Behind Oklahoma’s nation-leading access-to-care problems
Filed under: Government, Health care reform, Health data, Health journalism, Hot Health Headline, Nursing, Public health, Public records
In February, the New England Journal of Medicine ranked Oklahoma as the worst when it came to access to medical care. With help from a California Endowment Health Journalism Fellowship, Tulsa World reporter Shannon Muchmore sifted through reams of data to emerge with a three-part series helping readers better understand the state’s unique health care delivery challenges.
Fans of data analysis and numbers will want to dive straight into the first installment. According to Muchmore, 66 of Oklahoma’s 77 counties contain “Health Professional Shortage Areas, which means “they don’t meet the national standard of one physician for every 3,500 people.” And those doctor-patient ratios aren’t improving.
The state is facing a severe shortage of doctors as the population ages. Adding to that, as many as 180,000 people are poised to receive insurance when provisions of federal health-care reform kick in 2 1/2 years from now.
What’s behind that shortage? Muchmore enumerates the key drivers.
Medical schools are not increasing their class sizes, residency slots are hard to come by, and doctors are choosing to locate in other states.
The last two factors go hand-in-hand, as doctors often practice where they have their residencies. Without a connection, they have little reason to locate in a rural area.
The state is not well-positioned to handle a further deterioration in its health-care system. Oklahoma consistently ranks among the worst states for obesity, diabetes, smoking, heart disease and overall health. It has the least improvement in the country in age-adjusted death rate since 1990.
In the second installment, she examines the link between disparities in access to medical care and disparities in life expectancy and other indicators throughout the state, with a special focus on Oklahoma’s most rural counties.
In the final piece, Muchmore looks at the future of health care provision in Oklahoma and the key role that physician extenders, such as nurse practitioners and physician assistants, are poised to play.
Keep an eye on the AHCJ website for an upcoming “How I did it” article from Muchmore in which she shares how she did the reporting on this project.
Patient gets billed $58k for a dubious airlift
Reporting for WCNC-Charlotte , Stuart Watson starts with a $58,477 air ambulance-related bill and works backward to determine the bewildering market forces that conspired to push a rural stroke victim’s bill into the stratosphere.
After reading or watching his story, most will agree with Watson’s assertion that “The details of Pridmore’s flight from Piedmont Medical to MUSC raise questions about whether the intense competition for patients and their health care dollars infects the decision of where patients are treated and whether they are flown to that treatment.”
The most baffling part of the whole story? That the patient in question was initially transported to a certified stroke center by ambulance, and the flight itself was only spurred by the dire proclamations of a remote doctor speaking over a webcam.
Almost as ridiculous? That the helicopter used for the flight came from 140 miles away and had to refuel en route, when there was another chopper hanging out on standby just 20 minutes from the patient. The final indignity? The patient was stuck with the bill for all these aerial shenanigans because his insurer reckons the flight wasn’t medically necessary.
Officials were a no-show for panel on government transparency, science news
Six journalists and an empty chair gathered at the National Press Club yesterday for a discussion about whether the Obama administration has lived up to early promises of openness and transparency in science news.
Photo by epSos.de via Flickr
Despite multiple invitations from Curtis Brainard, science editor for the Columbia Journalism Review, the chair designated for a representative from the Obama administration remained empty. It was symbolic of the relationship reporters say they have with many public information officers in the government.
We are hoping for an archived version of the webcast but, in the meantime, this Storified collection of tweets hits the high points, with suggestions for journalists and those working in government to improve the relationship.
The panel, which included AHCJ board member Felice Freyer, was cosponsored by the National Press Club, Columbia Journalism Review, Society of Environmental Journalists and Reporters Without Borders.
Earlier: Panel of science, health journalists will discuss government transparency in webcast panel
Former Practitioner Data Banks official says HRSA ‘erroneously interpreting the law’
Filed under: Government, Health data, Health journalism, Public records
A former federal official criticized a decision by the U.S. Health Resources and Services Administration for removing the Public Use File of the National Practitioner Data Bank from the agency’s website – a major development as journalism groups fight to restore access to the important tool.
Timeline: National Practitioner Data Bank Public Use File
Letter and statement from Robert Oshel (PDF)
Letter to Sebelius (PDF)
See how reporters have used NPDB’s public use file to expose gaps in oversight of doctors
Letter to members of Congress (PDF)
HRSA letter to Bavley (PDF)
Articles, editorials about public access to the NPDB public use file (PDF)
Sept. 15, 2011: AHCJ, other journalism organizations protest removal of data from public website
Get the NPDB public use file
Investigative Reporters and Editors, working with the Association of Health Care Journalists and the Society of Professional Journalists, has posted the data for download, free to the public.
Robert Oshel, who created the Public Use File in the mid-1990s and managed it until his retirement in 2008, said in a statement released to the Association of Health Care Journalists on Sunday that HRSA is “erroneously interpreting the law” governing the data bank.
The National Practitioner Data Bank is a confidential system that compiles malpractice payouts, hospital discipline and regulatory sanctions against doctors and other health professionals. For years, HRSA has made a public version of it available without identifying information about the health providers.
HRSA officials removed the public file from the data bank website last month because a spokesman said they believe it was used to identify physicians inappropriately.
But in his letter to AHCJ, Oshel said HRSA officials have confused the requirements of the law.
“HRSA’s current management seems to confuse the law’s requirement that a public data file not permit use of its records to identify individual practitioners with a very different requirement, and one not in the law: that the file not allow the records of previously identified practitioners to be identified in the file,” Oshel wrote.
Oshel further wrote that HRSA’s view will “seriously hinder use of the file for important public policy research.”
“For example, it will be impossible to identify state licensing boards which are not taking action to protect the public from physicians with records of repeated malpractice payments and serious sanctions against their hospital clinical privileges based on the quality of their care or their behavior,” he wrote.
As he notes in his letter, Oshel served as associate director for research and disputes for HRSA’s Division of Practitioner Data Banks, which operates the National Practitioner Data Bank, from 1997 *(updated) until his retirement in 2008. Among other duties, he personally designed the Data Bank’s Public Use File in about 1995 and oversaw its development and quarterly updating.
AHCJ President Charles Ornstein said Oshel’s letter reaffirmed what AHCJ and five other journalism groups are fighting for. He said the Public Use File has been a vital tool for journalists writing about insufficient oversight of physicians in their states. Without such articles, some unsafe doctors would very likely continue to be practicing with clean licenses and patient protection legislation in several states likely would not have been enacted.
“It is abundantly clear that HRSA made a mistake in taking the Public Use File offline, putting physicians’ interests ahead of patient safety,” Ornstein said. “With Robert Oshel’s detailed statement, we call on HRSA and HHS Secretary Kathleen Sebelius to make the right decision and restore access to the public version immediately.”
In his letter, Oshel also criticized the process that HRSA introduced as an interim way for reporters and researchers to request data from the data bank. To get information, individuals must disclose the focus of their work and HRSA officials must approve – or reject the request. If the request is granted, HRSA officials will be the arbiters of what data fields an individual needs to complete the research.
“I believe HRSA’s current policy is contrary to the law,” he wrote.
* There was a typo in the date in an earlier version of this post.
Earlier coverage
- AHCJ, other journalism organizations protest removal of data from public website
- Journalism organizations offer data government blocked from public
- More journalism groups join effort to restore access to National Practitioner Data Bank
- Agency declines to restore public data
- Journalists turn to Sebelius for access to National Practitioner Data Bank file
Why are some patients stuck in hospitals for weeks, months?
Yanick Rice Lamb
Patients typically complain about being released from the hospital sooner than they would like. So Yanick Rice Lamb, associate publisher and editorial director of Heart & Soul magazine, became intrigued when when she heard about patients languishing in hospitals weeks and even months after being medically ready for discharge. This can happen to uninsured and underinsured patients who need long-term care.
This could potentially happen to anyone who loses a job and the health coverage that came along with it. Rice Lamb found that delayed discharge was an underreported topic and information was fragmented and spotty, at best.
Find out what she learned from her 10-month look at this narrow slice of the population – the sickest, poorest and most invisible patients. She includes an extensive list of story ideas and angles for other reporters to look into. AHCJ members, read more …
Panel of science, health journalists will discuss government transparency in webcast panel
Filed under: Government, Health journalism, Health policy, Public health, Studies
A panel at the National Press Club this afternoon, which will be webcast, will look at government transparency when it comes to science news.
Six journalists, including AHCJ board member Felice Freyer, will take part. Representatives of the Environmental Protection Agency, the Department of Health and Human Services and the White House Office of Science and Technology Policy have been invited.
The moderator is Seth Borenstein, science reporter for The Associated Press. The other speakers include Curtis Brainard, CJR’s science editor; Joseph Davis, Society of Environmental Journalists; Darren Samuelsohn, Politico’s senior energy and environment reporter and Clothilde Le Coz, Reporters Without Borders.
The panel will be webcast at 3 p.m. ET.
From the event description:
Access Denied: Science News and Government Transparency
Has the Obama administration lived up to its promise to make science more transparent and accessible to the public? An investigation in the current issue of Columbia Journalism Review finds that despite President Obama’s early promise to create an open government, the nation’s science reporters feel there has been little to no progress since the Bush administration.
The panel discussion is free and open to the public. It is cosponsored by the National Press Club, CJR, SEJ, and Reporters Without Borders. A cash-bar reception will follow.
Fauber finds ‘failed back surgery syndrome’ after off-label use of Medtronic’s Infuse
Filed under: Conflicts of interest, Hot Health Headline
John Fauber follows up his previous investigations into the myriad problems and conflicts of interest surrounding Medtronic’s Infuse product with a story on the emerging national epidemic of what pain specialists are calling “failed back surgery syndrome.” One local pain specialist Fauber contacted said that a full 10 percent to 15 percent of his patients suffered from the condition.
To bring the whole thing full circle, Fauber spends much of the body of this latest installment explaining how conflicts of interest and other questionable ethical situations, including off-label use, propelled the early and sustained success of Medtronic’s spine-fusion blockbuster and set the stage for the emerging pain epidemic.
Fauber’s Medtronic coverage is a joint project between the Milwaukee Journal Sentinel and MedPage Today.
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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
