GAO on Katrina: Fed. grants helpful, not sufficient
A pair of Government Accountability Office reports evaluating the progress of ongoing post-Hurricane Katrina rebuilding efforts – one looking at mental health services for children (highlights, full report), the other at organizations providing primary health care (highlights, full report) – find that while federal grants have had an impact in both areas, there is still considerable work to be done.
Photo by AuthenticEccentric via Flickr
In terms of mental health services for children, the GAO reports that progress has been made in recruiting and funding providers — school-based programs have been particularly successful – and in providing the transportation needed by children and families hoping to take advantage of such services. Obstacles include a lack of stable housing for many children and funding shortage looming on the horizon as many hurricane-related grants will dry up in 2010.
In 2007, the Department of Health and Human Services awarded Louisiana a $100 million grant targeted to restore primary care services to low-income populations. The state passed that money on to 25 outpatient providers in the greater New Orleans area. Most of those organizations, the GAO found, used that money to hire additional staff. Many also expanded the services they offered and added new sites or improved existing ones. The report does not come to a conclusion as to the long-term sustainability of the project.
Both GAO reports should serve as reminders that efforts to rebuild the Gulf Coast in the wake of Katrina are ongoing. The reviews show that the GAO hasn’t taken its eye off the affected areas, and neither should journalists.
Health care reform: A crossroads?
There’s an endless stream of stories about health care reform in advance of President Obama’s prime-time news conference tonight. We’ve highlighted a few:
Karen Tumulty of Time reviews where things stand and writes that legislators are saying, privately, that it would help if Obama would be clearer about how he wants to fix the health care system. She reports that the press conference is just one sign that the president is becoming more engaged on the subject.
This Jan. 29 photo was taken during a meeting about how to fund health reform. (White House photo by by Pete Souza)
Ezra Klein of The Washington Post points readers to a column by The New York Times‘ David Leonhardt: “He’s trying to puzzle through (a) what’s in health-care reform for the average insured American, and (b) how to explain to to them.” Leonhardt says “The immediate task facing Mr. Obama — in his news conference on Wednesday night and beyond — is to explain that the health care system doesn’t really work the way it seems to.”
Klein was among a group of reporters invited to discuss health care reform with Sen. Nancy Pelosi today. He posted a report of what she said. Interesting to note that Pelosi said “the [Congessional Budget Office] doesn’t count things that we know will save money, like prevention, wellness and end-of-life issues.” One of the country’s leading experts on the subject, Rutgers’ Louise Russell, disagrees that preventive care saves money.
The National Association of Health Centers points us to C-SPAN to follow the committee mark ups on health care reform bills. C-SPAN is streaming them live and archiving them. C-SPAN also has a page devoted to health care.
Jonathan Cohn of The New Republic breaks down the question of cost in the House bill into three separate questions.
AHCJ president Trudy Lieberman, writing for Columbia Journalism Review, continues her look at lessons from the health reform law passed in Massachusetts three years ago.”The last few weeks have not been great ones for the Massachusetts health reform law. As Congressional committees issue draft legislation calling for reform resembling Massachusetts’s Grand Experiment, the ghosts of cost controls—or, more aptly, the lack thereof—are beginning to haunt.” (The entire series is archived here).
CNN asks “Will Obama’s health care plan mirror the 1994 Clinton failure?” in a piece that lays out the challenges in his way and reveals poll results that show that 44 percent of people polled don’t approve of how he’s handling the issue.
Writing in the Wall Street Journal, Janet Adamy boils down the entire health care reform effort into ten bite-sized questions, ranging from “What is the problem with health care any way” all the way to “Which industries are most likely to lose, and which to gain, from any overhaul?” Adamy juggles economics, politics and history without sacrificing the simplicity of her well-reasoned wide-perspective look at a notoriously complex process.
Slate’s Timothy Noah has updated the online magazine’s cheat sheet to following health care reform online. Noah’s take on who and what you should be reading, sprinkled with a healthy dose of opinion, encompasses a mix of government sources, pundits, lobbyists, bloggers and academics. He even squeezes a few journalists in there; his “Journalism and Essays of Lasting Interest” section is a handy list of milestone pieces of the past few years.
The White House Briefing blog says advance excerpts of tonight’s address will be posted. At 8pm ET, the press conference will stream live at Whitehouse.gov/Live.
Doc praises, explains benefits of electronic records
Calling the typical paper-based health record system “a primitive, fragmented and unreliable way to do business,” Rahul Parikh, M.D., writing for the Los Angeles Times, shows how electronic medical records have improved his practice.
Parikh’s piece starts from a foundation of a few electronic interactions with patients and builds a thesis from there:
In the past, these parents would have left a phone message and we probably would have spent the better part of a day or two playing phone tag. Or they would have had to make an appointment, strap their children into car seats, pack diaper bags and snacks and sit in a waiting room full of sick children — only to spend 5 to 10 minutes with me while I told them everything was fine. Instead, we fixed the issues by e-mail, allowing parents to stay in their lives at home and at work.
Parikh says that while EMRs do increase his workload – data entry is far more of a hassle than just scribbling something on a scrap of paper and shoving it into a file – they also allow him to shift between work and home when needed, giving his schedule a flexibility it lacked when he was permanently tied to the office by mountains of paper. While EMRs are “far from perfect,” he writes, they are still a significant improvement over the status quo.
Parikh acknowledges some criticisms of electronic medical records, such as a study that concluded using hand-held PDAs led to an increase in wrong and redudanct diagnoses. He says those errors can be remedied by “holding doctors and others accountable for the accuracy of their documentation.” As far as the security issues surrounding electronic records, he says they are legitimate concerns but no different from those in other industires, such as finance.
Past news about EMRs
- Kaiser’s switch to electronic records hits snags
- Failure to use digital record system hurts soldiers’ care
- Strides in efficiency don’t necessarily benefit doctors or patients
- Military resists new health records system
- Issues remain before personal health records go mainstream
- Health IT reforms move slowly in Calif. prisons
- Weigh risks, benefits of electronic personal health records
Tip Sheet
- Improving patient safety through health information technology: Presentation by Rainu Kaushal, M.D., M.P.H., assistant professor of public health, Weill Medical College of Cornell University
Reports/Studies
On the Web
- The American Health Information Community recommends specific actions to achieve a common interoperability framework for health information technology. (May 2007)
Latest regulatory activity just a click away
A new site could let you keep up with the latest regulatory action at your favorite federal agency with OpenRegs.com.
The site takes the Federal Register’s daily XML feeds and makes them accessible to everyone, allowing you to see the latest rulemaking activity and topics open to public comment by the federal government.
For example, on the page for the Department of Health and Human Services, you can see now that public comment is now being accepted about changes to Medicaid and the Children’s Health Insurance Program. There’s also a page for the Health Care Financing Administration, though it doesn’t look like there’s been any recent activity from that agency.
Other health topics available:
- Health
- Health And Safety
- Health Care
- Health Care Health Insurance
- Health Care Insurers
- Health Facilities
- Health Insurance
- Health Maintenance Organizations
- Health Professionals
- Health Professions
- Health Programs
- Health Records
- Health Standards
- Health Statistics
- Health Status Indicators
- Health Warnings
- Health-Clinical Research
- Health-medical Research
- Healthcare
It appears there isn’t any activity for many of those topics but it’s worth keeping an eye on by subscribing to the RSS feeds so you’ll be alerted if there is an addition.
The site does note that it should not be a substitute for Regulations.gov, which is the official site run by the federal government and includes comments that have been filed. “OpenRegs.com should serve as the launching pad, research portal, and discussion community for your regulatory adventures.”
CJR: BPA truth lies in the middle
In the Columbia Journalism Review, Sanhita Reddy reviews a recent STATS critique of media coverage regarding Bisphenol A and the dangers it may hold. According to Reddy, both STATS and outlets like the Milwaukee Journal-Sentinel have taken overly extreme positions in the debate. While science hasn’t quite figured out the truth yet, Reddy says, it probably lies somewhere toward the center.
In an even-handed critique, Reddy disputes STATS’ attacks on popular anti-BPA source Frederick vom Saal’s credentials, but agrees that the media has been overly reliant on the University of Missouri scientist. Reddy also points out the fine line between placing more importance upon larger-scale, more valid studies (many of which are industry-sponsored) and identifying the conflicts of interest which may or may not exist alongside those industry connections.
In the end Reddy concluded that the conflict was a confusing one, but that as long as they brought a healthy dose of skepticism and took an extra look at the methods and materials sections of the research they were consulting, reporters should be able to give it fair coverage.
Lack of oversight contributes to Army suicides
Filed under: Government, Hot Health Headline, Studies
The Army reported that 143 active duty soldiers killed themselves in the last year, the highest number since the statistics started being kept in 1980. This year’s numbers are on track to break that unfortunate record. Gregg Zoroya of USA Today reports that an Army investigator blames at least part of this rise to a lack of day-to-day oversight by commanders accustomed to leading amidst the intensity of the battlefield rather than the less-obvious perils of the barracks.
The investigator’s solution is simple: commanders need to interact with their troops more, to keep in touch and keep their eyes out for risk factors.
Zoroya also noted another contributing factor to the climbing suicide rate:
Along with soldiers who engage in risky behaviors, McGuire says, the Army has a greater number of troops who entered the service with pre-existing anxiety or depression or who have stopped taking their behavioral medication in order to meet entrance requirements.
Soldiers concerned they may be at risk can try this online mental health self-assessment designed specifically for members of the armed services.
Grassley digs into journal ghostwriting practices
Filed under: Conflicts of interest, Hot Health Headline
Ben Comer of Medical Marketing & Media reports that Iowa Republican Senator Chuck Grassley sent a letter to eight prominent medical journals, asking them to share their editorial policies regarding the disclosure third parties involved in the creation of journal articles, as well as the penalties they have set for authors who don’t follow those policies. Grassley asked the journals to respond by July 22. Read the senator’s press release here.
Bariatric patient’s story shows potential savings
Las Vegas Sun reporter Marshall Allen follows one man’s story to look into the ultimate cost (or savings) of bariatric surgery and discusses why insurance companies don’t always cover the procedure.
The narrative alone makes the story worth reading, and when Allen adds the numbers it draws a particularly compelling picture.
• In the first five months of 2008, taxpayers provided Daswell (who topped out at 380 pounds) with 17 medications for obesity-related health problems at a cost of $8,374.19.
• In the first five months of 2009 (after the surgery), taxpayers provided Daswell with 13 medications for obesity-related health problems, many at reduced dosages, at a cost of $5,106.54.
It’s a simple measure, but shows a savings of $3,267.65 in the five months, a 39 percent reduction in expenses in drugs alone.
Daswell’s surgery cost about $16,000 for the procedure and first year of follow up. If the pharmacy costs were the only savings realized, the expense could be recouped in just over two years. That does not count the costs Medicare would presumably save in doctor visits and medical equipment — he barely uses the sleep apnea machine he once depended on every night. The equation would also have to factor in the long-term chance that Daswell could contribute to the economy by getting a job and going off Medicare disability.
Marshall goes on to say that while Daswell’s case is somewhat exceptional, the results and savings are, for the most part, generalizable to the population at large. Bariatric surgery, Marshall found, usually pays for itself within a few years.
Air-traffic-control methods could aid patient safety
An Air Force medic with aviation experience has proposed that principles from a modified air-traffic control system be implemented in hospitals to keep track of patients and medications during handovers and shift changes.
Photo by moogs via FlickrIn a small-scale experiment involving senior medical students and mock casualties, those following the air-traffic methodology had fewer errors and lost track of less information.
The adapted method relies on centralized information and regular updates.
Air traffic controllers use a method in which each aircraft is represented by a flight progress strip. Multiple strips are stacked in order of priority within a bay representing a unique stage of flight. Reprioritization regularly occurs for faster aircraft or those that require expedited throughput for emergency or other reasons such as low fuel or weather. Flight progress strips are moved from bay to bay as aircraft move from one stage of flight to another.
UN: Africa plagued by counterfeit malaria/HIV pills
Filed under: Hot Health Headline, Public health, Studies
A recent assessment by the United Nations Office on Drugs and Crime found that weak and or/useless drugs have proliferated across Africa and Asia, with malaria-ridden West Africa being the hardest hit (102-page PDF). Smugglers, organized criminals and shady manufacturers in more developed countries are getting rich at the expense of individuals and countries with little capacity to distinguish between fraudulent pharmaceuticals and the real thing.
From the accompanying press release:
As much as 50-60 per cent of anti-infective medicines tested in Asia and Africa have been found to have insufficient amounts of the active ingredients. Medicines with low levels of active ingredients pose a greater hazard than those with none, because substandard antibiotics and anti-malarial drugs can promote the development of drug resistant strains, or “super bugs” that can spread beyond the region.
The UN report calls for immediate action, including the naming, shaming and banning of companies producing the faux pills and stronger government regulatory efforts.
-
Awards for Excellence in Health Care JournalismDeadline: Feb. 3
- How I did it: Falsified charts in nursing homes linked to patient care
- Access Denied: Looking at a lack of health care availability
- Transparency & medical errors: Public reporting of patient harm is a potent force
- Focus on freelancing: Tips for buying liability insurance
- Why do some patients get stuck in hospitals for weeks, months?
- Investigate health professionals and the boards that regulate them
- Presidents of AHCJ, SPJ call for more openness from Obama administration
