St. Louis reporters find felons practicing medicine
Filed under: Health care reform, Hot Health Headline
The St. Louis Post-Dispatch’s Blythe Bernhard and Jeremy Kohler tell the story of an ophthalmologist to show how a convicted felon can be allowed to return to medical practice, sometimes in the same state in which he or she was convicted. The ophthalmologist in question went to prison after lying to patients, defrauding Medicare and obstructing the resulting investigation, yet now works in an Illinois clinic and has permission to reapply for his Missouri license.
The investigation is strengthened by two sidebars, one listing examples of other felons/physicians and the other explaining how and why an ophthalmologist lied to patients and Medicare about what he was injecting into their eyes.
For the record, my favorite sentence in the entire piece is “Medical boards don’t release statistics on how many active licensees are convicted felons.” It certainly would make things easier.
Earlier stories from Bernhard and Kohler document similar problems with a lack of openness of records and how disciplined doctors can still keep their records clean:
AHCJ members can read about how the pair have done much of the reporting on this ongoing project.
Story on soldiers’ aches and pains wins member a Mid-America Emmy
Filed under: Government, Health journalism, Member news
A story inspired by a session at Health Journalism 2009 earned member Meryl Lin McKean the 2010 Emmy for Health/Science News at the Mid-America Emmy Awards this year. McKean is the medical reporter at WDAF-Kansas City. Her story looked beyond casualty rates to the everyday aches and pains that come as a result of active military service in Iraq and Afghanistan. The video is no longer available, but the accompanying text demonstrates the scope and severity of such problems.
Soldiers return to a border checkpoint in the Khowst province of Afghanistan. Photo by The U.S. Army via Flickr
A V.A. report found that nearly half of the returning vets from Iraq and Afghanistan have bone, joint or tissue injuries. At Kansas City’s V.A. Medical Center, 17% of the vets seen in the new post-deployment clinic have those injuries. That’s still far higher than in non-vets.
“This age group between 18 and 30 — you might expect five percent at the most,” says Bob Fletcher, V. A. Physician’s Assistant.
Fletcher says the problems are clearly related to the combat load. And the problems for many vets will continue. Those problems include include arthritis pain and stiffness, the inability to hold certain jobs that require much movement, and possible dependence on pain medication.
Anti-fraud guide may be useful to reporters
A just-issued 31-page guide for new physicians from HHS’ Office of the Inspector General teaches doctors how (and why) to avoid defrauding their patients and the federal government. As their public-facing antifraud campaign ramps up, the office is responding to a need for better education of medical students. It makes sense, as physicians are generally the gatekeepers for medical spending. The government doesn’t often restrict their actions on the front end, which means physicians need to know the rules before they act.
The guide is fairly engaging reading, as OIG reports go, and it may serve as a primer to reporters looking into Medicare and Medicaid fraud. It covers doctors’ relationships with payers, other providers and vendors, as well as a summary of the five primary anti-fraud statutes.
False Claims Act
Doctors shouldn’t submit claims they know are wrong, or they’ll get socked with an $11,000 fine for every little item billed falsely, in addition to repaying the cost of the item several times over. This includes upcoding, or billing for a more severe (and expensive) illness than the patient really had, or billing for an item already included in a larger overall reimbursement.
Anti-Kickback Statute
Don’t pay for patient referrals or anything else that generates business. And yes, all forms of payola are covered, not just cash.
This also extends to getting paid, whether it be by pharmaceutical companies or the college buddy who’s getting all the referrals.
Note: Doctors can waive patient copays in specific situations (they’re uninsured, can’t afford it or the doctor can’t collect), but physicians can’t do it systematically as a way to gain patients.
Physician Self-Referral Law (aka the “Stark law”)
With a couple of gigantic exceptions, doctors can’t refer patients to imaging centers that they or family members own. The rules also apply to physical therapy, prosthetics, home health services and hospital services, among other things.
Physicians can invest in health care business ventures, but they should look out for possible conflicts of interest, especially if they’re getting the sort of preferential treatment not afforded to ordinary investors.
Red flag: If the money you’re getting paid is out of proportion to the work you’re doing, then something shady is probably going on. Especially if it in any way influences the treatment your patients get.
Remember, nearly all gifts and payments from drug and device companies will be disclosed starting in 2013.
Exclusion Authorities
Doctors shouldn’t deal with folks who have already been convicted of Medicare or Medicaid fraud, patient abuse or neglect, or any related offenses. If you don’t want to get on their black list, don’t violate the other four key fraud laws.
Civil Monetary Penalties Law
CMS can seek civil monetary penalties (and black listing) if doctors violate any of the above, or provide them with false information. Physicians also need to provide adequate screening to emergency patients.
Finally, the guide ends with instructions for doctors on how to report themselves, emphasizing that doing so “allows providers to work with the Government to avoid the costs and disruptions entailed in a Government-directed investigation.”
Professor: Research, training can improve South African health journalism
In discussing a large grant his university has received and the center for health journalism that it will fund, South African professor Guy Berger (bio) has unleashed a scathing critique of African health journalism, and of the profession as a whole.
Berger says South African health journalists don’t look hard enough for real news, don’t know enough about health care, and aren’t even that good at telling the stories that they do uncover.
It’s a dire picture, of course, but Berger’s overall message is one of hope. He implies that there’s a lot of great work to be done on health and the health care industry in in South Africa and the new center, he says, could help make health journalism the “healthiest trend-setter for the whole family of journalism.”
The “Discovery Centre for Health Journalism” will be funded by a $2 million grant from South African insurer Discovery Health. It will offer an honors program, six annual scholarships and an “annual symposium for working health journalists and stakeholders.” Berger also writes that it will “enjoy full academic freedom.”
For more on the center and African health journalism, see Issa Sikiti da Silva’s related post on bizcommunity.com.
Community-led effort sparks public health wave
Filed under: Health policy, Hot Health Headline, Public health
Writing in The New York Times, Jessica Reaves writes about how a 2000-06 Chicago community survey embodies the block-by-block, community-reliant approach to public health that it helped inspire.
In the heavily Puerto Rican Humboldt Park neighborhood, researchers worked with community leaders to write study questions, then relied on community members to conduct the actual survey. From these roots, the level of community participation snowballed, and locals demonstrated an interest and investment in public health that researchers hasn’t seen before. Today, initiatives born out of that study still provide residents with access to fresh produce, free diabetes screenings, fitness classes and more.
Now, researchers are further localizing and intensifying their effort with a block-by-block approach. The Humboldt Park model has become one that others are working to replicate across the country.
The specifics of the Sinai approach (In Humboldt Park) — change-oriented and invested in the fate of a neighborhood — are distinctive, but they also reflect a sea change in the overall strategy of public health professionals, said Janine Lewis, executive director of the Illinois Maternal and Child Health Coalition, a nonprofit advocacy organization in Chicago.
“I think the field is becoming more responsive to the idea of community-based participatory research,” Ms. Lewis said. “Those of us in the field realize that community members are experts on the needs and gifts in their communities, and should be consulted” at every phase of research.
This approach, she added, not only helps investigators devise more meaningful questions, but also means residents feel a part of the process and motivated by the results.
Dialysis program: Experiment in socialized medicine comes with high costs, risks
Filed under: Europe, Government, Health care reform, Health data, Health journalism, Health policy, Hospitals, Hot Health Headline, Pharmaceuticals, Public health, Public records, Tools
ProPublica’s Robin Fields has put together an artful examination of the nation’s Medicare-funded dialysis system. Part history and part investigation, it explains how this massive anomaly of government-run medicine came to be, and how it demonstrates the promise and peril of so-called socialized medicine.
The reporting has had an immediate impact, both upon the dialysis industry (read leaked plans for their response here) and upon the federal government. For health journalists, the federal response is particularly interesting, as it involves the disclosure of previously hidden data, and a classic government excuse.
ProPublica first asked CMS for the clinic-specific outcome data it collects — at taxpayer expense — two years ago under the Freedom of Information Act. The agency declined to say whether it would release the material until last week, as this story neared publication. It subsequently has provided reports for all clinics for 2002 to 2010. ProPublica is reviewing the data and plans to make it available for patients, researchers and the general public.
The reasons CMS has given for withholding the information until now is that some measures are disputed or lack refinement. Regulators and providers can put the data in perspective, officials had said, but patients might misinterpret the information or see it as more than they really want to know.
As befits something destined for publication in The Atlantic, Field’s piece might take more than one sitting to fully digest. And, if you haven’t yet had that second sitting, you’ll have missed some particularly nifty bits of comparative journalism, particularly where Fields compares the U.S. system to that in Italy, where the costs are significantly less and patients “got half the average dose of Epogen given to U.S. patients, perhaps because there’s no profit incentive to give them more.”
In Italy, about one in nine dialysis patients die each year. In the United States, that number is one in five. In dialysis treatment, there’s a trade-off between speed, cost and outcomes. And even high-rated Italy has had to make a few sacrifices, as evidence by comments from an Italian doctor:
“The decision to make dialysis faster wasn’t a scientific decision, it was a managerial decision,” he says. “It’s to allow you to do four shifts a day and make money.” He schedules just two shifts a day to accommodate longer treatment times.
Fields ends the piece on a high note. There’s hope for future efficiency in the dialysis system, thanks to a new program of bundled payments that will supplant the current system in which clinics see the actual dialysis as a “loss leader” and profit instead from heavy use of well-reimbursed drugs.
ProPublica promises more stories about this throughout the week, so be sure to check back its site for developments. Fields discussed dialysis on NPR today, as did Dr. Barry Straube, the chief medical officer at CMS.
Understanding risk, and why 83% is really 10.5%
Physician and blogger Alex Lickerman used a discussion he had regarding hormone replacement therapy and breast cancer as an opportunity to explain absolute versus relative risk. It’s a an issue we’ve tackled in Covering Health before (Thanks, Ivan), but the difference between an 83 percent jump in relative risk and a 10.5 percent increase in absolute risk is so fundamental that we’re happy to spotlight Lickerman’s particularly newsworthy example.
In case you don’t have time for Lickerman’s entire tale, here’s one of his smaller examples. It’s a blunter version of the same overall point.
Studies show in patients who’ve had a heart attack that taking one aspirin a day reduces their relative risk of having a heart attack over nearly a 10-year period by almost 50%. In patients over the age of 80, for example, whose absolute risk of having a heart attack can be as high as 12% in just the first six months following their first heart attack, this amounts to a recalculated absolute risk of 6%. Arguably still significant, but not nearly as much as the 50% relative risk reduction commonly bandied about in medical circles.
Related
For more on relative and absolute risk, as well as other statistical concepts that are important in health journalism, be sure to download AHCJ’s latest slim guide, “Covering Medical Research.”
The guide helps journalists analyze and write about health and medical research studies. It offers advice on recognizing and reporting the problems, limitations and backstory of a study, as well as publication biases in medical journals. It includes 10 questions you should answer to produce a meaningful and appropriately skeptical report. This guide, supported by the Robert Wood Johnson Foundation, will be a road map to help you do a better job of explaining research results for your audience.
CURE magazine earns Trailblazer Award
CURE magazine, a free, patient-oriented health publication which employs four AHCJ members, was named “Best Consumer Healthcare Publication” by PM360 magazine. The honor was part of the magazine’s annual Trailblazer Awards, and marked the first time the category had been included in the competition (PDF).
The AHCJ members who work for the 8-year-old magazine are:
- Kathy LaTour, editor-at-large
- Elizabeth Whittington, web managing editor
- Lena Huang, fitness & nutrition editor
- Bunmi Ishola, editorial assistant
LaTour also recently earned top honors in the American Cancer Society High Plains Division 2010 Media Awards with a piece that examined sleep disturbances in cancer survivors.
And, for the record, here’s the disclaimer posted on CURE magazine’s website:
CURE Media Group is affiliated with US Oncology, Inc., the nation’s leading oncology services company. CURE and www.curetoday.com are editorially independent from US Oncology.
In other news…
The two publications competing with CURE were WebMD the Magazine and Crohn’sAdvocate Magazine. While WebMD’s print publication is a fairly common sight, Crohn’sAdvocate is, in my experience, not. It’s funded by UMB, the pharmaceutical company behind the Crohn’s drug Cimzia. A visit to crohnsadvocate.com will redirect you to cimzia.com.
Georgia Health News aims to fill gaps in coverage
Georgia Health News has entered the growing group of independent websites covering health news.
Andy Miller
The site’s mission is “to fill the widening gap in media coverage by creating a substantive website that will provide crucial information about health care in Georgia.” It features original stories as well as links to health stories published by other Georgia media outlets.
The new site, founded by AHCJ board member Andy Miller, has applied for federal nonprofit status. Patricia Thomas, an AHCJ member and the Knight Chair in Health and Medical Journalism at the University of Georgia’s Grady College of Journalism and Mass Communication, serves on GHN’s board of directors.
Miller covered health care at The Atlanta Journal-Constitution until he left the paper in 2009.
The site joins ventures such as Health News Florida, the California HealthCare Foundation Center for Health Reporting, Kaiser Health News, ProPublica, California Watch and others that were collectively referred to as a thriving “new journalism ecosystem” in a recent study.
Calif. hospitals slow to prep for quakes
California Watch health reporter Christina Jewett has found that despite an earthquake readiness push that’s a decade and a half old, few at-risk California hospitals have even had their potential collapse risk calculated, and even fewer have done anything about it.
Photo by martinluff via Flickr
It seems to come down to the inherent difficult in enforcing regulations like these. A strict interpretation would call for the wholesale closure of noncompliant hospitals, a move that would create a public health issue every bit as severe as the one it’s trying to solve.
In the mean time, smaller quakes cracked floors and walls in at least one at-risk hospital in 2008, and some of the hospitals with the highest assessed risk are taking slow, expensive steps toward correcting it. The deadlines have already been extended repeatedly, though Gov. Schwarzenegger appears to be taking a hard line stand on pushing them back any farther. Hospitals now have until 2013 or 2015 to comply, depending. Hospitals that can prove financial hardship (regardless of assessed risk) have until 2020.
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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
