by Chris English on Friday, July 30, 2010
Leave a CommentOn June 16-17, the Iowa Hospital Association hosted its summer leadership forum: Reform and the Road Ahead. Conference objectives were to discuss the current MedPAC recommendations regarding health care payment reform, how scale matters in health care and what the impact of the current U.S. economy will have on the entire health care industry.
The following video is the first in a two-part series of interviews conducted with a couple of the forum’s esteemed speakers. IHA had the chance to speak with Herb Kuhn, President and CEO of the Missouri Hospital Association (Jefferson, MO), on how health care reform will impact states like Iowa and Missouri.
Part two of the series will be posted next week and will feature David Swenson, Associate Scientist, Dept. of Economics at Iowa State University.
YouTube link: http://www.youtube.com/watch?v=nWSOlXI7qiA
by Scott McIntyre on Thursday, July 15, 2010
IHA has released results from its latest hospital community benefit survey, which show Iowa hospitals provided a total of $1.2 billion in community benefit. Community benefits are activities designed to improve health status and provide greater access to health care. Along with uncompensated care (which is made up of both charity care and bad debt), community benefits include such services and programs as health screenings, support groups, counseling, immunizations, nutritional services and transportation programs.
IHA also includes hospital losses to Medicare and Medicaid in its community benefit report. This is because those losses – more than $310 million in 2009 – impact the hospitals’ ability to provide community benefit.
Providing community benefits is an essential mission of non-profit community hospitals (117 of Iowa’s 118 hospitals are non-profit) and it is also required under federal laws that cover these hospitals’ tax-exempt status. However, those laws do not specify an “amount” of community benefit from each hospital.
Instead, hospitals are given the flexibility to determine how to meet the specific needs of their individual communities through these programs and services. IHA believes that flexibility is important because community needs vary, not only from hospital to hospital and community to community, but from year to year – even from month to month. A one-size-fits-all approach to community benefit would negate that flexibility and undermine the ability of hospital boards, administrators and employees to react to community needs in a timely fashion – if at all.
In the coming weeks, IHA will be sharing more about the unique programs and services Iowa hospitals provide to their communities.
by Dan Royer on Friday, June 18, 2010
Late this week the U.S. Senate failed its second attempt to gain the 60 needed votes to pass the so-called “Jobs Bill.” The bill contains important health care related provisions that have been scaled back from the original proposal.
Senate Majority Leader Harry Reid (D-NV) (Credit: AP)
Senators Ben Nelson (D-NE) and Joe Lieberman (I-CT) voted with all Senate Republicans to block the $120 billion bill. The measure failed having only received 56 “aye” votes.
Of key concern for hospitals is the enhanced Medicaid funding in the bill that would extend the increased federal share of Medicaid dollars for states. Iowa’s state budget currently relies on nearly $150 million that would cease to exist should the Senate not pass this legislation.
In addition the bill contains an temporary patch for physician Medicare payments that are currently in limbo. A flawed payment mechanism in the Medicare program causes physicians to face huge annual cuts that, until now, had been prevented by Congress. Physician Medicare claims have been held by the Centers for Medicare & Medicaid Services for the past week and will likely have to be held longer.
IHA supports this legislation and urges the Senate to take final action to ensure appropriate funding for state budgets and fix the physician payment cuts.
by Scott McIntyre on Monday, June 14, 2010
Consumers want safe and effective health care, but they don’t talk about it that way; consumers tend to simply say they want “the best.” Just what that means was clarified in a recent study published in the current issue of Health Affairs.
What the scientists found as they were gauging consumer understanding of evidence-based medicine was that many consumers follow a conventional wisdom, believing the best care is provided in large, expensive and shiny new doses. As one focus group participant put it, “I don’t see how extra care can be harmful to your health. Care would only benefit you.”
Fully one-third of the study participants agreed with this view. Telling them that not all care meets accepted quality standards and that more or new (and therefore unproven) care could actually be harmful simply did not compute. (The Associated Press took on this issue in a six-part series last week).
The good news (sort of) is that 40 percent of consumers weren’t sure either way, meaning that they are open to the concepts of comparative effectiveness and evidence-based medicine. Most consumers trust their providers implicitly and generally believe that what their physician prescribes is best for them.
However, this kind of passivity also means they may not be prepared to challenge or even engage a provider – most don’t bring any kind of research to appointments or even take notes. Forty percent said they didn’t ask questions because the physician seemed rush or they were unsure how to talk to him or her.
Confused or intimidated consumers could also be swayed another direction, toward those who couch evidence-based health care as “rationing” or worse. More than a few consumers in the Health Affairs study were already in that camp: “Using medical guidelines sounds like…your doctor can’t give you other treatment without approval,” one said. “It’s taking away your choice and putting the decision in somebody else’s hands.”
Such is the double-edged sword of empowered consumers and their role in high-value health care. But with transparency, patience and well-planned outreach (the researchers have produced a communications toolkit for providers), health care consumers will embrace evidence-based medicine and join high-value hospitals, like those in Iowa, as allies in assuring that they receive the right care, in the right place and at the right time.
by Scott McIntyre on Thursday, June 3, 2010
Researchers at the Dartmouth Atlas of Health Care are reacting to a recent New York Times article with pointed criticism. Principal scientists Elliott Fisher and Jonathan Skinner said they are “disappointed” in the article’s attack on the veracity of Dartmouth Atlas data, which has been widely cited and highly influential with regard to health care reform.
The two scientists go on to point out several factual errors and misrepresentations in the article. Among the errors: the Times claims Dartmouth data does take into account quality of care; Fisher and Skinner show that the atlas does indeed contain quality data. The article also claims that “neither patients’ health nor differences in price are fully considered by the Dartmouth Atlas”; the scientists respond that risk adjustments are included in their studies. As for price, they point out that because their investigations focus on actual measures of utilization, price adjustments are not necessary, though fully price-adjusted expenditure data is also available on the Dartmouth Atlas Web site, just the same.
Rather than the Times article, which cites “critics” of Dartmouth’s work but fails to present any substantial criticism (or at least none that can hold up to scrutiny) and Skinner and Fisher describe as “superficial,” the researchers urge readers to take the time to read their initial but very thorough responses to the reporters’ questions, which the Times posted as a sidebar.
In an article that ran in the Dartmouth campus newspaper, Fisher reiterated that the Dartmouth Atlas findings – essentially, hospitals that spend more on high-intensity health care “are less likely to deliver safe and effective care” – remain largely undisputed in the scientific community.
“All of this research and all the findings they cite [in the Times’ article] are consistent with ours,” Fisher said. “The Times is not helping advance the public’s understanding of what’s going on.”
Fisher went on to say that the potential remains to save “about 20 to 30 percent of health care spending” if more hospitals engage in “better performance measures, greater accountability and payment systems that reward improved performance.”
Like the scientists at the Dartmouth Atlas, IHA and Iowa’s hospitals are committed to understanding variations in health care delivery for the purpose of ensuring access to high-value health care.
The New York Times, meanwhile, appears less interested in improving health care and more interested in creating controversy where there is none.
