Reporter checks records, hits facility with news
of looming closure

After picking up new tools and techniques at Health Journalism 2011, reporter Sarah Bruyn Jones returned to The Roanoke Times and lost no time in putting it to use. Her story, on the impending closure of a local assisted living facility, came as a direct result of checking nursing home inspections. It also, if home operators are to be believed, came as a surprise.

Edward Jones, president of Ashed Healthcare Systems, which owns Monticello, said he was unaware of the state’s intentions to close the facility.

“I had no clue of any of this until you mentioned this,” Jones said when contacted late Thursday about the impending closing.

Thanks to the inspection records, Jones’ story is loaded with details like “Moldy bathrooms, poor plumbing, water leaks, crumbling walls, broken lights and roaches,” and a solid chronology of events.

At one point an inspector found that residents had been without toilet paper for at least two days. In July the building’s water was turned off because the owners had failed to pay the bill.
…
Patients were being given prescription medication when there was no record of a diagnosis for those drugs. In some instances, drugs that were supposed to be given weren’t being dispensed. A diabetic wasn’t receiving insulin. Another patient was only getting half the prescribed dose of medicine.

Earlier this year two residents lost Medicaid coverage after the Monticello staff member assigned to file annual renewals for the residents failed to complete the work.

Laser spine clinics use Internet search ads to push unproven, costly treatment

Bloomberg’s David Armstrong has put together an investigation of a simple, effective and dubious new business formula, one which begins with pain in the back. In thousands of patients, this chronic back pain leads to desperation, desperation leads to Internet searches, and Internet searches lead to rosy-sounding ads for laser spine treatments from the fast-growing, high-priced, high-volume clinics that are blossoming around the country.

According to Armstrong, this trend is epitomized by Laser Spine, the six-year-old industry leader with $109 million in sales last year and a monster profit margin of 34.3 percent from 2006 to 2009. It typically charges about $30,000 per procedure, or about half of what any insurer would be willing to pay for a garden-variety laser-free surgery.

Laser Spine and its competitors, part of a boom in outpatient clinics operated by entrepreneurial physicians, sell a high-tech version of procedures that have been around for years — despite a lack of independent research to show that their variations lead to better outcomes. The company commands higher prices than laser-less rivals, driving up the cost of health care. Its number of malpractice claims per 1,000 surgeries is several times the rate for all U.S. outpatient surgery centers, based on insurance industry data.

How do these companies get away with charging high prices for procedures with shaky track records? Through a gap in federal regulation that will be familiar to reporters who have investigated surgical robots and other high-tech procedures.

While the Food and Drug Administration regulates the use of drugs and medical devices, there’s virtually no federal oversight for the effectiveness of surgical techniques.

“This is an issue with surgery generally,” said Robert McDonough, head of clinical policy research and development at Aetna. “Surgeons can introduce new procedures that might be significantly different from established ones with no oversight of the claims they make.”

Drug-makers’ ads — including sponsored links that appear in response to search-engine queries — must disclose their medications’ risks, under FDA rules. Ads for surgical techniques have no similar rules.

PR professional offers cash for attending Allergan-hosted event

Journalist Lisa Collier Cool was “truly appalled” to receive an email that offered her a $250 stipend if she would attend a “Facial Aesthetics Advisory Panel” hosted by Allergen – makers of Botox, Juvederm and Latisse.

The PR pro, of Chandler Chicco Companies,  a health care public relations firm, wrote:

The goal of this Panel is to engage in a discussion about current facial aesthetics trends and innovations, perceived gaps in data, and any questions, concerns or misperceptions your readers may have about products and treatments. Allergan will provide an overview of the evolution of the facial aesthetics marketplace and then will open the panel for discussion.

As a seasoned reporter in this space, we would greatly value your feedback, and we’d like to offer you a stipend of $250 for your attendance and insights.

Cool, who brought the email to AHCJ’s attention, said she considers this “an all-time low in drug company promotion to the media” and that this is the first time she’s received such an offer in more than 25 years of health reporting.

AHCJ’s Vice President, Karl Stark, said AHCJ’s board of directors was alarmed by the offer.

“We report all the time on the potential conflicts of interest that money creates between drug companies and doctors,” said Stark, a Philadelphia Inquirer editor. “How would this be any different?”

Cool agreed, saying she is “shocked that along with questionable payments to doctors, the pharmaceutical industry – or at least Allergan – is now stooping to offering fees to reporters, presumably in the hope of securing favorable press coverage for its products. I view this as a thinly disguised attempt at bribery and hope that this practice won’t become widespread.”

Certainly accepting such money would violate common ethical guidelines for journalists. For example, AHCJ’s Statement of Principles includes the advice to:

• Deny favored treatment to advertisers and special interests and resist their pressure to influence news coverage.
• Refuse gifts, favors, and special treatment. Refuse meals from drug companies and device manufacturers and refuse to accept unsolicited product samples sent in the mail.

The Society of Professional Journalists’ code of ethics advises journalists to:

• Remain free of associations and activities that may compromise integrity or damage credibility.
• Refuse gifts, favors, fees, free travel and special treatment, and shun secondary employment, political involvement, public office and service in community organizations if they compromise journalistic integrity.

“Assisting medical companies with their public relations efforts is not the role of journalists,” Stark said.

AHCJ has contacted the representative who sent the email for details on this arrangement, including whether other reporters have taken her up on the offer, if any reporters have raised questions about it and whether this is an approach she or her company has used in the past. We will update this post if we get a response. [Update: PR rep says journalists’ stipend to attend Allergan event was misconstrued]

Meanwhile, Forbes’ Matthew Herper contacted Allergan and posted its response.

VA centers in 30 states, D.C. used recalled wipes

JoNel Aleccia of MSNBC.com continues her reporting on tainted and recalled alcohol prep pads, finding that “A quarter of the nation’s Veterans Health Administration medical centers and the agency’s outpatient mail-order pharmacy used recalled alcohol prep pads and other products …”

The FDA has identified problems with contamination and sterilization at the plant where the products were manufactured and hundreds of millions of products were recalled because of the threat of bacterial contamination.

The VA says “38 of the country’s 152 major veterans medical centers in 30 states and the District of Columbia removed recalled wipes, pads and other products from use” and “products were removed from the Consolidated Mail Outpatient Pharmacy, which provides more than 97.4 million prescriptions a year to veterans.”

Previously, the FDA the company that manufactured the wipes refused to identify which hospitals used the products, but Aleccia has obtained and published a list of the affected VA facilities.

Recalled povidone iodine prep pads from the same company also have been included in first aid kits intended for animals, such as this equine first-aid kit.

Previous coverage:

• Parents blame toddler’s death on tainted wipes
• FDA knew of problems at plant that made tainted wipes
• FDA defends actions on tainted wipes
• Colo. hospital blew whistle on tainted wipes
• Pressured firm closes line that made tainted wipes
• Infection risk triggers new recall of wipes
• Two-thirds of alcohol wipes contaminated
• FDA asks maker of tainted wipes to stop production
• Senators question FDA’s response to tainted wipes
• Wipe-maker shuts doors after U.S. Marshals arrive
• Feds seize $6 million in products from wipe-maker

Herald reports on failures of assisted living system

The Miami Herald’s yearlong “Neglected to Death” series on abuse and violations in assisted living facilities is expansive, but I recommend starting with this explanation of how the story came together. In short, the crux of project, reported by Rob Barry, Carol Marbin Miller and Michael Sallah, is a huge database, which never had been made public, the paper obtained from state regulators. An accompanying editorial from Aminda Marques Gonzalez details its somewhat unique provenance.

At the heart of the reporting is a rich database of hundreds of thousands of records that includes all inspections and complaint investigations by the Florida Agency for Health Care Administration, the sole regulatory agency for ALFs [assisted living facilities]. Layered in: a decade of complaints filed with the State Department of Elder Affairs and public records including police reports, death certificates and autopsy reports.

The paper has made the database searchable and open to the public.

The Herald reports on a facility where violence is so commonplace that incidents have prompted more than 1,200 calls to 911 in the past five years. It’s important to note that, while we usually think of assisted living for the elderly, there are such facilities for those who have mental illness and other disabilities.

Other stories tell of residents suffering from sores that went untreated, homes and caretakers that failed to keep medical records, facilities that did not protect vulnerable residents from those with a criminal background, a failure to track patients with dementia and more.

A timeline helps explain how and why the assisted-living facilities became a part of the Florida system and their growth.

ProPublica investigates ties between doc groups, industry

With an assist from Sen. Chuck Grassley, ProPublica senior reporters Tracy Weber and Charles Ornstein, AHCJ’s board president, have published their latest data-heavy investigation (USA Today version). This time, their journey into the myriad avenues pharmaceutical companies pursue to influence physicians has taken them into the world of professional societies and annual conferences. The duo writes that despite the power of these groups, their dependence upon millions and millions of dollars in industry funding has often slipped under the radar.

Professional groups … are a logical target for the makers of drugs and medical devices. They set national guidelines for patient treatments, lobby Congress about Medicare reimbursement issues, research funding and disease awareness, and are important sources of treatment information for the public.

Their strongest anecdote comes from the Heart Rhythm Society, a group which, in 2010, pulled in about $8 million – half their total income – directly from manufacturers of the drugs and devices their members specialize in prescribing for, or implanting in, patients. The society has started to disclose these relationships, but perhaps not to limit them, the reporters write. “’This is our business,’ said Dr. Bruce Wilkoff, the incoming society president. ‘We either get out of the business or we manage these relationships. That’s what we’ve chosen to do.’”

The companies also pay two-thirds of the society’s board members speaking or consulting fees, a situation Weber and Ornstein found is far from unusual. In addition to these financial conflicts, the reporters gathered some fascinating examples of just how deep industry influence can run. My personal favorite comes from the conference of a well-known collection of cardiologists.

Last month, the American College of Cardiology attached tracking devices to doctors’ conference ID badges. Many physicians were unaware that exhibitors had paid to receive real-time data about who visited their booths, including names, job titles and how much time they spent.

For more examples, I recommend Robert Durrell’s photographs from the 2011 Heart Rhythm Society annual conference, which show dozens of industry-sponsored objects alongside the amount of money each company paid for that particular privilege. Dan Nguyen and Nicolas Rapp put together an infographic that expands upon a similar theme.

Much of the disclosure data the ProPublica team depended on for their reports was released in response to a request for informationGrassley sent out in late 2009. His investigation has started to yield some preliminary results.

There are fledgling efforts to push medical societies toward stricter limits on industry funding: 34 groups have signed a voluntary code of conduct calling for public disclosure of funding and limits on how many people on guideline-writing panels have industry ties.

“The general feeling is that the societies need to be independent of the influence of companies,” said Dr. Norman B. Kahn Jr., chief executive of the Council of Medical Specialty Societies, which helped draft the code.

Ex-pharma rep talks about pressure, tactics to sell

A story reported and produced by Gerri Shaftel at KTTV-Los Angeles (and presented by Christine Devine) gives viewers a look into the world of pharmaceutical representatives, a world of former beauty queens and long lists of off-label uses and side effects.

It’s based around a former pharmaceutical rep and cheerleader named Jennifer Shaw, and opens with the standard portrait of reps as former models with short skirts and even shorter scientific résumés, but also goes into how reps get the information about doctors’ prescribing habits.

Confessions Of A Pharmaceutical Rep: MyFoxLA.com

Over the course of the story, viewers learn how pharmaceutical companies track every prescription a doctor writes, press doctors to raise specific prescription numbers, and rank physicians on a scale of 1 to 100, then reward them accordingly with speaking engagements and the like. Even Jennifer, the rep turned tell-all author, has a compelling story about how she left the industry when her company pushed her to sell a reformulated drug despite the alarming side effects that were cropping up along her sales route.

It may come in a fancy package, but it’s wholesome stuff.

Spreadsheet lists malpractice claims against VA

In its “FOIA Friday” feature, the Project On Government Oversight reveals a spreadsheet (XLS format) of claims against the Department of Veterans Affairs, including thousands related to medical malpractice.

The spreadsheet lists administrative claims, the first step in the VA’s process for filing claims.

Nick Schwellenbach explains more about the data:

The data provided has details on over 12,000 claims against the VA from 1989 to November 2008, although the data appears largely incomplete for the first several years. Not all of the claims are medical malpractice-related, but several thousand are. There are fields for the VA facility involved, the date the claim was received, the date of the last tort status (where the claim is in the administrative process), the date of that status, alleged negligence descriptions (none exist for non-medical malpractice tort cases), and amount paid out, if any. The spreadsheet is over two years old, so the latest tort status field may be out-of-date for many of these claims.

The spreadsheet includes 16 cases in which more than $1 million was paid out. The descriptions of the allegations are pretty vague but those 16 cases include:

• Failure To Obtain Consent or /Lack Of Informed Consent; Improper Technique; Improper Performance; Improper Management; Delay In Diagnosis; Failure To Treat; Failure To Order Appropriate Medication; Failure To Monitor; Failure To Diagnose (i.e., Concluding That Patient Has No Disease or Condit[ion)]
• Failure To Respond To Patient
• Surgical or Other Foreign Body Retained
• Unnecessary Procedure; Intubation Problem; Improperly Performed Test; Improper Management

It’s worth noting that another recent “FOIA Friday” also was related to health. It was a letter sent by the National Institutes of Health to Emory University “after the media exposed Dr. Zachary Stowe’s cozy financial relationship with GlaxoSmithKline (GSK) while also receiving NIH grants to study antidepressants like GSK’s Paxil in pregnant women.”

Potter: Insurance industry taking advantage of media’s inattention to health reform

Wendell Potter, the former insurance company public relations executive who has been critical of the industry, writes that journalists who were covering health reform have moved on and insurance companies have noticed the lack of scrutiny.

Potter, writing for the Center for Public Integrity, says some journalists consider the writing of regulations to implement the legislation boring and of little interest to the public.”

But insurance company lobbyists know the media are not paying much attention. And so they are able to influence what the regulations actually look like—and how the law will be enforced—with little scrutiny, much less awareness.

Consumer advocates tell Potter that the insurance industry is “pushing back” against rules that would give consumers clear information about their rights and would expedite appeals in urgent situations.

Those rules, which were written by the National Association of Insurance Commissioners, were scheduled to go into effect on July 1 but indications are that the Obama administration will push the implementation date back to Jan. 1, 2012, Potter says.

How can we help you cover reform and implementation?

As AHCJ’s health reform topic leader, Joanne Kenen is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. Her latest post is “Health reform battle entering a new phase.” If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.

Health reform battle entering a new phase

As I try to figure out what AHCJ members most need as they cover health reform in year two of the Affordable Care Act, I tried to see if I could detect themes at the AHCJ conference in Philadelphia. That unified theory of health reporting plan went out the door as I heard questions ranging from very basic queries about pre-existing conditions to far more technical inquiries about accountable care organizations.

My next plan was to blog about the “reporting on health reform” session.  A conference fellow  beat me to that - (also see the tip sheets Covering health reform issues, Health care reform: Litigation update, Three health reform issues to watch in the states).

The repeal and replace stage of the health wars isn’t over. But I think we are entering another phase. The dominant national discussion topic is the deficit and the debt – and that leads into Medicare, Medicaid and other entitlements.  I’ve done a tip sheet on Medicare and “premium support.” Medicaid is next up.

The proposals in the House-passed version of the budget are not brand new; Medicaid block-grant proposals have been around since at least the Reagan years, and they were definitely part of the Gingrich era. I remember hearing about variants of premium support and/or Medicare vouchers in the late 1990s, and I suspect they were around before that.

We don’t know every detail of what the Ryan plan would do; the budget plan is a federal framework, and the details aren’t filled in. And of course the Ryan budget won’t be accepted by the Democratic-controlled Senate or President Obama.  But this idea isn’t going to go away. We need to watch how it plays into reforms being considered at the state level, and see what kind of steam it picks up (or loses) after 2012.

If your governor or state legislature favors block granting Medicaid, it’s time to start asking questions.

• What would Medicaid look like under a block grant?
• Who would still get it?
• Would there be enrollment caps and waiting lists?
• How much of the costs would be shifted to the beneficiaries and families?
• Would providers get paid less?

States can already get waivers for Medicaid, and that can allow for innovation in red and blue states alike.  States will have a lot more flexibility under some of the ACA provisions in the next few years, including ways of doing a better job caring for people with chronic disease and the “dual eligibles” on Medicaid and Medicare.

Here are a few articles I’ve seen recently that describe some of what the states are already doing – or considering – as they confront rising Medicaid costs today.

Looking at the coverage

Carol M. Ostrom of The Seattle Times had an April 17 piece: “Doctors: State plan to limit Medicaid ER trips risks lives.”

Several of the Florida papers have had pretty good coverage of Gov. Rick Scott’s plans to transform Medicaid. But a solid hour of Googling didn’t net me one good big clear step-back story (it may be out there somewhere … send it if you see it) that tells out-of-state readers the whole story. But I still found work by John Kennedy and Stacey Singer at The Palm Beach Post (here’s one) and Marc Caputo of The Miami Herald (click here - you have to read down a bit to get the state overview) helpful.

The Oregonian has been taking a look at some of Gov. John Kitzhaber’s agenda, which should be worth watching as he has a track record as an innovator (and knows CMS administrator Don Berwick quite well).  And of course we’ve all heard a lot about Arizona.

A lot of the stories I looked at from around the states were written by state capitol reporters, not health beat folks, so they were heavy on process and “Republican said X, Democrat said Y” kind of coverage. They didn’t always do a great job of getting beyond a fusillade of quotes.  I guess if I’ve been Googling for more than an hour and can’t find a really solid health overview story, I should stop here and invite you to send me any you’ve seen (or written).

Don’t forget about Medicaid

Medicare is getting an awful lot of ink – after all, old people vote, and most of us expect to get old someday and need Medicare. We’ve got to look harder at Medicaid which covers poor kids and their parents, some of the disabled and mentally ill, some of the HIV population, and lots of the residents of nursing homes. That isn’t who votes. That isn’t who decides what reporters cover. And it’s certainly not a benefit most of us hope to use someday.

Last comment for today - and you’ll probably hear me return to this theme frequently because, to me, it’s some of the most interesting reporting we’ll be able to do in the coming years:  Remember the Affordable Care Act, the health reform law, isn’t only about coverage and insurance exchanges. It makes countless changes to Medicare and Medicaid - changes that will affect the current fee for service model, changes that affect the private managed care sections of it and changes that will add new dimensions as we explore new ways of delivering care (medical homes, ACOs, a number of Medicaid programs aimed at getting people care in the community, not just nursing homes).

Joanne Kenen is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.

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