ProPublica investigates ties between doc groups, industry
Filed under: Conflicts of interest, Health data, Hot Health Headline, Pharmaceuticals
With an assist from Sen. Chuck Grassley, ProPublica senior reporters Tracy Weber and Charles Ornstein, AHCJ’s board president, have published their latest data-heavy investigation (USA Today version). This time, their journey into the myriad avenues pharmaceutical companies pursue to influence physicians has taken them into the world of professional societies and annual conferences. The duo writes that despite the power of these groups, their dependence upon millions and millions of dollars in industry funding has often slipped under the radar.
Professional groups … are a logical target for the makers of drugs and medical devices. They set national guidelines for patient treatments, lobby Congress about Medicare reimbursement issues, research funding and disease awareness, and are important sources of treatment information for the public.
Their strongest anecdote comes from the Heart Rhythm Society, a group which, in 2010, pulled in about $8 million – half their total income – directly from manufacturers of the drugs and devices their members specialize in prescribing for, or implanting in, patients. The society has started to disclose these relationships, but perhaps not to limit them, the reporters write. “’This is our business,’ said Dr. Bruce Wilkoff, the incoming society president. ‘We either get out of the business or we manage these relationships. That’s what we’ve chosen to do.’”
The companies also pay two-thirds of the society’s board members speaking or consulting fees, a situation Weber and Ornstein found is far from unusual. In addition to these financial conflicts, the reporters gathered some fascinating examples of just how deep industry influence can run. My personal favorite comes from the conference of a well-known collection of cardiologists.
Last month, the American College of Cardiology attached tracking devices to doctors’ conference ID badges. Many physicians were unaware that exhibitors had paid to receive real-time data about who visited their booths, including names, job titles and how much time they spent.
For more examples, I recommend Robert Durrell’s photographs from the 2011 Heart Rhythm Society annual conference, which show dozens of industry-sponsored objects alongside the amount of money each company paid for that particular privilege. Dan Nguyen and Nicolas Rapp put together an infographic that expands upon a similar theme.
Much of the disclosure data the ProPublica team depended on for their reports was released in response to a request for informationGrassley sent out in late 2009. His investigation has started to yield some preliminary results.
There are fledgling efforts to push medical societies toward stricter limits on industry funding: 34 groups have signed a voluntary code of conduct calling for public disclosure of funding and limits on how many people on guideline-writing panels have industry ties.
“The general feeling is that the societies need to be independent of the influence of companies,” said Dr. Norman B. Kahn Jr., chief executive of the Council of Medical Specialty Societies, which helped draft the code.
Spreadsheet lists malpractice claims against VA
In its “FOIA Friday” feature, the Project On Government Oversight reveals a spreadsheet (XLS format) of claims against the Department of Veterans Affairs, including thousands related to medical malpractice.
The spreadsheet lists administrative claims, the first step in the VA’s process for filing claims.
Nick Schwellenbach explains more about the data:
The data provided has details on over 12,000 claims against the VA from 1989 to November 2008, although the data appears largely incomplete for the first several years. Not all of the claims are medical malpractice-related, but several thousand are. There are fields for the VA facility involved, the date the claim was received, the date of the last tort status (where the claim is in the administrative process), the date of that status, alleged negligence descriptions (none exist for non-medical malpractice tort cases), and amount paid out, if any. The spreadsheet is over two years old, so the latest tort status field may be out-of-date for many of these claims.
The spreadsheet includes 16 cases in which more than $1 million was paid out. The descriptions of the allegations are pretty vague but those 16 cases include:
- Failure To Obtain Consent or /Lack Of Informed Consent; Improper Technique; Improper Performance; Improper Management; Delay In Diagnosis; Failure To Treat; Failure To Order Appropriate Medication; Failure To Monitor; Failure To Diagnose (i.e., Concluding That Patient Has No Disease or Condit[ion)]
- Failure To Respond To Patient
- Surgical or Other Foreign Body Retained
- Unnecessary Procedure; Intubation Problem; Improperly Performed Test; Improper Management
It’s worth noting that another recent “FOIA Friday” also was related to health. It was a letter sent by the National Institutes of Health to Emory University “after the media exposed Dr. Zachary Stowe’s cozy financial relationship with GlaxoSmithKline (GSK) while also receiving NIH grants to study antidepressants like GSK’s Paxil in pregnant women.”
Berwick debuts website featuring health data
Filed under: Government, Health care reform, Health data, Health journalism, Health policy, Member news, Public health, Studies, Tools
By Susan Jaffe, Independent Journalist
From Health Journalism 2011
Journalists have a key role to play making health care safer and informing the public, Medicare chief Donald Berwick told reporters attending the annual conference of the Association of Health Care Journalists in Philadelphia on Thursday.
Donald Berwick
To help them do their job, Berwick unveiled a government website, the “Health Indicators Warehouse,” and offered a live demonstration. He said the site offers “a treasure trove of data,” including information never released before in an easily accessible form, including patient safety data, preventive health care indicators, Medicare payment claims and hospital performance at the state and hospital referral region level. Information is searchable by topic, location, health outcomes among other factors.
After highlighting well-publicized features of the Affordable Care Act, Berwick explained how the law provides tools to reduce health care costs that can also improve the quality of care.
“The best way to make care more affordable and sustainable is to make care better,” he said. “Higher quality and lower cost go together.”
To reduce health care costs, he promised continued scrutiny of Medicare Advantage plans, the government-subsidized private health plans, noting that the health law rewards top-performing plans with bonus payments. The law creates accountable care organizations, in which health care providers coordinate patient care in various medical settings. The new Center for Medicare and Medicaid Innovation “can now nurture invention around the country… that have the effect of lowering cost and raising quality.”
Berwick criticized a Republican proposal to use state block grants to replace Medicaid, the state-federal partnership that provides health insurance to low-income families.
“They are untested, they are hazardous,” he said, and could short change states during an emergency. “What happens if we issue a block grant to a state and then there’s a flu outbreak or the recession comes back? Well, you’re on your own.”
During the question and answer period, reporter Jodie Jackson of the Columbia (Mo.) Daily Tribune, had a query related to his reporting that showed a lack of communication about inspection findings between CMS, the FDA and The Joint Commission. After hearing about Jackson’s findings, Berwick said he wanted to read that series of articles.
Berwick spoke for about 90 minutes, without a prepared text, and chatted with individual reporters for another half-hour. It was his second appearance at an AHCJ conference; in 2005, he was key-note speaker when he headed the Institute for Healthcare Improvement, a nonprofit organization dedicated to improving patient care and safety. Unlike his first visit, Berwick did not stay and join AHCJ members in watching a basketball game.
Scenes from day one of the conference
The first day of Health Journalism 2011 included workshops on mapping and charting health data, criteria to help reporters accurately report on medical research and tools to add multimedia elements to health stories.
CMS releases hospital-by-hospital data on never events
Filed under: Health data, Health journalism, Hot Health Headline, Public records, Studies, Tools
About nine months after its original due date, the Centers for Medicare and Medicaid Services have overcome industry opposition and made data for hospital acquired conditions publicly available online. The data come in a 1.2 MB zip file, inside of which you’ll find a hulking 26,889-line spreadsheet.
The sheet breaks down the nation’s 4,700 or so hospitals, using Medicare fee-for-service claims from October 2008 through June 2010, based on the rates of eight different “never events,” each of which is compared with the national rate for the event in question. The hospitals can be sorted by name and state. Below, I’ve illustrated the national rates for all included HACs.
According to MedPage Today’s Emily Walker, CMS published the data to help patients make informed decisions and to help hospitals improve their quality of care. They did so, she points out, over strenuous industry objections.
The data was originally scheduled to be published in September 2010 but was met with strong resistance from hospital groups such as the American Hospital Association (AHA); the groups say that CMS never made specifics available for how it calculates the HAC rates, making “fundamental assessments of the accuracy of capturing the incidence of these conditions” impossible to conduct.
“Hospitals continue to urge CMS not to publish these data,” read a March 31 joint statement from the AHA, the Federation of American Hospitals and the Association of American Medical Colleges.
International cooperative to share health data
Filed under: Europe, Health data, Health policy, Hot Health Headline, Public health, Public records, Tools
Writing that “the importance of data sharing in advancing health is becoming increasingly widely recognised,” 17 major public health players entities, from the CDC and AHRQ to the Bill and Melinda Gates foundation and the World Bank, have banded together to form a sort of data cooperative around the Wellcome Trust and the Hewlett foundation. In a Lancet commentary announcing the initiative, Wellcome director Mark Walport and Hewlett president Paul Brest write that, while fields such as genetics and molecular biology, a mature data-sharing system has sped up discoveries and increased efficiency, public health is lagging behind.
Much of the infrastructures, technical standards, and incentives that are needed to support data sharing are lacking, and these data can hold particular sensitivities. And some researchers are reluctant to share data. Too often, data are treated as the private property of investigators who aim to maximise their publication record at the expense of the widest possible use of the data. This situation threatens to limit both the progress of this research and its application for public health benefit.
Each organization will work within its own structure and their initial goals include the creation of data standards to facilitate sharing as well as increasing the prestige of creating public data sets. They acknowledge there will be some bumps along the way, but call on other organizations to join the initiative and to pursue the long-term goal of the widespread, fair and privacy-respecting sharing of public health data.
New EHR error-reporting system to keep data confidential
Filed under: Government, Health care reform, Health data, Health journalism
EHRevent.org, a service that will allow health workers to report and track errors associated with electronic health records, has launched with broad support and no small amount of fanfare. In cooperation with the federal government, the new system will be run by the iHealth Alliance and the PDR network. The iHealth Alliance already runs the Health Care Notification Network, while the PDR Network, perhaps best known for their Physicians Desk Reference, already distributes FDA warnings and drug labeling information.
It shows promise, of course, but that promise comes with one hefty caveat for health journalists: The resulting data will be kept under wraps. Wall Street Journal health blogger Katherine Hobson has the details:
The aggregated data will be available to medical societies, liability carriers and agencies such as the FDA, but will remain confidential — and won’t be subject to legal discovery. (The mechanism for this type of information sharing is the patient safety organization, federally sanctioned groups formed by providers, nonprofit groups and other interested parties to analyze data about medical errors. Groups can get aggregated data if they agree to keep it out of the public domain.)
State-by-state data, the plug-n-play version
We write about state-by-state federal health statistics a lot here, but acknowledge that they can sometimes require basic spreadsheet and database skills, not to mention an understanding of statistics.
That’s where the National Center for Health Statistics Stats of the States pages comes in. It has piles of neatly packaged and ranked PDFs on things like “Kidney Disease Mortality by State” and “Percentage of Births Born Preterm by State,” and it even tidies it all up further by giving each state its own fact sheet full of ranks and numbers.
This is a site for the curious, as well as for folks who just need quick, clean numbers. Data-savvy reporters will already have their own ways of accessing all of this basic information, and would probably rather not deal with the PDF-entrapped numbers anyway. But, for what it is, it does the job nicely.
Related AHCJ tip sheets
Using the Census for health reporting
Finding patterns and trends in health data: Pivot tables in spreadsheets
Looking at Health Indicators by Zip Code
Understanding risk, and why 83% is really 10.5%
Physician and blogger Alex Lickerman used a discussion he had regarding hormone replacement therapy and breast cancer as an opportunity to explain absolute versus relative risk. It’s a an issue we’ve tackled in Covering Health before (Thanks, Ivan), but the difference between an 83 percent jump in relative risk and a 10.5 percent increase in absolute risk is so fundamental that we’re happy to spotlight Lickerman’s particularly newsworthy example.
In case you don’t have time for Lickerman’s entire tale, here’s one of his smaller examples. It’s a blunter version of the same overall point.
Studies show in patients who’ve had a heart attack that taking one aspirin a day reduces their relative risk of having a heart attack over nearly a 10-year period by almost 50%. In patients over the age of 80, for example, whose absolute risk of having a heart attack can be as high as 12% in just the first six months following their first heart attack, this amounts to a recalculated absolute risk of 6%. Arguably still significant, but not nearly as much as the 50% relative risk reduction commonly bandied about in medical circles.
Related
For more on relative and absolute risk, as well as other statistical concepts that are important in health journalism, be sure to download AHCJ’s latest slim guide, “Covering Medical Research.”
The guide helps journalists analyze and write about health and medical research studies. It offers advice on recognizing and reporting the problems, limitations and backstory of a study, as well as publication biases in medical journals. It includes 10 questions you should answer to produce a meaningful and appropriately skeptical report. This guide, supported by the Robert Wood Johnson Foundation, will be a road map to help you do a better job of explaining research results for your audience.
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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