Express-News investigates Texas nursing homes
Filed under: Hospitals, Hot Health Headline, Public records
San Antonio Express-News reporters Karisa King, John Tedesco and Melissa Fletcher Stoeltje took advantage of a number of tools to assemble a broad investigation into the city’s nursing homes.
Slow action on nursing home problems
In the package’s centerpiece, the reporters plowed through 2,200 claims filed against the town’s 55 licensed nursing homes from 2006 to 2009 and found that investigators arrived long after the incidents in question and marked so many claims “unsubstantiated” that the state attorney general posted a notice advising residents that they should take even unsubstantiated claims into account when evaluating nursing homes. They also consulted ratings and visited 10 local nursing homes.
With the ratings as a guide, the newspaper examined more than 3,000 pages of abuse and neglect investigations and annual inspections of 10 nursing homes with the lowest scores. It also reviewed dozens of wrongful-death lawsuits filed against local nursing homes to examine how Texas watches over its elderly.
In addition to a few dangerous homes and some disquieting anecdotes, the reporters found an unenforced reporting law:
(Department of Aging and Disability Services) also is failing to enforce a state law that requires nursing homes to report details about every resident who dies. State officials are supposed to analyze the fatality reports to publicize problems and trends, but that research isn’t being done.
To top off this tale of dysfunction, they also unearthed at least five cases in which would-be nursing home whistle blowers were fired.
Stoeltje added a sidebar on nursing home rating systems, their utility and their shortcomings. She addresses both the local Texas system and the federal Nursing Home Compare database. She talks to both nursing home operators and patient advocates; the operators tend to dwell on ratings’ weaknesses while advocates spoke on their strengths.
LIST: Examples of problems found at nursing homes
Six more examples culled from complaints and often backed with interviews.
MAP: Quality of nursing homesA Yahoo! map linking nursing home location, size and rating.
Texas Public Radio
Terry Gildea, host of a news discussion program called “The Source,” interviewed all three Express-News reporters about their investigation.
Slim guide:
Covering the Health of Local Nursing Homes
This reporting guide gives a head start to journalists who want to pursue stories about one of the most vulnerable populations – nursing home residents. It offers advice about Web sites, datasets, research and other resources. After reading this book, journalists can have more confidence in deciphering nursing home inspection reports, interviewing advocacy groups on all sides of an issue, locating key data, and more. The book includes story examples and ideas.
AHCJ publishes these reporting guides, with the support of the Robert Wood Johnson Foundation, to help journalists understand and accurately report on specific subjects.
• More investigations of nursing homes
• Aging Nation: Troublesome Health Care Issues
• Headlines an advocate for seniors would like to see
• The impact of aging upon health care
• Covering nursing homes and other issues of aging
• How will retiring boomers affect the national health agenda?
• You Can Run, but You Can’t Hide: Policy and Problems in Long-Term Care
• Biology of Aging: Sources and Resources
ProPublica guides reporters to check local boards
Filed under: Government, Health data, Health journalism, Nursing, Public records, Tools
For those of you who have followed the ongoing investigation ProPublica’s Charles Ornstein and Tracy Weber have done into nurses and whether states are reporting disciplinary actions, you might have a chance to localize the story.
ProPublica has posted a guide, “Reporting Recipe: How You Can Investigate Your State’s Oversight of Its Nurses and Other Licensed Professionals,” to help reporters and the public check up on what’s happening in their states.
ProPublica editor-in-chief Paul Steiger and managing editor Stephen Engelberg, explain why they are providing the reporters’ techniques and insights:
We hope that others will use the techniques created by Ornstein and Weber to hold local officials accountable. Reporters who look into the local boards that oversee nurses or other health professionals will make new discoveries, some of which will undoubtedly go beyond what we have found. That, in turn, will help others push the story ahead. We hope statehouse reporters, beat reporters, general assignment reporters, bloggers, citizen journalists and others will use this road map.
Use the state-by-state guide prepared by Ornstein (also president of AHCJ’s board of directors) and Weber that shows what information is available to the public in each state and specific things to look for in the records.
They have used the data to identify some states that appear to be inconsistent in reporting disciplinary actions against medical professionals. If you are covering any of these states, you should probably be looking into the story yourself:
- Florida
- Georgia
- Illinios
- Indiana
- Kentucky
- Michigan
- Mississippi
- New Jersey
- Ohio
- Tennessee
- Wisconsin
- West Virginia
Analysis reveals who hired health care lobbyists
Filed under: Government, Health care reform, Public records
The Center for Public Integrity has put together an interesting analysis and graph of what interests were lobbying on health care reform in Congress in 2009.
Information to create the chart is drawn from an analysis of Senate lobbying disclosure forms. The analysis found that “more than 1,750 companies and organizations hired about 4,525 lobbyists — eight for each member of Congress — to influence health reform bills in 2009.”
Trade, advocacy and professional organizations led the lobbying push, with hospitals, insurance companies and manufacturers behind them.
Some interesting tidbits:
- AARP deployed 56 in-house lobbyists and two from outside firms
- The U.S. Chamber of Commerce had 47 lobbyists, all but eight from outside firms
- The American Medical Association had 33, 11 from outside firms.
- Some unexpected organizations, including Americans for the Arts and the International Association of Amusement Parks and Attractions, also had lobbyists trying to influence health care legislation.
Reporters use county rankings for analysis
Filed under: Health data, Public health, Public records, Studies, Tools
On Feb. 17, rankings of the relative health of counties in each American state were released by the Robert Wood Johnson Foundation and the University of Wisconsin. The rankings used data from 13 distinct (mostly federal) sources, including the National Center for Health Statistics, the Census Bureau and the Dartmouth Atlas. With that data, researchers computed eight separate composite scores, which were then weighted to produce one overall score. The ratings are navigated by clicking through a national map to the state and county level. Enough clicks will even bring you to the raw data itself. The state only compares counties, not states, because data collection varies from state to state and isn’t always standardized.
It’s a combination of data, analysis and an intuitive interface, and journalists have been quick to localize the story. Many reporters reached beyond the easy numbers (”our county is 67th!”) to use the system for deeper stories.
For example, Robin Erb of the Detroit Free Press dissected the ratings process and how individual factors and disparities played into them before launching into the standard state breakdown.
Writing for Health News Florida, David Gulliver took a broader state view and considered how various socioeconomic factors played into the rankings of Florida counties. Gulliver’s analysis:
The strong-performing coastal counties, like Collier, St. John’s Sarasota, Charlotte, Palm Beach and Broward, all benefit from having heavy concentrations of retirees who have guaranteed health care access via Medicare. …
[Dr. Kevin Sherin, director of public health for Orange County] said that in Florida’s tourism and service industries, workers tend to be transient and less likely to have insurance or consistent primary care.
He noted the low-ranked counties were some of the poorest in Florida, like Union and Bradford in the rural north, and Glades and Okeechobee, with heavy populations of migrant workers. Those counties also tend to have more people who speak only Spanish, Creole or other languages.
Gulliver localized the story on a county level for his Sarasota Health News site.
In USA Today, Mary Brophy Marcus took the national view and looked for broad trends and generalizations. Marcus’ story was accompanied by a map by Frank Pompa highlighting each state’s healthiest and least healthy counties.
Defaulted doctors: Hundreds fail to pay on loans
More than 300 health care providers who received Health Education Assistance Loans made no payments during 2008, despite having earned income that year, according to a new report from the Office of the Inspector General of the Department of Health and Human Services.
These 312 HEAL defaulters earned $13.4 million and owed $47.5 million on their loans in FY 2008. Ninety-eight of these defaulters (31 percent) earned $50,000 or more. These 98 defaulters were responsible for nearly $15 million of the $47.5 million owed.
The program, known by the acronym HEAL, provided federal insurance for educational loans made by private lenders to more than 156,000 graduate health professions students between 1978 and 1998. Loans were available to students in schools of medicine, osteopathy, dentistry, veterinary medicine, optometry, podiatry, public health, pharmacy, chiropractic, health administration or clinical psychology.
The names of borrowers who are in default on their loans are published online in a searchable database quarterly. Information available includes the borrower’s name, discipline, state, amount due, school and date of graduation or separation.
The site says it lists borrowers who:
- had one or more default claims paid by the Department of Health and Human Services (DHHS);
- been excluded from the Medicare program as a result of his or her HEAL default; and
- not had the Medicare exclusion stayed, or lifted, by the Office of Inspector General as a result of entering a settlement agreement.
The site says it was last updated in November 2009, so reporters will need to verify any information found on the site. But it could be a starting place for stories about local health care providers.
New federal caregiver database full of holes
Filed under: Hot Health Headline, Public records, Tools
Tracy Weber and Charles Ornstein are still working with databases of disciplined caregivers, this time exposing gaping holes in the federal database released to hospitals on March 1 (LA Times version | ProPublica version). Weber and Ornstein trace the holes to a lack of reporting by state agencies, and mention California, South Dakota, New Hampshire, Alabama, Delaware, Ohio, Tennessee, Indiana as states whose database entries were demonstrably incomplete. Some states don’t even have a single disciplined caregiver showing up in the federal database even though scores of offenders are listed on those states’ own sites.
The omissions took federal health officials by surprise. Only last month, a spokesman for the agency that oversees the database told reporters that “no data is missing.” Another official said the agency had been “constantly” checking its data against state licensing board websites.
But Friday, the head of the Health Resources and Services Administration (HRSA) acknowledged that records were missing. She said her agency had launched a “full and complete” review to determine what is wrong and how to fix it.
The Department of Health and Human Services has reacted swiftly, Ornstein and Weber report. HHS boss Kathleen Sebelius sent U.S. governors a letter requesting that they identify and correct any holes in the federal database by June 1, at which point any states whose entries were not updated will be named and shamed in an HSS report. HHS will train state staff in compliance and audit the database to make sure everybody’s following the rules. States have, as of yet, not faced any penalties for failing to update the list over the preceding two decades.
‘Gold mine’ of workplace toxicity data released
Filed under: Health data, Hot Health Headline, Public health, Public records
After a long FOIA battle that ended with a federal lawsuit, Adam Finkel, former OSHA director of health standards programs for the Occupational Safety and Health Administration (bio and contact information), has “acquired data on some three million samples, taken at about 75,000 locations from 1979 to 2009,” the Center for Public Integrity reports as part of its “Data Mine” series.
The air and “wipe” samples in question were taken to determine workplace exposure to toxic substances. Finkel plans to analyze this data “gold mine” and make it available to the public in an easily digestible format (a project for which he has already secured grant money). At some point, OSHA itself may do the same.
Asked if OSHA plans to make the sampling data public, agency spokeswoman Diana Petterson responded in an e-mail that “it is under consideration and must address certain concerns including the data integrity and the completeness of the data.” Finkel, who left OSHA after accusing the agency of failing to test its own inspectors for dangerous levels of beryllium, is skeptical. “They made it as hard as they possibly could,” he said. “This database is up to 30 years old, and they’ve shown no interest in making it accessible or doing anything useful with it internally.”
The Data Mine series, a collaboration between The Center for Public Integrity and the Sunlight Foundation, will highlight inaccessible or poorly presented information from the federal government.
From the CIA to the CDC, we’ll be looking at data that needs to be public, with regular posts on the Center’s and Sunlight’s websites. We’ll describe each data set, as well as officials’ plans for putting it online – or not.
Open government directive bears fruit, databases
Filed under: Government, Health data, Hospitals, Hot Health Headline, Public records, Tools
In December, 2009 Peter Orszag, director of the White House’s Office of Management and Budget, issued an Open Government Directive (original PDF here) requiring a number of agencies to “identify and publish online in an open format at least three high-value data sets” on Data.gov within 45 days. That deadline came on Jan. 22, and the resulting data sets have all been posted online. The beefiest and most immediately useful are those from the Department of Veterans Affairs, but we’ve also included other sets which could prove useful for health care journalists. Descriptions are taken directly from Data.gov.
Department of Veterans Affairs
Veterans hospital report cards and safety reports
The VA has divided report cards (11 categories) and safety reports (4 categories) into topic-specific files, from Infrastructure to Nosocomial Infections. The best way to find what you’re looking for is to visit the Open Government Directive site and then scroll down to “Department of Veterans Affairs.”
FY08 Veterans Compensation and Pension by County
The Compensation and Pension by County dataset is a count of the number of veterans receiving disability compensation or pension payments from the Department of Veterans Affairs. The data is reported at the county level, by age group and by % disability rating.
Social Security disability claims
SSA Disability Claim Data
The dataset includes fiscal year data for initial claims for SSA disability benefits that were referred to a state agency for a disability determination. Specific data elements for each year and state include receipts, determinations, eligible population, and favorable determination rates.
SSA State Agency Workload Data
The dataset includes monthly data from October 2000 onwards concerning initial claims for SSA disability benefits that were referred to a state agency for a disability determination.
USDA nutrition data
MyPyramid Food Raw Data
MyPyramid Food Data provides information on the total calories; calories from solid fats, added sugars, and alcohol (extras); MyPyramid food group and subgroup amounts; and saturated fat content of over 1,000 commonly eaten foods with corresponding commonly used portion amounts.
USDA National Nutrient Database for Standard Reference
The USDA Nutrient Database for Standard Reference, Release 22 (SR22) is the major source of food composition data in the United States and provides the foundation for most public and private sector databases. SR22 contains nutrient data for over 7,500 food items for up to 143 food components, such as vitamins, minerals, amino acids, and fatty acids.
Medicare
CY 2009 MTM Contact List
CMS approved contact list of Part D Sponsors in Medication Therapy Management Program (MTMP) which is in their plans’ benefit structure.
Office of Medicare Hearings and Appeals Claims Listed by State
Total count of Claims received by Region, State and fiscal year. Appeals can be found here.
Part B National Summary Data File
The Medicare Part B National datasets are summarized by meaningful Health Care Common Procedure Coding/Current Procedural Terminology, (HCPC/CPT), code ranges. Each dataset displays the allowed services, allowed charges and payment amounts by HCPC/CPT codes and prominent modifiers.
Other
OSHA Data Initiative - Establishment Specific Injury and Illness Rates
Each year the Occupational Safety and Health Administration (OSHA) collects work-related injury and illness data from employers within specific industry and employment size specifications. This data collection is called the OSHA Data Initiative or ODI. The data provided is used by OSHA to calculate establishment specific injury and illness incidence rates.
What else is there?
The “Tools” section of the site includes widgets and data-mining and extraction tools, applications, and other services to “provide the public with simple, application-driven access to Federal data with hyperlinks.” The “Geodata” section includes federal geospatial data with metadata and links to more detailed Federal Geographic Data Committee (FGDC) metadata information.
The site is soliciting comments about what datasets should be made available, so you can suggest more datasets here. The site also offers a tutorial.
Third-party PubMed video tutorials in plain English
PubMed’s fantastic, but it can also be mighty frustrating. Maintained by the National Library of Medicine, it’s the interface through which folks can search or browse their way through NIH’s vast repository of health-related research articles.
Unfortunately, it’s also not quite like the user-friendly search engines most of us have come to know and love. That’s where third-party tutorials come in.
If you’re looking for a strong distillation of the basics, head straight for AHCJ’s tip sheet. If you prefer more technical info and less hands-on guidance, see Wikipedia. But if you’re looking for an in-depth, easy-to-follow introduction broken into easily digestible chunks, head for this nine-part video tutorial created by an Indiana University medical librarian.
She uses accessible language, analogies and well-paced demonstrations to peel back the layers of the labyrinth and help viewers understand the purpose and relevant applications of the interface’s features. Here’s the first installment:
Note that on Screenjelly webcasts, such as this one, you can click on the “full-screen” icon in the bottom-right corner of the player. Screenjelly looks much better in the full-screen mode than most players.
Groups give Obama “A” for openness despite barriers between journalists, federal experts
Filed under: Government, Health journalism, Hot Health Headline, Public records
A coalition of reform groups, including Common Cause, Democracy 21, the League of Women Voters and U.S. PIRG, recently issued “A Report Card from Reform Groups on the Obama Administration’s Executive Branch Lobbying, Ethics and Transparency Reforms in 2009.” The administration gets high marks in a number of categories, including an “A” for open government. The report card, however, seems to overlook an issue of particular interest to health care journalists.
The groups praise the administration’s “unprecedented steps to implement Executive Branch transparency,” steps they said include the disclosure of official visits to the White House, the publication of stimulus and other government contracts online and the administration’s “presumption of disclosure” approach to FOIA requests. They also note a few shortcomings, including the administration’s reliance on Internet-only avenues of disclosure and time lags in the availability of some information.
According to AHCJ’s Right to Know Committee, there’s another shortcoming those reformers missed in their report card: Restricted access to federal employees. AHCJ has already requested that the administration reverse inherited policies that allow federal public information officers to restrict the access the public has to federal experts, and while committee representatives praised the administration’s move toward a more open government, they don’t think this particular obstructionist policy should be ignored.
By way of explanation, here’s an excerpt from a letter sent by Right to Known Committee Chair Felice Freyer and AHCJ President Charles Ornstein to the groups responsible for the report card.
… we wanted to make you aware of another issue the administration has yet to address: the continuing difficulty that journalists face in speaking with federal employees. Under policies that have intensified over the past 15 years, public information officers often block or delay our access to the people who have the facts needed to inform the public.
This is not just a matter of reporters looking to make their jobs easier. It’s a question of our ability to tell the public what federal employees are doing with taxpayers’ money and to report on important research and public health issues. Many times staff members are eager to talk with us, but they require permission from public information officers. The PIOs sometimes simply say “no.” Or they never call back. Or they tell the reporter to wait for the official news release. Many insist on listening in on interviews, ensuring that staff will stick to the “official story.”
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Health Journalism 2010, AHCJ's annual conference, features a world-class program with story ideas, sources, stronger reporting skills, chances to meet newsmakers and network with other journalists.
- Health and education: Covering these intersecting beats
- Reporting on the business of health care
- Health reporting resources for journalists on state and local government beats
- Shortened Lives: How location, lifestyle affect health
- Covering a complex story for the long haul
- Aging in the 21st Century: Presentations and tip sheets
- AHCJ calls for better information from Joint Commission Web site
