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

Iowa News

As Iowa GOP honors Branstad, US Senate plans China confirmation hearing
Terry Branstad unspooled a greatest hits of anecdotes, sayings and advice from his long tenure as Iowa’s governor on Tuesday, during a reception celebrating his political career and looking forward to his new role as a diplomat. A six-term Republican, Branstad has been nominated by President Donald Trump as the US ambassador to China. At this point, he could be on his way to Beijing by the end of May. (Des Moines Register)

Swing-state Iowa pivots to the right with GOP now in control
Iowa has been a swing state for decades. But this legislative session, the state swung decidedly to the right. Republicans in Iowa asserted a broad mandate after winning complete control of the state’s government in November, enacting a sweeping conservative agenda unlike anything seen in the state. Perhaps no state experienced a political jolt like Iowa. Democrats are struggling to return to power in Iowa, as the state is increasingly trending toward Republicans. (The Hill)

Iowa nonprofit helps redistribute drugs
Every week in Des Moines, the employees of a small nonprofit, SafeNetRX, collect bins of unexpired prescription drugs tossed out by nursing homes after residents died, moved out or no longer needed them. At a time when anger over soaring drug costs has perhaps never been more intense, redistributing discarded drugs seems like a no-brainer. “There are literally millions of dollars of prescription medications thrown away every day in this country,” said John Forbes, an Iowa pharmacist who dispenses SafeNetRx’s recovered drugs to his low-income patients. (ProPublica)

Iowa’s gonorrhea infection rate up 75 percent since 2013
Reported cases of gonorrhea infections in Iowa are up 75 percent in the last three years, according to preliminary data from the Iowa Department of Public Health (IDPH). The department says while Iowa’s overall infection rate isn’t unusual, the sudden increase in infections from 2013 is unique. Part of the reason for this increase is that providers are conducting more comprehensive testing, which has identified cases that would have otherwise gone undetected. (Iowa Public Radio)

National News

Rural hospital in East Georgia to close, citing economic pressures
Another rural hospital is closing its doors in Georgia. Jenkins County Medical Center in Millen will close in June, and its services will merge with a hospital in Sylvania in neighboring Screven County. Jenkins will become the seventh Georgia rural hospital since the beginning of 2013 to close. Many other such hospitals are financially imperiled. Georgia’s decision not to expand Medicaid has hurt the hospital industry, health care experts say. (WABE)

Health care operator eyes distressed Topeka hospital
A group that specializes in turning around distressed hospitals has expressed interest in acquiring a Topeka hospital whose financial troubles have reinvigorated debate about Medicaid expansion in Kansas. California-based Prime Healthcare’s nonprofit arm notified Governor Sam Brownback last week that it has “potential interest” in “saving” St. Francis Health. St. Francis hospital’s problems also have advocates promising to push again to expand the state’s Medicaid program under former President Barack Obama’s signature health care law. (Associated Press/Kansas City Star)

Legislature set to tackle changes to “Arkansas Works” Medicaid expansion in special session
The governor of Arkansas is expected to call the special session to get legislative approval of his proposed alterations to Arkansas Works — the state’s unique version of Medicaid expansion. Governor Hutchinson announced last month that he will seek a federal waiver of Medicaid rules to enact a series of changes to the Arkansas Works program. The governor’s plan imposes significant new burdens on beneficiaries, including work requirements and enforceable premiums. (Arkansas Times)

Key provisions of proposed GOP health care compromise
House Republicans are debating a proposed compromise that might help them revive stalled legislation to roll back much of Democratic President Barack Obama’s health care law. The broader bill would rework subsidies for private insurance, limit federal spending on Medicaid for low-income people and cut taxes on upper-income individuals used to finance Obama’s overhaul. (Associated Press/New York Times)

What changed in the health repeal plan to win over Freedom Caucus
A month after pulling their health care overhaul bill from the floor, House Republicans are growing increasingly confident that they may have found a way to pass it. An amendment drafted by Tom MacArthur, a New Jersey congressman, would keep much of the American Health Care Act in place. But it would set up a waiver program that would allow states to apply to eliminate three major insurance regulations established by Obamacare. (New York Times)

David Clark is a nurse anesthetist at Montgomery County Memorial Hospital in Red Oak. He recently had a kidney transplant. In honor of April being Donate Life Month, he decided to tell his story. Here it is in his own words.

My name is David Clark and I have kidney disease.

I found out when I was 17. It was just a fluke, really. I was in a high school health class that visited the local hospital for a day. They sent me to watch some ultrasound procedures in X-ray, but that particular time they had no patients so they used me to perform an ultrasound. The tech said, “Let’s look at your kidneys. Everybody likes seeing kidneys.”

Well, not very many people had kidneys like mine. Mine were full of cysts. It kind of freaked out the tech, but polycystic kidney disease (PKD) runs in my family so I was not shocked. My mom, my aunt, and both of my sisters had it, as well as countless past relatives that I never knew.

Being so young, I failed to fully realize the seriousness of this discovery. I told my mom about it and all she said was, “Don’t tell anyone about it or you won’t be able to get life or health insurance.” You see, one of my sisters also found out at a young age during a scheduled test so it was in her permanent health record. She never could get private health or life insurance unless she participated in a group plan, so I kept it secret. I told no one. I think for a while I even convinced myself that my kidneys were just fine. They weren’t.

Polycystic kidney disease is the most frequently inherited disease in the United States. More than 600,000 people in the U.S. have it, and more than 12 million suffer worldwide.

PKD causes the formation of cysts in the kidney that grow over time. These cysts grow and push normal tissue out of the way and slowly affect the function of the kidney. Kidneys can grow to be the size of footballs and weigh up to 20 pounds. Mine were almost the size of a football.

Since the kidney is over-engineered, it takes a long time to see any changes, but inevitably, kidney failure is the end result. There is no cure. Options are dying, dialysis or a kidney transplant.

If you have never heard of PKD, you are not alone. We are pretty quiet about it. It’s not a glorious disease, and patients have a reputation of being difficult. We get cranky and itchy and have leg cramps. We are generally short-tempered. These are generalizations, of course. Some get along pretty well (like me) and some are completely disabled by their symptoms.

About 16 years ago, I had a bad kidney stone attack that landed me in the hospital and led to a three-hour surgery to remove the three stones. Needless to say that the cat was out of the bag. My polycystic kidney disease was in the open. I decided to start seeing a nephrologist to monitor my condition. For 15 years, I did just that.

In 2015, notable changes started. My kidneys had reached a point where they could not keep up as much and lab values began to rise. As my levels continued to rise, the symptoms of kidney failure began to get worse; itching that would not go away, being tired all the time no matter how much sleep I got, irritability, and frequent nausea with eating.

In January of 2016, my levels reached the point where I qualified to be put on the kidney donor list. This meant a complete two-day workup, about a gallon of blood draws, and counseling. Once I was approved and put on the donor kidney waiting list, I was told that the average wait time for my blood type was 18 months unless the perfect kidney presented. I was to remain within a two-hour radius of Omaha and to avoid getting sick. A donor could be found at any time and I would have to drop whatever I was doing a report to the hospital.

Average wait time of 18 months – I didn’t think my native kidney would keep working well enough to keep me from needing dialysis for that long!

Why is the wait so long? There is a lack of kidney donors. There are more needs than can be filled in a timely fashion.

In the early morning of last Aug. 11, I got a call from the Nebraska Medicine Transplant Office. They had a kidney for me. I had only been on the list for four months. I definitely was not expecting a call this soon. I was speechless.

Several things went through my mind – first, disbelief, then panic, then excitement. My wife and I had to make several quick phone calls to family and work (I was on call at the time), pack up some things, and then drive quickly to Nebraska Medicine to check in. That day was a whirlwind of activity with final tests, visits with all the staff that would take care of me, and family coming in.

After waiting 20 hours I was finally taken in for my transplant. For me, the next thing I knew was waking up and in a little pain. It was all over. Just like that I had a new kidney! My doctor said everything went great and that the kidney was already working hard. What a special thing that was to hear.

I later learned that I received what amounted to the perfect kidney and that is why I was moved to the head of the line. My doctor said that even a family member donor would probably not have been as good of a match as the one that I received.

Now for the hard part of the story.

In my case I received a donor (cadaver) kidney meaning someone had to die first before the kidney was made available. Someone died for me to live. I am grateful for the gift and blessings I received that day but somewhere out there was a family grieving at their loss. For a long time I took that very hard and would get emotional just thinking about it.

In December I received a special holiday surprise – a couple of letters from the mother and aunt of my kidney donor. I found out who my donor was. When I say I found out who she was, I don’t just mean her name. I mean I “found out” who she was. What I learned that day was that there is a higher power out there and He works in very mysterious ways.

This person was not only a match to me physically, but we were also a match in our personal lives. Personality, interests, temperament – all were a good match. This person had been involved in a car accident 10 years ago that almost claimed her life. She survived, but that accident changed her.

That was when she made the decision to become an organ donor. She also informed her family and they supported her decision. I say this because until I read that letter, I was feeling guilty. I am still emotional about the whole thing but not guilty anymore. Her family is grateful that her death was not the end of her story. A part of her is living in so many other people. Her mother expressed thankfulness that I was blessed with this gift of life. My donor’s nickname was “Ladybug” and out of tribute to her I have named my new kidney “Ladybug.”

My life has been changed by the gift of a kidney donor. As a result of my experience, most of my wife’s family has decided to become organ donors. I hope and pray that more people hear stories that impact the way that they feel about organ donation. There is so much need out there.

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

Iowa News

‘State of Addiction’ shines a light on Iowa’s opioid problem
Opioid overdoses killed 67 Iowans in 2016. That’s double the number from 2005. On Tuesday, health experts, victims and families got together on KCCI’s “State of Addiction” special to make sure that powerful pain medications are used but not abused. The show, which was broadcast from Mercy Medical Center, marks a milestone in a yearlong project of reporting on opioid abuse. Producer Julia Manning said it is about recognizing the struggle, hearing from victims and getting answers from health care experts and law enforcement officials. (KCCI)

Grassley visits med center: forget ‘Trumpcare’
US Senator Charles Grassley couldn’t make it for the dedication of a $26 million expansion at Buena Vista Regional Medical Center earlier, but took advantage of Congress’ Easter break to tour the facility last week and answer questions for about 50 health care workers. The Senator wasn’t surprised to hear concerns about a health care plan – or lack of one. “I would like to tell you I can pass one more bill that will solve all the issues, but that’s not going to happen,” Grassley told the crowd of hospital staff. (Storm Lake Pilot Tribune)

National News

Rural doctors’ training may be in jeopardy
Budget decisions in faraway Washington, DC, may make it more difficult for doctors who want to practice in small towns or underserved cities. Under the Teaching Health Center Graduate Medical Education program, which is part of the Affordable Care Act, the federal government dispenses grants to community health centers to train medical residents. The goal of the program is to address the shortage of primary care physicians in rural and poor urban areas. But the federal government will stop funding the program at the end of September. (Stateline)

Ideas and a sense of urgency permeate Georgia rural health care symposium
For many rural hospitals in Georgia, the threat of closure is constant. The state has one of the highest closure rates for hospitals in the nation, and those numbers do not show any sign of slowing. Policymakers, medical professionals and those interested in rural health care converged at a symposium at the University of Georgia School of Law last week to discuss the unique challenges of rural medicine. Legislators are also passing new laws aimed at helping struggling hospitals. (Georgia Health News)

Lack of access to mental health services concerns health execs in New Hampshire
Executives from six of New Hampshire’s largest health care systems wrote to Governor Chris Sununu recently to express their “deep concerns” about access to mental health services in the state and the backlog of patients in emergency rooms awaiting admission to the state’s psychiatric hospital. The state recently added 10 beds to the state hospital, but that has had minimal effect on easing the backlog of individuals waiting in hospital emergency rooms, which at times has exceeded 50 patients statewide. (New Hampshire Union Leader)

Hospitals could lose $250B from MACRA, study finds
A new study in Health Affairs found that Medicare hospital reimbursement could decrease $250 billion – or could even increase by $32 billion depending on the model – over a 15-year period under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The researchers projected Medicare payment policy from 2015 to 2030 under four scenarios and found hospitals could take a financial hit as physicians get used to the different value-based payment model. (Healthcare Dive)

Republicans finalize new Obamacare repeal proposal
The White House, top House conservatives and a key moderate Republican have finalized a new Obamacare repeal and replace plan they hope will break a month-long logjam on a key priority for President Donald Trump. But it is far from clear that the fragile agreement will provide Speaker Paul Ryan the 216 votes needed for the House to pass the stalled legislation. Optimism is growing among Republican officials on the Hill and in the White House. (Politico)

The uninsured rate among veterans less than age 65 declined by nearly 40 percent during the first two years of the Affordable Care Act (ACA), according to a new study by the Urban Institute with funding from the Robert Wood Johnson Foundation.

The uninsured rate fell from 9.6 percent in 2013 prior to ACA, to 5.9 percent in 2015, according to the report. Approximately 429,000 veterans gained coverage, and the gains were broad-based across demographic groups.

Among veterans ages 45 to 54 and those who served in the era between the Vietnam and Persian Gulf wars, the uninsured rate dropped by almost 50 percent.

Before the ACA’s implementation, nearly one million veterans — almost one in 10– were uninsured, the study said. By 2015, the number of uninsured veterans fell to 552,000.

While many veterans have access to healthcare through the Department of Veterans Affairs, not all use or qualify for these services, the report said.

The study found that Medicaid expansion also helped to lower the uninsured rate for veterans. The uninsured rates in 2015 averaged 4.8 percent in expansion states, compared to 7.1 percent in states that didn’t expand the program. Iowa is one of 31 states that have expanded Medicaid.

For veterans with incomes up to 138 percent of the federal poverty level and eligible for Medicaid in expansion states, the uninsured rate dropped by 43 percent.

Veterans’ families also benefited from ACA, the study said. Using data from the 2013–2015 American Community Survey, researchers found uninsured rates for veterans’ spouses dropped from 9.2 percent in 2013 to 5.5 percent in 2015 and from 4.5 to 2.9 percent for their children.

Among black and Hispanic veterans, uninsured rates fell from 10.6 to 6.5 percent and from 11.0 to 7.1 percent, respectively, by 2015.

“The coverage provisions of the ACA have led to a 40 percent decline in uninsurance for non-elderly veterans,” said Katherine Hempstead, senior adviser at the Robert Wood Johnson Foundation. “Expansion of Medicaid in remaining states would increase those gains.”

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

Iowa News

The $12M patient that drove insurance rates higher in Iowa
David Anderson, a research associate at Duke University Margolis Center and former health insurance official, discusses Iowa’s exchange market in a recent post on his health care blog called Balloon Juice. He notes that Iowa’s exchange market is facing many of the same challenges as those in other states, but it is also experiencing the unique problem of providing insurance to an individual with $12 million in annual medical claims. (Becker’s Hospital Review)

Event honors organ donors, recipients
Emotions ran high as two speakers told their organ-donation stories on April 21. The message behind the stories was simple — register as an organ donor to give someone a second chance. The University of Iowa Hospitals and Clinics held an annual event on April 21, called Gift of Life Ceremony, to recognize donors and recipients saved by organ donations. “I hope the message to the audience is that donation and transplantation are life-changing for both the donor family and the recipient,” said Suzanne Witte, coordinator of the Family Support Program. (Daily Iowan)

National News

Community mental health groups in Michigan worry about privatization
Community mental health groups fear that their funding and management could be transferred to private insurers under a budget proposal that emerged. The plan suggests it would align with Governor Rick Snyder’s proposal last year to move $2.5 billion of community mental health Medicaid money to private insurers in the state’s Medicaid health plans. The National Alliance on Mental Illness in Michigan and other mental health leaders have voiced their concerns about having the health plans in charge. (Associated Press/Charlotte Observer)

Change in 52-year-old Medicaid rule will expand Ohio’s mental health care
A change in a federal Medicaid rule that has stood for 52 years is expected to allow more Ohioans to get badly needed mental health services. Effective July 1, Medicaid recipients ages 21 to 64 who are in a managed care plan will be eligible for up to 15 days of inpatient mental health treatment. Terry Russell, executive director of the National Alliance on Mental Illness Ohio, said his organization endorses the prospect of getting help more quickly for more people in need. (Columbus Dispatch)

Minnesota hospital confronts dilemma of opioid addicts who are expectant moms
For the first time, a concentrated effort at Sanford Bemidji Medical Center in Minnesota supports addicted mothers before their deliveries has started to make a difference. And hospital leaders across Minnesota are hoping to expand on the success of Sanford Bemidji’s First Steps to Healthy Babies program to combat a worsening opioid epidemic. Dr. Rahul Koranne, chief medical officer of the Minnesota Hospital Association, said, “Our viewpoint is that every mom should be assessed for this.” (Minneapolis Star Tribune)

States move to help insurers defray costs of sickest patients
As congressional Republicans’ efforts to repeal and replace the Affordable Care Act remain in limbo, the Trump administration and some states are taking steps to help insurers cover the cost of their sickest patients. The fix is a well-known insurance industry practice called reinsurance. Claims above a certain amount would be paid by the government, reducing insurers’ financial exposure and allowing them to set lower premiums. (Kaiser Health News)

Government shutdown, health bill rescue at stake in Congress
Bipartisan bargainers are making progress toward a budget deal to prevent a partial federal shutdown this weekend, a major hurdle overcome when President Donald Trump signaled he would put off his demand that the measure include money to build his border wall with Mexico. Republicans are also vetting proposed changes to their beleaguered health care bill that they hope will attract enough votes to finally push it through the House. (Associated Press/Washington Times)