Data analysis reveals wide variation in use of heart procedures
Filed under: Health data, Health policy, Hospitals, Hot Health Headline
One town’s high rate of elective angioplasties has drawn the attention of the California HealthCare Foundation Center for Health Reporting and the San Francisco Chronicle.
Tricuspid valve in a model heart. (Photo by robswatski via Flickr)
Emily Bazar reports that people in Clearlake, Calif., have undergone the procedure at 15 times the rate of people in nearby Sonoma County and more than five times the rate of San Franciscans and Californians. Clearlake residents had elective angiography at nearly six times the state rate.
The project includes a downloadable spreadsheet of heart surgical procedures for 208 geographic areas in California.
The analysis was done by Stanford health research and policy Professor Laurence Baker and was commissioned by “the Campaign for Effective Patient Care, an interest group that promoted the involvement of patients in making medical decisions. Formed during the health reform debate, the group recently disbanded.”
The financial and health implications of extreme variation are enormous, raising the prospect that billions of dollars are wasted each year on unnecessary and potentially dangerous treatments. About 600,000 angioplasties alone are performed nationwide annually at a price tag of more than $12 billion, according to a recent study in the Journal of the American Medical Association.
The analysis finds the heart procedures were performed frequently in other parts of California as well. While one hospital says the disparity is because its rural community suffers from overlapping health situations, comparing it to the Third World, the research shows that above-average use of the procedures was found in urban areas as well.
Yet long-standing research suggests that something else usually causes large geographic variation in medical procedures: striking disparities in how doctors treat diseases.
“You just have a group of physicians that tend to order more angiograms or (angioplasties). That’s how they think and do things. They’ve never been told not to. They’ve never been told they’re the outliers,” said Eric Hammelman, a vice president at Avalere Health, a health care consulting firm in Washington, D.C.
The project includes a consumer’s guide to heart procedures, graphics and an explanation of Baker’s methodology.
Learn how to use this data
In a webinar next week, Hiding in plain sight: California hospital data, Charles Ornstein, senior reporter at ProPublica and president of AHCJ’s board of directors, will guide attendees through using the data from the California Office of Statewide Health Planning and Development to determine rates of variation for types of treatments.
Ornstein calls the data set a “gold mine” that can answer questions such as:
- Does your local hospital place more cardiac stents than others?
- Do more of its patients leave the emergency room without being seen?
- Does it have a high level of C-section births?
It doesn’t matter if your hospital is public, nonprofit or for-profit, data on its patients and services are available online. Join us on Sept. 13 to learn how to use this data. California journalists will find this particularly useful, but it also introduces data sets that journalists can request in other states.
Regulatory board fails to collect on fines
When a California regulatory board fines dentists for things like unsanitary conditions or failure to provide patient records during an investigation, it actually collects the money only about 20 percent of the time.
Christina Jewett of California Watch found that nugget, about the Dental Board of California, in a recent legislative report.
The state’s Board of Vocational Nursing & Psychiatric Technicians collects about 80 percent of fines. California’s Board of Registered Nursing has, in the past, collected as little as 14 percent until ProPublica exposed problems with the board’s enforcement.
Calif. prison doc made $777,000 for not treating patients
Using state records, Jack Dolan of the Los Angeles Times found that one of the most highly paid state employees in California is a doctor who has not been allowed to treat patients in six years.
Dr. Jeffrey Rohlfing is a prison surgeon who has a history that includes a psychiatric crisis, revocation of his clinical privileges after a patient died and allegations of substandard care that led to his being fired.
While appealing his termination, he has “been relegated to reviewing paper medical histories, what prison doctors call ‘mailroom’ duty.”
Last year, Rohlfing made $777,423 – that’s his base pay of $235,740 plus back pay for two years when he didn’t work while he successfully appealed his termination.
Rohlfing isn’t the only doctor in California’s cash-strapped prisons earning big money to shuffle paper. Dozens have been relegated to the chore in recent years, according to Kincaid, who said it’s the standard assignment given to physicians when questions arise about their clinical ability. Some eventually return to treating patients, some quit and others are ultimately fired, she added.
Dolan writes that California’s prison system has a history of employing doctors with problems. In 2006, judges said that contributed to the “fact that a prisoner died ‘needlessly’ every six to seven days in a state lockup.”
Hat tip to @wheisel, who has tips from this investigation.
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CHCH Center, Sac Bee investigate hospital-acquired infections
Filed under: Health data, Hospitals, Hot Health Headline
In a series titled “Death by Complication,” the California HealthCare Foundation Center for Health Reporting and The Sacramento Bee teamed up to investigate hospital-acquired infections in the state as well as efforts to combat them.
In the centerpiece, the CHCF’s Deborah Schoch used records and privacy waivers granted by a cooperative family to explore how an apparent hospital-acquired C. difficile infection seems to have killed an otherwise healthy 75-year-old man who was originally hospitalized for a broken femur. The cause of death was listed as “complications.” His story was far from unique, Schoch writes.
One in 20 hospital patients get infections. In California, roughly 200,000 people get hospital infections annually, and 12,000 of them die, according to state Department of Public Health statistics. That makes such infections one of the state’s leading causes of death, ahead of automobile accidents and Alzheimer’s disease.
Yet these deaths have remained mostly in the shadows. They often are classified as “deaths from complications,” an oblique term used in obituaries and often unquestioned by relatives and friends.
Even the best doctors can be baffled whether an infection was acquired before or after a patient was admitted, and if it was the principal cause of death or no factor at all.
Many health care providers historically have viewed hospital infections - going by obscure names or acronyms such as C.diff, CLABSI, VRE and the more familiar MRSA - as a sometimes inevitable consequence of being hospitalized.
In related pieces, reporters find that while hospitals are waking up to the toll taken by hospital-acquired infections, neither they nor the state have really managed to take authoritative measures to address the problem.
See the full series, complete with infographics, on CHCF’s site.
Weiss joins Calif. Center for Health Reporting; Udesky joins FairWarning
Folks attending Sunday’s broadcast panel at Health Journalism 2011 should know that one of the speakers, AHCJ member Kelley Weiss, has joined the California HealthCare Foundation Center for Health Reporting.
Weiss demonstrates the proper placement of a microphone during Thursday’s panel on adding multimedia elements to a story.
Her mission at the USC-based organization will be to expand their work in the broadcast arena, particularly in public radio. Along with several AHCJ Awards for Excellence in Health Care Reporting – she even took the top radio spot in 2008 – Weiss was a 2007-08 Midwest Health Reporting Program Fellow, won a 2009 Edward R. Murrow award for investigative reporting and has contributed work to numerous top public radio programs, as well as for Reuters and California Watch.
Speaking of good news, if you happen to bump into member Laurie Udesky at the conference, be sure to congratulate her on her new assistant editor position at FairWarning, a “nonprofit online investigative news organization” that focuses on “news of safety, health and corporate conduct.” Regular readers of Covering Health will no doubt be familiar with Udesky’s byline and her coverage of big-picture California health issues.
Rural health care in Calif. nearing ‘crisis’
In a collaboration between the California HealthCare Foundation Center for Health Reporting and the San Francisco Chronicle, the center’s David Freed ventures into rural Mendocino County in northern California to explain and examine the ongoing (and worsening) shortage of physicians in American rural areas.
Ukiah emergency room physician Marvin Trotter says that within the next five to seven years, the shortages will grow into a “full-blown health care crisis.” It’s a crisis about which the 58-year-old doctor speaks with eloquence and force.
“You’re going to see more complications and a lesser quality of life,” said Trotter, who puts in 12-hour days three days a week in the emergency room at Ukiah Valley Medical Center, the town’s only hospital. “You’re going to have your foot cut off more as a diabetic. You’re going to have more heart attacks because nobody’s taking care of your cholesterol. You’re going to have more people lose their vision because they can’t get in to see an ophthalmologist. That’s all a function of physician accessibility, and accessibility’s going away.”
Trotter’s quote is a reminder that, for rural America, “doctor shortage” means far more than just primary care. For a broad overview of the growing rural physician shortage, I recommend the “Older doctors, fewer hours” subheading on the story’s first page. The following subhead, “Scarcity at critical levels,” offers a deeper look.
In the second story in the package, Freed looks at how rural communities are working to solve the shortage, and why their efforts keep falling flat.
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New health-related state laws for 2011
Filed under: Government, Health care reform, Health policy, Hot Health Headline, Public health
Many thanks to Melissa Preddy for pointing out, in a post on the Reynolds Center’s businessjournalism.org, the National Conference of State Legislatures’ roundup of new laws that have already go into effect in 2011, or will soon. It’s a national list loaded with localization-ready ideas and issues that should be surfacing throughout the year. Hot-button topics include expanding medical coverage and several nutrition-related laws.
Here are a few highlights, taken directly from the NCSL’s list.
Connecticut will soon be requiring health insurance policies that cover anticancer medications to cover the oral drugs at least as favorably as it does the IV ones. The law prohibits insurers from reclassifying anticancer medications or increasing the patient’s out-of-pocket costs as a way to comply.
A new Missouri law requires all group health benefit plans to cover the diagnosis and treatment of autism spectrum disorders. Coverage is limited to medically necessary treatment ordered by the insured’s treating physician. The law also requires the Department of Insurance and other institutions to submit a report to the legislature regarding the implementation of this coverage, including specified costs.
California became the first, on Jan. 1, 2010, to prohibit oil, shortening or margarine containing artificial trans fats in restaurants and other food facilities. Beginning Jan 1, 2011, the original law will extend to other foods containing artificial trans fats, primarily baked goods.
Retailers in Minnesota will now be banned from selling cups and bottles intended for children age 3 or younger that contain bisphenol A (BPA). These same restrictions went into effect for in-state manufacturers and wholesalers on Jan. 1, 2010.
California lawmakers have also enacted a new law requiring free drinking water for students in school cafeterias or food service areas. Schools must comply by July 1, 2011.
California will soon require all children under the age of 18, including patrollers and resort employees, to wear helmets while skiing or snowboarding. Resorts will be required to post notice about the law, including on trail maps and resort websites.
Prolific antipsychotic prescribers have industry ties
Filed under: Conflicts of interest, Health data, Hot Health Headline
California Watch’s Christina Jewett compares a list of that state’s top antipsychotic prescribers reimbursed by state Medicaid (obtained through Sen. Charles Grassley, R-Iowa) to ProPublica’s database of educational and speaking fees pharmaceutical companies have paid to doctors.
Not surprisingly, she finds matches. Of the top 10 prescribers, Jewett writes, “Three of them accepted $20,000 or more in educational or speaking fees from the company that makes the drug they prescribe to Medi-Cal patients.” Of those, the most remarkable are a duo who share an office near San Diego:
Samuel Etchie prescribed Seroquel more than 1,000 times in 2009 at a cost of $449,000 to the state, according to Medi-Cal records collected by the ProPublica news organization and provided to California Watch. The drug’s maker paid him $25,350 this year to speak to health professionals.
Etchie did not return two calls to his office.
John Allen, who shares an office with Etchie, was among the state’s top prescribers of Zyprexa, also an antipsychotic drug. Allen dispensed 418 prescriptions at a cost to the state of $346,569. This year and last, the drug’s maker, Eli Lilly and Co., paid him about $27,000 to educate other medical professionals.
The icing on the cake? A quote from Allen:
“I think it’s unfortunate that there’s an implication in articles that we’re robots for drug companies,” Allen said. “We have to have our own experience with medications and find out what works best. We’re not 5-year-olds in front of TV watching cereal and toy commercials.”
Agent Orange’s oft-overlooked American victims
We’ve mentioned reports on the health effects of Agent Orange in Vietnam and upon returning American soldiers. But there is another key group of victims, as K. Oanh Ha reports in The California Report. Vietnamese who fought alongside Americans during the war, then emigrated to the United States, were exposed to the same toxins as the Americans and North Vietnamese, yet have no available benefit system.
Vets who have one of 15 diseases can qualify for disability compensation and medical care from the Veterans Administration. That’s not the case for South Vietnamese soldiers, said Ed Martini, a history professor at Western Michigan University, who’s writing a book about the use of Agent Orange in Vietnam.
“If you’re a South Vietnamese soldier, you’re a man without a country,” Martini said. “There’s no benefits system available to you. You can’t get the Vietnamese benefits, and you can’t get the American benefits.”
Ha ends his piece with a small ray of hope for these forgotten allies. At least one politician is taking notice.
Now, the plight of former South Vietnamese soldiers is attracting attention in Congress. Congressman Mike Honda, whose district includes San Jose, says he’s willing to meet with former South Vietnamese soldiers and their families to consider legislation that would extend them benefits.
“Nothing’s too good for our veterans,” Honda said. “That same attitude should be provided to the all the veterans we’ve created and those who have fought with us.”
Report on juvenile mental health courts earns award
AHCJ member Laurie Udesky’s writing was part of the winning entry in the weekly newspaper category of the Price Child Health and Welfare Journalism awards. Udesky’s award-winning piece in the East Bay Express, a weekly paper that covers Alameda and Contra Costa counties in northern California, profiles a local mental health court created to assist teenagers who have broken the law, but suffer from underlying psychiatric issues. It’s an innovative approach to reducing the load on the juvenile detention and judicial systems.
In Alameda County and about fourteen other US counties, attorneys have teamed up with judges, social workers, psychologists, psychiatrists, and families to offer treatment and services to minors with psychiatric problems who’ve broken the law. The idea is to get teenagers like Cindy out of the penal system and help them lead productive lives. Instead of watching kids get thrown out of school for behavior problems, advocates attempt to create environments that would enable them to stay in school. Rather than cycling through group homes, these kids get help so they can live with their families. Instead of simply handing out referrals for psychiatric help, mental-health court makes sure that teens actually attend their appointments. And rather than simply sentencing kids to jail for violating probation, mental-health court tries to address the problems that caused the violation.
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