Troubled Mont. nursing home illustrates special federal status
Filed under: Government, Health data, Hot Health Headline, Public records
Reporters looking to implement the tricks they picked up at AHCJ 2011 or one of our workshops can look to Billings (Mont.) Gazette reporter Cindy Uken, whose story about a dangerously deficient local nursing home was carried by inspection reports and her understanding of federal programs and regulation.
The program in question, known as the Centers for Medicare and Medicaid Services Special Focus Facility Initiative, has singled out 49 of the nation’s 16,100 nursing homes based on what it calls “a history of serious quality issues.” In the case of the Montana nursing home, these problems included serious bed sore issues, possible abuse and a failure to get to the bottom of patient injuries of “unknown origin.” Homes in the federal initiative are treated to about two inspections a year – twice the regular rate.
The Centers for Medicare and Medicaid Services (CMS) selects facilities for the improvement program after receiving reports from state agencies. More nursing homes could be candidates for the improvement program, but a lack of funding restricts how many participate, said Mike Fierberg, public-affairs officer for the CMS Region 8 office in Denver.
After 18 to 24 months in the program, officials aim to have the problem facilities either improve their quality, lose Medicare and Medicaid funding or, if they’ve shown progress, to keep improving apace.
When CMS released the most recent list of homes in the SFFI, it released them in a PDF. AHCJ has converted and posted the list as Excel and HTML files to make searching the list easier for reporters. More information about nursing home quality is available from CMS and in AHCJ’s slim guide, “Covering the Health of Local Nursing Homes.”
HHS unveils ‘National Prevention Strategy’
Today, in a live webinar and a companion piece in the New England Journal of Medicine, the Department of Health and Human Services released its “National Prevention Strategy,” a broad effort to realize the preventive care goals set forth in the Affordable Care Act. The specifics of implementation are still taking shape, but the release centered around four primary talking points:
- The ACA seeks to “remove cost as a barrier” to “clinical preventive services,” by requiring new private plans to cover preventive services in the “strongly recommended” and “recommended” categories (examples include certain vaccines and screening procedures) with no cost to the beneficiary. Medicare will take a similar approach, and state Medicaid plans will be incentivized to do the same.
- It promotes workplace wellness initiatives through new grants and a re-evaluation of existing programs.
- It seeks to involve communities and local governments through community-based efforts. “Community Transformation Grants,” for example, “promise to improve nutrition, increase physical activity, promote smoking cessation and social and emotional wellness, and prioritize strategies to reduce health care disparities.”
- It makes preventative health a federal priority through “a newly established National Prevention, Health Promotion, and Public Health Council, involving more than a dozen federal agencies,” which “will develop a prevention and health promotion strategy for the country.” It also promises a “national strategy to improve the quality of health care,” and “improved data collection on health disparities.”
In addition to the four big messages, HHS officials pointed to initiatives designed to address specific, salient concerns such as smoking, obesity and the looming shortage of primary caregivers.
Health journalism bridges climate change, daily news cycle
Science journalists have struggled to reconcile the undeniable long-term relevance of climate change reporting with the lack of day-to-day immediacy inherent in such a gradual event. Writing in the Yale Forum, Lisa Palmer makes a persuasive case that the work of health journalists will lead the way in creating an immediate, personal link between readers and the warming globe they live on.
Photo by Buzz Hoffman via Flickr
More than anything else, the link between health and climate promises to transform abstract observations into personal actions and reactions as opinion among health professionals reaches critical mass.
In May 2009, the health community took an especially firm position on climate change when a joint commission led by the British medical journal The Lancet and University College London Institute for Global Health published findings that climate change poses the biggest public health threat of this century. The report outlined “major threats” to global health involving disease, water and food security, and extreme weather events, and added a cautionary statement: “Although vector-borne diseases will expand their reach and death tolls, the indirect effects of climate change on water, food security, and extreme climatic events are likely to have the biggest effect on global health.”
Reporters looking for a deeper look on health and climate would do well to review Linda Marsa’s December, 2010, cover story in Discover, which she is now expanding into a book. “Climate change is going to be the biggest science story for the rest of my career,” Marsa told Palmer. For more on how Marsa’s Discover story came together, AHCJ members can see this background questionnaire in which she explains her sourcing and gives advice to those who aspire to report on the intersection of health and climate.
Related tip sheets and resources for AHCJ members
- Ten Comments on the Health Risks of and Public Health Responses to Climate Change
- Beating the heat: Resources for reporting on extreme heat
- Reporting on the intersection of health and the environment
- Hot or Not?: Recognizing and Managing the Health Impacts of Climate Change
FCC report on journalism reveals failures, unique potential of the health beat
Filed under: Government, Health journalism, Health policy, Studies
An FCC working group led by Steven Waldman (formerly of U.S. News & World Report and Beliefnet.com, among other things) has unleashed its behemoth report on American journalism, titled “The Information Needs of Communities: The changing media landscape in a broadband age.”
The full report runs 365 pages (475 if you count footnotes) and addresses the current failures and future path of journalism in these United States. If you don’t have a few hundred hours to spare, you can get the highlights from the executive summary.
While the authors do refer to health journalism throughout the work, they specifically address the beat on pages 49 and 50, where they quote from the 2009 Kaiser Family Foundation report “The State of Health Journalism in the U.S., ” (PDF) which was partially based on a survey of AHCJ members.
The report dwells on the health care stories that go unreported due to lack of resources, though it does cite one bright spot, namely Kaiser Health News and all the local health-focused nonprofit outlets that have sprung up in recent years.
As regular readers might expect and Gary Schwitzer, author of the 2009 report, addresses in depth on his blog, local television health news was singled out for special criticism, both for its lack of focus on truly local stories and the increasing reliance on pay-for-play or similarly fishy arrangements with local medical outlets, like when “a hospital in Ohio paid local TV stations $100,000 or more to air ‘medical breakthrough’ segments that benefited the hospital.”
Pay-for-play arrangements with the health care industry have prompted an outcry from journalists in the field. The Association of Health Care Journalists and the Society for Professional Journalists issued a joint statement urging local broadcast stations to avoid arrangements that improperly influence health coverage. The statement said that even if such deals are disclosed, handing over editorial decision making to hospitals violates the principles of ethical journalism and betrays the public trust.
At the same time, health news remains important to advertisers. As the report’s authors write, “Certain topics are so attractive to advertisers that websites that focus on them can fetch even higher rates. This is especially true for health and financial content, which is why a disproportionate number of the successful content websites have been in those sectors (e.g., WebMD, Everyday Health, CBS MarketWatch, the Motley Fool).”
Other random health-related tidbits:
- A shout-out to Florida’s Healthy State Collaborative Local Journalism Center, which “recently launched a website to promote its mission of “super serv[ing] the residents of [the] region with an intense journalistic commitment to the unifying topic of health care.”
- A survey found that, when it comes to use of shared library computers, health information (37 percent) trailed only education (42 percent) and employment (40 percent). It’s an odd factoid, but health information consumption patterns always intrigue me.
- Speaking of which, “In a Pew Internet Project survey of residents of Philadelphia, Pennsylvania; Macon, Georgia; and San Jose, California, 62 percent said that they were very confident that they could find local information about medical and health problems. But only 24 percent said they were very confident that they could find information to ‘assess [whether] local politicians were doing their jobs.’”
The report also offers a more general take on the possible future of journalism in this country, one which doesn’t leave much room for the public sector. According to CJR’s Joel Meares, when it comes to correcting the issues facing the industry, “the theme seems to be to hold a steady course, loosen up the system, put a lot of information online, and hope foundations are willing to do some hard work.” Alongside that assessment, Meares also offers a functional summary of the concrete ideas contained in the report. He also offers a reaction roundup, as well as a quick sidebar on public broadcasting.
Over at ReportingOnHealth.org, Barbara Feder Ostrov gives a personal testament to the trend of laying off health reporters and not replacing them. As she says, “the health beat is simply added to the daily responsibilities of other reporters who may be covering education, science, the environment or local government.”
New life expectancy data can add context
to reporting on local health
A new data release today from the Institute for Health Metrics and Evaluation gives journalists some unique tools to help depict the health of a local population.
Emmanuela Gakidou, M.Sc., Ph.D., the director of education and training for IHME, told a Health Journalism 2010 audience that the institute was working on a project to show health information to the county level.
Just over a year later, the data allow the user to analyze life expectancy for every county in the United States and compare those numbers worldwide.
For example, the data could add context for a journalist following up on a tip from a speaker in an entirely different AHCJ event. In the recent Rural Health Journalism Workshop in St. Louis, Ellen Barnidge, Ph.D., M.P.H., of St. Louis University, discussed efforts in Missouri’s high-poverty Pemiscot County. A quick filter of the spreadsheet data shows men in that county share the same life expectancy – 68.5 – with Mauritius and Indonesia.
The data go back to 1987, allowing a journalist to look at changes over time as well for more than 3,000 counties.
Project researchers found that, while people in Japan, Canada and other nations are enjoying significant gains in life expectancy every year, most counties within the United States are falling behind.
The researchers, in collaboration with researchers at Imperial College London, found that between 2000 and 2007, more than 80 percent of counties fell in standing against the average of the 10 nations with the best life expectancies in the world, known as the international frontier.
Women have been especially affected. More than 850 counties in the U.S. have seen life expectancy remain static or go backwards for women since 1997.
The data also offers a breakdown of life expectancy by selected race – black and white – for each county.
The institute is an independent global research center at the University of Washington providing sound measurement of population health and the factors that determine health, as well as rigorous evaluation of health system and health program performance.
FDA creates embargo policy in response to reporter concerns
The Food and Drug Administration has adopted a policy on embargoes that permits reporters to share embargoed information with outside sources, provided the sources agree to uphold the embargo.
The policy explicitly supports embargoes as a way for reporters to add depth and detail to their stories, and conforms to common practice among medical journals and other sources of complex information.
The policy was shared with AHCJ this week after complaints from the organization earlier this year. In January, the FDA barred reporters from interviewing experts about new regulations on medical devices until the embargo lifted. AHCJ wrote to the FDA that such an approach created obstacles to serious journalism.
In an embargo, the group releasing information chooses the time and date that it will be made public, and reporters get an advance look as long as they agree to delay publication or broadcast until that time. Reporters are willing to do this because it allows time digest the information and seek comments from experts.
In a letter this week to AHCJ, the FDA outlined its policy going forward:
“A journalist may share embargoed material provided by the FDA with non-journalists or third parties to obtain quotes or opinions prior to an embargo lift provided that the reporter secures agreement from the third-party to uphold the embargo.”
The letter, from Meghan H. Scott, FDA’s acting associate commissioner for external affairs, said the FDA did not previously have a policy on embargoed news. After AHCJ’s inquiry, she wrote, the media staff met with AHCJ members, other journalists, and editors of medical and scientific journals as it worked to develop a policy.
“The FDA is committed to a culture of openness in its interaction with the news media and the public,” Scott wrote to Charles Ornstein, AHCJ president, and Felice Freyer, chair of AHCJ’s Right to Know Committee.
She specified that the FDA may provide embargoed information when:
- the issue is not related to regulatory or enforcement issues and does not contain confidential, commercial information; and
- the subject is complex or technical and early access to materials and subject matter experts will help reporters prepare their articles in a timely, accurate manner with the context needed to understand the material.
“We’re grateful that the FDA media staff took the time to study the issue and develop a suitable policy,” Freyer said. “The results are clear rules that are reasonable and workable – and a step forward in improving relations between the FDA and the media.”
Study offers context for reporting on health insurance exchanges
Filed under: Health care reform, Health journalism, Studies, Tools
The first tip sheet I wrote about covering health reform was pegged to the one-year mark of the Affordable Care Act. One topic I addressed was the creation of state-based health insurance exchanges, or marketplaces. I won’t rehash that here – here’s the link to the brief – but I do want to point out a useful resource that became available just a few days after we posted that first guide.
What questions do you have about health reform and how to cover it?
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.
It’s an in-depth look at the two states that already do have exchanges – Utah and Massachusetts. Those states help illustrate the decisions, both practical and ideological, legislators and governors must make as to how active the exchange is going to be in shaping the local insurance market and the consumer experience.
Those exchanges are of course dramatically different – Massachusetts covers a couple of hundred thousand people, and Utah covers a couple of thousand. Massachusetts was the inspiration in many ways for the national health reform, while Utah is the model for states that want to do a lot less and rely a lot more on the free market. But the study by experts at the Georgetown University Health Policy Institute and the Center for Children and Families also found those two state exchanges also had a lot more overlap than is widely assumed.
For those of you who are writing your first story on exchanges, this report isn’t the place to start. For help with the basics, check out ideas from Sarah Kliff, a Politico health care reporter, and some background from Noam Levey, health policy reporter for the Los Angeles Times. And the Alliance for Health Reform had an event last year that explained the basics (this link includes a webcast, transcript and lots of other resources to help you get started.)
For those reporters who have been tracking the state debate over the size, shape and structure of the exchange, or following the initial phases of implementing the exchange, the Georgetown study should help provide some context for concepts that you may have heard of like “active purchaser” (an exchange that can be more discriminating about which insurers get to sell policies in the exchange and which don’t versus an “open market” (open to any health plan that wants to play.) Here’s a taste:
To many, the Massachusetts and Utah exchanges represent opposite points on a continuum of what exchanges can provide for consumers and small businesses. Yet the stereotype of Massachusetts’ exchange as an “active purchaser” and the Utah Exchange as the open market model is, in the words of one observer, “a false stereotype … perpetuated by … a media that likes simple contrasts.”
So be part of a media that goes beyond simplistic contrasts … dig in.
Duluth duo investigates disciplined doctor
Filed under: Health data, Health journalism, Hospitals, Hot Health Headline, Public records
The latest crop of disciplined doctors stories, spearheaded by the work of ProPublica’s Charles Ornstein and Tracy Weber, has focused on problem caregivers in the aggregate, with liberal use of anecdotes. Now, Brandon Stahl and Mark Stodghill of the Duluth News Tribune have assembled an investigation that proves there’s still plenty of room for a disciplined docs piece with just one subject.
Working from court records and a state reprimand, the Minnesota duo found that Stefan Konasiewicz, a highly paid neurosurgeon who practiced in the city for much of the past decade, was the target of nigh on a dozen malpractice suits.
When he moved from Duluth about three years ago, Konasiewicz left behind two dead patients, one woman paralyzed from the neck down and six others who say his treatment caused them serious physical harm.
His former employer, St. Luke’s hospital, was aware of the harm Konasiewicz was alleged to have caused and yet continued to let him practice, according to records obtained and interviews conducted by the News Tribune.
The exhaustive report that follows is a tribute to their investigative tenacity, loaded with quotes from colleagues who long questioned Konasiewicz’ judgment and a careful, painstaking rundown of the malpractice cases filed against the embattled surgeon.
For more on how they searched court records to find malpractice cases, and on why malpractice suits in the state face such high hurdles, see Stahl’s sidebar.
Hot pipes lead reporter to radioactive aquifer
Filed under: Government, Health data, Hot Health Headline, Public health, Public records
Mark Greenblatt, reporter for KHOU-Houston, reports that officials in Central Texas have been alarmed to discover high levels of radiation in the pipes and related systems that provide much of the region’s drinking water.
According to local officials, the contamination comes from years of exposure to drinking water that already tests over federal legal limits for radioactive radium. Of even more concern, they say, is that any water quality testing is done before the water runs through the contaminated pipes that could be adding even more radiation.
Almost as remarkable as the waterborne radiation itself? The fact that it was only discovered when city workers dug up old piping, brought it to the recycling center and were rejected because they were “too radioactive” to recycle.
Through his sources, Greenblatt knew the documents and tests proving the connection between a radioactive aquifer and “hot” pipes existed, but getting his hands on them was a different matter.
The call (with sources) was prompted by internal documents from the Texas Commission on Environmental Quality, which identified a main source of the region’s water as radium contaminated. The TCEQ had initially refused to release the paper after a public-records request, and only did so under order from the Attorney General of Texas.
Greenblatt’s story runs much deeper, and it’s worth taking the time to appreciate the scope of his dense, document-rich investigation.
Reporter FOIA’s database further exposing the toll war takes on returning vets
Filed under: Government, Health data, Health policy, Hot Health Headline
Writing for the Bay Citizen and The New York Times, Aaron Glantz brings a new, data-based take on the mental and physical toll the wars in Iraq and Afghanistan have taken on returning veterans, thanks to what he calls “an obscure government database called the Beneficiary Identification Records Locator Subsystem death file,” which he obtained via FOIA.
The database, which reveals a high rate of suicide and fatally risky behavior, lists all veterans who earned Veterans Affairs benefits since 1973.
Records from that database, provided to The Bay Citizen under the Freedom of Information Act, show that the VA is aware of 4,194 Iraq and Afghanistan veterans who died after leaving the military. More than half died within two years of discharge. Nearly 1,200 were receiving disability compensation for a mental health condition, the most common of which was post-traumatic stress disorder.
Names were redacted, but Glantz nonetheless managed to identify a number of veterans, including a troubled 26-year-old man who threw himself under a train just three days after being turned away by the VA. In the course of his investigation, Glantz has managed to fill in some of the gaps in the federal records, a process which has shown just how lacking the VA’s data can be.
In October, The Bay Citizen, using public health records, reported that 1,000 California veterans under 35 died from 2005 to 2008 — three times the number killed in Iraq and Afghanistan during the same period. At the time, the VA said it did not keep track of the number of Iraq and Afghanistan veterans who died after leaving the military.
The VA database does not include veterans who never applied for benefits or who were not receiving benefits at the time of their death, according to the agency. The VA said it also did not keep track of the cause of death.
When confronted with his agency’s shortcomings, a VA representative responded in a manner that belied his agency’s lack of focus on recordkeeping.
David Bayard, a VA spokesman, said the agency was working hard to treat veterans with mental health issues. “VA has some pretty fine programs,” Mr. Bayard said, “but unfortunately we aren’t always successful.”
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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
