The White House has released rules concerning the provision in the health care reform law that allows young adults to stay covered under their parents’ insurance up to age 26. The U.S. Department of Health and Human Services has estimated this proposal would expand access to 1.2 million young adults across the country.

The rules do not go into effect until September 23, although several insurance companies across the nation, including Wellmark Blue Cross and Blue Shield of Iowa, have elected to implement the policy earlier.

Trends show that patients in the young adult age group are less likely to have insurance, which places burdens on hospitals in areas with high volumes of young adults. Mike Tretina, CFO at Mary Greeley Medical Center in Ames, home to Iowa State University, says that the hospital has budgeted $670,000 in uncompensated care to offset the cost of treating students or other young adults who do not have insurance.

Tretina hopes that the new provision will help to encourage parents to add their children to their coverage to reduce the number of young adults who are uninsured, and thereby reduce uncompensated care costs for hospitals.

Since 2008, Iowa law has allowed young adults up to age 25 to stay on their parents coverage.  The new federal provision adds an additional year, but it’s up to parents and young adults to take advantage of these benefits.

Nationwide, according to a White House fact sheet, estimates show that young adults comprise the largest percentage of uninsured of any age group, with an estimated 1 out of every 5 uninsured American falling in this age group.

It’s official: Health care reform guru Donald Berwick has been formally announced by President Obama as his nominee to head the Centers for Medicare & Medicaid Services (CMS).  The first sentence of the president’s two-sentence statement about Berwick succinctly addresses why he was chosen: “Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost.” 

Bringing real value to government-supported health care will be Dr. Berwick’s foremost challenge.  And with health care reform set to trim billions of dollars from the Medicare program while adding millions of new enrollees to Medicaid, it is a formidable challenge, indeed. 

But Dr. Berwick has two things going for him.  First, he knows what he is talking about.  His work and leadership at the Institute for Healthcare Improvement (IHI), which he cofounded nearly 20 years ago, has led to changes in the way hospitals provide health care that have saved lives, lowered costs and improved quality.  IHI’s current initiative, it’s “Improvement Map,” is perhaps its most ambitious.  

The Improvement Map is an interactive, Web-based tool designed to bring together the best knowledge available on key process improvements that lead to exceptional patient care. It offers clear guidance through the often confusing health care landscape, helping hospitals set change agendas, establish priorities, organize work and optimize resources.  The Improvement Map is also a testament to IHI’s dedication to shared learning, which it established from its beginning through collaboratives, learning networks and mentor hospitals (among these are Mercy Medical Center and St. Luke’s Hospital in Cedar Rapids, University of Iowa Hospitals and Clinics in Iowa City and Buena Vista Regional Medical Center in Storm Lake). 

But leaders succeed only when they energize followers, and that is Dr. Berwick’s other strength.  Throughout the medical world, Dr. Berwick is highly respected not only for his ideas but for his ability to bring key players to the table and keep them there.  Time and again, Dr. Berwick has been described as “a visionary.”  Hospital leaders in Iowa continue to be pleased about his nomination: 

“I was very excited to hear of the nomination of Dr. Don Berwick as the administrator for CMS,” said Jim FitzPatrick, CEO at Mercy Medical Center-North Iowa in Mason City.  “Dr. Berwick has spent his career on a quest for improving quality in the nation’s health care system.  His passion for improving processes for our patients and keeping focus on the ‘big dot’ issues to eliminate defects in care makes him the perfect leader for CMS. 

“Dr. Berwick’s appointment to CMS would be very positive for the health care industry,” said Eric Lothe, administrator at Iowa Lutheran Hospital in Des Moines.  “He has a long history of setting transformational goals for health care quality and then achieving great results.  Dr. Berwick would continue the focused work of IHI to help physicians and hospitals improve quality, reduce errors and eliminate adverse events.” 

The real question is, can Dr. Berwick’s ability to unite diverse interests come through in a U.S. Senate that remains bitterly divided over health care reform?  Can he show that not only can Medicare and Medicaid lead the way in improving care, but they can do it at less cost?  And can he hold his ground should talk of “rationing” and perhaps even “death panels” rear its ugly head? 

Answers should come fairly quickly, as Dr. Berwick’s first stop will be in front of the Senate Finance Committee and its ranking Republican, Iowa’s own Chuck Grassley.

On this week’s Iowa Journal on Iowa Public Television, host Paul Yeager discussed the new health care laws with representatives of Iowa insurance, business, Medicaid and hospitals.

IHA President and CEO Kirk Norris joined Jim Swift, Chairman and CEO of Holmes Murphy and Associates, an insurance brokerage firm with more than 500 employees and Jennifer Vermeer, Director of Iowa Medicaid, which is the third largest provider of insurance in Iowa.

Watch the video here.

Federal health care reform legislation cleared the U.S. House with a final vote of 219-212 this weekend.  This vote completed the legislative process on the Senate’s bill, H.R. 3590, and sends the bill to President Obama for his signature.  The House also passed a “side-car” bill, H.R. 4872, containing legislative fixes that will now be sent to the Senate for its consideration.  The Senate will use the procedural reconciliation process which allows the chamber to pass legislation with a simple majority of 51 votes rather than the 60 as required under Senate rules.

IHA’s take on the bills as passed by the House:

Overall: The legislation passed by the House and Senate have addressed many of the concerns that affected hospitals in the original proposals.  The resulting legislation will bring about positive reforms for the health care industry by increasing access to health insurance coverage for citizens while also holding the immediate and long term potential of increasing the historically low payments for Iowa hospitals and physicians.

Insurance Coverage: Having millions more people covered by insurance is good news for hospitals.  Hospitals across the state have seen a notable increase in charity care cases, often because people have lost their jobs and their insurance.  The cost of that care eventually impacts those who do have insurance.  The larger the pool of insured people, the lighter the impact.  And when people have insurance, they are more likely to receive routine care – i.e., check-ups, immunizations, etc. – and avoid serious and expensive illnesses.  This legislation provides access to coverage to 30 million Americans.  Iowa currently enjoys a relatively low uninsured rate, but this legislation seeks to make health insurance more portable, while also making important reforms to the insurance industry.

Cost: We believe the legislation holds the potential to reduce costs by insuring more people (as explained above) and improving the way health care is provided.  The bill emphasizes providing care at the primary level (by providing higher Medicare payments to primary care physicians, for example).  Together with greater numbers of insured, the emphasis on primary care should help establish “medical homes” for more people, a model of care based on the primary care physician that improves quality of care and reduces cost.

Geographic Variation: Iowa’s congressional delegation has made a bi-partisan effort to address geographic inequities in hospital payments across the U.S.  Iowa will benefit from the negotiations as the legislation contains critical reforms that will increase payments to hospitals and physicians that have remained stagnant for decades.  For the first time, the Medicare program will finally recognize value over volume and incent and reward providers that provide the highest-quality of care at the lowest cost like that provided in Iowa hospitals.

IHA will remain actively engaged in the process as the reconciliation bill now moves to the Senate for debate, and applauds the work done thus far by Iowa’s Congressional Delegation that worked to address the issues surrounding geographic variation that negatively impacts payments to hospitals and physicians in Iowa.

Todd Linden, CEO at Grinnell Regional Medical Center, did a nice job this week on his blog talking about “health care” versus “sick care”: 

The health care system in this country has really been more of a “sick care” system. Too much emphasis has been on mending bodies after health has left them. We have shielded folks from the true cost of health care through the proliferation and misuse of health insurance. The personal responsibility for maintaining optimal health has not been incented in the system. Although a growing number of Americans are health conscious, it is hard to deny the obvious epidemic of poor health. 

The “sick care” issue is at the foundation of health care reform.  It is one of the reasons health care and health insurance costs have risen.  We live in a very healthy society and most of us take it for granted, even though it was only 70 or 80 years ago that thousands of Americans were killed by accidents and diseases that scarcely exist today.  Advances in medicine, safety and nutrition keep people out of the hospital.  And when they go to the hospital, advances in treatment – like minimally invasive surgery – mean procedures are safer, recovery is faster and the likelihood of complications is greatly reduced. 

Our good health also comes with our good insurance coverage.  Since World War II, we have been a well-covered society.  On the up side, this has given broad access to the health care system and increased both the quantity and quality of life.  On the down side, as Todd notes, it has shielded health care users from the real cost of care and incented providers to offer more but not always better care. 

People don’t like going to the hospital and today they almost never have to.  But when they do go unexpectedly, it can be quite serious and very expensive.  For those with insurance, there is little incentive to prevent these occasions – the relatively low out-of-pocket cost and the fact that even very sick people are healed is what most of us see and remember.  For those without insurance, the result is often even more serious illness as they delay treatment. 

Certainly, we need to make sure as many people as possible are insured.  But how our society “uses” health care must also change and hospitals are helping make that happen with a focus on prevention and wellness.  This has been going at Grinnell Regional Medical Center in many ways and for several years, as Todd mentions.  In fact, every Iowa hospital provides services and programs that support prevention and advance wellness.  But hospitals are doing more than putting out the water and waiting for the horses to come around.  They are actively working to change our health care culture, to change our society’s mindset and put a focus on wellness. 

But cultural shifts don’t happen overnight.  It will take all of us, as health care consumers and providers, to create a true “health care” system.