Are insurers to blame for rising costs?
The San Francisco Chronicle’s Carolyn Lochhead and Victoria Colliver use the recent furor over insurer Anthem’s rate hikes to explore just how much of the blame for rising health care costs should be shouldered by insurers. The reporters find that, in the end, insurers are just another one of the cartels (others include device makers and providers) and operate inside the opaque world of medical pricing and snag hefty cuts for themselves. Lochead and Colliver put it thus:
While the Anthem case has raised a political storm, the underlying surge in costs gets far less scrutiny. But each sector of the health industry points fingers at the other for driving up prices, and all are raking in money.
Insurers blame hospitals and doctors, doctors blame insurers, and hospitals blame doctors and medical devicemakers in what academics call an inscrutable medical-industrial complex that rivals anything the defense industry ever invented. All these groups are combining into what many experts describe as cartels.
The reporters write that, despite their best efforts, they weren’t able to get many folks on the record. When they did find someone who was willing to talk, it was often a source we’ve seen before in other cost stories. It’s a tough theme to get quotes on, as nobody wants to burn bridges with their professional suppliers and everybody’s got some sort of skin in the game. They did, however, manage to find a local source who offered an original and illuminating anecdote:
Christina Bernstein, a medical-device engineer and independent sales representative based in San Francisco, sells disposable surgical tools made mostly out of plastic that she estimates are manufactured for about $40 each. These are marked up and sold to hospitals for as much as $350, she said, for a single use in a surgery on a patient.
“But if you were to get a detailed bill of what the hospital was charging the insurance company for the insured patient, those things get marked up to something like $1,200,” Bernstein said. “It’s ridiculous. There’s no open competition.”
(Hat tip to AHCJ Immediate Past President Trudy Lieberman, who wrote a column on CJR.org praising the Chronicle’s story.)
Group’s tours highlight pollution in West Oakland
California Watch’s Ali Winston writes that to increase awareness of both legacy and ongoing sources of toxins in their venerable neighborhood, the West Oakland Environmental Indicators Project is offering “toxic tours” of the area’s most polluted locations.
Crane unloading shipping containers in West Oakland. Photo by oso via Flickr.The tour focuses on the neighborhood’s industrial legacy and includes West Oakland’s own federal Superfund site, where a chemical company “left a deposit of cancer-causing vinyl chloride in the soil and groundwater” as well as the largest recycling smelter west of the Mississippi and the docks where lines of cargo ships and big rigs sit idling every weekday as they wait for containers to be loaded and unloaded.
Related
In their series “Shortened Lives,” Suzanne Bohan and Sandy Kleffman profiled people from different (though nearby) ZIP codes, finding wide disparities in their expected life spans, based on where they live, their social status and the toll of chronic stress. The series explains the effect these disparities have on health care costs, as well as how they are caused and how they might be addressed. Bohan and Kleffman wrote about the project in a piece for AHCJ members and we have included additional resources for those interested in exploring disparities in health care in their own communities.
Calif. reluctant to boost Medi-Cal’s anti-fraud staff
California Watch’s Christina Jewett reports on the California Assembly’s lukewarm response to the assertion of Medi-Cal’s fraud busters that, with another 38 staff, they could save the $16 billion program at least $51 million annually.
Jewett says Medi-Cal’s audit and fraud staff already numbers 712 employees (at full strength) and their calculations indicate that there may be $400 million in fraud in the system, as well as another $600 million in what Jewett describes as “Erroneous billing for services, supplies and care that is not necessary or poorly documented.” Jewett also lists a few examples of what auditors say are fraudulent cases.
Member news: New book; new Web site
“Open Government: Collaboration, Transparency, and Participation in Practice,” a new book published by O’Reilly media, was edited by AHCJ member Daniel Lathrop and Laurel Ruma. Lathrop is chief digital strategist for InvestigateWest.
Journalist Daniel Weintraub has launched HealthyCal.org, a nonprofit Web site focused on news about the health of Californians and their communities. The site is initially funded by the California Endowment and is staffed by contributing journalists and community members. Weintraub previously was a columnist and blogger at the Sacramento Bee.
Calif. maternal death on rise, according to report
Filed under: Government, Hot Health Headline, Public health
Citing investigators who wrote a yet-to-be-released report, Nathanael Johnson of California Watch reports that the “mortality rate of California women who die from causes directly related to pregnancy has nearly tripled in the past decade.”
The state’s Department of Public Health has held the report without releasing it for the past seven months, according to Johnson.
In a Sentinel Event Alert sent to hospitals nationwide last month, the Joint Commission advised doctors to be aware of medical conditions that contribute to maternal death, including pre-pregnancy obesity, diabetes and high blood pressure. Johnson writes that the alert may signal that the problem is national.
The California report was presented to the American College of Obstetricians and Gynecologists in 2007 - to gasps from the audience, Johnson reports.
The state of California has yet to share the report with the public. Researchers say that, after reviewing the report in 2008, officials in the Department of Public Health asked for technical clarifications. Revisions were complete and approved in the first half of 2009, according to [Shabbir Ahmad, the scientist in California’s Department of Public Health who organized the statewide review].
California Watch serves up data, health stories
The new Center for Investigative Reporting-backed California Watch site is an ambitious and, by virtue of its commitment to providing resources for readers’ own investigations, a particularly reporter-friendly nonprofit news site. Unlike many of their peers, they’re looking toward a syndication-based funding model and seem ready to try just about anything.
This spirit of openness is evidenced by reporter Christina Jewett’s list of story ideas, which include meaty standards (hospital finance, aging population) and a slightly less-covered story (problems with the child welfare system), as well as the health subject page, where Jewett is fairly open about what she’s working on, as well as what she’s reading. All-in-all, the site uses a careful balance of self-promotion and transparency to create a compelling news destination.
KQED profiles those who live with disease, injury
This month’s edition of Health Dialogues, part of KQED’s California Report, focuses on living with disease. In the report, KQED reporters talk to folks living with chronic disease, the effects of traumatic injury and other conditions that can have lasting effects on a person’s quality of life.
To provide insight into the life and routine of someone coping with chronic disease, reporters profile a music programmer ‘coping’ with diabetes, an activist who stumbled upon a forgotten childhood diagnosis of hepatitis B and a cellist with multiple sclerosis. They also talk to a couple dealing with cancer and two sisters on opposite ends of an organ donation chain.
In addition to cancer and disease, KQED reporters also explore how the lasting effects of traumatic injury can shape your life. Pieces include a KPBS reporter talking about his own traumatic brain injury and the story of a surfing-based physical therapy program for veterans.
Series examines life expectancy disparities
In their Contra Costa Times series “Shortened Lives,” Suzanne Bohan and Sandy Kleffman start by profiling three different people from three very different (though nearby) ZIP codes, noting the life expectancy for each. Then they deliver the kicker on which all subsequent reporting hinges:
The Contra Costa Times team also produced a wonderful interactive Google Map breaking down life expectancy by ZIP code.
Though Angelis, Orantes and Rettig all have health coverage, a growing body of research shows that where they live, their social status, and the toll of chronic stress have a much more decisive effect on their health and life span than visits to a doctor’s office.
The pair explains the effect these disparities have on health care costs, as well as how they are caused and how they might be addressed, themes which are all explored further in other stories in the package.
In a companion piece, Bohan and Kleffman explain how they put the multimedia series together. Their step-by-step breakdown of how to go from census data and death certificates to an in-depth series is particularly interesting. The series was a project for the California Endowment Health Journalism Fellowships.
Learning from Calif.’s mental health parity law
On the Los Angeles Times Booster Shots blog, Shari Roan writes about a recent scholarly review of California’s mental health parity law that illuminates lessons that will be key to the success of the upcoming national mental health parity law. The California law has been in place for five years.
Roan summarizes the most important of these lessons, including the accuracy of price estimates and the lack of public awareness about the program. The study considers the views of consumers, insurers and providers as well as the public at large.
The national mental health parity law, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (HR 6983), is intended to prevent discrimination against patients seeking treatment for mental illness by prohibiting “insurers and group health plans from imposing treatment or financial limitations when they offer mental health benefits that are more restrictive from those applied to medical and surgical services.”
However, as MIWatch.org reports, the three federal agencies that are supposed to write the regulations to implement the act missed an Oct. 3 deadline. The law will go into effect in January.
Lopez finds glamour in LA’s marijuana community
Los Angeles Times columnist Steve Lopez has released his latest dispatch from medical marijuana’s front lines.
The Medical License page of Dr. Sona Patel’s site, Doc420.com. Patel specializes in medical marijuana recommendations.
This time, Lopez checks in with a physician who specializes in herbal medicine, worked as a model to help pay her bills to attend a Caribbean medical school, wears high heels and a lab coat in her ornate gold-and-maroon office, and writes about 15 medical marijuana recommendations a day.
“I guarantee a 100% refund if you do not qualify for a medical marijuana recommendation,” she announces on her Web site, Doc420.com. The really crazy part about Dr. Sona Patel? Unlike some of her peers, she spends about half an hour on each appointment and actually turns down some of her patients’ requests.
In two earlier columns, Lopez tells the story of how he got a recommendation to purchase medical marijuana after a brief visit to a gynecologist and how he then used that recommendation to join a cooperative and legally purchase marijuana.
Related
- Lopez, author of The Soloist, was the keynote speaker at AHCJ’s 2008 Urban Health Journalism Workshop.
- Covering Health: Feds issue guidance on medical marijuana
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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
