Disclosure of hospital infections still in its infancy
On Forbes.com, Gergana Koleva evaluated the woeful state of national hospital-associated infection reporting, with the help of recently published research. As Koleva writes, such infections account for more than 8,000 deaths each year in the United States and add an estimated $10 billion in annual cost, and hospitals routinely collect valuable data on such things for internal use, yet no clear reporting standards exist on a national level.
The report … shows that only 21 states currently have legislation that requires monitoring and public reporting for surgical site infections. Of those, only eight states actually make the data publicly available, and only a total of 10 procedures – out of 250 possible types of surgeries - get reported.
And even many those states that reported some surgical infection rates as of late 2010 (Colorado, Massachussetts, Missouri, New York, Ohio, Oregon, South Carolina, and Vermont)
Reporters must listen to learn, accurately report about the experience of aging
How do people feel about growing older?
You might think this is a much-examined subject in the media. It’s not.
While the angst and energy of youth appears endlessly fascinating – what are they wearing and drinking? Which apps do they use? What movies or music are most appealing? – the interior life, tastes and thoughts of older adults are largely ignored.
Public opinion research on the topic is surprisingly scarce. The most authoritative study I know of was published almost three years ago by the Pew Research Center. Results were based on a survey of 2,969 adults.
One of the most provocative findings relates to peoples’ perception of when old age begins. Answers varied across the generations: while young people (age 18 to 29) said they thought 60 was the threshold, middle-aged people moved the bar closer to age 70 and people 65 and older pushed it even further, to age 74.
In an equally interesting, parallel finding, older adults said they felt younger than their actual age – by 10 years or more.
In academic circles, the study of people’s age perceptions is known as “age identification.” Research suggests that older adults think they’re younger than they actually are when they’re healthy, active, and have a purpose in life.
“To me, old age is always fifteen years older than I am,” said Bernard Baruch, a famous financier who died in 1965 at the ripe old age of 95, voicing a widespread sentiment.
This disconnect between society’s notion of what constitutes old age and how individuals perceive themselves is revealing. Who wants to identify as “old” when our cultural narrative about aging - one that revolves around physical decline, loss of efficacy and purpose, isolation and irrelevance – is fundamentally negative?
It turns out, there are health consequences attached to our perceptions about getting older.
In an intriguing line of research, Becca Levy of Yale University’s School of Public Health has shown that people who internalize negative stereotypes of aging are more likely to respond poorly to stress, less likely to take good care of themselves, and more likely to experience cardiovascular events and other serious health problems.
Conversely, people with positive images of getting older live 7.6 years longer than those with negatives outlooks, Levy’s research has demonstrated.
In other words, images of dimwitted, sluggish, incompetent, and unattractive old people that circulate widely in our society aren’t just in bad taste. They’re potentially dangerous to people’s health.
There’s a countervailing push from organizations that recognize the insidiousness of negative stereotypes and want to alter our social construct of aging. One example is the International Council on Active Aging “rebranding aging” campaign, launched last year.
The danger here is that efforts to create a new narrative focused on the positive aspects of aging – one that centers on activity, wellness, encore careers, volunteering, and having more time to spend with friends, family – risks marginalizing older people who aren’t especially healthy or well off financially.
This split is reflected in the terminology we use to describe this stage of life. Recently, I’ve come across the terms “wellderly” and “illderly.” Their meaning is clear, and more commonly used terms such as the “young-old” (translate: healthy and active) and the “old-old” (translate: frail, with a larger share of disabilities) essentially serve the same purpose.
Which brings me back to that Pew Research poll.
While there are many interesting insights in the Pew study about older people, reporters who want to know how people actually experience aging – one of life’s profound transitions – will find no substitute for face-to-face interactions.
One of the best pieces of advice I ever got from an editor was “go out there and see what’s going on, even if you don’t necessarily know what you’re looking for.” I’ll repeat it here, in a different context. When you’re writing about older people, go out and sit down with them and ask them about their lives.
You may encounter a degree of resistance: Many seniors are reluctant to talk about themselves. You may have to probe gently and be agile in redirecting your questions if the conversation isn’t moving along as you had hoped. You may have to spend some time making a personal connection before you start getting answers.
But I suspect you’ll be surprised by what older people will tell you, if you take the time, suspend judgment and truly listen.
Judith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.
If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.
Tulsa World investigates billing, compensation at ambulance utility
Filed under: Conflicts of interest, Government, Health data, Hot Health Headline, Public records
The Tulsa World’s Ziva Branstetter has, for months now, been doggedly investigating the billing practices of the Emergency Medical Services Authority, an agency that provides ambulance service to many residents in and around Tulsa and Oklahoma City. The service is largely funded by utility fees which, unless users specifically opt out, should cover the payers’ out-of-pocket costs.
Instead, Branstetter has found, EMSA has followed a number of apparently deceptive billing practices, including sending bills that list a “due from patient” balance of something like $1,100, even though that amount is actually covered by the utility fee. It also unilaterally implemented a policy making patients responsible for the balance if they don’t provide insurance information within 60 days, while providing lavish benefits to employees and executives.
Branstetter’s latest efforts have been directed toward innovative ways of proving EMSA’s sketchy billing practices, as well as uncovering the details of benefits given to the public utility’s CEO. For a full list of Branstetter’s stories on the subject, databases and documents, as well as a summary of the issues at hand, visit the World’s excellent landing page for the investigation.
HHS responds to questions about enforcement of NPDB restrictions
Journalists who name troubled physicians in their stories after downloading a public version of the National Practitioner Data Bank do not have to answer government questions about their sources and will not be subject to criminal, civil or administrative penalties if they violate new restrictions on use of the database.
That’s according to a spokesman for the U.S. Department of Health and Human Services, who wrote to AHCJ last week. AHCJ had asked the U.S. Health Resources and Services Administration, which operates the database, how it intended to enforce the new restrictions on its use, which were imposed late last year.
The federal response is the latest in a long-running dispute between the Obama administration and journalism organizations about the Public Use File of the government’s doctor disciplinary database.
The National Practitioner Data Bank compiles malpractice payouts, hospital discipline and regulatory sanctions against medical practitioners, for private use by hospitals and other organizations that credential them.
While the data bank is secret, for years HRSA has posted a Public Use File, often consulted by reporters and researchers. This public version of the data bank lists the disciplinary actions, but identifies the doctors and other practitioners only by number. As required by law, it contains no identifying information, such as names, addresses, Social Security numbers or dates of birth. But reporters have used the Public Use File to enhance information they had gathered elsewhere on known doctors.
HRSA removed the Public Use File from its website last year for two months after a doctor and his lawyer complained that a Kansas City Star reporter improperly used it to identify him. Following protests from journalists and consumer groups, in November, HRSA restored the public file but began requiring anyone wishing to download it to agree he or she will not use it to identify individual physicians.
The Association of Health Care Journalists, Investigative Reporters and Editors, National Association of Science Writers, National Freedom of Information Coalition, Reporters Committee on Freedom of the Press, and Society of Professional Journalists protested this decision.
In a letter sent to HRSA administrator Mary Wakefield in December, the groups asked what process HRSA would follow to determine whether a reporter had violated the agreement and whether HRSA would ask to see notes and talk to sources, among other questions.
In a response, HHS Deputy Assistant Secretary for Public Affairs Chris Stenrud wrote:
“As you know, HRSA is required by law to maintain the information in the Public Use File of the National Practitioner Data Bank (NPDB) in a form that does not permit the identification of individual practitioners or health care entities. The data use agreement (DUA) was added to help ensure that the data would be in such a form and HRSA’s legal obligation under the statute would be met.
“HRSA will investigate alleged breaches of the DUA on a case-by-case basis. HRSA may request additional information from the reporter or third parties, but the Department cannot compel reporters or third parties to speak with us. We have been advised by the HHS Office of the General Counsel that a user who violates the Public Use File’s DUA is not subject to criminal, civil or administrative penalties. If HRSA determines that data from the PUF have been misused, however, HRSA would need to re-examine the data and consider removal of any specific data points that are making the information identifiable.”
AHCJ President Charles Ornstein said he believes the government continues to misinterpret the law governing the database, noting that previous Democratic and Republican administrations had not imposed this requirement on the same information. That said, he advised reporters using the Public Use File to exercise their rights not to answer questions about their reporting methods that federal officials may ask.
“This fight is not over,” Ornstein said. “While we are adamant that the government return free and open access to this database, this letter provides answers to some of the questions we asked,” Ornstein said. “In the event the government comes calling, reporters do not have to answer questions about their sources, and they and their organizations cannot be penalized in any way for their use of the Public Use File.”
Ornstein suggested reporters speak to their editors and attorneys before downloading the database. Another option, he said, is for concerned reporters to download a slightly older version of the file -which has no restrictions on its use - from the website of the Investigative Reporters and Editors. The file has not been updated since August 2011.
“If anyone encounters any difficulty or problems from government officials regarding their use of the doctor discipline database, please alert us immediately,” Ornstein said.
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
Ranking may lead to sources for reporting on aging
Health reporters covering the aging beat might be interested in which hospitals offer the best geriatric services, according to recent rankings published by U.S. News & World Report.
Don’t take the magazine’s word as gospel; its method for rating hospitals has been questioned by many and is by no means the definitive word on the subject.
That said, each of the hospital departments mentioned on the U.S. News list houses experts knowledgeable about aging and health. You might want to put the list in a file so it’s handy when you’re looking for sources to comment on a story you’re covering.
These are the top 25 geriatrics departments, according to the magazine:
1. Mt. Sinai Medical Center, New York
2. Ronald Reagan UCLA Medical Center, Los Angeles
3. Johns Hopkins Hospital, Baltimore
4. Massachusetts General Hospital, Boston
5. Duke University Medical Center, Durham, N.C.
6. Mayo Clinic, Rochester, Minn.
7. Cleveland Clinic, Cleveland
8. New York-Presbyterian University Hospital of Columbia and Cornell
9. UPMC-University of Pittsburgh Medical Center, Pittsburgh
10. Yale-New Haven Hospital, New Haven, Conn.
11. University of Michigan Hospitals and Health Centers, Ann Arbor
12. UCSF Medical Center, San Francisco
13. Johns Hopkins Bayview Medical Center, Baltimore
14. Hospital of the University of Pennsylvania, Philadelphia
15. NYU Langone Medical Center, New York
16. Hospital for Special Surgery, New York
17. Beth Israel Deaconess Medical Center, Boston
18. Rush University Medical Center, Chicago
19. Barnes-Jewish Hospital/Washington University, St. Louis
20. University of Washington Medical Center, Seattle
21. St. Louis University Hospital, St. Louis
22. Brigham and Women’s Hospital, Boston
23. Methodist Hospital, Houston
24. University Hospitals Case Medical Center, Cleveland
25. Indiana University Health, Indianapolis
I’m struck by the absence on this list of hospitals in the South, the Southwest and the interior West. This may have to do with U.S. News‘ methodology, which relies heavily on recommendations from medical specialists. But it’s a bit disconcerting, nonetheless.
Judith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.
If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.
AP puts numbers on the prescription drug epidemic
Filed under: Government, Health data, Hot Health Headline, Pharmaceuticals
The Associated Press’ Chris Hawley has worked through the latest numbers on the prescription painkiller boom, helping to illustrate the ongoing toll the opiod abuse epidemic is taking on traditional hotspots like Appalachia and emerging ones like the American Southwest and parts of New York City. Nationally, numbers continue to hit new heights.
Nationwide, pharmacies received and ultimately dispensed the equivalent of 69 tons of pure oxycodone and 42 tons of pure hydrocodone in 2010, the last year for which statistics are available. That’s enough to give 40 5-mg Percocets and 24 5-mg Vicodins to every person in the United States.
Hawley writes the numbers can be distorted by things like clinics for returning servicemembers, whose ranks have greatly increased in the past decade, as well as by mail-order clinics, but they still paint a detailed picture of where the opiods are going. Absent federal regulation, there is currently only a patchwork of state prescription drug tracking systems, many of which are not fully interoperable, but Hawley’s federal numbers help fill in the gaps.
The AP analysis used drug data collected quarterly by the DEA’s Automation of Reports and Consolidated Orders System. The DEA tracks shipments sent from distributors to pharmacies, hospitals, practitioners and teaching institutions and then compiles the data using three-digit ZIP codes. Every ZIP code starting with 100-, for example, is lumped together into one figure.
AHCJ urges Joint Commission to release inspection results
The Association of Health Care Journalists has called upon The Joint Commission to make public its hospital accreditation surveys and complaint reports.
In a letter to the agency sent last week (PDF), AHCJ president Charles Ornstein noted that some consumers can obtain hospital inspection reports while others cannot, depending on where they live and which organization or regulator did the survey.
State licensing agencies and the federal Centers for Medicare and Medicaid Services consider the results of their inspections to be public record. But the Joint Commission does not release details on inspections it performs.
“This peculiar patchwork system treats consumers unequally and leaves millions in the dark about the performance of their local hospitals,” Ornstein wrote to Joint Commission president Mark Chassin, M.D.
AHCJ’s letter follows an effort by a group of consumer organizations to change the law to make inspections public.
“I urge the commission to take the lead on this issue, and demonstrate your commitment to transparency, by voluntarily opening these records to the public,” Ornstein wrote.
The Joint Commission said it has received AHCJ’s letter and is reviewing it.
Understand how Supreme Court’s possible decisions will affect seniors
Older Americans have a lot at stake as the Supreme Court considers the future of the Affordable Care Act, and it behooves reporters on the aging beat to understand this slice of the health reform debate.
Howard Gleckman gave a good overview recently on his “Caring for our Parents” blog. Gleckman is a former senior correspondent at Business Week, author of the book “Caring for Our Parents,” and a resident fellow at the Urban Institute.
Here’s a look at how older adults might be affected, drawing on Gleckman’s piece and my thoughts.
Medicare. As Gleckman notes, health reform offers an important benefit to seniors: an eventual end to the dreaded “doughnut hole” – the multi-thousand dollar gap in coverage for prescription drugs, available through Medicare Part D.
If the Supreme Court strikes down only the individual mandate component of the Affordable Care Act – the requirement that everyone carry insurance or pay a penalty – there’s no reason this provision couldn’t stand, except for its expense. If, however, the Supreme Court invalidates the entire Act, this benefit may well disappear, leaving many seniors vulnerable to high medication costs.
Since adults 65 and older already have coverage through Medicare, they wouldn’t be harmed if the court overturns key provisions expanding health insurance coverage to 30 million Americans. But uninsured adults in the 55 to 64 age group would be hard hit. As Families USA noted in a report:
“While people in this age range are currently the least likely to be uninsured, they can have very serious problems finding coverage if they leave or lose their jobs: They are too young for Medicare and too old to purchase affordable coverage on their own in the private individual market. Options for coverage outside the workplace are limited.”
It’s highly unlikely that Medicare will cancel new preventive services for seniors - a popular element of health reform that became effective in January 2011. Services now provided without beneficiary cost sharing include an annual wellness exam and screenings for diabetes, cognitive impairments, high cholesterol and cancer.
Medicaid. Health reform would add up to 16 million new members to Medicaid, mostly poor children and adults under age 65. In terms of seniors, its biggest impact lies in two areas: a push to provide more long-term care services outside of institutions (see below) and a drive to better coordinate care provided to “dual eligibles” – sick, poor seniors covered by both Medicare and Medicaid.
A complete invalidation of the Affordable Care Act would hamper both initiatives by withdrawing legislative support and crucial funding. Both initiatives could survive a partial invalidation of the Act, but whether leadership for these changes would materialize is in question.
Home and Community-Based Care. For years, advocates have pressed for an expansion of long-term care services available to seniors outside of nursing homes. The Affordable Care Act recognized this and directed billions of dollars toward so-called “home and community-based services,” as Gleckman notes:
“The ACA includes important new incentives for states to expand Medicaid long-term care services for people living at home. Today, nursing homes still get the lion’s share of Medicaid long-term care dollars. Yet seniors and adults with disabilities overwhelmingly want to receive assistance at home. The ACA includes a number of new programs to expand those home and community-based programs, but all would die with the law.”
Gleckman is correct if the entire law is upended. But if only the individual mandate is rejected by the court, it’s likely this shift toward home and community-based care will persist, if only in a reduced form. The economics and preferences of aging baby boomers will require these changes to occur.
Integrated care. If health reform is torpedoed by the Supreme Court, many experts expect the government to continue testing innovative programs that improve medical care and lower costs. But several prominent Republicans have questioned the value of programs funded through the newly created Center for Medicare and Medicaid Innovation and appear poised to mount political attacks on its work.
Gleckman says that “In the long-run, perhaps the most important provisions for seniors are a far-reaching package of experiments aimed at improving the way care is delivered to people suffering from chronic disease, as nearly all seniors do. ” He predicts that these demonstration projects will end if health reform is struck down by the Supreme Court.
Other experts believe similar efforts to improve chronic care will be undertaken by the private sector if health reform fails.
Long-term care insurance. The CLASS Act, part of the health reform package, would have created the nation’s long-term care insurance program but that initiative fell by the wayside when the Obama administration decided that it was unaffordable. See AHCJ’s recent tip sheet on long-term care for more details.
Without this program, long-term care insurance will remain an unaffordable expense for many consumers, especially as insurers across the country sharply raise premiums.
This is a lot to assimilate, but here’s another thought: if health reform is deep sixed by the Supreme Court, it will be many years before Congress will be willing to undertake another substantial overhaul of the health care system, Gleckman suggests. That’s a sobering thought, since older adults’ health is frequently compromised by costly, sometimes unjustified, fragmented and uncoordinated care in the system we now have.
Related: Joanne Kenen, AHCJ’s topic leader on health reform, writes that there is still plenty to watch and report on as the Supreme Court deliberates.
Judith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.
If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.
How health care price fixing works in Maryland
Filed under: Health care reform, Health data, Hospitals, Hot Health Headline
As part of her series in National Journal, Margot Sanger-Katz explains how four decades of health care price controls have held costs in Maryland from 25 percent above the national average in 1976 to 3 percent below average in 2009.
In addition to price, the state’s system has also had an impact on quality of care and on hospital access, because Maryland’s universal prices mean that inner-city hospitals won’t be lured out to more affluent suburbs as they have been in cities such as Detroit and St. Louis.
Maryland’s system is what health care economists call all-payer rate-setting. The cost-containment board looks at services and hospital needs and then selects a uniform menu of prices for all payers. In most states, prices for the same procedure vary. Some payers, usually the public ones such as Medicaid, get a steep discount, while others pay more to make up the difference. (The country’s most expensive CT scan of the head is $1,545, according to the international health-plan study.) In Maryland, Medicare, Medicaid, private insurers, and patients who pay cash all get the same bill for a CT scan. It means that bigger, more powerful hospitals can’t demand higher prices from insurers. It also means that hospitals that treat Medicaid patients don’t get bankrupted by skimpy reimbursement rates.
Sanger-Katz is writing this series as part of an AHCJ Media Fellowship on Health Performance, supported by the Commonwealth Fund.
After AHCJ protest, HHS stipulates public meetings are open to media
Filed under: Government, Health care reform, Public records
Can you imagine holding public meetings open to everyone – except reporters who want to cover them? That’s exactly what the U.S. Department of Health and Human Services did last year. But, after complaints from the Association of Health Care Journalists, HHS has agreed to make it a policy that public meetings are open to the media.
“We are hopeful this will not happen again,” said Felice Freyer, chair of AHCJ’s Right to Know Committee. “But to make sure, we will need your help.”
Here’s what happened:
In November, HHS held a series of “listening sessions” in 10 cities to gather input on an important aspect of the Affordable Care Act. These meetings were publicized among thousands of invited “stakeholders,” and anyone who heard by word of mouth could also attend.
But apparently no media advisories went out and, worse, reporters who happened to learn about the meetings were barred from attending. The meetings were not transcribed or recorded.
AHCJ learned about these meetings from Laura Newman, an independent medical journalist and blogger at Patient POV, who asked to attend and was told she could not. Alarmed that the government would bar coverage of public meetings, AHCJ wrote to every member working in the cities where the listening sessions were held (Chicago, Boston, Philadelphia, Dallas, New York, Kansas City, Atlanta, Seattle, Denver and San Francisco) to find out what they knew. Among the 26 who replied, only two knew about the meetings before they took place – Newman and another member who had not been interested in attending.
Over a period of weeks, AHCJ worked with the HHS media office to find out what had happened and to express our concerns. “By excluding the news media, HHS was essentially shutting the door on the majority of people who weren’t on the mailing list or connected with someone who was,” Freyer said. “Most people don’t go to such events, but rely on the news media to tell them what happened.”
The meetings sought input on the definition of “essential benefits,” the minimum that would be covered by plans sold on health insurance exchanges. This was a key aspect of carrying out the health care law; in the end, HHS decided to leave that question to the states.
We asked for the list of “stakeholders” who attended and any notes from the meetings, but HHS was unable to provide them. In a phone conversation last month with Freyer and AHCJ president Charles Ornstein, HHS media officials acknowledged that such meetings should be open to the media. At our request, they agreed to add this sentence to their media guidelines: “Meetings that are open to the public are, by definition, open to the media.”
Please watch out for any violations of this principle, and let us know about them.
“This incident illustrates how members can make a big difference by alerting us to access problems,” Ornstein said. “We’re grateful to Laura Newman for bringing this to our attention, and to all those who responded to our letter. The work of the Right to Know Committee is among AHCJ’s most important endeavors – but none of it can happen without our members’ vigilance and willingness to step forward with information.”
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