Uninsured face delays, increased risks en route to long-term care
Writing for Heart & Soul, Yanick Rice Lamb offers up a comprehensive take on the special challenges patients and hospitals face when it comes to long-term care for the uninsured.
… a growing number of uninsured people … need long-term care after hospital stays. They lack insurance because they can’t afford it, their employers don’t offer it or they were dropped by private carriers after taking out policies on their own. Consequently, these patients experience delays in moving on to the next step in their care once they are medically ready for discharge. They are stuck in the hospital, because it’s hard to place patients in long-term care facilities or send them home with a nurse when they have no coverage, especially when there are complications. Hospitals end up picking up the tab — sometimes even after patients leave. Those costs are ultimately passed on to everyone who pays taxes and anyone who has a medical bill.
Rice Lamb fleshes out this scenario not only with anecdotes, but with a raft of statistics and studies showing that the ranks of such patients are swelling rapidly, as is the financial toll they’re taking on the system. She ties it in with the hospital “frequent flyer” and charity care issues that have received so much ink in recent years. At the same time, she takes a deeper look at the issues faced by the patients themselves, from the difficulty of spending days and weeks away from family, to the lower levels of attention they may receive from hospital staff as their stays drag on, to the increased risk of hospital-acquired infections and lack of specialized rehab.
Some of the most surprising observations came in relation to undocumented immigrants, who present major challenges despite being a small part of the patient population.
In some cases, when community support can’t be found, Rice Lamb writes that hospitals “Often pay to transport immigrants back to their countries — if the patients agree — and sometimes cover medical bills in their homelands. This often costs less than absorbing the expense of continuous care in the United States.”
Furthermore, she says, “Even with U.S. citizenship, language barriers can contribute to discharge delays. When caregivers spoke little English, the length of stay increased to 6.1 days, compared to four days for the control group, according to a study published recently in the Archives of Pediatrics & Adolescent Medicine.”
Throughout her work, Rice Lamb takes advantage of sources which reporters around the country should find useful when localizing similar topics.
Rice Lamb completed this project while on an AHCJ Media Fellowship on Health Performance, supported by the Commonwealth Fund.
Fla. hospitals make little progress on error reduction
Filed under: Government, Health care reform, Health policy, Hospitals, Hot Health Headline, Studies
South Florida Sun Sentinel reporters Sally Kestin and Bob LaMendola report that, despite the myriad initiatives and protocols launched in the dozen years since a landmark report thrust medical errors into the headlines, little progress has been made in actually reducing the toll taken by medical errors.
“I don’t really see any improvement in patient safety,” said Dr. Arthur Palamara, a Hollywood vascular surgeon and advocate for safer practices. “Unfortunately, despite all the protocols that were put in place, the adverse incidents, the wrong-site surgeries still keep happening at the same rate.”
A long list of technological advances and a national emphasis on preventing mistakes “hasn’t made a difference,” said Douglas Dotan, chief executive of CRG Medical, a Houston firm that sets up error-prevention systems…
They found that, while some progress has been made, even the most aggressive hospitals have found it difficult to crack the exceeding complex web of human and mechanical interactions that make errors possible.
These findings, which have become a depressingly predictable event, are built in part on research published in the April, 2011 issue of Health Affairs, a publication to which AHCJ members are granted free access.
AHCJ resources on patient safety
- Health Journalism 2008: Dennis Quaid acts on medical errors
- Health Journalism 2010: Patient safety expert Peter Pronovost, M.D., Ph.D., of Johns Hopkins University was the keynote speaker.Watch an excerpt of his address and see his PowerPoint presentation.
- Deciphering hospital quality data
- Public handicapped by lack of information on medical errors
- Medical errors and the movement toward transparency
- Sunshine Week: Some hospital quality measures online but more could be done
- Hospital patient safety initiatives borrow from transportation industry
- Outsourcing of pharmacies: Prescription for problems?
- Medical misconnections: Patient-safety problems
- Reporter documents surgical errors through public records
Wahlberg offers advice on avoiding unfortunate incident
It’s the kind of call every journalist dreads.
David Wahlberg, of the Wisconsin State Journal, writes that a call from the medical examiner to his editor on July 22 started the worst day of his 22-year journalism career.
David Wahlberg
A patient featured in his front-page story about a new treatment for brain aneurysms, who was quoted as saying she felt “fantastic” after having the procedure, had died six days before the article was published. She died from a hemorrhage in a different part of her brain from where her aneurysm had been and other factors may have contributed to the bleeding. But when Wahlberg wrote the story, the patient was at home, doing well, with no warning signs.
In a forthright article for AHCJ, Wahlberg explains how this unfortunate episode happened, explores ways it could have been avoided and shares lessons for both journalists and health care providers. Read more …
Reporter’s investigation exposes inefficient charity
Filed under: Health journalism, Hot Health Headline, Public records
In the Minneapolis Star Tribune, Jane Friedmann used simple tax documents and a local woman’s complaint to show that most of the money raised by the Austim Spectrum Disorder Foundation goes toward sustaining the foundation’s fundraising, not toward families living with autism. It’s a brief, effective piece of reporting of the sort that can and should be localized more often. For the record, here are the numbers Friedmann got from the return.
The charitable group pulled in $1.2 million in 2009, according to its IRS filing, but the charity listed a negative balance of $29,679 at the end of the year. It listed three employees and 89,128 “volunteers” …
The group hired two companies to raise funds for ASDF in 2009, but neither did much to help the cause. Ohio-based Infocision kept all $876,832 it raised, while Missouri-based Precision Performance Marketing kept all but $37,842 of the $203,227 it raised.
The tax form reveals the group held no “structured, formal meetings” in 2009. It spent $313,751 on “materials and fulfillment” and $120,241 on postage.
She also called local and national autism charities for their perspective on the dubious foundation, then included a few paragraphs which helped readers make more informed choices when doling out charitable contributions.
To investigate charitable organizations in your area, find out how to to understand an IRS 990 form, the tax return that nonprofit organizations file. It tells you the organization’s revenues and expenses, and its assets and liabilities. You can see whether or not it is making a profit, and how its fund balance, or net assets, has changed over the past year.
Medtronic hires Yale researchers to review Infuse data
Medtronic, the manufacturer of spine fusion product Infuse, has hired Yale University researchers to review patient data and adverse event reports for the product.
Photo by planetc1 via Flickr
The review follows months of reporting by John Fauber for the Milwaukee Journal Sentinel and Medpage Today that have raised questions about the independence of doctors involved in clinical trials for the product.
The Wall Street Journal’s John Carreyou and Tom McGinty also used their paper’s Medicare data stockpile to look at the conflicts of interest and royalty money that drive the popularity of spine fusion treatments whose effectiveness has been disputed.
Serious complications involving Infuse have gone unreported in medical journal articles that were written by doctors who have financial ties to Medtronic.
The June issue of The Spine Journal was devoted to unreported complications related to Infuse, revealing that “complication rates … were 10 to 50 times greater than the estimated complication rates revealed” papers co-authored by doctors with financial ties to the company.
In a statement about the review by Yale researchers, Eugene J. Carragee, M.D., editor in chief of The Spine Journal, says “this appears to be a big first step in the right direction” but points out three challenges that lay ahead for the reviewers.
Minority population swells in nursing homes
Filed under: Aging, Health data, Hot Health Headline, Public health, Tools
In The Providence Journal, reporter and AHCJ board member Felice Freyer reports on the local effects of the national trend toward higher proportions of minority residents in nursing homes. In addition to the logistical concerns raised by this demographic shift, Freyer also explores what it says about health disparities and access to care in minority communities.
Freyer’s report is built on a Brown University study published in the July edition of Health Affairs. As you may know, free access to Health Affairs is one of the many benefits that come with your AHCJ membership.
… between 1999 and 2008, the number of Hispanics and Asians living in U.S. nursing homes grew by 54.9 percent and 54.1 percent, respectively, while the number of whites dropped 10.2 percent.
These numbers reflect the changing demographic profile of elderly people, whose ranks include growing numbers of blacks, Hispanics and Asians. But the researchers say their findings also raise questions about whether minority-group members have poorer access to assisted-living and community-based care. The question may be especially relevant as states such as Rhode Island strive to “rebalance” the long-term system to favor home-based care over institutional care.
Freyer’s story also includes data from Brown’s LTCfocus.org site, a handy tool for sorting and visualizing data related to long term care and nursing homes.
Balancing readers’ desire for short articles with need for meaningful analysis
Writing for Prepared Patient Forum, Jessie Gruman uses the demise of the News of the World to explore the commodification of health journalism, particularly in the online realm, as exemplified by Murdoch’s defunct populist publication and others devoted to a Huffingtonesque metric maximization.
In the health domain, the effects of these demands were described in a series of conversations the Center for Advancing Health hosted with health care journalists over the past month. The themes that emerged were that journalists are often encouraged to:
- Avoid ambiguity. Write short, definite pieces. Don’t qualify the findings or describe limitations of studies. Stay away from “We don’t know what works” and “More research is needed.”
- Make things simple. Present “The Top Five Things You Need to Know (or Do) About X.”
- Write to get clicks. “We are successful based on how many people open our articles.” “I write articles based on questions readers submit.”
Gruman writes that while these observations are neither groundbreaking nor inherently evil, they are problematic. She frames the discussion as one between what readers want (as shown through what links they click) versus what they need. And while readers may crave brief, declarative articles with immediate and alarming personal ramifications, every health journalist understands that what they actually need is well-reasoned, long-term analysis that embraces the ambiguity inherent in day-to-day health research.
With that in mind, Gruman ends on a hopeful note, observing that quality journalism is still readily available, and pointing journalists to a few handy examples and resources. All hyperlinks are taken directly from the original text.
It is still possible to find thoughtful and lengthy discussions of evidence on specific questions in mainstream publications. The lively Association of Health Care Journalists provides a range of services and activities to uphold the quality of reporting. Gary Schwitzer and his cadre of fellow critics at HealthNewsReview.com [sic] publicly ding the most egregious laggards. And there is considerable interest among journalists in improving, not weakening, the quality of their health care coverage.
(Please note that Schwitzer’s site is HealthNewsReview.org.)
Welcome to AHCJ’s newest members
Please welcome AHCJ’s newest group of members. All new AHCJ members are welcome to stop by this post’s comment section to introduce themselves, and you’ll also find many of them waiting on Twitter! Take a minute to follow a few of your new colleagues and find out what they’re adding to the conversation.
- Lominda Afedraru, science writer, Kampala, Uganda
- Timothy Darragh, senior writer, The Morning Call, Allentown, Pa. (@timdarragh)
- Nancy Faass, independent journalist, San Francisco
- Astrid Fischer, journalist, Danish Broadcasting Corp., Copenhagen, Denmark
- Anna Gorman, staff writer, Los Angeles Times, South Pasadena, Calif. (@annagorman)
- Jeffrey Meade, managing web editor, Robert Wood Johnson Foundation, Princeton, N.J. (@rwjfjeff)
- Jeannette Moninger, independent journalist, Highlands Ranch, Colo. (@Health_Writer)
- Andy Pierrotti, reporter, WBBH, Ft. Myers, Fla. (@ReporterAndy)
- Reema Rattan, section editor-health/medicine, The Conversation, Carlton, Victoria, Australia(@reemarattan)
- Lois Rogers, independent journalist, London
- Kay Zakariasen, independent journalist, Nyack, 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.
For Hawaii reporter, scarce nursing home inspections become the story
Filed under: Health data, Hot Health Headline, Public records
The Honolulu Star Advertiser’s Rob Perez reports that, thanks to cutbacks, Hawaii has failed to meet federal standards for “evaluating the severity” of nursing home complaints in four of the past five years. His two-part investigation (Part 1 | Part 2) is built in part on the back (or, in this case, “lack”) of documents that should be familiar to many AHCJ members: Nursing home inspection reports. For more on how to use these, and related documents, check out AHCJ’s slim guide, Covering the Health of Local Nursing Homes.
The Centers for Medicare and Medicaid Services, the federal agency that oversees most nursing homes nationally, imposed only one sanction against a Hawaii facility last year, the lowest number among the 50 states, according to CMS data. North Dakota also had just one sanction.
Over the past six years, the agency took enforcement actions against 4 percent of Hawaii institutions that were cited for a certain level of deficiencies, compared with a national average of 30 percent, the data show. Only North Dakota, at 3.5 percent, had a lower percentage. In 2006 and 2007, no Hawaii nursing homes were penalized.
In the first installment, “Hobbled oversight,” Perez shows how far behind the state has fallen when it comes to inspections. The story has already attracted nearly 150 comments. In the second piece, “Abuse goes unpunished at Hawaii’s care homes,” Perez takes a look at the real-world impact of these administrative failures.
AHCJ members get new jobs, fellowships, awards and more
Constance Alexander, a freelance columnist in Murray, Ky., has been selected as a featured speaker on the roster of presenters approved by the Kentucky Humanities Council. This is the third time she has been selected as a statewide presenter. She has added “The Way Home: What the Dying Teach Us About Living & Life” to the list of programs she presents.
Beth Baker was hired as the features editor for BioScience, the journal of the American Institute of Biological Sciences. It’s a part-time position and she will continue to work as a freelance health and science writer.
A radio documentary by Karen Brown, a reporter/producer at WFCR Public Radio in Amherst, Mass., aired in July. “Living with Hypochondria: The Real Costs of Imagined Illness” is available for wider broadcast.
Gerri Shaftel Constant was nominated for four Los Angeles Area Emmy Awards this year. Winners will be announced Aug. 6.
Hannah Douglas is an intern at Illinois Times, which published her first piece on health reform in Illinois.
Susan FitzGerald, an independent journalist based in the Philadelphia area, is coauthor of a new parenting book, “Letting Go with Love and Confidence: Raising Responsible, Resilient Self-Sufficient Teens in the 21st Century” (Avery, August 2011). FitzGerald, who specializes in children’s health issues, wrote the book with Kenneth Ginsburg, M.D., an adolescent medicine doctor at Children’s Hospital of Philadelphia.
The seventh edition of “How to Write and Publish a Scientific Paper,” by Robert A. Day and Barbara Gastel, M.D., M.P.H., was released last month. Gastel is professor of integrative biosciences/medical humanities at Texas A&M University.
Samantha Gluck is covering health care for a new health and wellness publication in the Cleveland/Akron area: Balanced Living Magazine.
David Gulliver is an investigative/enterprise reporter at The Bradenton Herald, a McClatchy paper on Florida’s Gulf Coast.
Terri Hansen received two Native American Journalists Association 2011 Excellence in Journalism awards: Best Environmental Story in a daily/weekly (Indian Country Today Media Network), and Best Feature Story in a Monthly/Bi-Monthly (High Country News).
Harriet Hodgson participated in a panel about “Writing and Getting Your Book Published” at the national conference of The Compassionate Friends, an organization for parents who have lost a child and their families. Her latest book, “Happy Again! Your New and Meaningful Life After Loss,” will be released by Centering Corporation in Omaha, Neb.
Bob Mitchell, of King of Prussia, Pa., was named Editor at CMIO, a TriMed Media publication written for chief medical informatics officers
Kathryn O’Hara was recently elected to the Board of the World Federation of Science Journalists representing North America.
Richard Peck is writing his third “Top 10″ article for Long-Term Living this year: Top 10 predictions for long-term care, following Top 10 Movements in LTC and Top 10 Most Influential in LTC. He has editing the magazine for 18 years been in geriatrics-related publishing for 27 years.
Stefan Pinto’s first book, “Fat-to-Fit: 50 Easy Ways to Lose Weight” was published in March by Vook. It is available for the iPhone, iPad and iTouch and was released in June on the Barnes and Noble Nook. It will be available on the Amazon Kindle in August.
Kathleen Raven was chosen to be a participant in the Online News Association Student Newsroom at its 2011 conference in Boston in September. She will be one of 20 journalism students from across the country participating in live conference coverage.
Bob Roehr has received a National Press Foundation fellowship to the Journalist to Journalist training program and AIDS Vaccine Conference in September in Bangkok.
Lara Salahi was selected as a Society of Professional Journalist’s Diversity Leadership Fellow and she will speak at SPJ’s annual meeting in September about personal branding.
Gary Schwitzer, publisher of HealthNewsReview.org, spoke to the Evidence-Based Practice Centers of the U.S. Agency for Healthcare Research and Quality, to the European Health Journalism Conference in Coventry, England, to the NIH Medicine in the Media workshop at Dartmouth, and to the Tufts Web Strategies for Health Communication Workshop. The American College of Sports Medicine also publicly supported the 10 criteria used by HealthNewsReview.org to review health care news stories.
Kurt Ullman was awarded an APEX Award for Publication Excellence in the news writing category for an article in The Rheumatologist on the controversy surrounding the release of Colcrys as an FDA-approved form of colchicine, subsequent removal of all other manufacturers from the market, and 50 times increase in price.
Medicine in the Media
In July, Rochester (Minn.) Post-Bulletin health reporter Jeff Hansel and independent journalist Erica Jorgensen attended the National Institutes of Health’s “Medicine in the Media” training at Dartmouth College. Gary Schwitzer, publisher of HealthNewsReview.org, was one of the speakers. About 50 journalists were chosen for the four-day educational series
Casey Medals
Three AHCJ members were among those honored by the Journalism Center on Children & Families in the 17th annual Casey Medals, which are awarded for exemplary journalism on the dilemmas of children and families.
Karen Garloch was part of the team at The Charlotte Observer who produced “Cradle of Secrets,” which was the winner in the Project/Series: Under 200,000 circulation category. The series looked at the cases of children whose deaths were attributed to sudden infant death syndrome and found that many infants in N.C. slept in unsafe settings and possibly suffocated.
Betty Ann Bowser and Bridget DeSimone contributed to a two-part series that received an honorable mention in the “Video Short Feature” category. In “Families Battle Obesity in Mississippi,” PBS NewsHour went to Mississippi to demonstrate two problems - a fatty everyday diet and a distinct preference for fatty foods - that help drive the obesity crisis.
- Mississippi Wages Fried Food Fight Against Childhood Obesity
- Mississippi ‘Food Deserts’ Fuel Obesity Epidemic
The winners will receive a Casey Medal, as well as $1,000, at an October ceremony in Washington, D.C. The winners will compete for two additional $5,000 awards presented by the America’s Promise Alliance.
California Endowment Health Journalism Fellows
Three AHCJ members have been named National Health Journalism Fellows in the 2011 California Endowment Health Journalism Fellowship Program. The fellows attend six days of workshops, seminars and field trips that explore community health issues. They then continue their fellowship work on ambitious reporting projects over the next six months to a year.
Betsy Cliff is a health reporter at The Bulletin, a daily newspaper in Bend, Ore. She will investigate the causes and incidence of medical errors, particularly at rural hospitals.
Sheree Crute is an award-winning writer and editor who covers a broad range of health topics and specializes in consumer and multicultural health. She will look at whether the latest potentially life-saving discoveries from the world of medical research will have any lasting impact on the nation’s health disparities.
Shannon Muchmore is the health reporter for The Tulsa World. Her project will look at the lack of health care accessibility in Oklahoma.
-
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
