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
HHS unveils ‘National Prevention Strategy’
Today, in a live webinar and a companion piece in the New England Journal of Medicine, the Department of Health and Human Services released its “National Prevention Strategy,” a broad effort to realize the preventive care goals set forth in the Affordable Care Act. The specifics of implementation are still taking shape, but the release centered around four primary talking points:
- The ACA seeks to “remove cost as a barrier” to “clinical preventive services,” by requiring new private plans to cover preventive services in the “strongly recommended” and “recommended” categories (examples include certain vaccines and screening procedures) with no cost to the beneficiary. Medicare will take a similar approach, and state Medicaid plans will be incentivized to do the same.
- It promotes workplace wellness initiatives through new grants and a re-evaluation of existing programs.
- It seeks to involve communities and local governments through community-based efforts. “Community Transformation Grants,” for example, “promise to improve nutrition, increase physical activity, promote smoking cessation and social and emotional wellness, and prioritize strategies to reduce health care disparities.”
- It makes preventative health a federal priority through “a newly established National Prevention, Health Promotion, and Public Health Council, involving more than a dozen federal agencies,” which “will develop a prevention and health promotion strategy for the country.” It also promises a “national strategy to improve the quality of health care,” and “improved data collection on health disparities.”
In addition to the four big messages, HHS officials pointed to initiatives designed to address specific, salient concerns such as smoking, obesity and the looming shortage of primary caregivers.
House calls on the rise as their economic benefits become clear
Filed under: Aging, Health policy, Hospitals, Public health
In The Miami Herald, Ana Veciana-Suarez looks into why doctor house calls are on the rise, especially among the Medicare set. Through her reporting, it becomes apparent that it’s primarily a function of economics, all driven by the fact that, while a house call may appear expensive when compared to a typical primary care visit, in many cases the real alternative to a house call and some preventative medicine is an emergency room visit and/or an overnight hospitalization, both of which are in another cost bracket entirely.
Veciana-Suarez writes that while the latest home care boom may have started with the growth of concierge medicine, especially in South Florida, it’s now being driven by the big guns — Medicare and major insurers.
House calls, once thought to be too time-consuming and not very cost-effective, are making a comeback as healthcare providers recognize that they’re actually the answer to good care for patients who can’t make it to a doctor’s office. Medicare-paid house calls have been steadily increasing, according to government figures, and doctors report the same for non-Medicare patients, according to the American Academy for Home Care Physicians. What’s more, technology has made accessibility to patients’ records and other medical information available at any time and any place, a boon to physicians on the go.
Now a three-year federal government pilot program called Independence at Home is encouraging doctors to pick up those black medical bags of yore and pay a visit to their sickest patients. As part of the new healthcare reform law, the demonstration project will cover 10,000 Medicare patients described as medically fragile. It is set to begin in January in locations yet to be decided.
The main targets for both the government and private insurance programs are the so-called “frequent fliers,” and others with chronic conditions that need to be managed to prevent repeat visits to the emergency room. To that end, some programs also include social workers and home health educators. Most programs are still in the experimental phase, but Veciana-Suarez paints a clear picture of a sector that’s poised to assume a growing role in the coming decade.
Covering Health Issues 6.0, coming soon to a mailbox near you*
Filed under: Health care reform, Health journalism, Member news, Tools
*Assuming you’re an AHCJ member. If you aren’t a member, then keep in mind that a free copy of each revision of the sourcebook is one of many perks you’ll gain by joining.
Thanks to a grant from the Robert Wood Johnson Foundation, the Alliance for Health Reform has released the sixth edition of its “Covering Health Issues” sourcebook. Since the fifth edition, released in 2009, editors have added loads of new content, particularly in areas related to the 2010 Affordable Care Act. The free online edition also comes with links to local stories that exemplify sourcebook-inspired reporting. If you can’t wait for your hard copy to arrive, you can also get the full book in PDF format.
As always, the book promises “fast facts, background, tips for reporters, story ideas and experts with contact information,” as well as “an extensive glossary, ideas and examples for TV and radio reporters, and links to polls on health issues.”
For tips on how to take advantage of this resource, scope out this video, presented by AHCJ member and NPR health reporter Julie Rovner.
Skyrocketing drug price is chance to examine manufacturing, FDA approval process
St. Louis Post-Dispatch reporter (and Midwest Health Journalism Program Fellow) Jim Doyle has put together a series of stories on KV Pharmaceuticals that read like a primer on the confounding economics of drug manufacture and FDA approval. In the stories, especially the first and last installments, Doyle presents the big picture and helps readers understand why the systems work they way they do.
The first story shows how FDA approval could end up sending the price of a prenatal drug skyrocketing 16-fold and earn piles of money for a local pharmaceutical company. The second involves a U.S. District judge condemning a former head of that same company for “greed, abuse of power, recklessness.” Finally, he ends his tour of pharmaceutical avarice with a stern warning about the potential longterm costs, both monetary and medical, that could result from the fast-track approval of the drug whose approval formed the basis of the first story. For lots more about KV Pharmaceuticals, be sure to check the “Related Reading” box on this page.
Further reading
If you’re looking for more on KV Pharmaceuticals and the Orphan Drug Act, check out Ed Silverman’s post on Pharmalot. There, he interviews a nonprofit advocate who helps explain how KV’s manipulations were possible, how it could happen again and how the act should be modified.
Fact-checking Pawlenty’s health reform claims
In some parts of the country, health care-related posturing for the 2012 election is already in full swing. Over at CJR.org, AHCJ Immediate Past President Trudy Lieberman applauds a forceful bit of health care reform fact-checking by Minnesota Public Radio reporter Lorna Benson. In her piece, Benson carefully picks apart claims made by former Minnesota Governor Tim Pawlenty as he touts his health reform record as a key piece of his 2012 presidential campaign.
Pawlenty’s two big health talking points are his “baskets of care,” or bundled payments for certain procedures, and his pay-for-performance plan. While both sound promising on paper, Benson found that some gaping holes had opened up as soon as the rubber met the road. See Benson’s full piece for the details of how any real change has been difficult to track or, indeed, even to detect at all.
NEHI maps out future of comparative effectiveness
Filed under: Government, Health care reform, Health policy, Studies, Tools
NEHI, a nonprofit research group that was known as the New England Heathcare Institute, has released a white paper mapping out a potential near future for comparative effectiveness research in the United States. We first noticed the report on the Kaiser Family Foundation’s Health Reform Source site.
The white paper’s authors, Tom Hubbard, Shin Daimyo and Karan Desai, make a strong case that proper dissemination will be the real key to the success of CER. Their argument hinges on the observation that, even today, good medical research rarely makes it into clinical practice without a hefty nudge. 
When it comes to delivering this nudge to all that stimulus-funded comparative effectiveness research, the paper’s authors have singled out the newly created Patient-Centered Outcomes Research Institute. PCORI’s stated role is to help all stakeholders make informed health care decisions. It’s also, the authors write, uniquely positioned to become a key force in CER dissemination alongside the AHRQ’s Office of Communications and Knowledge Transfer. Unlike AHRQ, PCORI is an independent organization that’s free to form relationships and build consensus across the spectrum.
All in all, the report’s a quick and handy read. There are only 9 pages of text, and you’ll come out with a better understanding of the practical problems facing those who seek to apply comparative effectiveness research. If you’re looking for examples of successful implementation programs, head to pages 8 through 10.
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