Featuring hospital and health care headlines from the media and Web from December 12-December 18.

Iowa Headlines

Harkin takes to radio, TV to back bill
The Iowa Democrat has been dispatched to ease the concerns of liberal groups and leaders who have voiced their frustrations with compromises the Democratic leadership has made to hold together its tenuous coalition. (December 18, Des Moines Register)

Union membership to decide whether to back Culver, leader says
Whether Iowa’s largest public employee union will work to help Democratic Gov. Chet Culver in his re-election bid will be up to the members of the union, its leader said Friday. GOP challengers are lining up for the chance to take on Culver, who is expected to seek his second term next year. Support for Culver from at least one union is not yet assured. (December 11, Waterloo-Cedar Falls Courier)

Official: UIHC turns financial corner
University of Iowa Health Care officials say the hospital has “turned the corner” after months of financial woes, and they are prepared to move forward with work on a new outpatient clinic in Coralville.  (December 17, Iowa City Press-Citizen)

Allen Child Protection Center to open next year
Each year more than 100 sexually or physically abused Black Hawk County children are sent to Cedar Rapids for a forensic interview and treatment. Nina Thomas has made that journey to the St. Luke’s Child Protection Center with several young people. She has seen the extra stress placed on the families and the child. (December 14, Waterloo-Cedar Falls Courier)

We should shoot for higher Iowa health ranking
Just as the Hawks were a few plays from maybe making the Top 5, Iowans could be a few calories or a couple of packs of cigarettes away from sliding further down the rankings.  (December 14, Dubuque Telegraph Herald)

Iowa set to get Mercy Capitol keys
The people of Iowa are about to become the new owners of an old hospital. The east-side Des Moines facility, most recently known as Mercy Capitol, “is not the greatest building,” said Ray Walton, director of the state Department of Administrative Services. But it’s in a valuable location, just northeast of the Statehouse, and it could house about 400 government employees now using rented space elsewhere. (December 14, Des Moines Register)

Experts weigh in on health care reform
If Mid-Iowa is to get meaningful health care reform, there has to be a focus on what’s causing spiraling costs, and Iowa must get a better level of Medicare funding, according to experts who addressed the Ames Chamber of Commerce Friday. Four panelists from the fields of medicine, politics and private health insurance spoke to a group of about 50 people at Mary Greeley Medical Center. (December 12, Ames Tribune)

Broadlawns’ Hall fights audit release
The chief pharmacist at Polk County’s public hospital wants a judge to block release of documents related to allegations the pharmacy was mismanaged.  Mark Hall has asked for an injunction to prevent Broadlawns Medical Center from giving The Des Moines Register copies of the documents, including an internal audit of how the pharmacy tracked drug supplies. (December 17, Des Moines Register)

U.S.  Headlines

Hospital, physician lobbyists fought Medicare buy-in plan
The proposal to allow people ages 55 to 64 to buy insurance through Medicare — one of the most significant ideas to emerge from the Senate’s side of the debate — appeared and vanished in a mere six days.  (December 16, Washington Post)

Unified, yes; united, no
As the new nursing union behemoth – the National Nurses United – is unveiled, some of its new members aren’t exactly jumping for joy. (December 16, Modern Healthcare)

California hospital vote pits upstart union against colossus
Hundreds of workers at Santa Rosa Memorial Hospital are scheduled to go to the polls in a closely watched union vote pitting the giant Service Employees International (SEIU) against an upstart rival. The balloting at has drawn scrutiny in labor circles nationwide because of the nasty underlying conflict between the SEIU and its breakaway competitor, the National Union of Healthcare Workers. (December 17, Los Angeles Times)

Public cooling to health-care reform as debate drags on, poll finds
Anew Washington Post-ABC News poll finds the public generally fearful that a revamped healthcare system would bring higher costs while worsening the quality of their care. A bare majority of Americans still believe government action is needed to control runaway healthcare costs and expand coverage to the roughly 46 million people without insurance.  (December 16, Washington Post)

Top 10 health care issues in 2010
Some might say that there’s no juice left to squeeze from the cost of providing care, but a new report from PricewaterhouseCoopers’ Health Research Institute says health leaders are going to have to try.  (December 18, HealthLeaders Media)

Smoking rate drops in Massachusetts, drawing attention
When Massachusetts began offering virtually free treatments to help poor residents of the state stop smoking in 2006, proponents hoped the new Medicaid program would someday reap benefits. But state officials never expected it would happen so soon. (December 17, New York Times)

New hospital debuts in Minnesota; patients wanted
The construction crews have gone. Balloons and bouquets dot the lobby, and fish swim placidly in an aquarium near the lounge. Now the Twin Cities’ newest hospital just needs some patients.  (December 16, Minneapolis Star Tribune)

Massachusetts ER policy passes checkup
A new Massachusetts policy requiring crowded hospital emergency rooms to accept all patients delivered by ambulance has not worsened conditions, as some doctors had feared. According to an analysis by state public health officials, the average time patients spent in 75 of the state’s emergency rooms remained about the same since the rules went into effect in January 2009. (December 14, Boston Globe)

Immigrants lose lawsuit against Atlanta hospital
Efforts to force the public hospital here to continue providing free dialysis treatment to a group of immigrants, most of them illegal, suffered a setback on Tuesday when a judge dismissed a lawsuit challenging the recent closing of the hospital’s outpatient renal clinic. (December 15, New York Times)

One major sticking point in the ongoing health care reform debate has been over the so-called “public option,” a proposed government-sponsored health care plan.  The primary point of contention came among the Democratic party itself as liberal Democrats wanted a “robust” public option, while more moderate Democrats, largely concerned over costs, were  more interested in a weaker public option.

This disagreement has stalled progress in the Senate for weeks, but after several behind-the-scenes negotiations, Senate Majority Leader Harry Reid (D-NV) announced a tentative agreement among Democrats this week moving the issue forward.

At issue, however, are early reports that the proposal will contain a major expansion of the Medicare program in exchange for either a weaker public option, or no public option at all.  The Medicare expansion would allow citizens aged 55 or older to buy into the Medicare program (versus the current age of 65 or older) which would add millions of Americans to the program.

IHA takes issue with this proposal as the Medicare program does not pay hospitals and other health care providers 100 percent of the actual cost of care.  In other words, if a patient on Medicare receives $1000 worth of health care, Medicare reimburses the hospital between $300-$600.  Though Medicare payment rates vary from state to state, compounding this issue is that Iowa receives some of the lowest Medicare reimbursements in the nation.  IHA data shows that in the most recent fiscal year, Iowa hospitals lost more than $100 million due to Medicare shortfalls.

What’s more, the Senate is also proposing a massive expansion in eligibility to the Medicaid program which reimburses Iowa hospitals even less than Medicare with an estimated $200 million shortfall that increases annually.

By adding millions of Americans to these programs that do not pay the full cost of care would be extremely damaging to Iowa hospitals as the shortfalls would increase dramatically.

IHA opposes the expansion absent Congress acting to correct the historical imbalance of payments among hospitals.  IHA has proposed language to correct this imbalance and Iowa Senator Harkin, a leader in Senate negotiations, should fight to make sure Iowa hospitals are not further disenfranchised by this expansion.

The full proposal will be released after being “scored” for costs by the Congressional Budget Office expected in the coming days.

Information released this week by the American Hospital Association (AHA) shows how the worsening economy has taken a toll on U.S. hospitals. 

According to AHA, U.S. hospitals provided $36.4 billion in uncompensated care in 2008, a $2.4 billion increase over 2007.  Uncompensated care is the combination of bad debt (money hospitals expected to receive for care provided but did not) and charity care (money not expected to be received from patients who met the hospital’s guidelines for free care). 

In Iowa hospitals, uncompensated care totaled $709 million in 2008, up from $613 million in 2007. 

Meanwhile, underpayment by Medicare and Medicaid to U.S. hospitals reached $32.4 billion in 2008, up from $31.9 billion in 2007 and $3.8 billion in 2000, respectively.  Medicare reimbursed 91 cents and Medicaid reimbursed 89 cents for every dollar hospitals spent caring for these patients.  In Iowa during 2008, Medicaid losses totaled nearly $178 million, while Medicare losses amounted to $103 million. 

The poor economy and the rising cost of insurance have led to more people becoming uninsured.  Research has shown that for every one percentage point increase in unemployment, 2.5 million people lose their employer-sponsored insurance.  More uninsured people means more spending by hospitals to pay for care for people who cannot pay for it themselves. 

Some of the uninsured qualify for government assistance to pay their medical bills, often through the Medicaid program.  But Medicaid doesn’t pay hospitals for the full cost of care (neither does Medicare, but Medicaid pays even less) and hospitals must cover the difference.  With more people going on Medicaid, that difference is growing larger. 

How does this impact hospitals?  Well, for one thing, the growing demand for charity care and more instances of bad debt makes it harder for hospitals to pay better salaries (it’s well known that Iowa nurses salaries are among the lowest in the nation) that help keep medical professionals (particularly young ones) in the state.  It also makes it harder for hospitals to build reserves that pay for replacing aging equipment and improving services. 

But uncompensated care and underpayment by Medicaid and Medicare also impact individual Iowans, because these costs are shifted to payers who do cover their full cost of care – mainly people who are privately insured.  In Iowa, Wellmark has estimated that 10-15 percent of the dollars it pays to Iowa hospitals and physicians is to compensate for government programs’ shortfall. 

Uncompensated care and underpayment by Medicaid and Medicare are always a challenge for hospitals.  This is why IHA supports efforts to insure more Iowans and more Americans and why IHA has fought to keep the government from cutting Medicare and Medicaid payments.

After months of negotiation and weeks of contentious behind-the-scenes bargaining in Washington D.C. the Senate voted 60-39 to move its health care reform bill forward this weekend.

The bill needed 60 affirmative votes to move forward and all Democrats voted “yes” and all Republicans voted “no.”  The Senate expects to begin full debate on the bill after the Thanksgiving recess.

In the end the three Democrats (Senators Ben Nelson (D-NE), Blanche Lincoln (D-AK) and Mary Landrieu (D-LA)) and one Independent (Senator Joe Lieberman (I-CT)) who were on the fence cast their votes to support moving the bill forward for debate, however, immediately following her yes vote, Sen. Lincoln made it clear that her support now does not mean she’ll vote to actually pass the bill in the coming weeks, leaving the bill’s fate uncertain.

In Iowa, Senator Tom Harkin who chairs the Senate Health, Education, Labor and Pensions Committee released a statement lauding the vote saying:

“With tonight’s vote, we have arrived at a pivotal moment, an historic moment, in the decades-long march toward passing comprehensive health reform. Tonight we say the Senate will bring The Patient Protection and Affordable Care Act to the floor and we will work toward lowering costs, guaranteeing affordable coverage for all Americans and improving the quality of care in America. And we will make history by, at long last, passing comprehensive health reform.”

Senator Grassley, ranking member of the Senate Finance Committee was disappointed by the Senate’s action stating:

“We ought to be doing everything possible right now to create jobs, and taxes should be decreased in a recession, not increased. Instead, Senator Reid’s bill raises taxes, penalties and fees immediately, choking off economic recovery.”

IHA is concerned about the coverage levels as presented in the Senate bill, as the Congressional Budget Office indicated the legislation will only expand health care coverage between 92-94 percent of the population.  The bill contains major cuts to Medicare payments to hospitals that were agreed to by the American Hospital Association in exchange for coverage levels at 97 percent of the population.  IHA will continue to work with Iowa’s Congressional Delegation to find ways to increase coverage levels.

Senate Majority Leader Harry Reid (D-NV) has announced the release of the Patient Protection and Affordable Care Act, the Senate’s health care reform bill.  The bill contains combined provisions from the Health, Education, Labor and Pension and Finance committee bills and has been scored by the Congressional Budget Office (CBO).

The CBO report says the bill will expand health insurance coverage to 94 percent of the population and will cost under $1 trillion and reduce the federal deficit by $127 billion over the next 10 years.

The 2,000 page bill includes major changes to the health care system including, health insurance industry reforms, prevention and wellness Initiatives, workforce initiatives and health care transparency proposals.

The bill also includes a government-sponsored public health insurance option.  The Senate bill, however, is vastly different from the House’s public option proposal as the Senate proposes to allow states to opt-out of offering the public plan if the state’s legislature and governor so choose.

For hospitals and doctors, payment rates would be individually negotiated with the Department of Health and Human Services.

Another key provision for hospitals is moving Medicare away from paying for volume but rather paying for value.  IHA has advocates for efficiency measures to be included in Medicare value-based purchasing program, and the Senate bill includes the IHA-supported measures that would also help to reduce geographic variations in Medicare spending by increasing payments for hospitals that provide high-quality care at a low cost and provide incentives for lower performing hospitals to become more efficient.

Overall IHA maintains concerns about the coverage levels and would like to see coverage expanded to at least 96 percent of the population at a minimum that more closely aligns with provisions contained in the House bill.

The Senate is poised to take action on the bill yet this week, and could have a final bill passed shortly after the Thanksgiving recess.