Reporters can explore states’ options for creating exchanges
Filed under: Government, Health care reform, Health policy
Give me an f…
… for Flexibility, that is. Flexibility is the buzzword these days, as federal health officials coax states along the road to exchange creation. (See some updated resources at the end of this post.)
Steve Larson, director of the Center for Consumer Information and Insurance Oversight at CMS, is the point person on a lot of the state regulatory issues under health reform. He spoke at a Health Affairs-sponsored breakfast with reporters in Washington, D.C., recently. He was sort of a blend of federal regulator and state cheerleader.
Exchanges under the health law must be up and running on Jan. 1, 2014. States must be certified as “on track” in January 2013. In states that don’t have an exchange, the federal government will step in – “federally-facilitated” is the term of art among administration officials, not “federally-run.” The Department of Health and Human Services hasn’t said exactly what that federal fallback will look like. Meanwhile, a lot of states are still either locked in a political argument over whether to set up an exchange and how to design and regulate it, or have a long way to go to complete the complex tasks required to set one up.
Larson noted that states are making progress. But federal health officials recently made clear (in newly released proposed regulations) that they realize that a lot of states may need a bit of extra help. That’s why “flexibility” has become such a drumbeat. Instead of “yes, we have an exchange ready to go” or “no, we aren’t ready,” states can pursue a middle path - they can be ready in some ways, but let the federal government step in and handle other components.
An example Larson gave: The state may open the exchange, create offices and a website for consumers, the “retail” side of it, but let the federal government step in to determine whether people qualify for Medicaid, or what kind of subsidies they would get in the exchange.
For state reporters, this hybrid raises another dimension to the exchanges. States can assess what they can, most realistically and competently, achieve, and what may take another year or two. It may help smooth over some of the politics, as states might be able to put off some of the contentious aspects of exchange design, such as whether to be an “active purchaser” (setting more criteria for which insurers can operate in the exchange) or to have an open model. Or whether to start open and gradually move to “active purchaser.”
Another open question is what “essential benefits” health plans will have to offer in the exchange. There is some speculation that states will be able to decide, or at least have some leeway, in keeping with the “state flexibility” orientation. Larsen didn’t say how that would play out, but it’s another area that state reporters should pay attention to.
Finally, a lot of states, Larson noted, have beefed up their ability to review proposed insurance rate increases. How much power they have to approve or reject increases varies. But even publicity about high increases can create a public relations/political climate in which insurers may roll back proposed increases. That’s definitely worth watching.
A few extra resources to keep you up to date if you haven’t seen them:
- The HHS release on the exchanges, including the “hybrid.”
- New Kaiser Family Foundation brief on state efforts.
- Here are Commonwealth Fund state exchange resources. Over on the right, here’s the Heritage Foundation’s perspective.
Visit NIH and learn how to use NLM research, tools
AHCJ has teamed up with the National Library of Medicine to present the AHCJ-NLM Health Journalism Fellowships. Four journalists will spend a week on the campus of the National Institutes of Health. The selected journalists will:
- Learn how to explore the latest NIH research
- Learn to understand and interpret biomedical statistics
- Take advantage of NLM’s data, programs and resources for stronger stories
- Get hands-on training in PubMed, MedlinePlus, ClinicalTrials.gov, ToxNet and Household Products Database
The fellowship includes membership, travel expenses, lodging and stipend.
Apply online or download a PDF application. Deadline: Aug. 22.
Reporter explores ‘dying peacefully in his sleep’
Filed under: Health journalism, Hot Health Headline
Spurred by the unenviable task of writing a very personal obituary to look beyond the stock phrases so common in those pieces, Virginian-Pilot reporter Elizabeth Simpson set out to find exactly what she was saying when she wrote that her 88-year-old father “died peacefully in his sleep.” She started with two simple questions.
What is it you die of when you don’t wake up in the morning?
And, is it the peaceful death everyone assumes?
She learned from a coroner that most common culprit for these deaths, including her father’s, is a cardiac arrhythmia, but that bit of knowledge raises more questions than it answers. She gained more insight from a post on AHCJ’s electronic discussion list (members can sign up for free!), where reporters shared both professional experiences and personal insights so compelling that Simpson included them in the story (you’ll find quotes about a third of the way down the page, under the “I posed the subject” subheading).
Simpson’s investigation takes her through the worlds of hard-nosed medical description, hospice and palliative care, life support and even sudden infant death syndrome, but ultimately ends up back where she started: “peacefully.”
Bush explained that sometimes you can die in your sleep during a massive stroke or a ruptured aneurysm. But in those cases, a person usually will have complained earlier about symptoms like a headache or other pain. A heart attack or pulmonary embolism usually will cause enough pain to lead the person to wake and go to an emergency room.
But death during sleep with no symptoms at all is likely due to the heartbeat going haywire. In Bush’s opinion, it is the way to go.
Peaceful? She thinks so.
Sometimes, she said, such a person will be curled up in a sleeping position, the blankets tucked around them, no evidence of thrashing about. Their faces are serene, their eyes closed. By contrast, in cases where death comes while not sleeping, there’s a 50-50 chance the eyes will be open.
Report: Calif. hospital chain profited from ER admissions
Filed under: Health data, Health journalism, Hot Health Headline, Public records
After months of investigation and updates, California Watch reporters Christina Jewett and Stephen K. Doig have unleashed their full report on California hospital chain Prime Healthcare Services and its knack for turning around failing hospitals by apparently pushing for the admission of ER patients who are insured by Medicare or insurance giant Kaiser Permanente, then keeping them in the hospital.
The report includes hyperlink sourcing, a raft of related documents and a great explainer on how they assembled the numbers behind the story. The duo took advantage of court testimony, sources and reams of public records.
The reporters say that evidence points to “an orchestrated campaign of admitting Medicare and Kaiser patients – moving them from the emergency room to a hospital bed – in the interest of changing the fortune of a money-losing hospital.”
State data shows that after the hospital chain took over 11 hospitals beginning in 2005, the percentage of Medicare patients who were admitted from the emergency room to Prime hospital beds increased from about 45 to 63 percent.
That 40 percent increase contrasts with other California hospitals that saw an average 8 percent decline from 2005 to 2009 in Medicare patients moved from the emergency rooms to hospital beds, data shows.
And, as you’ll see throughout the story, the interviews and anecdotes back up the numbers.
Tina Buchanan, the hospital’s former chief nursing officer, testified that [Prime founder and chairman Dr. Prem Reddy] began to require emergency room staff to put a yellow sheet of paper on each patient record that listed their health insurance status.
She said he would go through the “goldenrods,” as the papers were called, and point out the Medicare or Kaiser patients and say, “Make sure you get this one admitted.”
“If it was … an uninsured patient, he would tell them, ‘Get them out of my hospital,’ ” Buchanan testified.
There’s plenty more where that came from, but I will just leave you with this editor’s note, which appears alongside the main story.
It came to our attention late Friday that Prime Healthcare had issued a press release saying it had taken legal action against California Watch. We have not been served and can’t fully comment until we have reviewed any legal filings. In our dealings with Prime over the course of the past several months, the company has yet to present to us a single factual error that has merited correction or clarification. We continue to stand by our reporting.
Newest members bring decidedly international flavor to AHCJ
Please extend a warm welcome to the latest trio of journalists to join AHCJ!
- Aliette Jonkers, independent journalist, Amersfoort, Netherlands (@AlietteJonkers)
- Henry Neondo, reporter, Africa Science News Service, Nairobi, Kenya
- Kate O’Rourke, managing editor, Clinical Oncology Today, Brooklyn, N.Y.
If you haven’t joined yet, see what member benefits you’re missing out on: Access to more than 50 journals and databases, tip sheets and articles from your colleagues on how they’ve reported stories, conferences, workshops, online training, reporting guides and more. Join AHCJ today to get a wealth of support and tools to help you.
In China, pharma hires thousands of doctors to sell drugs
Filed under: Government, Hot Health Headline, Public health
Bloomberg News reports that pharmaceutical companies in China are poaching thousands of trained physicians, many of them recent grads, to become sales representatives in the massive push to take advantage of China’s exploding drug market. The companies can offer salaries that are two to three times those the physicians would earn otherwise, and Bloomberg’s sources estimate that as many as 14,000 more Chinese doctors will become marketers in the coming five years.
The hiring boom is hampering China’s three-year, $131 billion effort to stem a massive shortage of doctors in rural and peripheral areas and provide basic health insurance to at least 90 percent of the population. Paradoxically, it’s that same push, and the demand for drugs that it has created, that’s providing the incentive for big pharma’s Chinese campaigns. One pharmaceutical representative told Bloomberg that China is expected to overtake the United States as his company’s largest market within the decade, and companies have been budgeting accordingly.
Foreign drugmakers like Sanofi and their local affiliates will hire at least 35,000 sales staff by the end of 2014, Aon Hewitt China estimates, based on a survey of 24 companies. The same employers had 33,000 on staff at the end of 2010. About 30 to 40 percent of people recruited for sales jobs will have a medical degree, said Jarroad Zhang, a consulting director with Aon Hewitt in Shanghai.
College football, sickle cell can be deadly combo
Rachel George, Iliana Limón and Shannon J. Owens of the Orlando Sentinel look at college football players whose deaths have been linked to sickle cell trait.
Overwhelmingly in the past 11 years, more non-traumatic football deaths have occurred from complications from sickle cell trait than any other cause. It has accounted for nine of the 21 non-traumatic deaths in that time despite the trait existing in just 8 percent of African-Americans. It accounts for an even lesser extent in Hispanics, Caucasians and other ethnicities. And while the trait has been linked to deaths in other sports and at other levels, it has affected a much greater number of college football players.
Many doctors, coaches and trainers wonder what factors push a “generally benign” trait into a dangerous medical condition. George outlines some of the factors, such as coming back to training after a break, the kinds of drills athletes do, heat and hydration, altitude and more.
In the stories, doctors, coaches and former players discuss why football accounts for 82 percent of the cases in the U.S. National Registry of Sudden Death in Athletes.
The story includes NCAA materials about sickle cell trait and a graphic of the difference between normal blood cells and sickle cells. In a related story, Owens reports that “every baby in the United States is tested for sickle cell trait at birth, many athletes who’ve had it either didn’t know or didn’t understand what it meant.” In another story, she talks to parents of a child born with sickle cell trait who say they didn’t get information about the potential fatal complications.
Report explains doctors’ reluctance to adopt EMRs
Filed under: Government, Health care reform, Health policy, Hot Health Headline
Writing for the Center for Public Integrity’s iWatch News, Susan Jaffe spent time in the trenches to better understand how government incentives toward the adoption of electronic medical records are (or aren’t) working. She spent time with Cleveland-area small practices and government agencies to understand the real obstacles faced by physicians on the ground. It offers a picture of the reality of EMR today. Some of my favorite tidbits:
- “570 different electronic health systems certified by private organizations for non-hospital settings may be used to qualify for the bonus.”
- “The systems are priced in a way that does not make comparison shopping ‘easy or necessarily valid,’ said Dottie Howe, a spokeswoman for the Ohio regional extension center. There is no basic price because each company offers different components, features, options, and level of technical support.”
- EMR systems can include more than a thousand sometimes-customizeable details, and that’s not including the myriad warnings and cross-checks.
- Compatibility with the systems in the area’s large hospitals is tough to guarantee, yet factors as a major concern for many small practices.
- How early adopters in the field were burned and are wary of getting fooled again.
- When practices adopt EMRs, they typically have to go through a “learning curve,” a period of weeks or months during which they can only see about half as many patients.
- Many major HIT companies don’t guarantee that physicians who adopt their systems will meet the standards for a government HIT bonus.
- The VA’s proven HIT system is available for free, but can’t handle billing and insurance.
- To get the maximum bonus payment, practices must adopt EMRs this year or next.
- Only certified systems can earn bonus payments, yet the second and third stages of certification haven’t even been finalized yet.
An accompanying piece by Emma Schwartz looks at one physician’s concerns.
Health officials, journalists agree on standards for releasing information
Filed under: Government, Public health, Public records
New guidance addresses public health emergencies
Public health officials and journalists now have guidance on what information should be made public when someone dies or falls ill during a public health emergency, thanks to a unique collaborative effort being made public today.
A new document – developed by leaders in public health and health-care journalism – provides a framework for releasing such information as the age and location of private individuals who have been affected by an epidemic or other public-health event.
These nonbinding recommendations, “Guidance on the release of information concerning deaths, epidemics or emerging diseases,” are meant to help public health officials balance the need to keep the public informed with requirements to maintain individuals’ privacy.
The guidance emphasizes the importance of openness, stating that information should be withheld only when there is a clearly justified reason.
The Association of State and Territorial Health Officials (ASTHO), the National Association of County and City Health Officials (NACCHO), and the Association of Health Care Journalists (AHCJ) teamed up to develop the guidance after the H1N1 “swine flu” pandemic of 2009.
Read the complete press release.
Earlier
- Health officials, journalists agree information is key in public health crisis
- Health journalists cite uneven disclosure of H1N1 deaths across country
- AHCJ leaders hold series of media access meetings with government officials
Investigations spotlight workplace safety
Filed under: Government, Health data, Health journalism, Hot Health Headline, Public health, Public records
Workplace safety got plenty of attention last week, from a public radio investigation in Seattle to a series by the Center for Public Integrity that includes plenty of opportunities for localizing.
KUOW’s John Ryan conducted hit the topic from all sides, with a five-part series on workplace safety in Washington. His story selection ranges from stats-directed investigations to features focusing on unique cases.
- Lineworkers Bring Power To The People, Without A Net
The curious case of one industry where its widely accepted for workers to work far off the ground with no safety equipment. - Workplace Safety Inspections Miss Their Target
Officials rarely enforce workplace safety rules, and even when they try, they miss the mark. - Violence In The ER
The most violent professions in Washington? Nurses’ aides and registered nurses. - Mental Hospital Staff Bear Brunt Of Workplace Violence
The state’s largest psychiatric hospital is also its most dangerous workplace. - Remembering Washington’s Fallen Workers
Chris Hamby did a two-part investigation in the Center for Public Integrity’s iWatch News on OSHA’s Voluntary Protection Programs, which exempt “model workplaces” from regular inspections (Part 1, Part 2).
Over the course of his eight-month investigation, Hamby pored over thousands of pages of documents which revealed, among other things, that “Since 2000, at least 80 workers have died at these sites, and investigators found serious safety violations in at least 47 of these cases.”
Workers at plants billed as the nation’s safest have died in preventable explosions, chemical releases and crane accidents. They have been pulled into machinery or asphyxiated. Investigators, called in because of deaths, have uncovered underlying safety problems — failure to follow recognized safety practices, inadequate inspections and training, lack of proper protective gear, unguarded machinery, improper handling of hazardous chemicals.
Yet these companies have rarely faced heavy fines or expulsion from the program. In death cases in which OSHA found at least one violation, VPP companies ultimately paid an average of about $8,000 in fines. And at least 65 percent of sites where a worker has died since 2000 remain in VPP today.
The program, with its emphasis on cooperation between regulators and industry, began under the Reagan administration and greatly expanded under the most recent Bush regime. There are some success stories, Hamby found, but he also uncovered a hearty helping of dirty laundry. Those included preventable deaths traced to OSHA violations, failures to self-police and an emphasis on expanding program participation at the expense of quality and safety.
In the second installment, Hamby spotlights oil refineries to illustrate what became a familiar pattern.
Recognition of “model workplace” status, missed opportunities to detect and fix hazards, a serious mishap or fatal accident, detection of safety violations and, ultimately, continuation of the government’s stamp of approval.
Hamby backs up these strong words with even stronger numbers. Here’s just one sample:
During 2009 and 2010, at least 21 of 55 fires at refineries falling under federal jurisdiction occurred at VPP sites, an iWatch News analysis of regulatory and news media reports found. VPP sites make up about 30 percent of these refineries, so these government-recognized sites have experienced more than their proportionate share of fires.
Reporters have already produced local versions of Hamby’s story throughout the country, particularly in Florida and Louisiana.
Related: OSHA lists 147 employers as “Severe Violators” of worker safety standards
-
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
