EU reviewing limits to physician work weeks
Filed under: Europe, Government, Hot Health Headline
The Telegraph’s Andy Bloxham writes that the European Union’s 48-hour-a-week average working time limit is under review, at least as far as doctors are concerned.
Photo by dimnikolov via FlickrThe limit has been in place since August, 2009, and doctors have a limited opt-out clause. According to Bloxham, European health providers have been hit hard by the rule, which cut back their hours “drastically.” Critics have said that “junior doctors, who used to work very long hours, were being stopped from learning or building up experience as quickly as in the past.”
The EU has committed to either reviewing or overhauling the law, and Bloxham lists a few possible modifications.
One way of altering the rules could see doctors’ hours spent on call at hospital rather than on duty counted differently to the hours spent treating patients.
It might also permit them to return from their breaks sooner than the law currently allows in cases where staff shortages are more severe.
The weekly average for American doctors is around 51, which is down from 55 in 1996.
Related
For more European health news, see AHCJ’s Covering Europe initiative.
Fraud-busting contractors slow to refer cases
Despite recent high-profile busts, the private contractors hired by Medicare to sniff out fraud cases and refer them to law enforcement seem to be lagging, according to recent government reports. The Associated Press’ Ricardo Alonso-Zaldivar reported on investigations that found that contractors took an average of 178 to refer fraud cases, and that the government was only able to recover a small fraction of the money identified as lost to fraudsters (OIG report | Testimony).
As this letter summarizing the congressional investigation shows, Iowa Sen. Chuck Grassley is on the case. He’s looking to figure out how much the fraud hunters are paid ($102 million in 2005) and how that balances with their benefit to taxpayers ($55 million recovered by the feds in 2007). The numbers are tricky, Alonso-Zaldivar writes, because fraudulent claimants have a habit of closing up shop and disappearing as soon as they’re notified of the pending investigation. Thus, the fraudbusters can’t be blamed entirely for the collection failures, though their tardy referrals are at least partially responsible.
The contractors have widely different track records. One identified $266 million in overpayments in 2007, while another found just $2.5 million, the Health and Human Services inspector general said in May.
Earlier, the inspector general found gaping differences in the number of new cases the contractors generate for law enforcement. Some had hundreds of cases, while others were in the single digits. Most were doing a poor job at spotting new fraud trends, with “minimal results from proactive data analysis,” the inspector general concluded.
The Obama administration says it’s aware of the problem and is close to completing a reorganization of the contractors, to consolidate their work, define their jurisdictions more clearly, and help them coordinate better with claims processors and law enforcement.
The new “Zone Program Integrity Contractors” will cast a somewhat wider net, and be more closely monitored by federal health officials.
Related
- Investigating health care: Essential public records
- Duff Wilson: Investigating health care fraud
- Reporting on the business of health care
- Center for Public Integrity writer says listserv led to Medicare-fraud story
(Hat tip to Ricardo-Alonzo Zaldivar for providing a copy of the Grassley letter)
Reform may worsen ER crowding
Filed under: Health care reform, Health data, Health journalism, Health policy, Hospitals, Hot Health Headline, Member news, Studies
Associated Press medical reporter Carla K. Johnson has found that, contrary to common assumptions, emergency rooms could become even more crowded with the passage and implementation of health care reform. Popular wisdom has it that, with more access to insurance thus to primary care, folks will be less likely to go to the emergency room for minor complaints or to allow illness to progress to the point where an emergency visit is necessary. Johnson, an AHCJ board member, gives three big reasons why it’s not that simple:
- There are not (will not) be enough primary care physicians in America to deliver that preventative care.
- At present, the uninsured are no more likely to use the ER than patients with insurance coverage.
- “The biggest users of emergency rooms by far are Medicaid recipients,” Johnson writes. “And the new health insurance law will increase their ranks by about 16 million.”
ERs are crowded, Johnson writes, not only because of a lack of insurance but also because of obstacles inherent in their structure and mission, such as an aging population, more people with chronic illnesses, the closures of many ERs in the 1990s and the demand for beds for both emergency patients and patients scheduled for elective surgeries that bring more money.
AHCJ Immediate Past President Trudy Lieberman praised Johnson’s story and linked it to reporting by The Boston Globe on the impact of that state’s reform law upon emergency room use. So far, events in Massachusetts reinforce Johnson’s predictions.
The Boston Globe revisited Massachusetts’s ER conundrum last week, and reported pretty much what it did last year—that despite the state’s reform law, which mandated everyone have coverage beginning in July 2007, emergency room use is rising. Last year, the state’s Division of Health Care Finance and Policy cautioned that it was too early to draw any conclusions from the seven percent rise in ER visits between 2005 and 2007. Now the agency is saying that expanded coverage may be one reason for the 9 percent rise from 2004 to 2008. According to commissioner David Morales, many studies have shown that expanding coverage does not reduce emergency room visits. That’s because the uninsured “are not really responsible for significant ER use,” he told the Globe.
Outpatient inspections show serious lapses
Filed under: Health data, Health journalism, Hospitals, Hot Health Headline, Public records, Studies
AP medical reporter and AHCJ board member Carla K. Johnson used FOIA requests to uncover a wealth of infection-control violations at outpatient clinics in Illinois. The majority of Illinois ambulatory centers have yet to be inspected under the tough new rules, but 76 percent of those which have been inspected also have been cited. The inspections are part of a national push to increase the oversight of ambulatory care centers.
Previously, inspectors from the Illinois Department of Public Health visited the centers about every seven years. But the state last year began more vigorous and frequent inspections of outpatient surgery centers, following directives from national health officials. The state now plans to inspect a third of Illinois centers each year, said Karen Senger, a supervisor in the Health Department’s Division of Health Care Facilities and Programs.
The crackdown resulted from a hepatitis C outbreak in Las Vegas believed to be caused by unsafe injection practices at two now-closed clinics.
Johnson’s state request turned up a laundry list of specific violations, all of which she summarized in one nifty sentence: “The five-second rule appears to be alive and well in Illinois same-day surgery centers, where medical staff were observed picking up items that had fallen to the floor and behaving as if they weren’t contaminated by germs,” Johnson wrote. In an e-mail to Covering Health, Johnson said her story should be easy to localize and explained just how she obtained the inspection reports and why they are now available.
I FOIA’d state inspection reports (CMS-2567s) for ambulatory surgery centers in Illinois that were cited for deficiencies in infection control during the past 12 months. States have been directed by HHS to use a new audit tool to look for infection control problems, following an outbreak linked to two centers in Las Vegas.
AP takes on medical costs of overtreatment
Filed under: Health policy, Hospitals, Hot Health Headline
The AP’s Lauran Neergaard has taken on medical overtreatment in America in the first two parts of a six-part series, both of which eschew the cost angle in favor of a more purely clinical discussion.
In the first installment, she focuses on the medical consequences of overtreatment, which include radiation exposure and complications. She looks at every stage of life, from cesarean births to unnecessary and painful cardiac tests performed on dying patients. In the second piece, she takes on one of the most notorious sectors of overtreatment: back surgery. Back pain is notoriously complicated, and surgeries are on the rise despite little evidence that they’re necessary or effective.
“The way medicine is so Star-Treky these days, they believe something can be done,” said Dr. Charles Rosen, a spine surgeon at the University of California, Irvine.
The reality is that time often is the best antidote. Most people will experience back pain at some point, but up to 90 percent will heal on their own within weeks. In fact, for run-of-the-mill cases, doctors aren’t even supposed to do an X-ray or MRI unless the pain lingers for a month to six weeks.
Related
- Understanding variations in spending (Elliot Fisher presentation)
- MedPACReport: Measuring Regional Variation in Medicare Service Use (Mark Miller presentation)
- Opportunities and Pitfalls of Spotlighting Regional Cost Differences (Patrick Romano presentation)
- Author Q&A: Shannon Brownlee on overtreatment of patients
AP looks at drug resistance worldwide
Filed under: Health policy, Hot Health Headline, Public health
The Associated Press has neatly wrapped up its wide-ranging look at drug resistance and the threat it poses to global health into a flash-based multimedia presentation. The presentation consists of stories, infographics, videos and a photo/audio slideshow.
The two videos explain drug-resistant strains of various infectious diseases. The first looks at the wide availability of powerful antibiotics without guidance or prescription, addresses the problem as it has emerged both in the United States and in locales like Mexico and the Philippines. The second, which is about the use of antibiotics in large-scale livestock operations, relies on just one source, Dr. Craig Rowles of Elite Pork Partnership.
The AP uses infographics to establish the spread and scope of the problem, relying heavily on various world maps. I particularly like the timeline that accompanies the malaria graphic (click “statistics” in the upper right, then “malaria”); it shows the span of time from when each malaria-fighting drug was introduced to the date at which a resistant strain emerged.
Finally, they drive the problem home with three strong anecdotes, including a Southeast Asian boy with drug-resistant malaria, a man fighting the drug-resistant tuberculosis that killed his HIV-positive partner, and a woman who lost an infant daughter to MRSA.
Stories in the series:
- New form of malaria threatens Thai-Cambodia border
- South African doctor sees drug-resistant HIV
- First case of highly drug-resistant TB found in US
- Solution to killer superbug found in Norway
The package is accompanied by this video.
How will health reform affect Medicare?
Filed under: Government, Health care reform, Hot Health Headline
The Associated Press’ Carla Johnson looks at how health care reform might affect those currently covered by Medicare, focusing on five key areas: Medicare Advantage, prevention, hospitalization, electronic medical records and prescription drug coverage. Here are the basics:
- Medicare advantage is popular but relatively expensive. Some private insurers may leave the program if funding is cut, forcing some seniors to change providers. Cuts may also hit extras like hearing aids and health club memberships.
- Preventative services such as mammograms and diabetes classes will be better covered under most proposals.
- Some plans may punish hospitals with high readmission rates and encourage all hospitals to work to keep patients from coming back.
- Any move to electronic medical records and better coordination of care would benefit Medicare patients and providers, as Medicare suffers from many of the same inefficiencies as the system at large.
- As for the notorious prescription drug coverage “doughtnut hole,” the house democrats have proposed a plan that would fill it in by 2023.
AP finds contaminated water in schools
The Associated Press has analyzed a decade of Environmental Protection Agency data and found that tests at thousands of American schools had shown the drinking water to be contaminated, with the water at some schools hitting unsafe levels in as many as 20 separate inspections. As part of the investigation, the AP provided an interactive map with which you can search and sort violations in your area. Although some children have become sick and some schools have resorted to bottled water, the AP found that the contaminants are generally not present in levels that would harm adults.
(Hat tip to Poynter’s Al Tompkins)
Related
- Leah Beth Ward of the Yakima Herald-Republic explains how she reported the “Hidden wells, dirty water” series.
- Greg Barnes of the Fayetteville Observer gives a behind-the-scenes look at the award-winning “What lies beneath” series that revealed contaminated drinking water in the Fayetteville area.
- NYT investigates Clean Water Act violations
- Herbicide levels high in many water supplies
- NYT’s Toxic Waters series takes on ag polluters
- Abandoned mercury mines taint water, fish
Abandoned mercury mines taint water, fish
As The New York Times‘ Toxic Waters captures attention across the country, the Associated Press has released its own story about government oversight failing to stop massive contamination, this time from abandoned mercury mines in California.
Creek near an abandoned mercury mine in the California ghost town of New Idria. Photo by mlhradio via Flickr
The AP’s Jason Dearen found that the government has only tried to clean up a handful of the hundreds of abandoned mercury mines in California’s coastal mountains.
According to Dearen, “mercury mines are the biggest sources of the pollution in San Francisco Bay and the Sacramento-San Joaquin River Delta, the largest estuary on the Pacific Coast.” At least 100,000 impoverished people are eating fish tainted with levels of toxins beyond EPA guidelines, Dearen found.
“Records and interviews show that federal regulators have conducted about 10 cleanups at major mercury mines with mixed results, while dozens of sites still foul the air, soil and water.”
Baucus plan takes on ’secret pricing’
Filed under: Health care reform, Hospitals, Hot Health Headline
The Associated Press’ Carla K. Johnson reports that a provision of Sen. Max Baucus’ health reform plan has brought attention to the “secret pricing” model that dominates in the health care system. According to Johnson, the Baucus bill would not only require hospitals to list standard charges for each procedure up front, it would also “require health plans to report how much of each dollar paid in premiums goes to items other than medical care.”
Maine and New Hampshire already provide online cost-comparison tools, and Johnson quotes a scientist at the Agency for Healthcare Research and Quality as saying such information “ought to be available on a more widespread basis.”
Related
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