WSJ sues for release of Medicare provider data
Filed under: Government, Health journalism, Public records
If successful, a legal move by The Wall Street Journal could open a flood of now-confidential Medicare data about providers to the public and journalists.
The filing, by parent Dow Jones & Company, seeks to overturn an injunction that “prevents the public from knowing how much taxpayer money individual doctors receive from the Medicare program,” according to a press release.
The Journal has been running a series of stories about Medicare data, showing that the federal government isn’t taking advantage of the data it has to detect fraud. To report the series, the paper and the Center for Public Integrity obtained the data from the U.S. Department of Health and Human Services but is barred from using the identities of individual providers.
Information about doctors in the Medicare claims database is kept confidential as a result of a lawsuit brought by the American Medical Association more than 30 years ago.
A press kit about the suit includes statements from reporters Maurice Tamman and Mark Schoofs and editor Michael Allen, as well as documents in the case and links to the WSJ series.
For more information, see “WSJ explains why Medicare data is hidden and “WSJ exposes flaws of Medicare’s pay now, investigate later culture.
Update
The board of directors of the Association of Health Care Journalists has released this statement:
AHCJ strongly supports the release of Medicare payment data that can help journalists better cover both the quality of care provided to patients and the finances of this critical government program. Publicly available information should include physician names connected to these payments. We see little reason why information on payments to doctors should be subjected to greater secrecy than payments to hospitals and nursing homes. The Wall Street Journal’s coverage demonstrates that data linked to doctors would help inform the public and likely would expose fraud and abuse in the program.
After 8 years, Quebec’s adverse event reporting law remains unenforceable
Filed under: Government, Health care reform, Health data, Health policy, Hospitals, Hot Health Headline, Public health, Public records
The Montreal Gazette’s Charlie Fidelman has assembled a round-up of what has, and hasn’t, happened in the eight years since Quebec passed a law requiring hospitals to tell patients about all adverse events as soon as staff became aware of them.
According to Fidelman, “the provincial Health Department has yet to set up its registry of adverse events,” which it was supposed to track in order to improve patient safety. It’s expected to finally get started next year.
Until then, hospitals are supposed to track their own events and report them each year, yet “no hospital contacted by The Gazette includes adverse events in its annual reports.” This may have something to do with the fact that the requirement came with no clear enforcement mechanism.
WSJ explains why Medicare data is hidden
Filed under: Government, Health data, Health journalism, Hot Health Headline
In The Wall Street Journal, reporters Mark Schoofs and Maurice Tamman have pulled off an impressive feat, weaving a tale of freedom of information and databases so compelling that it’s already attracted hundreds of comments and attention from all over. At its heart, it’s the tale of why public Medicare payment data does not identify the doctors and individual providers who receive about an eighth of its annual disbursements. If the practitioners were identified, the authors argue, the public and press would be better equipped to expose and deter fraud.
The Medicare claims database, partially available for around $18,300 a year, is one of the most powerful health data resources in the world. It’s also hamstrung:
While the services and earnings of hospitals and other institutional providers can be publicly identified, such information is kept strictly confidential for doctors and other individual providers. The reason is that the American Medical Association, the doctors’ trade group, successfully sued the government more than three decades ago to keep secret how much money individual physicians receive from Medicare. The AMA has continued to defend this ruling, including in two cases in which federal appeals courts issued decisions last year.
This time around, The Wall Street Journal and the Center for Public Integrity took the AMA on. For health journalists, their description of what followed is really the crux of the story:
The Wall Street Journal, in conjunction with the nonprofit Center for Public Integrity, attempted for nearly a year to obtain the database. As part of the effort, the CPI filed a lawsuit against the Department of Health and Human Services, which houses the Medicare program. The Journal and CPI wanted the data at no cost; the government wanted $100,000 for eight years of data. In a settlement, The Journal and CPI obtained the requested data at a substantially reduced fee. They later obtained a decryption key to identify individual providers but signed a contract agreeing not to publish such identities in most cases.
The database, technically known as the Carrier Standard Analytic File, focuses on doctors and others paid on a fee-for-service basis. It contains 5% of all beneficiaries, and includes all doctor claims that Medicare paid directly in association with their care.
There’s far more to the story including information about the Consumers’ Checkbook lawsuit and the penultimate paragraphs on just how clear-cut fraud cases can be, once you know what to look for. An article on the Center for Public Integrity’s website promises more reporting, presumably based on the database, of “some of the questionable spending that occurs in the Medicare program.”
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Canadians fight for disclosure of medical treatment
It took eight years, a whistleblower and intervention from a state commissioner to uncover a fatal medical error in a Newfoundland hospital, one committed by a doctor with an (undisclosed) record of such actions. As Canadian broadcaster CTV reports, Canada’s free access to health care doesn’t translate to free access to information.
Here’s my summary of the story’s key events, as I understand them:
- A woman in Newfoundland dies soon after her ER doctor misdiagnosed a blood clot in her lung and gave her treatment that a colleague said would have been equivalent to a “lethal injection.”
- The victim’s family doesn’t know that anything was out of the ordinary until six years later, when the colleague contacted the family directly to explain what he believed to be a mistake.
- The family approaches the hospital for information, and gets a few treatment records, but is denied access to records from an internal investigation of the incident.
- Using the province’s FOI laws, the family again pushes for the investigation information. Their request is denied.
- Finally, “the family appealed to the province’s Information Commissioner, who ordered Eastern Health to hand over the records.”
- A year later, the records were disclosed – but key EKG information was not. Thus, the family’s fight for disclosure continues unabated.
California law re-seals some child abuse autopsies
Filed under: Children, Health data, Health journalism, Hot Health Headline
On the California Watch blog, Ryan Gabrielson reports that the state has partially reversed a SB 39, the 2008 ruling that made public the autopsy reports of all children who died from abuse.
The measure, nearly unopposed in the state Assembly and Senate, empowers the parent (biological, legal, or by marriage) of a child who died as a result of a crime to have the autopsy report sealed.
The San Diego County District Attorney’s Office initiated the legislation. But unlike many similar exemptions to the state public records law, the child autopsy bill is not driven by law enforcement concern about undermining criminal investigation.
Instead, Gabrielson writes, the law was passed so that families aren’t “victimized a second time” by media coverage of the autopsy reports. Gabrielson seems to find this logic curious, as “the opening section of SB 39 two years ago specifically discussed information dissemination as critical to advancing public safety.”
Gabrielson also notes that the new law comes less than a month after The Los Angeles Times reported that L.A. County failed to make dozens of child abuse deaths public.
Full coverage of the legislation, from The Reporters Committee for Freedom of the Press, can be found here.
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Canadian government obstructs journalists’ access
Filed under: Government, Health journalism, Hot Health Headline, Public records
Writing in Nature News, Kathryn O’Hara celebrates Right to Know Week by declaring that “the information policies of Conservative Prime Minister Stephen Harper are muzzling scientists in their dealings with the media.” She paints a picture that should be painfully familiar to those who deal with American federal agencies or have followed the recent work of AHCJ’s Right to Know Committee.
Margaret Munro, a science reporter for PostmediaNews, has uncovered that a policy enacted in March stipulates that all federal scientists must get pre-approval from their minister’s office before speaking to journalists who represent national or international media. The pre-approval process requires time-consuming drafting of questions and answers, scrutinized by as many as seven people, before a scientist can be given the go-ahead by the minister’s staff. This is to spare the minister ‘any surprises’.
O’Hara, president of the Canadian Science Writers’ Association, provides some distressing examples, including the systematic burying of climate change research and the odd case of a report on a 13,000-year-old flood that broke outside of Canada, because Canadian journalists didn’t have access to the sources.
Scientists in departments that deal with natural resources, health, fisheries and oceans have also felt the pinch of the muzzle. Consequently, Canadians learn little about the results of their wider government science, at least first-hand. Media clearance can take four or five days — ridiculous in a 24/7 news world. And because of the delays, research led by Canadian scientists is regularly channelled through international collaborators and released through their agencies.
All this message micromanagement is even more remarkable, O’Hara writes, given Harper’s past pledges to maintain a transparent government, and to get Canadians excited about science. Canadian journalists are calling for better access to federal researchers, a position that echoes that of AHCJ’s Right to Know Committee and other American journalism groups.
The Canadian Science Writers’ Association in Toronto is asking for timely access to federal scientists whose research is published in journals or presented at conferences open to the media. Our journalists need to speak with scientists to avoid misinterpretation of research. And, as journalists around the world will testify, scientists usually avoid politics and steer clear of policy-sensitive discussions. Canada’s researchers are no different.
J-S settles records suit; docs rebel against COI rules
Filed under: Conflicts of interest, Health journalism, Hot Health Headline, Public records
As a result of the Milwaukee Journal Sentinel’s now-settled lawsuit against the University of Wisconsin, John Fauber was able to review newly public e-mails which show just how angry a segment of the faculty became when faced with the university’s new, stricter conflict of interest regulations. The regulations came, of course, in the wake of Fauber’s investigative reporting on the subject.
The newspaper’s lawsuit argued that the faculty comments were public records under Wisconsin law and sought a court order to obtain them. To settle the lawsuit, the newspaper agreed to accept the 41 e-mails with the names of the doctors blacked out. The foundation also provided a separate list with the names of the 28 doctors who wrote the e-mails.
The (UW Medical Foundation) also agreed to pay the newspaper’s attorneys’ fees of about $12,400.
The e-mails make for good reading, and Fauber wastes no time in deploying the liveliest phrases in his story.
For example, some physicians complained about the 18-month exemption for orthopedic surgeons and other implanters of medical devices, including one who said “Allowing our docs to shill for device companies is a complete perversion.” An orthopedic surgeon responded with a different take, saying it was “clearly ridiculous” to limit his hourly take from device makers to just $500.
For an explanation from Fauber on how he has been able to consistently produce groundbreaking stories on the conflict-of-interest beat, see the article he wrote for AHCJ.
News service to disclose when PIOs listen in
MedPage Today, an online breaking-news service for physicians, today instituted a rule requiring reporters to inform readers whenever a press officer has listened in on an interview.
“If a source’s comments are monitored by a press officer, then the person may not have been speaking freely,” said Peggy Peck, vice president and executive editor. “That’s information readers should have.”
Peck instructed her staff to use phrases like “said in a telephone interview that was monitored by a public information officer” whenever using quotes from such an interview.
Peck emphasized that a reporter’s goal should be to avoid having a press officer listening to calls or attending face-to-face interviews. “But if that is the only way a researcher will talk, we need to let our readers know that,” said Peck’s memo to eight reporters.
Peck is a member of AHCJ’s Right-to-Know Committee, and the rule sprang from the committee’s work to end interference by public information officers in newsgathering, especially in the federal government.
“I applaud MedPage Today for taking this step and encourage reporters and editors everywhere to follow suit,” said Felice J. Freyer, chair of the Right-to-Know Committee and a member of AHCJ’s Board of Directors.
“Reporters have come to accept the presence of public relations people at interviews, but it’s really not acceptable. We all know that such eavesdropping hinders the free flow of information – and we need to let our readers know that this is happening.”
AHCJ is seeking input from reporters about their experiences obtaining information from the federal government. “If you’ve given up trying to reach federal officials because of past delays and obstacles, we want to hear about that too,” Freyer said. Please send your comments to felice.freyer@cox.net.
Related
- Tell us about your access to federal officials
- Major journalism groups demand agency end newsgathering constraints
- AHCJ calls on new administration to improve access to federal experts
UPDATE
Freyer would like to clarify that, in her quote above, “monitoring” would be a more accurate description of public relations staff sitting in on interviews because journalists are typically aware when PIOs are present.
AHCJ also is looking for positive experiences or examples in which relationships between journalists and press officers work well. Send those examples to felice.freyer@cox.net.
Tell us about your access to federal officials
Have you recently tried to get information from the federal government or arrange an interview with a federal official?
AHCJ’s Right-to-Know Committee is calling on journalists to report their experiences, as part of a continuing effort to pry open the doors of the federal government. We’re looking for recent anecdotes about journalists’ experiences with public information officers, especially at the Department of Health and Human Services and any of the agencies that are part of it (e.g., CDC, FDA, CMS etc.).
Freyer
Please write to Felice J. Freyer, Right-to-Know Committee chair, at felice.freyer@cox.net, about problems you have encountered, including mandates to clear interviews with the press office, slow responses, refused interviews, burdensome requirements (such as written questions and answers only), extreme time limitations on interviews, PIOs listening in on your conversations, or anything else that made it hard for you to get the information and quotes that you needed in time. Additionally, do you know whether your requests have been sent to HHS or the White House? What effect did that have?
For background on the committee’s work so far, see these links:
- Major journalism groups demand agency end newsgathering constraints
- AHCJ calls on new administration to improve access to federal experts
In reversal, Mich. agency releases H1N1 documents
Filed under: Government, Health journalism, Public health, Public records
Michigan’s Department of Community Health has reversed an earlier decision to withhold documents about how the state has spent money on H1N1 prevention.
Todd A. Heywood of the Michigan Messenger reports the department had turned down a Freedom of Information Act request from that publication for “information related to a $25,000 budget item for the involvement of the Civilian Air Patrol. It also refused to release information about an exercise which was budgeted at nearly $50,000 and refused to identify which ‘partner agencies’ had received gloves, masks and other supplies purchased by the department.”
In its denial, the department said releasing the information would violate the state’s anti-terrorism laws. Heywood reports the documents that have been released do not appear to have any relationship to terrorism or national security.
“It’s absurd to think that releasing plans for preventing and treating H1N1 would compromise the state’s security or increase its vulnerability to terrorism,” said Charles Ornstein, president of AHCJ’s board of directors and a senior reporter at ProPublica.
“I’m pleased the Michigan Department of Community Health released the requested documents, and I hope reporters in other states will ask for similar information.”
AHCJ has been concerned about the withholding of information about H1N1 around the country. Last fall, an informal poll of AHCJ members and a review of press releases and news reports revealed a wide variation in what information local and state health officials are disclosing about H1N1 deaths.
At the time, Felice Freyer, chair of AHCJ’s Right-to-Know Committee, said, “in some places, officials are withholding more information than necessary, perhaps because of a lack of clear guidelines about what should be revealed. This comes at a high cost; health officials lose the public’s trust when they hide information. Anyone may wonder: If they won’t even say how old the victim was, what else are they concealing about the sicknesses affecting my community?”
After being approached by AHCJ, the Association of State and Territorial Health Officers agreed to organize a group of state officials, public information officers and health-care writers to develop guidelines on reporting deaths that are of concern or interest to the public. We will learn more details soon, says Freyer, a reporter at The Providence (R.I.) Journal, but “we are happy that ASTHO agrees the issue is worthy of discussion and intends to include us.”
In California, Ryan Sabalow of the Redding (Calif.) Record Searchlight put together a local take on ongoing inconsistencies in how local health departments release outbreak-related information to the public. He wrote about examples from local health departments and explained the nuances of when and how certain health departments choose to disclose infections, and how inconsistent those standards can be in practice.
(Hat tip to the Reporters Committee for Freedom of the Press.)
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