AHRQ asks ‘Who’s paying for rising health costs?’
Filed under: Health care reform, Health data, Hospitals, Studies
The latest statistics brief out of the Agency for Healthcare Research and Quality address what researchers called the “growing burden of hospital-based medical care expenses on the government, tax payers, consumers, and employers.” In this brief, they’re looking to figure out where to put the blame for those in-patient cost jumps that occurred between 2001 and 2007 and thus divided the increases into four categories: Medicare, Medicaid, private insurance and payments from those without insurance.
The numbers hold a few interesting subplots, any one of which would benefit from further exploration. Here are a few:
- When you compare 2001 and 2007, private insurance paid for slightly fewer stays, while stays for Medicare and Medicaid were up,respectively, by 20.1 and 29.9 percent.
- “From 2001 to 2007, the number of stays with a principal diagnosis of blood infection nearly doubled (97.1 percent; 675,400 stays in 2007).”
- The cost of a hospitalization for intestinal infection jumped 148 percent, yet hospital stays for such infections were up only 69.5 percent.
- “For four of the top ten conditions—blood infection, acute kidney failure, respiratory insufficiency, arrest, or failure, and skin and subcutaneous skin infections—the uninsured demonstrated greater increases in growth in total costs and number of hospital stays than the other three payer groups.”
- Private insurance paid 55.7 more for C-section-related hospital stays over the study period, while Medicaid costs increased 95.1 percent for the same sort of visits.
Check pages seven through 10 for summary tables, including overall numbers and two tables of the ten conditions for which costs are increasing most rapidly.
APA’s new policy seeks collaboration with pharma
Filed under: Conflicts of interest, Hot Health Headline
The Wall Street Journal’s Shirley Wang looked beyond the American Psychiatric Association’s new conflict of interest guidelines to explore what the APA’s loosening of ties with major pharmaceutical manufacturers meant for their business model and future. The APA has lost 10 percent of its revenue – about $7.5 million – over the past year as pharma is spending less on advertising in their journals and sponsored symposia have been phased out of the APA annual meeting. That last move, Wang found, cost the organization about $2 million.
In an interesting twist, Wang says that while some of the decline in pharma advertising can be attributed to the recession and APA’s attention to COI, some of it comes “because the industry faces its own pressures to avoid potential conflicts of interest.” Overall, pharma’s ad spending in health care publications has slipped from $865 million in 2005 to $626 million in 2009.
Reactions to these tightening regulations and budgets among APA membership has been mixed, as Wang illustrates:
At the annual conference in 2008 in Washington, D.C., Dr. Scully recalled meeting a group of young residents and medical students at the bottom of an escalator who wanted to “express their outrage” at the industry influence at the meeting. At the top of the escalator ride, he encountered another group of doctors upset that there weren’t enough seats in the industry-sponsored symposia. “A number of members liked those [symposia] and they liked that they got fed,” said Dr. Scully.
In an accompanying blog post, Wang writes that the APA hopes its new guidelines will increase transparency, decrease conflict and still maintain a good, cooperative relationship with the pharmaceutical industry.
Related
COI policy change has medical associations talking
COI policy change has medical associations talking
Filed under: Conflicts of interest, Hot Health Headline
A policy intended to reduce conflicts of interest in continuing medical education will take effect at the American Heart Association’s annual Scientific Sessions in November: Pharmaceutical industry employees will not be allowed to make medical education presentations at the event.
John Fauber of the Milwaukee Journal Sentinel reports the change comes as the result of “a relatively new interpretation on a policy of the Accreditation Council for Continuing Medical Education, the national body that accredits medical education courses.” Such presentations can be used to boost the marketing of new drugs, according to James Stein, a cardiologist and professor at the University of Wisconsin School of Medicine and Public Health.
Clyde W. Yancy, president of the American Heart Association, explains the new policy.
The policy came up at a meeting at the National Institutes of Health last week, where Keith Yamamoto, executive vice dean of the University of California, San Francisco, School of Medicine, called it “bloodcurdling.”
Fauber quotes people on both sides of the issue, including a former editors of JAMA and NEJM, as well as critics of industry funding of medical education.
Clyde W. Yancy, M.D., president of the AHA, was at the NIH meeting and expressed “consternation” about the policy and was hoping to get support from others in the room to appeal the ACCME’s decision. He points out that the AHA’s event is the first major medical meeting at which these policies will be in place but that other organizations will have to deal with the changes to remain accredited by the ACCME.
Video of the meeting is online and the relevant proceedings start at about the 108 minute mark. It’s well worth watching to see the reactions in the room.
New data on insurance coverage released
The first full-year 2009 numbers about health insurance coverage from the NCHS’ National Health Interview Survey have been released. The notable numbers:
- 58.5 million Americans were insured for at least part of the previous year
- 46.3 million were without insurance at the time they were interviewed
- 32.6 million had been uninsured for more than a year
The numbers are sliced and diced a number of ways. I’ve included a visualization of one of the livelier categories: The number of people getting their health coverage from public or private sources.
AHCJ’s own featured as journalist to follow
A bow to AHCJ’s own Pia Christensen, featured in the May/June SPJ Quill as part of a “Journalists to Follow” feature. She runs this blog and the AHCJ website, among many other jobs.
The magazine featured “questions with a bunch of cool journalists and innovators. … These are people in the industry we think have great ideas and hold great potential. In short, you should pay attention to them — not only on Twitter, but in the wider industry. See what they do. Interact with them. Learn. Engage.”
The article gives Christensen’s insight into journalism’s struggle to move into its next successful business model and what future journalists might consider about the industry. “I hope we will be able to look back on this as a transformative time in journalism,” she said. “Without discounting the turbulence in the industry and the many jobs that have been lost, I think this period will be marked by new ways of reporting and telling stories in a variety of formats.”
Plus, she talked about the best practices of journalists using resources such as crowdsourcing and social media and how citizen journalists and “user-generated content” can fit into mainstream media.
Christensen manages the AHCJ website and oversaw its redesign; she developed the blog Covering Health. She also assists with the editing and production of AHCJ’s publications, including books, conference programs and the quarterly newsletter.
She previously was publications coordinator for Investigative Reporters and Editors, where she oversaw website content, edited IRE publications and assisted advertisers. She worked as a copy editor and an interactive producer at the South Florida Sun-Sentinel, a producer for Tribune Interactive, a sports copy editor for the Marin (Calif.) Independent Journal, and was job and internship coordinator at the Center for Integration and Improvement of Journalism in San Francisco. She telecommutes from Oklahoma.
Follow her on Twitter via AHCJ_Pia.
Pharma starts disclosing sample numbers
Filed under: Health care reform, Health data, Health journalism, Hot Health Headline, Pharmaceuticals
The health reform law will require drug makers to disclose the amounts of free samples they distribute, a requirement which promises to shed light on a practice whose scope could previously only be estimated. The Wall Street Journal’s Jared Favole has found some preliminary disclosures; the resulting numbers can be found in the graph below. The numbers should only be treated as the roughest of estimates, as some companies disclosed the market value of the drugs while others gave wholesale numbers. Likewise, some measured the number of samples based on the number of doses, while others counted larger units. 
Samples, Favole writes, are a key weapon in pharma’s war against generics as they can be a gateway to brand-name medicines.
A 2008 study in the Southern Medical Journal found that doctors in a clinic were more than three times more likely to prescribe generic medications to uninsured patients after drug samples were removed from that clinic. “Free drug samples may lead to higher costs for uninsured patients by encouraging physicians to write prescriptions for brand-name drugs only,” the study said.
A PDF of that study can be found here.
British article unleashes debate on science coverage
Highlighting good science journalism would contribute to improving coverage, according to Ed Yong, writing for Discover Magazine’s Not Exactly Rocket Science blog.
Photo by Alex Barth via Flickr
He writes that a lack of accountability fuels frustration with poor science journalism, as it does in the case of a story in the UK’s Observer newspaper that was critiqued by the Guardian’s Ben Goldacre and has now been removed from the Web site.
The episode has triggered a number of pieces about whether such critiques are helpful or whether science journalists are unfairly criticized, including “an opinion piece from the Independent’s health editor Jeremy Laurence criticising Goldacre, a response from Goldacre criticising Laurance, and a defence of Laurance from Fiona Fox of the Science Media Centre.”
Yong also points readers to an amusing – and angry – post by Martin Robbins at the Lay Scientist, who says, “Robust criticism is a vital part of science, and it should be a vital part of journalism.”
Robbins also points out, in more colorful language, that journalists who don’t do simple fact checking are making themselves irrelevant.
Hospital sends ER wait times via text
Edward Hospital in Naperville, Ill., has taken the art of making ER wait times available to prospective patients to the next level, the Chicago Tribune’s Julie Deardorff reports. The hospital, which markets itself as “For people who don’t like hospitals,” has worked to decrease “door to doctor” wait times and are now making it as easy as possible for patients to know just what those wait times are. Folks can get up-to-date wait times online, over the phone or by text message.
A sign in the ER at Beth Israel Deaconess Medical Center in Boston. Photo by kbrookes via Flickr.According to the hospital’s site, these wait times are “the average time from when a patient arrives and checks-in at our ER to the time when they are placed in a room and treatment begins. The times are updated every 15 minutes based on actual times from the preceding 30 minutes.”
When I tested the service, texting “ERwait” to 41411, I got the following response:
Edward ER Wait Times: Naperville ER 2 minutes/Kids’ ER no wait, Plainfield ER 1 minute, visit us at www.edward.org/ERWaitTimes
It seems effective enough, though I have to wonder just how many people in need of emergency medical attention are going to have the number and requisite text handy.
You might recall that HealthLeaders Media wrote in January about the increasing number of hospitals that post wait times on their websites.
Why ER wait times are all-important
In a recent and conveniently relevant blog post, veteran South Carolina ER doctor Edwin Leap (bio) described how lengthening wait times can bring an emergency room to a “screeching halt.”
At that point, a helplessness descends on the nursing and physician staff. Wait times creep from two hours to four, four hours to eight, eight hours to ten. Only those who are obviously the sickest come back for care. Remarkably, on some of the busiest shifts ever, I discover that I have seen the fewest patients. If the pace were like normal, I could burn through ER visits like crazy; so could my partners. But when the numbers waiting climb, when the patients being admitted and held grow to legions, then speed is dead.
These are the dangerous times. These are the times when the sickest sometimes give up and go home. And the times when overwhelming amounts of data crush clear thinking.
It’s an evocative picture and one that Leap characteristically blames on the mission creep suffered by ER departments around the country. His laundry list of the extra responsibilities crushing today’s emergency rooms — “chronic pain” sufferers shopping for pills, constant chest pain and cardiac care, and basic primary care — should be familiar to anyone familiar with emergency medicine issues, but there were a few that stood out. The most telling was his rant about ERs as mental health facilities.
Mental health holding centers. A private, nationally known chain of mental health centers used to advertise: ‘if you don’t get help here, get help somewhere.’ That is, the ER. Call a suicide hot-line and you’ll be directed to an ER. It doesn’t matter that many facilities (like ours) don’t have psychiatrists or even counselors (except by tele-psych). It doesn’t matter that they take up beds, languishing in line for commitments (which seem to be growing exponentially in number). It doesn’t matter that the law requires us to pay one on one observers (and if they are RN,’s they get RN pay to read novels at $25/hour). It doesn’t matter that we don’t have the security to manage it. We are the last common pathway, so that someone, somewhere can feel good that ‘at least he’s finally getting the help he needs.’ No, he isn’t. He’s getting observed and largely ignored until we can send him somewhere else.
Leap always writes with a chip on his shoulder, but it reaches a crescendo when he decries the role of ERs as “guilt assuaging centers” for fellow physicians.
Call any doctor’s office. ‘If this is an emergency, hang up and dial 911.’ All you need to do, to do the right thing, is send someone to the ER. No matter how many stretchers are lined up in the hall, or how many schizophrenics or arrested drunks are screaming and terrorizing the little children with fevers.
Even when taken with a grain of salt, Leap’s writings bring across the chaos and urgency of the emergency department and highlight the way that it all revolves around that one magic number: The wait time.
List reveals drugs U.S. consumers buy from Canada
On the Los Angeles Times‘ Booster Shots blog, Jeannine Stein has located the Canadian International Pharmacy Association’s list of the top drugs purchased online by American customers in 2010.
The list swings heavily toward treatments for chronic conditions, with Plavix, Advair and Flomax topping the list. As Stein notes, international and online prescriptions are in dubious legal territory, but it’s right in Wikipedia’s wheelhouse and the site can point you to the relevant laws.
By the way, the Canadian International Pharmacy Association is an association of retail pharmacies that sell pharmaceuticals and maintenance medications in 90-day quantities to Canadian and U.S. citizens. The group might be a good source if you are writing about people in the United States buying drugs in Canada. The organization is certainly tracking news coverage of the topic.
Tell us about your access to federal officials
Have you recently tried to get information from the federal government or arrange an interview with a federal official?
AHCJ’s Right-to-Know Committee is calling on journalists to report their experiences, as part of a continuing effort to pry open the doors of the federal government. We’re looking for recent anecdotes about journalists’ experiences with public information officers, especially at the Department of Health and Human Services and any of the agencies that are part of it (e.g., CDC, FDA, CMS etc.).
Freyer
Please write to Felice J. Freyer, Right-to-Know Committee chair, at felice.freyer@cox.net, about problems you have encountered, including mandates to clear interviews with the press office, slow responses, refused interviews, burdensome requirements (such as written questions and answers only), extreme time limitations on interviews, PIOs listening in on your conversations, or anything else that made it hard for you to get the information and quotes that you needed in time. Additionally, do you know whether your requests have been sent to HHS or the White House? What effect did that have?
For background on the committee’s work so far, see these links:
-
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
