Journalism organizations ask HRSA to clarify how it will exercise restrictions
Filed under: Government, Health data, Health journalism, Public records
The Association of Health Care Journalists and five other journalism organizations asked federal health officials this week to specify how they plan to enforce new rules governing access to the public version of the National Practitioner Data Bank.
In a letter to Mary Wakefield, administrator of the Health Resources and Services Administration, the groups continued to express disappointment in the agency’s restrictions on the data bank’s Public Use File. In the past, reporters have used the file to expose faulty oversight of doctors by state medical boards.
The Health Resources and Services Administration removed the public file from its website in September after a complaint from a doctor who complained information on him was used inappropriately. The agency republished the data last month but put in place restrictions on how the data could be used.
Among the restrictions is a provision that bars users from matching data in the Public Use File with other data sources to identify physicians. If journalists or others are found to have violated the provision, they could be required to return the data and be barred from receiving it in the future.
In the letter to Wakefield, sent Wednesday, the groups asked for answers to several questions:
- What process will HRSA follow to determine whether a reporter has violated the agreement? If a reporter identifies a doctor in a story and also had access to the Public Use File, how will the agency find out whether the reporter used the file to identify the doctor or got the information from another source? Will HRSA ask to see notes and talk to sources? What will the agency do if reporters decline to discuss their reporting methods beyond what appears in their stories?
- What recourse will reporters have if they believe they have been unfairly barred from future access to the file?
- If you ask a reporter to return data, will you take any steps to ensure the data hasn’t been copied or saved elsewhere? If so, what will those steps be?
- How will HRSA address stories written based on copies of the Public Use File downloaded before Sept. 1? Such files are available without restriction on the websites of journalism organizations, and reporters do not need to sign any agreement to access them. Will reporters face penalties if they use the information in a way that HRSA objects to?
AHCJ president Charles Ornstein said he continues to believe that the new restrictions are both ill-advised and likely unconstitutional. But he added, “If HRSA intends to stick to them, it’s imperative that journalists understand how they will be enforced before deciding whether to use this information.”
Other groups signing the letter were Investigative Reporters and Editors, the Society of Professional Journalists, the National Association of Science Writers, the Reporters Committee for Freedom of the Press and the National Freedom of Information Coalition.
Investigative Reporters and Editors, working with AHCJ and the Society of Professional Journalists, has posted the data for download, free to the public.
For more background, please see AHCJ’s Right to Know page or this timeline.
Related
- Secrecy around data bank protects ‘Practitioner No. 222117′
- Numbers reveal how often, or how rarely, states check doctors’ disciplinary records
- Agency’s restrictions on data about disciplined doctors continue to get attention
- Journalism groups protest HRSA restrictions to Sebelius
Tsouderos looks at federal funding of alternative medicine
Filed under: Government, Health care reform, Health policy, Hot Health Headline, Pharmaceuticals, Public health
In her latest series, Chicago Tribune reporter Trine Tsouderos, whose award-winning reporting has brought her hard-nosed approach to investigating less-proven areas of medicine, which will be familiar to many members, to bear upon the federal government.
This time, her target is the National Center for Complementary and Alternative Medicine, which she calls “a small, little-known branch of the National Institutes of Health … launched a dozen years ago to study alternative treatments used by the public but not accepted by mainstream medicine.” According to Tsouderos, the center has spent $1.4 since its inception, some of it on curious projects.
A Tribune examination of hundreds of NCCAM grants, dozens of scientific papers, 12 years of NCCAM documents and advisory council meeting minutes found that the center has spent millions of taxpayer dollars on studies with questionable grounding in science.
You’ll want to read it for yourself, but highlights include sentences such as “The cancer treatment involving coffee enemas was based on an idea from the early 1900s, and patients who chose to undergo the risky regimen lived an average of just four months” and “Thanks to a $374,000 taxpayer-funded grant, we now know that inhaling lemon and lavender scents doesn’t do a lot for our ability to heal a wound.”
It’s not all just cherry-picking wacky studies, of course. Tsouderos also looks deep into the powerful alternative medicine industry as well as the scientific rigor, or lack thereof, that sits at its core.
AHCJ objects to CMS meeting privately with investors
Filed under: Conflicts of interest, Health journalism
Responding to a report that federal health officials met in private with Wall Street investors, AHCJ leadership sent a letter to the acting administrator of the Centers for Medicare and Medicaid Services objecting to the selective release of information to stakeholder groups.
The Project on Government Oversight reported earlier this month that a dozen senior staff at CMS met with five Wall Street professionals for nearly two hours in 2009 and that a senior CMS analyst filed an ethics complaint about it.
AHCJ’s letter, signed by president Charles Ornstein, states, “We feel strongly that journalists should receive information from CMS no later than other groups. If guidance or previews are provided to special interest groups, it also should be provided to journalists, who inform the public.”
The letter to acting CMS administrator Marilyn Tavenner was sent on Dec. 15.
AHCJ does not seek to prevent CMS from meeting with members of the public including stakeholders. Nor is the group asking for journalists to receive confidential information from the agency about pending decisions.
“But we don’t think the public should be the last to know about CMS actions. Journalists should be in the loop when information is released,” the letter said.
Secrecy around data bank protects ‘Practitioner No. 222117′
Filed under: Government, Health data, Health journalism, Public records
Alan Bavley of The Kansas City Star provides us with a stark illustration of why new restrictions on the use of the National Practitioner Data Bank are not in the public interest.
In the most straightforward example yet, Bavley reports on “Practitioner No. 222117,” a doctor whose medical licenses have been revoked or suspended by 20 states, who was banned from billing Medicaid or Medicare and whose license to prescribe was yanked by the Drug Enforcement Administration. Bavley learned all of that from perusing the data bank’s Public Use File.
The NPDB includes reports on malpractice payments and disciplinary actions involving health care professionals. Hospitals and state medical boards can use the data when deciding to grant staff privileges or when reviewing license applications, though AHCJ found state medical boards do that less than you might expect. The NPDB’s Public Use File, available for download on a public website, removes identifying information. Bavely’s article explains more about how they de-identify the data.
Despite all we know about Practitioner No. 222117, we don’t know if he or she is still practicing medicine. The public, including journalists, is restricted from using the data to identify this doctor.
In the past, reporters have used information in the Public Use File, in combination with other records, to identify to flesh out their reporting on troubled doctors and show the failure of medical boards to act against doctors with multiple malpractice awards.
That ended on Sept. 1, when the U.S. Health Resources and Services Administration, which runs the database, removed the public use file because one doctor complained about stories that Bavley was writing.
AHCJ, along with other journalism groups and patient-safety advocates, decried the database’s removal. In November, HRSA restored the Public Use File – but with restrictions on how it can be used. Reporters and researchers have to agree not to connect any individual to information in the database. Reporters can be barred from future access to the database if HRSA decides they have violated the rules. For more background, please see AHCJ’s Right to Know page or this timeline.
What do you wish you knew about covering health reform?
You’ll notice today that we have launched our Core Topic pages on health reform to offer helpful reporting resources.
Joanne Kenen is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to joanne@healthjournalism.org. One of the features is something called Shared Wisdom, where we tap into the insight of our members on some new ground, on a specific reporting angle or a coverage hurdle.
I will seek out these words of advice from you every so often and also welcome your questions for the brief insights you are seeking.
My first question to you: Tell me – as a fellow reporter: “What’s the one thing you wish someone had told you during your first week on the health reform beat?”
Send your thoughts, preferably in just 100-300 words, directly to me at joanne@healthjournalism.org. I will pick out useful thoughts to highlight on the site. Thanks for your help.
Americans unprepared to pay for long-term care
Filed under: Aging, Government, Health care reform
In the Chicago Tribune, Deborah Shelton examines how unprepared Americans are to pay for their own long-term care needs as they age. Long-term care tends to slip under the radar because, as one of Shelton’s sources told her, “People buy insurance for their life because they know they are going to die, for their car because they know that can get in an accident and for their health because they know they can get sick, but people don’t tend to buy insurance because they think they are going to need someone to help them take a bath.”
Long-term care encompasses everything from nursing home fees to in-home assistance with everyday routines. It all comes with a price tag; Medicare only covers a limited amount and Medicaid programs apply only to those below certain economic thresholds. That leaves the middle class, who can’t afford the services but don’t really qualify for Medicaid, in the lurch, Shelton writes.
Most people assume Medicare will pay the bills, but the program covers long-term care only under certain conditions and for a limited time. While Medicaid covers long-term care, beneficiaries have to be poor or willing to “spend down” their assets to be eligible. Private insurance can be expensive and excludes applicants with serious medical problems.
As a result, many families pay out of pocket until they exhaust their resources and then turn to Medicaid.
The Affordable Care Act attempted to fill in the blanks, but long-term care provisions of that reform plan withered under intense cost pressure.
An initiative that would have incorporated long-term care into the Obama administration’s health reform plan was scrapped in October after actuaries determined that it would not be financially self-sustainable over the long haul. The Community Living Assistance Services and Supports Act would have created a voluntary, self-funded, employer-based insurance option to help people save for long-term care.
Related
Where health and journalism education meet
Writing for U.S. News and World Report, Menachem Wecker examines the proliferation of health-focused programs at journalism schools across the country, many of which are affiliated with medical schools and/or medical institutions, and how they may or may not benefit both journalists and health professionals.
This recent influx of programs has raised questions from journalists and doctors about the degree to which the collaborations benefit medical and journalism students. Some say that M.D.’s can help journalists better understand the health beat, while others prescribe a “healthy ignorance,” rather than medical school credentials, to reporters. Others say that aspiring physicians can improve their bedside interactions with and empathy for patients by studying journalism.
Wecker writes that while, according to AHCJ treasurer and Reuters Health executive editor Ivan Oransky, M.D., a medical degree appears to have become almost a requirement for broadcast health journalists, there are big-picture views and tools of the trade that those with an exclusively medical education may struggle with. Here, Wecker quotes former AHCJ board member Andrew Holtz, M.P.H.:
“I often compare asking a doctor about health policy to asking an auto mechanic about transportation policy. Maybe they have something useful to say, but it is generally not from what they learned in their training program,” he says.
Peter Fiske, author of the recent article “Unleash Your Inner Dummy” on the website of the journal Nature, says a reporter with less health expertise may find it easier to connect with readers despite the increasing complexity of the medical field.
And, given the difficulty of explaining health to a lay audience, the exchange goes both ways, Wecker writes. Several of his sources, journalists and medical professionals alike, suggested that it might not hurt physicians to improve their communication skills and media savvy.
Editor’s note: An earlier version of this post incorrectly attributed Fiske’s comments to Holtz. We apologize for the error.
Reporter recounts fellowship visit to CDC
Filed under: Government, Health journalism, Health policy
This is a guest post from Winnie Yu, a freelance journalist based in Voorheesville, N.Y. She was among this year’s class of AHCJ-CDC Health Journalism Fellows who spent last week studying public health issues at two Atlanta campuses of the Centers for Disease Control and Prevention.
The fellows met with Ali S. Khan, M.D., M.P.H., assistant surgeon general and director of the CDC's Office of Public Health Preparedness and Response. (Photo: Len Bruzzese/AHCJ)
Life can get lonely when you work as a freelance writer. So it was a real thrill for me last week when I got the chance to attend the AHCJ-CDC Health Journalism Fellowship and listen to experts from the Centers for Disease Control and Prevention discuss the most pressing health issues of our day.
Ten journalists from around the country came to Atlanta to hear presentations on topics as varied as motor vehicle safety, vaccines, patient safety and prescription drug abuse. It was quickly apparent that the CDC is much more than the authority on when to get your vaccines.
We heard from numerous experts, including Mike Bell, M.D., associate director for Infection Control for the Division of Healthcare Quality Promotion; William Dietz, M.D., Ph.D., director of the Division of Nutrition, Physical Activity and Obesity for the National Center for Chronic Disease Prevention & Health Promotion; and Ann Albright, Ph.D., R.D., director of the Division of Diabetes Translation for the National Center for Chronic Disease Prevention and Health Promotion. We also enjoyed a brief presentation from the CDC’s director Thomas R. Frieden, M.D., M.P.H.
Each day ended with a tour. We saw the CDC’s emergency operations center, walked through the tobacco lab and peered in at scientists probing for foodborne illnesses. We looked at viruses under a microscope, marveled at slides the size of a pinhead (used under an electron microscope) and winced at the amount of nicotine that smokers continue to inhale from cigarettes.
And while I couldn’t get the tour guide to tell us where the United States hides its stockpile of smallpox - Russia has the only other one - I was amazed by the challenges that researchers must endure in order to work in the pathogen labs, including chemical showers and protective suits that preclude regular visits to the bathroom. Not surprisingly, we learned that a calm and even temperament is a requirement for the job.
No doubt, some of the information we already knew: Americans weigh more than ever. Autism is on the rise. Diabetes is a major health issue. But we also learned that polio remains a persistent problem in some parts of the world, tuberculosis still afflicts some segments of our population and the United States takes its role as a world leader seriously when it comes to public health.
It was truly an honor to be part of this fellowship, to get an up-close glimpse of the CDC and to share my time with a great group of journalists who were smart, funny and great dinner companions. I have no doubt the experience will spawn story ideas, beef up our source lists and provide ample background for future articles. I know it will for me.
Long-term care insurance premiums jump
Filed under: Aging, Government, Health care reform, Hot Health Headline, Public health
As the population ages and costs continue rising, paying for long-term care is a big issue for middle class families. Some say long-term care insurance can be a solution, but there are significant issues associated with these products.
In the Minneapolis Star Tribune, Jackie Crosby reports that, “Trapped between fast-rising costs for care and weak returns on their investments, insurers have been raising long-term care premiums by double-digit percentages in Minnesota and nationwide.”
Long-term care coverage has been around since the 1970s, and gained popularity in the ’90s, when the government started offering tax incentives. According to Crosby, it’s getting more expensive now because of what one expert called “the perfect storm.”
Insurers set their rates on assumptions that some people would let their policies lapse. But people held on to policies longer than expected. And their claims are bigger because they’re living longer.
Low interest rates have had perhaps the biggest impact, because insurers planned to cover claims based on reserves they invested. When those investments fell short of expectations, insurers turned to policyholders to make up the difference.
State and federal officials see long-term care insurance as key to limiting the strain placed upon government health programs by America’s aging popular, Crosby writes, and they have thus “spent considerable energy trying to encourage the middle class to plan ahead with long-term care insurance, without much luck.”
The Obama administration last month scrapped the CLASS Act, a long-term care insurance program and major piece of federal health care reform. Minnesota launched a program in 2008 that allows median-income households that buy long-term care policies to shelter some assets if they apply for Medicaid. Still, only about 11 percent of people in the state have the insurance.
Even though the Medicaid program was designed as a safety net for people in poverty, middle-class seniors routinely deplete their assets and turn to the state.
In Minnesota, Medicaid pays about 40 percent of elderly long-term care. Costs could rise fivefold by 2035 to an “unsustainable burden” of $5 billion, according to a report last year from the Citizens League.
Aging in place becoming more popular, possible
Filed under: Aging, Health care reform, Health policy, Hot Health Headline
In the latest installment in The Associated Press series on growing old in America, David Crary explores how the health care system is evolving to accommodate “aging in place” and seniors’ preference to remain in their private homes, even at points when their health care situation might seem to suggest relocation is in order. As the population ages, this preference is starting to play a role in policy decisions.
There’s no question that aging in place has broad appeal. According to an Associated Press-LifeGoesStrong.com poll conducted in October, 52 percent of baby boomers said they were unlikely to move someplace new in retirement. In a 2005 survey by AARP, 89 percent of people age 50 and older said they would prefer to remain in their home indefinitely as they age.
Communities have explored a number of programs to better serve this population, and Crary profiled some of the more notable efforts, including:
- The Naturally Occurring Retirement Community (NORC)
… can be either a specific housing complex or a larger neighborhood in which many of the residents have aged in place over a long period of time and need a range of support services in order to continue living in their homes.
- “Village” organizations
Members of these nonprofit entities can access specialized programs and services, such as transportation to stores, home health care, or help with household chores, as well as a network of social activities with other members.
About 65 village organizations have formed in the U.S. in recent years, offering varying services and charging membership fees that generally range between $500 and $700 a year.
- Aging-friendly homes
AARP has teamed up with the National Association of Home Builders to create a designation for certified aging in place specialists trained in designing and modifying residences for the elderly. Several thousand builders, contractors, remodelers and architects have been certified. Building or remodeling homes can include such details as touchless faucets, trim kitchen drawers instead of cupboards, grab bars and nonslip floors in the bathrooms.
Arizona’s Pima County, along with a few other local governments, has gone a step further, passing an ordinance requiring that all new homes in the unincorporated areas around Tucson offer a basic level of accessibility. They must have at least one entrance with no steps. Minimum heights and widths are set so that light switches can be easily reached and doorways are passable in a wheelchair.
- Medicaid changes
In several states, there’s debate about whether to promote aging in place by shifting more Medicaid dollars to community-based programs and away from traditional nursing facilities. But budget problems may complicate such efforts as some financially struggling states cut back on home health services that help keep some elderly people out of nursing homes.
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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
