With state funds gone, Okla. dental programs still serve needy
Writing for the local NPR StateImpact outlet, Logan Layden looks at how dental programs for the needy are coping in the absence of state funding. In the 2010 state budget crisis, Layden writes, “Funding for several programs, including Dentists for the Disabled and Elderly in Need of Treatment, was totally eliminated.”
Among those was Oklahoma’s D-Dent, which provides a sort of superstructure that takes care of logistics and tests in order to allow dentists to donate their work to the needy and elderly. Since the cuts, the statewide program has gone from supporting about 800 patients a year to about 600. They no longer get state funds, though they still rely on the health department for most of their referrals, as well as a little moral support.
“We here are entirely supportive of this program,” Jana Winfee, Chief of Dental Health Services the Department of Health, said. “They have our support, just no funds.”
For more on NPR’s StateImpact project and a list of current participants, check out their lab.
Americans unprepared to pay for long-term care
Filed under: Aging, Government, Health care reform
In the Chicago Tribune, Deborah Shelton examines how unprepared Americans are to pay for their own long-term care needs as they age. Long-term care tends to slip under the radar because, as one of Shelton’s sources told her, “People buy insurance for their life because they know they are going to die, for their car because they know that can get in an accident and for their health because they know they can get sick, but people don’t tend to buy insurance because they think they are going to need someone to help them take a bath.”
Long-term care encompasses everything from nursing home fees to in-home assistance with everyday routines. It all comes with a price tag; Medicare only covers a limited amount and Medicaid programs apply only to those below certain economic thresholds. That leaves the middle class, who can’t afford the services but don’t really qualify for Medicaid, in the lurch, Shelton writes.
Most people assume Medicare will pay the bills, but the program covers long-term care only under certain conditions and for a limited time. While Medicaid covers long-term care, beneficiaries have to be poor or willing to “spend down” their assets to be eligible. Private insurance can be expensive and excludes applicants with serious medical problems.
As a result, many families pay out of pocket until they exhaust their resources and then turn to Medicaid.
The Affordable Care Act attempted to fill in the blanks, but long-term care provisions of that reform plan withered under intense cost pressure.
An initiative that would have incorporated long-term care into the Obama administration’s health reform plan was scrapped in October after actuaries determined that it would not be financially self-sustainable over the long haul. The Community Living Assistance Services and Supports Act would have created a voluntary, self-funded, employer-based insurance option to help people save for long-term care.
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Reporters spend 10 weeks immersed in end-of-life care
Filed under: Health journalism, Hospitals, Hot Health Headline, Nursing
Toronto Globe and Mail reporter Lisa Priest and photographer Moe Doiron spent two-and-a-half months embedded in a 20-bed critical care unit at a Toronto
Photo by quinn.anya via Flickr
hospital, following four patients and their families and chronicling life in an environment where, Priest writes, “death is a constant, almost routine event, claiming one in five patients who enter.”
Their assignment was to find out “How does one prepare for the end of life?” and explore the medical, ethical and economic challenges of that stage of life.
The result is a sprawling, intensive report on the state of end-of-life care in Canada, heavy on anecdotes. Priest’s centerpiece is subtitled “Spending 10 weeks with patients facing death“) but remains cognizant of big picture issues like cost and quality of life.
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.
Rising medical debt spawns problems, fosters solutions
Filed under: Government, Health policy, Hospitals
Kelley Weiss, of the California HealthCare Foundation’s Center for Health Reporting, dug deep into the rising mountain of medical debt accumulating around American patients. Her package includes four pieces (one an extended forum, embedded below) on KQED as well as numerous companion stories online. Her stories consider both the causes of and solutions to medical debt, an issue which plagues hospitals as much as it does patients.
In her first piece, Weiss lays out the simple formula driving all that indebtedness: It’s “because health care costs continue to rise at the same time people are losing their jobs and health coverage.” She uses the story of an unfortunate, unemployed motorcyclist to show how the American billing, credit and insurance systems can quickly add debt to injury.
In the second piece, she looks at the debt from the other side, exploring the massive and largely ineffective lengths hospitals go to in order to collect what they’re owed. Since the recession began, even the most successful collections agencies have only been able to collect about 12 percent, one hospital official said. Confronted with this fact, Weiss asked the obvious question.
So why even bother, if you get such a low return? Maybe they could give those financially squeezed patients with no other options a break. Well, to a certain extent they can, and charity care is on the upswing.
But it turns out there are statutes in place that require hospitals to make collection efforts. Medicare is one of the biggest payers to hospitals and it says that hospitals must try to collect money from every patient. And if they don’t? Medicare won’t pay off its bills. Todd Nelson with the Healthcare Financial Management Association said that leaves hospitals in a tough spot.
As wallets remain tight and debt collection becomes increasingly difficult, both hospitals and patients are starting to take steps to become more up front about exactly how much their care is going to cost, Weiss writes in her third installment. Finally, when all else fails, Weiss finds in her fourth installment, patients can turn to California’s Hospital Fair Pricing Act, which “says hospitals must give patients who are at 350 percent of the Federal Poverty Level a discount on their bills if they’re uninsured or underinsured.”
Dartmouth Atlas report shows little improvement in readmissions
Filed under: Government, Health care reform, Health data, Hospitals, Public health, Tools
In the National Journal, Maggie Fox explains a new Dartmouth Atlas Project report (PDF) which demonstrates that, despite the looming implementation of penalties included in the Affordable Care Act and the existence of a simple, proven road map to improvement, most hospitals haven’t significantly cut down their readmission rates over the better part of the past decade.
“Only seven of the 94 academic medical centers we studied had statistically significant changes in 30-day readmission rates following medical discharge from 2004 to 2009,” [Dr. David Goodman's] team wrote.
According to Goodman, improving readmission rates is a simple matter of actively scheduling follow-up visits and implementing a team approach to care delivery. Unfortunately, he told Fox, making that work in a busy hospital appears to be easier said than done, even with significant federal penalties lurking just over the horizon.
The 2010 health-care reform law begins using a stick in one year, penalizing hospitals with higher-than-expected readmission rates for Medicare patients treated for heart failure, heart attack or pneumonia. Medicare payments could be cut by up to 1 percent in October 2012, 2 percent in 2013 and 3 percent in 2014.
In addition to the overall message of the report, it’s interesting to note that readmission rates were affected by the same regional variation which has provided such fertile ground for reporters covering other Dartmouth Atlas Project research.
The percent of patients landing back in the emergency room within 30 days of discharge after surgery varied from less than 12 percent in 2009 in Rapid City, South Dakota, to 19 percent in Kingsport, Tennessee and 18 percent in Newport, Rhode Island.
For an example of how to localize the information in the report, see this article by Stacey Singer in The Palm Beach Post. To learn more about readmission data from CMS, see this article by Charles Ornstein, AHCJ president and ProPublica senior reporter.
Uninsured face delays, increased risks en route to long-term care
Writing for Heart & Soul, Yanick Rice Lamb offers up a comprehensive take on the special challenges patients and hospitals face when it comes to long-term care for the uninsured.
… a growing number of uninsured people … need long-term care after hospital stays. They lack insurance because they can’t afford it, their employers don’t offer it or they were dropped by private carriers after taking out policies on their own. Consequently, these patients experience delays in moving on to the next step in their care once they are medically ready for discharge. They are stuck in the hospital, because it’s hard to place patients in long-term care facilities or send them home with a nurse when they have no coverage, especially when there are complications. Hospitals end up picking up the tab — sometimes even after patients leave. Those costs are ultimately passed on to everyone who pays taxes and anyone who has a medical bill.
Rice Lamb fleshes out this scenario not only with anecdotes, but with a raft of statistics and studies showing that the ranks of such patients are swelling rapidly, as is the financial toll they’re taking on the system. She ties it in with the hospital “frequent flyer” and charity care issues that have received so much ink in recent years. At the same time, she takes a deeper look at the issues faced by the patients themselves, from the difficulty of spending days and weeks away from family, to the lower levels of attention they may receive from hospital staff as their stays drag on, to the increased risk of hospital-acquired infections and lack of specialized rehab.
Some of the most surprising observations came in relation to undocumented immigrants, who present major challenges despite being a small part of the patient population.
In some cases, when community support can’t be found, Rice Lamb writes that hospitals “Often pay to transport immigrants back to their countries — if the patients agree — and sometimes cover medical bills in their homelands. This often costs less than absorbing the expense of continuous care in the United States.”
Furthermore, she says, “Even with U.S. citizenship, language barriers can contribute to discharge delays. When caregivers spoke little English, the length of stay increased to 6.1 days, compared to four days for the control group, according to a study published recently in the Archives of Pediatrics & Adolescent Medicine.”
Throughout her work, Rice Lamb takes advantage of sources which reporters around the country should find useful when localizing similar topics.
Rice Lamb completed this project while on an AHCJ Media Fellowship on Health Performance, supported by the Commonwealth Fund.
Report: Calif. hospital chain profited from ER admissions
Filed under: Health data, Health journalism, Hot Health Headline, Public records
After months of investigation and updates, California Watch reporters Christina Jewett and Stephen K. Doig have unleashed their full report on California hospital chain Prime Healthcare Services and its knack for turning around failing hospitals by apparently pushing for the admission of ER patients who are insured by Medicare or insurance giant Kaiser Permanente, then keeping them in the hospital.
The report includes hyperlink sourcing, a raft of related documents and a great explainer on how they assembled the numbers behind the story. The duo took advantage of court testimony, sources and reams of public records.
The reporters say that evidence points to “an orchestrated campaign of admitting Medicare and Kaiser patients – moving them from the emergency room to a hospital bed – in the interest of changing the fortune of a money-losing hospital.”
State data shows that after the hospital chain took over 11 hospitals beginning in 2005, the percentage of Medicare patients who were admitted from the emergency room to Prime hospital beds increased from about 45 to 63 percent.
That 40 percent increase contrasts with other California hospitals that saw an average 8 percent decline from 2005 to 2009 in Medicare patients moved from the emergency rooms to hospital beds, data shows.
And, as you’ll see throughout the story, the interviews and anecdotes back up the numbers.
Tina Buchanan, the hospital’s former chief nursing officer, testified that [Prime founder and chairman Dr. Prem Reddy] began to require emergency room staff to put a yellow sheet of paper on each patient record that listed their health insurance status.
She said he would go through the “goldenrods,” as the papers were called, and point out the Medicare or Kaiser patients and say, “Make sure you get this one admitted.”
“If it was … an uninsured patient, he would tell them, ‘Get them out of my hospital,’ ” Buchanan testified.
There’s plenty more where that came from, but I will just leave you with this editor’s note, which appears alongside the main story.
It came to our attention late Friday that Prime Healthcare had issued a press release saying it had taken legal action against California Watch. We have not been served and can’t fully comment until we have reviewed any legal filings. In our dealings with Prime over the course of the past several months, the company has yet to present to us a single factual error that has merited correction or clarification. We continue to stand by our reporting.
Report explains doctors’ reluctance to adopt EMRs
Filed under: Government, Health care reform, Health policy, Hot Health Headline
Writing for the Center for Public Integrity’s iWatch News, Susan Jaffe spent time in the trenches to better understand how government incentives toward the adoption of electronic medical records are (or aren’t) working. She spent time with Cleveland-area small practices and government agencies to understand the real obstacles faced by physicians on the ground. It offers a picture of the reality of EMR today. Some of my favorite tidbits:
- “570 different electronic health systems certified by private organizations for non-hospital settings may be used to qualify for the bonus.”
- “The systems are priced in a way that does not make comparison shopping ‘easy or necessarily valid,’ said Dottie Howe, a spokeswoman for the Ohio regional extension center. There is no basic price because each company offers different components, features, options, and level of technical support.”
- EMR systems can include more than a thousand sometimes-customizeable details, and that’s not including the myriad warnings and cross-checks.
- Compatibility with the systems in the area’s large hospitals is tough to guarantee, yet factors as a major concern for many small practices.
- How early adopters in the field were burned and are wary of getting fooled again.
- When practices adopt EMRs, they typically have to go through a “learning curve,” a period of weeks or months during which they can only see about half as many patients.
- Many major HIT companies don’t guarantee that physicians who adopt their systems will meet the standards for a government HIT bonus.
- The VA’s proven HIT system is available for free, but can’t handle billing and insurance.
- To get the maximum bonus payment, practices must adopt EMRs this year or next.
- Only certified systems can earn bonus payments, yet the second and third stages of certification haven’t even been finalized yet.
An accompanying piece by Emma Schwartz looks at one physician’s concerns.
Potential changes in regulation of medical devices would likely impact health care costs
As the medical device industry ramps up its campaign against further government regulation, Merrill Goozner takes stock of the regulatory and business environment in that arena and explains what is at stake. The key battleground at present is possible modifications to the 1976 law which allows devices to bypass some rigorous testing as long as they’re similar to something that has already been approved for market. The problem? That similarity doesn’t always mean they’re safe, as Goozner points out.
Photo by AlishaV via Flickr
A study published earlier this year in Archives of Internal Medicine found that of 113 major product recalls between 2005 and 2009, only 19 percent had gone through the more rigorous clinical trial testing required for new products, while 71 percent had used the follow-on process. There had been only 49 major recalls in the prior five years.
Despite slipping onto market through the similarity provision, many of these new products claim to be improvements over their predecessors and thus come with commensurately higher price tags. According to Goozner and his sources, this little disconnect has done quite a bit to increase the cost of health care in America.
“Requiring evidence of benefit of effectiveness for patients before device approval would prevent billions of dollars from being spent on technologies that are not helpful for patients and are even harmful,” said Rita Redberg, editor of the Archives of Internal Medicine and a cardiologist at the University of California, San Francisco. “There are many examples, such as vertebroplasty and kyphoplasty for back pain [compression fractures], on which Medicare spends approximately $1 billion annually. After they were FDA-approved, randomized clinical trials showed they were no more effective than a sham procedure in relieving symptoms.”
The device industry, often cited for its red-hot growth rates in the past, now posts numbers that, while huge, still lag behind the health sector at large. That may be why the industry is stepping up political pressure to reduce its regulatory burden and to sidestep a 2.3 percent excise tax that was passed as part of recent health care reform efforts. For more on the money and politics involved, see Goozner’s full piece, which was also published in The Fiscal Times.
Related
- Medical device investigation unearths conflicts, regulatory issues
- House Committee on Oversight and Government Reform hearing: FDA Medical Device Approval: Is There a Better Way?, June 2, 2011
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