Senate, reporters return to the health reform bill
Filed under: Government, Health care reform, Public health, Public records
As the Senate gets back to work on health care reform, some reporters have taken a a good look at what’s contained in the proposed legislation.
Mike Shields of the Kansas Health Institute’s News Service focuses on school health clinics, saying that both the House and Senate versions of the bill “differ somewhat in their provisions for school-based health centers, but if either becomes law millions of federal dollars for starting and equipping the clinics would become available and services provided at them could be reimbursed through Medicaid or the Children’s Health Insurance Program. That would be a major financial boost for many of the operations.”
AHCJ members visit a school-based health center in the Bronx during a field trip as part of the 2008 Urban Health Journalism Workshop.
School-based health clinics provide primary care services to children on the school grounds. Attendees of the 2008 Urban Health Journalism Workshop had the opportunity to see the school-based health centers in two Bronx schools. Read more about the visit and see a multimedia presentation from P.S. 28.
MaryJo Webster of the Pioneer Press looks at the role of school nurses in public health and legislation that could provide money for more school nurses. The story touches on health care reform, H1N1, declining school revenues and rising medical problems among students.
In comments on the NICAR-L mailing list, operated by Investigative Reporters and Editors, Webster noted that this is a story that could be done anywhere:
Just need to find out if your state or at least your local school district(s) tracks the number of school nurses, their qualifications and their salaries – and then get data over a period of years to look for trends.
Mary Agnes Carey, Phil Galewitz and Laurie McGinley of Kaiser Health News found that the Senate’s health bill is “chock full of interesting but little publicized provisions affecting consumers” and lay out the details on seven of them.
Scott Hensley, on NPR’s Shots blog, writes about amendments that legislators are expected to add to the health care reform bill.
Calif. adopts strict rehab rules for medical workers
ProPublica reporters Tracy Weber and Charles Ornstein have filed a report (Los Angeles Times version, ProPublica version) on the fallout from their work exposing failures in California’s nurse rehab program.
The state has adopted strict new rules governing drug abusers in the health care industry, requiring that those in the rehab program be tested more than 100 times in the first year, and pulling them from practice immediately should a relapse be detected.
In addition, public Web sites will now list any restrictions to their licenses, “easing the long-standing confidentiality protections that have shielded participants and kept their patients in the dark.”
Hospital’s struggle illustrates health IT woes
Filed under: Health data, Hospitals, Hot Health Headline
The University of California San Francisco Medical Center has written off more than a third of the $50 million it has spent on a system to digitize patients’ medical records, according to an article by AHCJ member Fred Schulte for the Huffington Post Investigative Fund and American University’s Investigative Reporting Workshop.
The hospital started the project more than five years ago but after “persistent technical headaches,” it is has terminated the contractor and will start over on part of the project.
The costly setback pointedly illustrates the challenges health professionals face trying to meet a government mandate to bring American medicine into the computer age.
Doctors and technology analysts are less than enthusiastic about products now available. “Early reports from some American and European hospitals, they say, suggest that some technology may prove unreliable and could even pose safety problems for patients.”
While critics are concerned about patient safetly, U.S. manufacturers say no injuries or deaths can be attributed to software failure. However, as Schulte points out, “companies manufacturing health information technology systems are under no obligation to report injuries resulting from software malfunctions to the government.”
Schulte then cites a number of examples that point to failures or problems with software systems.
Related
HHS blog intended as forum about health IT
Filed under: Government, Health care reform, Health data
The first post on the new Health IT Buzz blog has generated more than 50 comments since it was posted Monday. The blog was launched by David Blumenthal, M.D., M.P.P., the national coordinator for health information technology in the Department of Health & Human Services.
A press release about the blog says it will “allow readers to learn more about health information technology (health IT) and provide a space for consumers, providers, policymakers, and technology experts to share their ideas and concerns regarding health IT.”
That first post emphasizes listening and says it will be a forum for engagement, inviting a wide range of stakeholder to discuss ideas and concerns about electronic health records.
The second post discusses the $80 million in Recovery Act money that will go toward training health IT professionals, saying that it will use community colleges to offer the education resources.
Related
Survey reveals how much patient privacy is at risk
Rounding up some of the latest health coverage
Filed under: Government, Health care reform, Health journalism, Hot Health Headline, Public health
With good topics for the blog flooding in and a short holiday week to get them all posted, I’m taking a shortcut to point you toward some interesting stories:
ProPublica: What Health Care Reform Means for the underinsured
Rapidly rising premiums have forced them to increase their deductible every year, and now they have a policy with a $5,000 deductible per illness per year.
Steve Lopez in the Los Angeles Times: A doctor is flummoxed by the costs when he becomes the patient
As a physician, he’s well aware that emergency room treatment is very expensive. But knowing the true cost of the limited supplies and labor required to treat such a minor wound, he found the experience more than a little disturbing.
Trevor Butterworth in Forbes.com: Why mall Santas do need the H1N1 vaccine, featuring AHCJ board member Maryn McKenna’s take on how well the media has covered H1N1.
McKenna gives the media a “gentleman’s C” for its coverage of swine flu, but believes it has been getting better in the past few months.
AHCJ member Elaine Schattner, M.D., in the Huffington Post: Mammography: A Not-So-Fatalistic View
I’m a medical oncologist and breast cancer survivor who holds a highly informed and intensely personal perspective on the subject. In my view, the press is getting and giving the wrong message on mammography. There are significant flaws in recent analyses that have escaped most headlines.
Can Americans learn that less may be better?
AHCJ member Laura Newman, the About.com guide to urology, writes about whether consumers will embrace the message that “‘less is more,’ when science confirms it.” In this case, Newman focuses on the American Urological Association’s guideline for kidney cancer treatment, released in April, that called for saving the kidney whenever possible.
Taken in the context of the conflicts in the past few weeks over recommendations for less PSA screening, less breast cancer screening, and less cervical cancer screening, I commend the AUA and other physician organizations for reviewing the balance of benefits and harms in treating early-stage kidney cancer more aggressively.
Overwhelmed sewage systems spread pathogens
Thousands of sewage systems around the country have been overwhelmed and dumped “human waste, chemicals and other hazardous materials into rivers and lakes and elsewhere,” according to Charles Duhigg in the latest installment of The New York Times series, “Toxic Waters.”
Despite more than $60 billion distributed to cities to upgrade sewer systems in the 1970s and 1980s, the Times‘ analysis of data from the Environmental Protection Agency shows that – in the past three years – more than 9,400 of the nation’s 25,000 sewage systems have violated the Clean Water Act of 1972. Fewer than one in five were fined or penalized.
Duhigg cites research that suggests as many as 20 million people a year get sick from water contaminated by bacteria and pathogens as well as a study showing that the number of children who visited one Milwaukee hospital with serious diarrhea rose when local sewers overflowed.
Related
- Paper’s investigation reveals contaminated drinking water
- Reporter finds efforts to monitor groundwater contamination leave much to be desired
Archive offers drug industry documents online
Filed under: Health data, Pharmaceuticals, Public records
In correspondence earlier this month, Kim Klausner, of the University of California, San Francisco Library and Center for Knowledge Management, suggested that reporters should be aware of the Drug Industry Document Archive.
Klausner, the industry documents digital library manager, sent a complete guide to what’s available, the history of DIDA and lots of examples of how reporters and others have used DIDA that is available on HealthJournalism.org.
The archive, available to anyone with access to the Internet, contains about 2,500 pharmaceutical industry documents submitted by “lawyers representing people who file law suits against drug companies and Congressional committees investigating the pharmaceutical industry,” according to Klausner.
William Heisel of the Antidote blog is doing a series of posts that show how the archive can be used to research stories. Heisel’s example uses depositions from a case against Wyeth over side effects of its hormone replacement therapy drugs.
ECRI reviews prostate cancer research
Filed under: Health data, Hot Health Headline, Studies, Tools, Uncategorized
The ECRI Institute’s new review of recent research on the utility of off-label prescription of Finasteride in the prevention of prostate cancer (PDF) presents research and clinical guidelines. Its bibliography and research review may be useful for anyone considering a follow-up to Gina Kolata’s recent New York Times piece on cancer prevention. Finasteride blocks an enzyme that aids the proliferation of prostate cancer cells. It’s used to reduce the size of enlarged prostates and, under the name Propecia, to treat male pattern baldness.
A large trial on finasteride, known as the Prostate Cancer Prevention Trial (PCPT), was published in 2003. The 18,882 men (asymptomatic, with normal PSA levels, 55 years of age or older) enrolled in the trial were randomly assigned to receive either finasteride or placebo for 7 years. … The authors of the trial reported that finasteride reduced the incidence of prostate cancer from 24.4% to 18.4%; however, the incidence of high-grade prostate cancers was 25.6% higher in the finasteride group than the placebo group. The clinical significance of these findings is unclear and has been widely debated.
The impact of prophylactic finasteride on long-term mortality and quality of life was not reported by the PCPT. Two models forecasting the impact of finasteride on mortality in participants in the PCPT were published. Grover et al. predicted that for every 1,000 men treated with finasteride, a total of 20 life-years (0.02 years per individual) would be saved, and Lotan et al. predicted that men treated with finasteride would, on average, gain 1.7 months of life.
The ECRI release was prompted by Kolata’s piece in The New York Times which questions why drugs that have been proven to prevent cancer are not being taken while many potentially harmful (and useless) supplements are. Kolata mentioned the Finasteride case in addition to similar examples involving breast cancer prevention drugs.
According to its Web site, the nonprofit ECRI Institute “dedicates itself to bringing the discipline of applied scientific research to healthcare to discover which medical procedures, devices, drugs, and processes are best to enable improved patient care.” The acronym ECRI has been adopted as the organization’s full name, but used to stand for “Emergency Care Research Institute.”
Two doors, two classes of service at clinic
Two doors represent two different tiers of service in one New York City clinic, according to MSNBC.com reporter Bill Dedman. MSNBC.com sent two producers to see how meaningful the differences in the two tiers prove to be.
One side of the clinic, Lenox Hill Radiology, takes insurance but patients wait longer for appointments, experience a crowded waiting room, might see only a technician and must wait days for their results.
Just around the corner, patients who pay cash up front enter through a door to New York Private Medical Imaging that leads to the same changing rooms and scanning equipment. Those patients get appointments more quickly, wait in a private reception area, get perks like spa robes and see a doctor who immediately gives them results of their scan.
Dedman writes about the “subtle” differences in which the two patients/producers were treated and a bioethicist weighs in on “boutique” or “concierge” health care, in which patients pay up front and the clinics do not take insurance. The bioethicist did not see the differences as subtle.
The owner of the clinics says she knows of other doctors in the city that run similar clinics with two doors. Employees are forbidden from talking about the system to avoid allegations of fraud. “Steering of patients to a more profitable service would violate the clinic’s contracts with insurance companies.”
AHCJ member JoNel Aleccia’s companion story looks at the growth of “concierge” practices and their effect on the growing “chasm between the haves and the have-nots.”
The move to smaller, premium practices will worsen an already dire shortage of primary care doctors, creating an elite group of well-compensated physicians who see fewer and fewer upscale patients, dumping the rest on their increasingly harried colleagues, critics contend.
Aleccia’s story includes information from doctors who have made the switch to concierge practices about how the finances break down and what motivated them to make the change, as well as their patients.
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Spend a week at the CDC studying public health, meeting sources. Apply for the AHCJ-CDC Health Journalism Fellowships today!
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