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)

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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)

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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)

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

Iowa News

DHS schedules hearings on Branstad’s Healthy Iowa Plan
The Iowa Department of Human Service has scheduled four public hearings in June and a public comment period on Gov. Terry Branstad’s proposed “Healthy Iowa Plan” to provide health care to about 89,000 uninsured Iowans. The hearings are for a federal waiver request that will be submitted to the Centers for Medicare and Medicaid Services to implement the plan for calendar years 2014 through 2018. However, the plan is still under debate in the Iowa Legislature. (Des Moines Register)

National News

Hospitals could lose $500M in federal funds
Hospitals nationwide could lose half a billion dollars in federal funding meant to offset the cost of covering the uninsured next year. The loss that will be especially felt in states where lawmakers have decided against expanding Medicaid coverage. According to rough estimates released Monday by federal health officials, cuts could jump to $4 billion in 2020. Hospitals around the country that treat a large number of uninsured residents rely on federal funds to offset costs. But the Affordable Care Act assumes more residents will have health insurance and that hospitals will treat a smaller number of uninsured patients. (ABC News)

Medicaid expansion signed into Colorado law
An expansion of Medicaid eligibility that’s expected to add 160,000 adults to public health care assistance in Colorado was signed into law Monday. The expansion is part of the federal health care overhaul, and at least 18 states had indicated at the beginning of the year they wanted to participate. Nearly a dozen states have refused to take part. Supporters of the expansion say it will reduce health care costs in the long run. (Summit Daily News)

Access to EHR notes lauded by patients, providers
Possibly the most famous consumer of electronic health records is Dave deBronkart, better known as e-Patient Dave. Several years ago, deBronkart participated in a trial of a new program that permitted patients to view all the notes in their EHR. “Weeks after a visit, I thought, ‘Wasn’t I supposed to have something followed up?’ Heaven knows where my printed visit notes were … it was late in the evening, so ordinarily I’d have waited till morning and maybe remembered to call in and have someone look it up—very inefficient and vulnerable to ‘I forgot.’ Instead, I went online right then and there, just as you might with anything else, from airline reservations to credit card info. There it was: actinic keratosis—a precancerous lesion.” (HealthLeaders Media)

Hospitals promote screenings that experts say many people do not need
Hospitals hoping to attract patients and build goodwill are teaming up with medical-screening companies to promote tests they say might prevent deadly strokes or heart disease. What their promotions don’t say is that an influential government panel recommends against many of the tests for people without symptoms or risk factors. The panel says such screenings find too few problems to outweigh the drawbacks, which include false positive results and unnecessary follow-up procedures and surgery. Other medical experts warn that the tests could needlessly raise health-care spending. (Washington Post)

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

Iowa News

Concerns grow as Iowa health debate drags on
As negotiations drag on in the State Capitol over providing health coverage for low-income residents, some Iowans are starting to worry about what the debate means for their doctor visits. Kyrie Borsay is one of about 66,000 residents enrolled in IowaCare, a limited-benefit program funded by the state and federal governments and offered to people with low wages who don’t qualify for Medicaid. She has heard conflicting information about what will happen to the program later this year. (Omaha World Herald)

iPhone app lets doctors track vaccine refusals
Doctors around the world can now contribute via an iPhone to a database that shows where and why people are refusing vaccinations. “Vaccine Refused,” an app developed at the University of Iowa, is the latest public health tool from a group that has drawn national attention for its efforts to track diseases through social media and search engines. By seeking to collect more information on those who refuse vaccines, the UI’s Computational Epidemiology Group has ventured into controversial territory. (Des Moines Register)

Mary Mosiman appointed Iowa state auditor; first woman to hold post
Former Story County Auditor Mary Mosiman was appointed by Gov. Terry Branstad on Monday as state auditor. She becomes the first woman to hold the statewide post. Mosiman, 51, who recently has been deputy secretary of state, succeeds former State Auditor David Vaudt, who resigned effective May 3 to become chairman of the Governmental Accounting Standards Board. She  is a certified public accountant and has a degree in accounting from Iowa State University. She served as Story County auditor and as county commissioner of elections from 2001 to 2010. (Des Moines Register)

National News

Ohio legislators should get moving on expanding Medicaid
If Ohio’s skittish General Assembly keeps dawdling, voters themselves may be asked to extend Medicaid coverage to hundreds of thousands of Ohioans who now rely on expensive emergency care or care provided by Ohio taxpayers. Given the broad support for Medicaid expansion in Ohio, there shouldn’t have to be an expensive referendum campaign to adopt it. If a referendum happens, blame political dysfunction in the legislature. Republican Gov. John Kasich, the state’s most conservative chief executive in decades, supports Medicaid expansion. So does the Ohio State Medical Association. So does the Ohio Chamber of Commerce. And so, large and small, do Ohio hospitals. (Cleveland Plain Dealer)

A patient’s view on the Oregon Medicaid experiment
A study of Oregonians who won Medicaid benefits in a 2008 state lottery has sparked an intense debate about the value of expanding health care to the poor — and the value of health benefits in general. Mary Carson is, in a way, at the center of that debate. The 55-year-old Oregon woman was accepted into the Oregon Health Plan, the state Medicaid program, in 2011. She and her partner live with her three children. (Washington Post)

Downward pressure on health care costs
Since the long, painful debate over health care reform began a few years ago, Americans have tended to split into camps for or against the 2010 Affordable Care Act and a larger role for government. But if there was one thing that most could agree upon, it was the frustration over the cost of medical procedures. Whether the law ultimately will make care as affordable as we’d like is uncertain, but one very positive step was undertaken last week under the act (“Obamacare”), which requires individual hospitals to disclose how much they charge for procedures. (Nashville Tennessean)

Useless noise from CMS
What on earth did CMS have in mind when it released the FY2011 chargemasters for America’s hospitals?  This is a case where the release of bad data is worse than having no data at all. A hospital’s chargemaster is an archaic fiction, a way previously used to allocate the joint and common costs of the hospital to particular services.  It does not serve as the basis for how much a hospital is paid by Medicare.  It does not serve as the basis for how much a hospital is paid by Medicaid.  It does not serve as the basis for how much a hospital is paid by private insurers. (Not Running a Hospital)

Five benefits hospitals gain from aligning with physicians
Health systems can extend their reach further once they align with a wider expanse of physicians and specialties. Often, the ability to provide a greater scope of services bolsters the hospital’s reputation in the market and can help retain patients who want to receive all of their services in one place. (HealthLeaders Media)

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