Seattle hospitals love building costly ERs
The Puget Sound emergency room construction boom is in full swing, and Seattle Times reporter Carol Ostrom has taken a pointed look at the cost-related consequences of local hospital expansion.
She examines why hospitals are opting for more and glitzier ERs over lower-cost alternatives such as clinics and urgent care facilities. She also considers why state efforts to guide hospitals toward more efficient spending have failed, and explains how hospitals justify their actions. If you don’t have time for the full story, here’s a relatively tame excerpt:
The ER building boom has prompted a backlash from some lawmakers and advocates of affordable health care, who complain that nearly all Washington hospitals get substantial tax breaks and construction financing through tax-exempt bonds.
Free-standing ERs, these critics charge, are cash cows for hospitals, strategically built in affluent areas to lure busy, well-insured patients and collect fat reimbursements.
KevinMD: Media is key to curbing MRI overuse
Filed under: Conflicts of interest, Health journalism, Health policy, Hospitals
On the MedPage Today outlet KevinMD.com, Dr. Kevin Pho himself writes that media coverage of the overuse of certain screening procedures is “long overdue,” and praises The New York Times‘ recent coverage of a study showing that in some cases MRIs can lead to more harm than good.
In the Times, reporter Gina Kolata explained, when unleashed upon the throwing shoulders of 31 healthy professional baseball pitchers, “M.R.I.’s found abnormal shoulder cartilage in 90 percent of them and abnormal rotator cuff tendons in 87 percent.” It’s a result, Kolata wrote, that shows that MRIs are “easily misinterpreted and can result in misdiagnoses leading to unnecessary or even harmful treatments.”
Back at his web portal, Pho writes that there are two steps that need to be taken to curb the overuse of the MRI. The first is cracking down on physicians who own their own MRI machines or otherwise profit from the tests, and the second is what he calls “adjusting patient expectations.” That’s where, he says, the media comes in.
there are some, but not all, patients who expect a scan and equate an MRI with “being thorough.” In fact, when orthopedic fellows cited in the Times story suggest that patients may not need a scan, patients “look at them like, ‘You don’t know what you’re doing.’”
Doctors can help educate patients away from the mythical benefits of overtesting. But the most effective teacher is the media, which wields significantly more influence. That’s why a story like this in the Times should be applauded, and promoted.
A fun aside? The study was conducted by none other than Dr. James Andrews, whose name will be familiar to anyone with even a passing familiarity with the sports pages.
Public hospitals, not nonprofits, shoulder burden of charity care
Filed under: Health data, Health journalism, Hospitals, Hot Health Headline, Member news, Public records
Writing in the Contra Costa Times, Sandy Kleffman reports that while nonprofit hospitals in the East Bay are given millions in tax breaks, “The responsibility of caring for the indigent falls largely on the region’s public hospitals.”
Kleffman’s findings are based on her analysis of publicly available California Office of Statewide Health Planning and Development reports, documents which she learned to access and process at a September webinar led by AHCJ board president and ProPublica senior reporter Charles Ornstein.
Her analysis revealed a substantial imbalance in the numbers, especially between public hospitals and nonprofits. For example, Contra Costa’s county hospital provided more than three quarters of the total amount of charity care given in the country in 2010, while the six nonprofits together accounted for just under 23 percent.
For their part, representatives of nonprofit hospitals protested that the numbers do not take into account the other community benefits they provide, nor are they adjusted to compensate for the differences in demographics across each institution’s patient pool.
For more on what went into Kleffman’s report, see her sidebar on “How we made comparisons.”
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.
Cash-strapped Ill. goes after hospitals’ nonprofit status
Filed under: Hospitals, Hot Health Headline, Public health
A New York Times article written by Bruce Japsen, an independent journalist writing for the Chicago News Co-Op, digs into Illinois’ recent challenges to the tax exemptions granted to a trio of prominent hospitals by virtue of their nonprofit status. The challenge, inspired in part by the state supreme court’s willingness to uphold the revocation of the nonprofit status of an Catholic hospital in Urbana last year, could expand to more than a dozen other institutions as the state scrambles to cover a looming revenue shortfall.
In its case, the state alleges that the hospitals aren’t providing a high enough proportion of charity care to fulfill the mission of a nonprofit.
All three of the hospitals the state is focusing on provided free and discounted medical care that ranged from 0.96 percent to 1.85 percent of patient-care revenue, according to the revenue department. The state also said that each one had been operating as a “for profit” business when the state’s Constitution says that “only charities are entitled to a tax exemption.”
The hospitals, for their part, point to the other benefits they provide the community, such as neonatal intensive care and burn units, that don’t always bolster their bottom lines. Advocates answer that paying taxes provides a community benefit as well, one that can readily be measured in dollars and cents. And Japsen found that paying those taxes doesn’t even seem to preclude the provision of charity care, especially at the parsimonious levels provided by the hospitals currently targeted by the state.
“The relative amounts of charity care provided by not-for-profit tax-exempts are not materially different from the amount provided by for-profit hospitals,” said Jim Unland, a longtime analyst of Illinois’ health care industry and president of the Health Capital Group, a consulting firm in Chicago. “This raises the issue of whether the tax-exempts are getting prejudicially favorable treatment.”
The three hospitals whose tax exemptions have been stripped by the state department of revenue plan to challenge the action in court, and state hospital organizations are gearing up for a lobbying push they hope will put their tax status on firmer ground.
CPI investigation details health information technology sector’s lobbying efforts
Filed under: Conflicts of interest, Government, Health care reform, Health data, Public records
Writing for The Center for Public Integrity’s iWatch News, Josh Israel reports that, with billions of stimulus dollars still at stake, the number of health information technology lobbyists taking advantage of the lucrative “revolving door” between Capitol Hill and the private sector is sky-high, even by D.C. standards.
The Obama administration is still working to iron out the details of the “meaningful use” mandate expressed in the recovery act, and the big players in health IT are pulling out all the stops to ensure the rules are written to their advantage.
Healthcare Informatics magazine publishes an annual ranking of the 100 largest health IT companies by annual revenue. According to the Senate Office of Public Records, 15 of the companies in the 2010 ranking — most of them ranked in the top third by revenue — reported health IT-related lobbying activity in the first quarter of 2011 or the last quarter of 2010. Of the 90 lobbyists listed as having done health IT lobbying for those firms, at least 63 were former Congressional and/or executive branch staffers, many of whom worked for health-related agencies or committees.
For those interested in additional details on HIT’s lobbying efforts, Israel also included two sidebars:
- Only 15 of top 100 health information technology firms are lobbying on health IT
- Just 16 of top health IT firms maintain corporate PACs
Hospital sues to block release of records
Filed under: Hospitals, Hot Health Headline, Public records
Parkland Memorial Hospital in Dallas, the subject of recent reports that patients were at risk, has sued the Texas attorney general in an attempt to prevent the release of records requested by The Dallas Morning News.
Parkland filed the latest lawsuit — its fifth against the AG related to the newspaper — on Monday. This time the goal is to block release of Parkland police department records dealing with the psychiatric emergency room. The News is not seeking medical records.
Related:
- Reports detail Dallas hospital on brink of losing federal funds
- Dallas Morning News hospital investigation required extensive use of public records
Reports detail Dallas hospital on brink of losing federal funds
Filed under: Government, Health data, Hospitals, Public records
Late Friday, a damning federal report declaring that patients were at risk at Parkland Memorial Hospital in Dallas was released. Even later that same day, Dallas Morning News reporters Miles Moffeit, Sue Goetinck Ambrose, Reese Dunklin and Sherry Jacobsen published their first report online (available to subscribers only).
The reporters write that the inspectors’ findings were released in response to a reform plan the hospital submitted just before its Friday deadline, a plan they report “involves hiring new nurses; rewriting some policies; retraining staff; retiring outdated medicines, supplies and equipment; and launching an intensive series of daily or weekly performance audits over at least the next five months.” According to those who have viewed the 600-page release, they have a lot to overcome.
“It appears safety was routinely relegated to a lower priority by other pressures,” said Vanderbilt University professor Ranga Ramanujam, a national expert in health care safety. “The CMS action is extraordinary. I am hard-pressed to think of an example of a similarly high-profile hospital facing the very real possibility of losing their CMS funding as a result of safety violations.”
The paper’s speedy, thorough response to the release shouldn’t be entirely surprising, considering that they’ve been out ahead of the story from the very beginning.
The top-to-bottom July inspection of Parkland was sparked by a News report of the death of a Parkland psychiatric patient in February. The hospital didn’t report the death to the Texas Department of State Health Services or to CMS, both of which then investigated the case. CMS regulators later determined that the rights of the patient, George Cornell, had been violated repeatedly by Parkland.
The hospital has until Sept. 2 to get its correction plan approved by CMS and to pass inspections, otherwise it could lose the Medicare and Medicaid funds on which it so heavily depends.
Nonprofit hospital CEO earns $5 mil in severance
Filed under: Health data, Hospitals, Hot Health Headline, Public records
Writing for The (Bergen County) Record and NorthJersey.com, Lindy Washburn used recent tax filings to discover millions in severance pay given to the executives of Hackensack University Medical Center, an area nonprofit hospital. The kicker? The top executives got this money while being forced out, in part because the hospital board had been shocked to discover just how much they’d been paying the execs.
The compensation packages came in a year in which tax filings show the 775-bed medical center employed 317 fewer staff and Moody’s Investors Service downgraded its credit rating to Baa1, leading to higher interest payments when new debt is issued. Two law firms also recommended a top-to-bottom overhaul of governance, including compensation practices, after the federal conviction of a state senator who was a paid consultant to the hospital.
Beyond the headline, Washburn used the tax filings to detail national comparisons, a debate on nonprofit status and data on all sorts of compensation at the hospital.
AHCJ articles and tip sheets
- Digging into hospital finances: Recent trends and five key documents
- IRS study of community benefit activity and executive compensation in nonprofit hospitals
- Changes to 990 forms make hospital finance investigations necessary
- Reporting on the business of health care
- Deciphering cost reports helps paint picture of hospital’s financial health
- Veteran editor offers tips for finding health stories on any beat
Drugs send more of the 45-plus crowd to hospitals
At a time when overall prescription drug use is climbing across the board, the AHRQ reports that the number of medication- and drug-related hospital visits for Americans over the age of 45 doubled between 1997 and 2008. Abuse is also on the rise in that age group, and the cost burden for the increase has fallen heavily upon Medicare and Medicaid. The numbers come from the AHRQ’s Healthcare Cost and Utilization Project, a wonderfully deep well of cost-related statistics from 2008.
A few numbers from the release:
Hospital admissions among those 45 years and older were driven by growth in discharges for three types of medication and drug-related conditions – drug-induced delirium; “poisoning” or overdose by codeine, meperidine and other opiate-based pain medicines; and withdrawal from narcotic or non-narcotic drugs.
Admissions for all medication and drug-related conditions grew by 117 percent – from 30,100 to 65,400 – for 45- to 64-year-olds between 1997 and 2008. The rate of admissions for people ages 65 to 84 closely followed, growing by 96 percent, and for people ages 85 and older, the rate grew by 87 percent. By comparison, the number of hospital admissions for these conditions among adults ages 18 to 44 declined slightly by 11 percent.
Beyond the headline-making news involving drugs, AHRQ’s report includes data on other types of medical conditions treated in hospitals, surgical procedures and costs in 2008.
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- Data gives depth to investigation of patient safety
- What reporters should know about Alzheimer’s and related dementias
- Apply for fellowships to attend Health Journalism 2012
- AHCJ asks Supreme Court to permit broadcast of arguments in health reform case
- Tips for print, online journalists to embrace broadcast opportunities
- Numbers reveal how often, or how rarely, states check doctors’ disciplinary records
- 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
