What transparency in state government actually looks like

“Together with leaders from all state agencies, we identified opportunities to align operations, resources, and services to better meet the needs of Iowans.” Or so Govenor Reynolds said when she promoted her massive state "reorganization" in 2023. 

Not long ago, I sought statistics from the Iowa Deparment of Health and Human Services on Iowans' incidence and prevalence of mental illness. I was intially told I would need to go through the FOIA procedure to request that (apparently) highly protected information. It was not until I pitched a hissy and threatened to publicize this totally irrational obstacle that the data was provided. 

At a time when our health care system is strained to the limits and our policy makers have their heads in a very dark place, only the light of day will lead to informed health care access and decision making for Iowans. Don't forget to bring your night goggles.

Des Moines Register of July 13, 2024

Two minute read: From the Upper Midwest? Ruh-roh.

The six states that comprise the Upper Midwest (Iowa, Nebraska, South Dakota, North Dakota, Minnesota and Wisconsin) have a common challenge: Their working age populations (18 to 64) are shrinking. At the same time, total populations are growing, along with their senior cohorts. And the number of new health care jobs is dramatically rising. It makes for a very bad combo platter.

Shall we try all rowing in the same direction?

Two-minute read: While you were sleeping on February 21 . . .

You know those letters you get every once in a while from a doctor you see, or may have seen in the past? The ones that tell you there was a cyberattack and you got hit? Well, it seems an estimated 85 million Americans should have gotten one of those by April 21, but didn't. You may be among the one third of U.S. patients whose medical records have been hacked:   

History's most significant health care cyberattack hiding in plain sight

Two-minute read: Jim Morrison still rocks.

If you study the history of the Baby Boom, you will find it was always a surprise when those 70+ million people showed up for kindergarten, college, homebuying, yada yada yada.

And now, being in line for health care resources that were already far below demand is another head-scratcher for policy makers and stakeholders. "Those who do not learn history are doomed to repeat it."

History lesson from a legend of rock-n-roll

Two minute read: How did they not see this coming?

In hindsight, it's not tough to see that a Baby Boom would result in an Elder Boom 70 years later. If you're wondering where all the health care workers (and auto mechanics) went, here's the answer. 

Never assume there's someone in charge

Does capping wages grow the health care workforce? Hmm, let's see . . .

The Iowa legislature is on the fence about whether it's a prudent move to limit the earnings of "traveler" or "contract" health care workers (this will most directly impact hospital nurses and nursing home CNAs). Their theory is that once the traveler nurse making $80 per hour can again make only $43 per hour as a hospital employee, she/he will quickly return to the fold. 

Probably not. But as one legislator said on a hot mic, "If we could put these contract agencies out of business, we'd do it, but this is as close as we can get." Well, yes, as long as the Iowa Constitution is still around. 

Those posing as worker advocates suggest it's time for "a broader conversation about health care workforce shortages"? Now, that is actually not true. That time was 15 to 20 years ago. To propose that the way to grow our census of health care workers is by limiting their earnings potential is like saying the way to put out a fire is to ban the use of matches. 

But by all means, form another "study group" or "task force" or "collaborative" to consider whether Iowans' access to health care is threatened, especially when registered nurses continue to hold the #1 spot for job openings at IWD and 71% of our rural hospitals are already operating in the red. Tick tock.

Des Moines Register article of April 4, 2024

You look away for a just a moment, and . . .

Meanwhile, as we're mesmerized by the geopolitical or economic shiny object du jour, health care giant UnitedHealth Group's subsidiary, Change Healthcare, is dealing with what is now called the most significant health care cyberattack in U.S. history. (One in every three health care claims in the U.S. are processed by Change Healthcare.) So far, it has paid $22 million in bitcoin ransom in an attempt to restore data since the February 21 attack.

Granted, there's little (read: nothing) you and I can do as individuals to stop these attacks or even to get policy makers or stakeholders to provide adequate security for our personal health care information. However, we CAN maintain our own digital and print records of crucial health care information. In an emergency or when seeing a new provider, you may be the only one with access to your medical history, current medications and existing conditions. Don't mess around--write it down. 

Change Healthcare cyberattack jeopardizes medical data

Two minute read: Ageism. It isn't just for seniors.

Medicine has come a long way over the past 20 years--a really long way. But it can't seem to get ahead of rising cancer rates for younger folks. That's right, those under 50 are at a greater risk for getting a cancer diagnosis than ever before. This is some scary stuff.

Cancer stats are going the wrong direction.

Two-minute read: I see dead people.

I know, I know, you don't want to think about death and dying. Few people do. But understanding trends gives us another peek at why we are short health care workers. Really.

Why so many obits these days?

Two-minute read - Just do it, already!

I totally get that going to the doctor is high on your list of Stuff I Don't Love To Do. But besides possibly spotting an issue that bears watching, there's another reason to see your physician at least once a year. Even if you feel fine. Even if you don't want to.

Annual exams: Can you guess the head fake?

Why it's important to look beyond the headline

Iowa's Governor Kim Reynolds is bragging that Iowa has been ranked second in the nation for having the best health care system. Oh, that it were so.

The source: WalletHub. (What?) That head-shaker aside, when you look at WalletHub's methodology, you see it includes the U.S. Department of Health and Human Services data on Health Professional Shortages Areas (HPSAs).

So here's a look at WalletHub's methodology:

The real story behind the press release of January 2, 2024

Two-minute read - Why we need data geeks

Census data on its own can be overwhelming, and, admittedly, meaningless. But if we put the pencil to those numbers and reduce them to simple ratios, they explain our current and future health care workers shortages.

Dependency Ratios and the Caregiver Support Ratio

2-Minute Read No.1 - Three more doctors is a start--sort of

Senator Chuck Grassley recently announced that Iowa has secured three more Medicare-funded residencies as part of the 2021 Consolidated Appropriations Act, which was signed into law in December 2020 (note how quickly solutions get implemented). 

Here's the backstory on that: 

Jo's 2-Minute Read on how Congress is addressing physician shortages

Planning to talk about making a plan is not really a plan, now is it?

The CMS proposal for maximum patient-to-staff nursing home ratios is not the solution to health care worker shortages. At the same time, with Iowa losing 26 nursing homes over the past 15 months and a moratorium on any new facilities, Governor Reynolds' plan to "enter into a genuine state-federal dialogue" is not really a plan either, is it? (And you can bet that similar ratio regs for hospitals are not far behind.)

If the current level of proactive leadership in addressing this crisis of health care access continues, Iowans are so monumentally screwed.

Iowa Capital Dispatch: CMS regulating nursing home staff ratios

For the love of God, take the day off.

Ted Lasso reminded us that the happiest creature on Earth is the goldfish. It has a ten second memory.

Today, enjoy nature's awesome Fall palette, give yourself a break, and be a goldfish. 😀