs, a Montana legislator is seeking to impose price controls on hospitals and place them under the authority of the state’s public service commission (PSC). Democratic Representative Tom Woods of Bozeman asserted Wednesday before the House Human Services Committee that Montana Hospitals have a virtual monopoly in many communities. He wants the PSC to review any increases in pricing. Montana Hospital Association Vice President Bob Olsen pointedly denied that hospitals were “ripping off consumers.” He said Montana hospital prices rank among the lowest in the country. (Associated Press/Washington Times)
Rural hospitals closing at an alarming rate
According to the North Carolina Rural Research Program, 80 rural hospitals have closed since 2010. On top of that, 673 vulnerable rural hospitals are teetering on the edge, according to a 2016 report by the Chartis Center for Rural Health. Rural America tends to be sicker, older and poorer than the rest of the country. The expansion of the Medicaid program under the Affordable Care Act provided coverage to millions of previously uninsured people from low-income households, including those in rural areas. By increasing the number of people with health insurance, the Medicaid expansion directly benefitted rural hospitals. (healthline)
New data show the nation’s uninsured rate hit a record low last year
The nation’s uninsured rate tumbled further last year, hitting the lowest rate on record, according to new government data that underscored what is at stake in the Republican effort to repeal the Affordable Care Act. In the first nine months of 2016, just 8.8 percent of Americans lacked health coverage, survey data from the federal Centers for Disease Control and Prevention show. That was down from 16 percent in 2010, when President Obama signed the health care law. But President Trump and GOP congressional leaders have pledged to roll back the law and replace it with something that will provide Americans with more affordable healthcare options. (Los Angeles Times)
Trump administration ushers in changes to Obama health law
The Trump administration took steps Wednesday intended to help calm jittery insurance companies and make tax compliance with former President Barack Obama’s health law less burdensome for some people. But the changes could lead to plans with higher annual deductibles, according to the administration’s own proposal. For consumers, the proposed rules mean tighter scrutiny of anyone trying to sign up for coverage outside of open enrollment by claiming a “special enrollment period” due to a change in life circumstances such as the birth of a child, marriage or the loss of job-based insurance. (Associated Press/Chicago Tribune)
Featuring hospital and health care headlines from the media and the Web.
BVRMC offers new 4K ‘big screen surgery’
Big screen surgery at Buena Vista Regional Medical Center (BVRMC) in Storm Lake now offers a new 4K ultra high-definition imaging system for unparalleled vision within the human body. BVRMC will be among the first in Iowa to use the Olympus VISERA 4K UHD System for minimally invasive surgery. The medical center announced the advancement late this week. The new system delivers four times the pixels, higher resolution, better light, and a wider color gamut than high-definition displays for a big screen surgery experience in the operating room. (Storm Lake Pilot Tribune)
New respiratory program opens at Regional Health Services of Howard County
Regional Health Services of Howard County in Cresco opened its new Respiratory Care Department and Cardiopulmonary Services last month. There are a number of services they can provide including pulmonary rehabilitation, coaching on breathing techniques to help treat your condition and at-home sleep tests. “We have an at home sleep test and it wraps around your chest and it has an apnea link and that is going to help you with your oxygen and tracking your snores,” says Rebecca Gardner, Respiratory Care Supervisor. (KIMT)
Changes ahead for inpatient cancer care at Mercy Medical Center
Some big changes are in the works for patients undergoing inpatient cancer treatment at Mercy Medical Center. The downtown Sioux City hospital is moving cancer patients from the seventh floor to the eighth floor. The seventh floor was devoted solely to cancer care, but on the eighth floor, cancer patients will share space with general surgery and urology patients. The consolidation is said to be happening for business reasons, most notably Mercy says it’s cancer unit is handling fewer patients than in years past. Mercy maintains there’ll be no change in the level of care patients receive. (Siouxland Matters)
Skiff Medical Center names new president
The leaders of Mercy Health Network have announced Laurie Conner will accept the role of president of Skiff Medical Center effective March 19. Conner has served as Skiff’s interim leader following the resignation of Brett Altman, who moved to a CEO position at Cass County Health System in Atlantic. Conner has served in various roles in her nine years with Mercy Medical Center. She was CEO for Dallas County Hospital, administrator for Mercy West Lakes and most recently vice president of business development for Mercy Des Moines. (Newton Daily News)
Angry town hall meetings on health care law in Wisconsin, and few answers
The questions from voters on display this weekend at a series of town-hall-style meetings in Wisconsin’s Fifth Congressional District, many of which were focused on the future of the health care law, underscored the quandary many lawmakers are facing even in solidly Republican districts. The imminent problem: Constituents want answers, and without any consensus on how to go about replacing the law, Republicans have little to say. (New York Times)
Major Ohio hospitals join together for a trauma care network
Cleveland Clinic, MetroHealth and University Hospitals in Ohio have joined together to create a new Northern Ohio Trauma System (NOTS), which will provide coordinated trauma care to patients throughout the seven-county Northeast Ohio region. The NOTS network was originally formed in 2010 between MetroHealth and Cleveland Clinic, and NOTS assisted the City of Cleveland public safety forces to get the right patient to the right place at the right time for their care. NOTS members will coordinate with public safety forces and network hospitals to ensure patients are rapidly triaged and taken to the appropriate level of care within the network. (Cleveland Plain Dealer)
Religious vaccine exemptions on the rise in New Jersey
More parents in New Jersey are choosing religious exemptions for child vaccinations, resulting in a steady increase in unvaccinated schoolchildren. The number of state religious exemptions among children in primary school more than doubled within a six-year period. The number of unvaccinated school-age children has public health experts worried, while vaccine-choice supporters say families are making the best decisions for their kids. Experts do say they are concerned rising exemptions will weaken “herd immunity” for those who depend on others for protection. (Miami Herald)
Trump administration tightens Obamacare enrollment rules
The Trump administration has released its first big Obamacare rule, and it tightens several rules for enrollment to try to “stabilize” the individual health insurance market. Now, health insurers could refuse to cover a person who hadn’t paid some of their premiums during the past year until they’ve paid their debts. The open enrollment period for next year will be shorter and anyone who tries to sign up outside of the open enrollment period through the HealthCare.gov website will have to prove they’re eligible. Insurers will have greater flexibility in determining the level of coverage in their plans and states will get to decide whether health insurance plans have adequate networks of doctors and hospitals. (Axios)
A deep dive into 4 GOP talking points on health care
Republican leaders have a lengthy list of talking points about the shortcomings of the health law. And they can point to a host of issues, including premium increases averaging more than 20 percent this year, a drop in the number of insurers competing on the Affordable Care Act marketplaces and rising consumer discontent with high deductibles and limited doctor networks. Yet a careful analysis of some of the GOP’s talking points show a much more nuanced situation and suggest that the political fights over the law may have contributed to some of its problems. Kaiser Health News provides an annotated guide to four of the most common talking points Republicans have been using. (Kaiser Health News)
Featuring hospital and health care headlines from the media and the Web.
‘Certificate of Need is more important than ever’
A significant reason for health care excellence in Iowa has been state oversight of institutional health care services through the Certificate of Need law. As the name implies, Certificate of Need ensures that new medical services are truly needed at the community level. This is important because new facilities must have sufficient patient volumes to support proficiency among medical staff and ensure high-quality care. Today, with the uncertainties surrounding the future of the Affordable Care Act, Iowa’s Medicaid program and even Medicare, the constancy of Certificate of Need is more important than ever. (Daily Iowegian)
Program for Eastern Iowa girls teaches hundreds about STEM careers
Cardiopulmonary resuscitation. How to suture wounds. The importance of noting observations during a scientific experiment. These are just a handful of topics that nearly 200 middle school girls from Eastern Iowa learned about this past weekend during a University of Iowa program that aimed to reverse a longtime trend. On Saturday, 191 middle school students gathered in the Medical Education Research Facility on the UI campus for the sixth annual Girls Go STEM event, which focuses on teaching participants about STEM — Science, Technology, Engineering and Math, careers. (Cedar Rapids Gazette)
Healthy talent: Iowa art focus of UnityPoint Health-Prairie Parkway collection
Experts say there is an art to acquiring a corporate collection that completes a space in a visually interesting way and also has meaning to people who work at and use the facility. When it was time to choose artwork for the new UnityPoint Health-Prairie Parkway Clinic, the focus was on Iowa artists. The works of 13 artists are displayed throughout the new clinic, and with the exception of one piece, all of the artwork was created by Iowans. “Health care is really local, and it’s a community asset. We really wanted the art to reflect the community we serve,” says UnityPoint-Allen CEO Pam Delagaredelle. (Waterloo-Cedar Falls Courier)
New Jersey audit confirms what patients have long said: Medicaid doctors hard to find
Advocates for low-income patients in New Jersey have long insisted that medical care is harder to find than it looks on paper. A recent state audit seems to have proved them right, identifying numerous inaccuracies on lists of Medicaid providers that insurance companies have submitted to regulators and posted online for policy holders. While the audit found quarterly reports from the insurance companies involved with the program often contained inaccuracies, it placed the responsibility for these problems on regulators at the Department of Human Services charged with overseeing these managed care contracts. (New Jersey Spotlight)
New Hampshire Governor says Medicaid expansion yields great results
Governor Chris Sununu says New Hampshire’s expanded Medicaid program has been a success. That conclusion is a shift from his prior statements about the program, which has provided health insurance to more than 50,000 people in the state. “There’s no doubt it’s been helpful,” Sununu said. “It was a price tag of somewhere between $400 and $500 million. We’ve been able to do it to date without a single New Hampshire taxpayer dollar. No state taxes go into it.” (New Hampshire Public Radio)
Georgia governor signs hospital provider fee to fill Medicaid gap
Georgia’s Medicaid program received a shot in the arm Monday when Governor Nathan Deal signed a measure into law that will avert a roughly $900 million gap in Medicaid funding. The so-called “bed tax” requires hospitals to pay 1.45 percent of their net patient revenue, which the state then uses to draw down additional federal funding to help fund Medicaid and bolster hospitals that provide care to uninsured patients. The governor signed the bill into law, which allows the Department of Community Health board to levy a hospital provider fee for an additional three years. (Atlanta Journal-Constitution)
Trump travel ban spotlights U.S. dependence on foreign-born doctors
Dr. Muhammad Tauseef was born and raised in Pakistan. After going to medical school there, he applied to come to the U.S. to train as a pediatrician. After training he had two options: return to Pakistan or work for three years in an area the U.S. government has identified as having a provider shortage. And the U.S. medical system depends on doctors like Tauseef, says Dr. Andrew Gurman, president of the American Medical Association. He worries that if President Trump’s executive order on immigration takes effect, it will mean parts of the country that desperately need medical care may not have a doctor. (NPR)
Why high-risk pools won’t crack the pre-existing condition dilemma
Some Republican leaders are promoting state high-risk pools as an alternative to the Affordable Care Act’s (ACA’s) popular provision requiring health plans to accept consumers regardless of pre-existing medical conditions. They cite Wisconsin’s pre-ACA pool, the Health Insurance Risk-Sharing Plan, as a model. But a Wisconsin insurance official recently cautioned a House panel that high-risk pools need a stable funding source and are not a solution for every state. Other experts say state high-risk pools generally were a policy failure across the country, and making them work properly would require a large amount of taxpayer funding. (Modern Healthcare)