House calls on the rise as their economic benefits become clear
Filed under: Aging, Health policy, Hospitals, Public health
In The Miami Herald, Ana Veciana-Suarez looks into why doctor house calls are on the rise, especially among the Medicare set. Through her reporting, it becomes apparent that it’s primarily a function of economics, all driven by the fact that, while a house call may appear expensive when compared to a typical primary care visit, in many cases the real alternative to a house call and some preventative medicine is an emergency room visit and/or an overnight hospitalization, both of which are in another cost bracket entirely.
Veciana-Suarez writes that while the latest home care boom may have started with the growth of concierge medicine, especially in South Florida, it’s now being driven by the big guns — Medicare and major insurers.
House calls, once thought to be too time-consuming and not very cost-effective, are making a comeback as healthcare providers recognize that they’re actually the answer to good care for patients who can’t make it to a doctor’s office. Medicare-paid house calls have been steadily increasing, according to government figures, and doctors report the same for non-Medicare patients, according to the American Academy for Home Care Physicians. What’s more, technology has made accessibility to patients’ records and other medical information available at any time and any place, a boon to physicians on the go.
Now a three-year federal government pilot program called Independence at Home is encouraging doctors to pick up those black medical bags of yore and pay a visit to their sickest patients. As part of the new healthcare reform law, the demonstration project will cover 10,000 Medicare patients described as medically fragile. It is set to begin in January in locations yet to be decided.
The main targets for both the government and private insurance programs are the so-called “frequent fliers,” and others with chronic conditions that need to be managed to prevent repeat visits to the emergency room. To that end, some programs also include social workers and home health educators. Most programs are still in the experimental phase, but Veciana-Suarez paints a clear picture of a sector that’s poised to assume a growing role in the coming decade.
CHCH Center, Sac Bee investigate hospital-acquired infections
Filed under: Health data, Hospitals, Hot Health Headline
In a series titled “Death by Complication,” the California HealthCare Foundation Center for Health Reporting and The Sacramento Bee teamed up to investigate hospital-acquired infections in the state as well as efforts to combat them.
In the centerpiece, the CHCF’s Deborah Schoch used records and privacy waivers granted by a cooperative family to explore how an apparent hospital-acquired C. difficile infection seems to have killed an otherwise healthy 75-year-old man who was originally hospitalized for a broken femur. The cause of death was listed as “complications.” His story was far from unique, Schoch writes.
One in 20 hospital patients get infections. In California, roughly 200,000 people get hospital infections annually, and 12,000 of them die, according to state Department of Public Health statistics. That makes such infections one of the state’s leading causes of death, ahead of automobile accidents and Alzheimer’s disease.
Yet these deaths have remained mostly in the shadows. They often are classified as “deaths from complications,” an oblique term used in obituaries and often unquestioned by relatives and friends.
Even the best doctors can be baffled whether an infection was acquired before or after a patient was admitted, and if it was the principal cause of death or no factor at all.
Many health care providers historically have viewed hospital infections - going by obscure names or acronyms such as C.diff, CLABSI, VRE and the more familiar MRSA - as a sometimes inevitable consequence of being hospitalized.
In related pieces, reporters find that while hospitals are waking up to the toll taken by hospital-acquired infections, neither they nor the state have really managed to take authoritative measures to address the problem.
See the full series, complete with infographics, on CHCF’s site.
Explain elements of health reform through the eyes, stories of doctors
In these posts about covering health reform, I usually don’t point to the big national dailies because a lot of people have already read those stories but a recent New York Times piece, “As Physicians’ Job Change, So Do Their Politics” is a story that may be able to help reporters think about a good local or regional jumping off point for telling aspects of the health reform story in a more narrative, accessible manner, through the eyes and experiences of doctors.
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.
The Times story, by Gardiner Harris, described a shift leftward (or at least less rightward) among physicians. He cited several reasons: younger doctors, more female doctors, and above all more doctors who are salaried employees of hospitals instead of basically being small businessmen (or women) running a practice.
Because so many doctors are no longer in business for themselves, many of the issues that were once priorities for doctors’ groups, like insurance reimbursement, have been displaced by public health and safety concerns, including mandatory seat belt use and chemicals in baby products.
Even the issue of liability, while still important to the A.M.A. and many of its state affiliates, is losing some of its unifying power because malpractice insurance is generally provided when doctors join hospital staffs.
He wrote mostly about Maine, but had a few observations about other states, including Texas. Last year Texas physicians opposed the national health reform law by a three to one margin. But doctors who did not have their own practices were twice as likely to support the law. The same goes for female doctors.
How does a story about physician politics translate into a narrative about health reform?
The shift to salaried positions has many causes (including work-balance for doctors who want more time with their families) but the move toward more clinical integration and the formation of accountable care organizations or ACO-like entities will hasten this trend. It is really, really, really hard to explain ACOS clearly and concisely (when an editor of mine recently asked me to give him a nice, tight two-graf description, I began it something like, “One of the challenges of ACO is that they defy simple explanation.”)
But doctors who are joining hospital staffs or whose practices are being bought up by hospitals or who are entering different contractual relationships and affiliations with hospitals have stories to tell. You can also talk about quality measures and “never events” and how that affects physicians and the practice of medicine, particularly in states mandating more public reporting. Through their stories, you can illustrate what an ACO is or isn’t, or how a medical home works, or what “clinical integration” means.
I interviewed a physician in South Carolina the other day, Dr. Angelo Sinopoli, who told me about how the team approach and the use of electronic medical record with clinical decision support was giving him more real-time feedback on his own performance – and he welcomed it.
“You think you are doing something and you might not be, or think you might not be, but you are,” he said. “Seeing real data in as real time as possible made a difference in how we think.” That made me understand an aspect of the electronic medical record that I hadn’t understood before, and readers can grasp that too.
You can explore the changing attitudes and politics along with that – in some states that may be more significant than others, depending on what your state is doing with health exchanges, malpractice legislation, quality reporting etc.
Editor’s note:
Learn more about how electronic health records could mean new opportunities to improve clinical care and public health, according to David Blumenthal, M.D., the former national coordinator for health information technology. Blumenthal spoke at Health Journalism 2011 as he was leaving his federal position.
Montana student documents frontier hospital
Every year, as part of the Montana Town Project, University of Montana School of Journalism students pick one little rural town in Montana and descend upon it to discover what unique stories it might hold. 
In this year’s target, a town surrounded by mountains with the incongruous name of Plains, Mont., (population 1,126), student Amy Fox stumbled upon the Clark Fork Valley Hospital.
By definition, CFVH is considered “frontier medicine” rather than rural medicine because of its size. The hospital only has 16 beds. To be considered rural, a hospital must have over 100 beds. The number of beds in a hospital typically represents the kinds and number of services the hospital can offer. With its own cardiologist, surgeon, anesthetists, and a full nursing staff, Clark Fork Valley Hospital is far from what one may think of as “frontier”.
In what I assume is a tribute to both the hospital’s size and small-town Montana accessibility, Fox was able to get an unusually candid portrait of the difficulties of administering a hospital on the edge of sustainability. I can’t embed her photographs here, but be sure to take a look. The hospital has trouble recruiting doctors, not because of their location, which is actually quite desirable, but because it’s difficult for doctors’ spouses and families to find work in the tiny community where the hospital is the largest employer. And those employees they do retain have to do more with less.
“We have found ways to be more resourceful,” says Tanya Revier- Marketing Director. “We just switched propane companies and saved over $25,000 that way. Or if someone leaves the hospital to retire or take a different job, we spread the staff we have to cover the vacant position, rather than hire someone new.” Another way they have been able to sustain is by offering more services in order to keep people from travelling elsewhere for their care.
…
Dr. Damschen says that often, people feel that frontier medicine is often thought of as a lesser practice, as compared to urban medicine. It does not take a person long to understand that, in fact, the opposite is true. Physicians and nurses alike are required to have skills that excel far outside the reaches of what is normal in large hospital settings. It is all about which hat to put on.
Newly named NYT editor spoke to AHCJ about health coverage
Jill Abramson, who will become executive editor of The New York Times in September, welcomed health journalists to AHCJ’s 2007 Urban Health Journalism Workshop. At the time (October 2007) she was the paper’s managing editor. In her brief talk, she discussed the importance of health journalism and the Times‘ expanding health coverage (MP3).
Listen to Abramson
She also was among the speakers discussing the future of science journalism at the Massachusetts Institute of Technology in April 2009.
Medical device investigation unearths conflicts, regulatory issues
Filed under: Health journalism, Hot Health Headline, Public health, Public records, Studies
The latest investigation from the Chicago Tribune’s Jason Grotto and Deborah L. Shelton focuses on a single medical device, yet still hits many of the health beat’s biggest narratives, primarily conflicts of interest and government regulation. In their centerpiece, they dig into the tale of a cardiologist who may or may not have tested a device he invented on patients without consent or regulatory approval. It’s in those gray areas that the story takes shape.
The device in question is an annuloplasty ring, which in 2001 was reclassified from class III to class II. In practical medical device terms, this means that new models don’t need clinical trials if they’re similar enough to devices that have already been approved. The reporters write that the rings earned this change of status in part because of the relatively low number of adverse events reported between 1991 and 1995 (465). Unfortunately, as their use has increased, so have the events.
Now that you have some idea of what they were up against, here’s a healthy excerpt from their “how we did it” sidebar, which is almost always Covering Health’s favorite part of a major investigative package.
The first hurdle in stories like these is understanding the medical science behind the device in question, which required us to gather up dozens of studies and reports on annuloplasty rings and the heart valve disease the device is intended to cure. We sifted through government documents and researched regulations as well as the history of the rings.
But writing about heart valve repair rings involves more than researching a disease and a device.
We also spent a lot of time with the patients in our stories because there is a level of trust that must be built up before people are willing to share personal information about their health. The same goes for Northwestern Memorial Hospital and surgeon, Dr. Patrick McCarthy.
We had to assure each of them that their viewpoint would be reflected in the stories. It’s a difficult balancing act that we tried to buttress with reams of documents, studies and interviews with independent sources.
For more on how Grotto and Shelton reported the story, watch for a “How we did it” article on the AHCJ website in the next couple of weeks.
If the issue sounds familiar, the storyline is similar to a 2005 investigation from The Wall Street Journal’s David Armstrong, which found a partnership between the Cleveland Clinic – and some prominent staff members – and companies manufacturing devices used in clinical trials there.
Critically evaluate, report on cell phone/cancer link
Filed under: Health journalism, Health policy, Hot Health Headline
Courtesy of the International Agency for Research on Cancer’s press release and the storm of advance coverage it has spawned, you’re probably already braced for Lancet’s imminent publication of the IARC’s report classifying “radiofrequency electromagnetic fields” as “possibly carcinogenic to humans,” otherwise known as the cell phone/cancer link.
While you’re waiting, it’s worth taking a few minutes to put yourself in position to critically evaluate the study. The six-page press release is a decent place to start, but as Dr. Len Lichtenfeld, blogger and deputy chief medical officer for the national office of the American Cancer Society, reminds us, IARC is a respected source, but the science they’re reviewing is tricky and, at this point, it’s just a press release.
For background on the scientific debate, see Lichtenfeld’s commentary and Eliza Barclay’s post on Shots, NPR’s health blog.
If you don’t have time for the full press release right now, I have pasted what I consider the two must-read paragraphs below. The first summarizes what the working group found upon reviewing established science, while the second explains exactly how the scientists are currently classifying the possible link between cell phones and cancer. Between the two of them, you get a quick snapshot of the study and its implications.
Results
The evidence was reviewed critically, and overall evaluated as being limited among users of wireless telephones for glioma and acoustic neuroma, and inadequate to draw conclusions for other types of cancers. The evidence from the occupational and environmental exposures mentioned above was similarly judged inadequate. The Working Group did not quantitate the risk; however, one study of past cell phone use (up to the year 2004), showed a 40% increased risk for gliomas in the highest category of heavy users (reported average: 30 minutes per day over a 10‐year period).
Group 2B: The agent is possibly carcinogenic to humans.
This category is used for agents for which there is limited evidence of carcinogenicity in humans and less than sufficient evidence of carcinogenicity in experimental animals. It may also be used when there is inadequate evidence of carcinogenicity in humans but there is sufficient evidence of carcinogenicity in experimental animals. In some instances, an agent for which there is inadequate evidence of carcinogenicity in humans and less than sufficient evidence of carcinogenicity in experimental animals together with supporting evidence from mechanistic and other relevant data may be placed in this group. An agent may be classified in this category solely on the basis of strong evidence from mechanistic and other relevant data.
For more perspective on what a 2B classification really means, see Katherine Harmon’s post on the Scientific American editors’ blog. Her key point is that “The May 31 announcement, however, doesn’t imply that cell phones cause cancer. It suggests that there are still enough unknowns not to rule out long-term health effects of the devices.”
Merrill Goozner expects the evidence to be murky and he concludes that IARC’s tenuous conclusion will be fully justified but also largely ignored by the public. He also points us to Lou Slesin’s Microwave News for solid reporting on the conflicts of interest surrounding the issue.
Finally, once the science is published and it’s time to file stories, be sure to refer to AHCJ’s guide to covering medical studies (membership required), where you’ll find all the tips and reminders necessary to ensure you’ve covered all the bases on this high-profile story.
Online guide focuses on covering medical studies
Reporters are inundated with lures to cover the latest medical study or scientific conference paper. And there are some significant milestones being reached in medical research. But, more often, the information reaching the public is way too preliminary or even misleading, say those behind a new AHCJ reporting guide on covering health studies.
The guide will help 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 and 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.
Horgan finds reasons to be optimistic about science writing
In yet another sign of the much-discussed science writing renaissance which may or may not be upon us, Scientific American’s John Horgan blogs that – despite the still-dire economics of reporting on health and science – the young folks entering the profession give him ample reason to be optimistic about the future.
The occasion? The Columbia University Graduate School of Journalism’s science writing awards, for which he has often been a judge.
This year [Columbia staff] sent me more submissions, 35, than in any of the previous dozen years I’ve served as a judge. The admissions were also better than ever. And as I told the J-school grads last week when I handed out the awards, I’ve never said that before — or if I did, I was lying. Some of the submissions were so well-written and reported that it was hard to believe rookies produced them, not seasoned pros.
Horgan was particularly gratified to find that so many of the entries were in a critical vein, revealing the limits and consequences of technology rather than simply trumpeting the triumphs of science. Of this year’s three winners, AHCJ members likely will be most interested in Elliot Ross’ work on ghostwriting in the pharmaceutical industry, which was picked up in a condensed form by the Guardian.
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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
