HIPAA’s role in transplant story, correction
Filed under: Health journalism, Hospitals, Public records
The Village Voice says things are rather tense at the New York Post after it incorrectly reported on Monday that an alleged killer received a liver transplant at New York-Presbyterian Hospital. Frederik Joelving of Reuters Health reported on Tuesday that the hospital denied the transplant had taken place there.
Cover of Monday's New York Post.
That was followed by a correction in the Post on Wednesday morning. The original story is no longer available on the Post’s site but is available through Google’s cache.
According to the Village Voice, which quotes unnamed sources in the Post newsroom, “Rupert Murdoch was so enthralled with the story when it ran, that he called Post editor-in-chief Col Allan to personally congratulate him on it.” It also says the tip for the story came from Allan.
Because of the Post’s story, the hospital eventually had to deny that Johnny Concepcion, accused of killing his wife, received a transplant there after eating rat poison in a suicide attempt. Hospital comments on whether a patient has been treated are fairly unusual as hospitals try not to run afoul of the privacy rules outlines in the Health Insurance Portability and Accountability Act.
In fact, the Post’s correction says the hospital declined to comment before it published the original story, citing HIPAA, but that “Curiously, the hospital now sees itself free to publicly discuss Concepcion’s case.”
Speaking of HIPAA, The Reporters Committee for Freedom of the Press recently released “FERPA, HIPAA & DPPA: How federal privacy laws affect newsgathering,” a guide to federal privacy protection laws.
The section on HIPAA explains the history of the privacy rules, the Standards for Privacy of Individually Identifiable Health Information, and discusses how it has been misunderstood and misused to keep information from reporters. AHCJ President Charles Ornstein, a senior reporter at ProPublica, is quoted extensively and offers examples of its misapplication. The piece also outlines what the law does allow.
Higher health care costs, lack of safety innovations traced to group purchasing organizations
Filed under: Health policy, Hospitals, Hot Health Headline
The Washington Monthly’s Mariah Blake writes about the ins and outs of group purchasing organizations (GPOs) and their effect on the development of newer, potentially safer, medical equipment. She reports the system has kept potentially lifesaving innovations off the market and may be contributing to the rising costs of health care.
Among the products she cites as having been created but largely kept out of the supply chain as a result of the GPO system are a syringe with a retractable needle, a syringe designed to reduce bloodstream infections and a surgical towel that can be spotted on X-rays to keep towels from being left in the body after surgery. Those products were developed by small suppliers who seem to be squeezed out of the market by the system.
Blake’s combination of narrative about the small suppliers who have been stymied by the system and her investigation into how GPOs became such a game changer will be of great interest to anyone who writes about health care costs and innovations in patient safety.
Blake explains the evolution of GPOs, “a system built on a seemingly minor provision in Medicare law that few people even know about.”
It’s a system that has stifled innovation and kept lifesaving medical devices off the market. And while it’s supposed to curb prices, it may actually be driving up the cost of medical supplies, the second largest expenditure for our nation’s hospitals and clinics and a major contributor to the ballooning cost of health care, which consumes nearly a fifth of our gross domestic product.
Through a series of court cases, one of which granted GPOs protection from antitrust actions, and their subsequent consolidation, GPOs revenues became “tied to the profits of the suppliers they were supposed to be pressing for lower prices.”
A former GPO employee explains, “But GPOs make their money by charging vendors fees. And if you get a percentage of sales, going with a lower bid from a little company just loses you money and pisses off the big vendors with multiple contracts.”
Blake reports that most small suppliers are wary of speaking out about GPOs. “Several talked to me off the record. At least a half dozen more agreed to speak, only to back out at the last minute or retract their statements after we had spoken.”
Blake points out that this incentive system has an effect on health care costs. GPOs contend that they keep costs down by pooling hospitals’ buying power, but Blake reports one company has kept data on hospital purchases and found that “bids hospitals got through their GPO contracts were substantially higher” than what could be had by negotiating directly with vendors for the same equipment.
More about GPOs
- Modern Healthcare surveys GPOs annually and a list of about 11 of them and their addresses is available.
- The Health Industry Group Purchasing Association represents 16 GPOs.
How NASA came to work with a children’s hospital
Brian Ahier, writing for Government Health IT, tells the story of how NASA’s Jet Propulsion Laboratories ended up collaborating with Childrens Hospital Los Angeles on a seven-year project focusing on the detection of pediatric cancer through a “a collaborative approach to the discovery and development of early detection biomarkers.” It sounds like a goofy match but, when Ahier breaks it down, it’s easier to see how and why these strange bedfellows ended up together.
Photo by nasa1fan/MSFC via Flickr1. JPL presents a paper on a software framework used for planetary science that functions as ” a kind of search engine that allows scientists working with data in one expression or format to find and compare their data with another.”
2. National Cancer Institute representatives involved with the Early Detection Research Network see the presentation, understand the framework’s potential and hire JPL to consult.
3. The project evolves and CHLA’s Virtual Pediatric Intenstive Care Unit joins the effort to “build a distributed data-sharing network to drive the next generation of clinical decision support for pediatric cancer treatment and research.”
Here’s Ahier’s explanation of why the NASA system makes a difference for the hospital:
The VPICU connects emergency rooms, community hospitals and intensive care units worldwide in a virtual network, extending consultations to even the most remote areas. Using (the JPL technology), clinicians can access data from a network of pediatric hospitals to build an evidence-based foundation for research into childhood cancers.
“The variability in patients in a pediatric ICU is enormous with regards to age, weight and other factors,” says David Kale, a research engineer in the VPICU. “So the question is can we build clinical decision support tools that will help clinicians by augmenting their experience by providing data.”
Analysis of billing record data reveals hospital quality issues in Las Vegas
Using data from hospital billing records, Marshall Allen and Alex Richards of the Las Vegas Sun have been able to identify “hospital-acquired patient harm,” that is, events in which patients are harmed while in the hospital.
Medicare does not pay for these “never events” and so they are reflected in hospital billing codes. Such events include things like leaving foreign objects in a patient, bed sores, falls, infections related to catheters or surgical sites, blood clots and poor glycemic control.
Nevada – and 40 other states – collect such data for analysis, Allen and Richards report. In Nevada, the state had not yet analyzed the data so the reporters requested it and did the analysis.
The pair requested and received records for “every Nevada hospital inpatient visit going back a decade — 2.9 million in all. The information, coupled with interviews with more than 150 patients and health care insiders, has yielded a sweeping and detailed portrait of hospital care in Las Vegas.”
The project includes stories about patients who were harmed while hospitalized, the documents behind the reporting, data tables, interactive graphics and more.
Lundberg’s list of why health care costs are rising
While people on the streets, experts and legislators debate the causes of rising health care costs, George Lundberg, M.D., editor-at-large of MedPage Today, does no such hand wringing.
He declares that a survey of the topic that was posted by his publication missed the point and did not provide the correct answers.
Lundberg, who edited the Journal of the American Medical Association for 17 years and is a member of the Institute of Medicine, lists what he sees as the “Primary Drivers of Rising Healthcare Costs.”
Physician-owned hospitals: Restricting us is unconstitutional!
Filed under: Health policy, Hospitals, Hot Health Headline
The National Law Journal’s Tresa Baldas has the details of a suit filed by physician-owned hospital advocacy and ownership groups against the Department of Health and Human Services. The suit alleges that reform-bill restrictions upon the expansion and creation of physician-owned hospitals that aren’t Medicare certified is unconstitutional.
Baldas writes that there are currently about 265 physician-owned hospitals in the country, with more than a hundred more in various stages of development, including about 29 set to open before the rule will take effect at the end of the year.
The law “has singled out hospitals owned by physicians in the United States for retroactive regulation and restriction, for arbitrary and irrational reasons,” the lawsuit contends.
“For non-legitimate reasons, Congress awarded competitive advantages to one class of hospital owners — non-doctors — in order to disadvantage and eventually destroy physician- owned hospitals as an economic model,” the plaintiffs asserted in their complaint. “Congress garnered support for its proposals from the large-hospital associations by promising to limit the ability of new and existing physician-owned hospitals that compete with non-physician-owned hospitals.”
According to Tim Eaton of the Austin American-Statesman, “the health insurance law was written in part to limit doctor ownership of hospitals, an arrangement that critics say can lead to conflicts of interest and the siphoning of paying and insured patients, which leaves traditional hospitals to shoulder the burden of indigent care.”
Blame aggressive treatment, tech for rising costs
Wholesome, clean-living and thrifty, Provo, Utah, has always been a Dartmouth Atlas darling. But in recent years, health costs in Provo – like those in similarly cheap markets nationwide – have risen faster than in the rest of the country. Kaiser Health News’ Jordan Rau takes a deeper look at the Utah college town in an effort to figure out why, despite recent efforts to bring everybody else down to Provo’s cost level, Provo seems to instead be climbing up to join its costlier cousins.
Provo, Utah (Photo by jpstanley via Flickr)
In Provo, the costs seem to come down to a few interlocking factors which should already be familiar to anyone who has investigated health care costs in the past. They include advancing technology and more aggressive treatment, all driven by an increase in the number of hospitals and clinics competing in the area. It’s a combination that’s looking increasing irresistible.
To some, it’s inevitable low cost areas such as Provo will catch up to their more expensive peers as a greater proportion of medical spending goes toward expensive machines and nursing salaries, which are rising, says Greg Poulson, senior vice president at Intermountain. Aggressive marketing of the latest technology also is making it more likely that patients everywhere are demanding the same novel treatments, even ones that aren’t proven to work better, Poulson says.
WSJ: Small hospitals get little benefit from device
In The Wall Street Journal, John Carreyrou uses the problems of a small New Hampshire hospital to illustrate how difficult it is for small hospitals to attain the cost and safety savings promised by the DaVinci surgical device’s manufacturers, a fact which has not deterred 131 of them from shelling out at least $1 million (plus maintenance and replacement fees) to own one.
“There’s a medical arms race,” says Paul Levy, chief executive of Beth Israel Deaconess Medical Center in Boston. “Technologies are being adopted and becoming widespread based on the marketing prowess of equipment makers and suppliers, not necessarily on the public good.”
Smaller hospitals, which Carreyrou defines as those with fewer than 200 beds, simply don’t have the volume to gain the DaVinci cost efficiencies promised by manufacturer Intuitive Surgical.
One study published in the Journal of Urology found that a hospital needs to do at least 520 surgeries a year with the robot to bring its costs in line with traditional surgery. That’s seven times the number of robotic surgeries Wentworth-Douglass has been averaging.
And while it’s unfortunate that they don’t even use the device enough to save money, it’s far worse that they also don’t use it often enough to master its steep learning curve. Surgeons at the New Hampshire hospital got two days of training and began operating unassisted after four cases.
Jim Hu, a surgeon at Brigham and Women’s Hospital in Boston who has done more than 1,000 surgeries with the robot, says it takes a urologist anywhere from 250 to 700 cases to master it. Dr. Hu considers the da Vinci a clear benefit for experienced surgeons, saying, “You can do a better job.” But he cautions it can do more harm than good when used without adequate training.
In New Hampshire, the hospital’s four urologists were pressured to use the device, but resisted because they felt more training was needed, Carreyrou writes. Three of them eventually left the hospital.
Reporter covers patient ‘dumping’ from inside
Filed under: Health journalism, Hospitals, Hot Health Headline
The Philadelphia Inquirer’s Michael Vitez has been given free reign for several months now to explore and report on Abington Memorial Hospital as an embedded reporter.
The result has been a mix of deep, wonderfully chosen anecdotes accompanied by quotes and hospital introspection that go far beyond what you often see in “look what went wrong at the local hospital!” stories.
His latest installment explores the effect of patient “dumping” on hospitals through the story of an 83-year-old illegal immigrant from Korea whose family dropped her off at Abington out of desperation and had no intention of picking her up on her discharge date. Vitez’ report is distinguished by his honest, thoughtful approach to both patient and caregiver.
In previous dispatches, he has chronicled how Abington is working to prevent with hospital-acquired infections and, as Covering Health has covered previously, palliative care.
Nurses face dangers of workplace violence
Marlene A. Prost, writing for Human Resource Executive Online, reports that workplace violence is a growing problem for nurses.
She cites reports from Australia and the United States showing that about half of nurses in two surveys had been punched or otherwise assaulted in the past year. It appears the assaults are coming from patients and their families and friends.
However, Prost reports, nursing and hospital associations are taking notice and action, such as “improving security, encouraging incident reports and fighting to strengthen state laws to prevent violence and punish offenders.”
Hospitals are using guidelines from The Joint Commission, the Occupational Safety and Health Administration and the National Institute for Occupational Safety and Health to make nurses safer. They also are training nurses to defuse volatile situations and encouraging them to report incidents, according to the article.
Reporters may be able to find more information through the Bureau of Labor Statistics and the American Nurses Association also has information about workplace violence. The Joint Commission issued a Sentinel Event Alert in 2008 about intimidating and disruptive behaviors in the health care environment.
-
Spend a week at the CDC studying public health, meeting sources. Apply for the AHCJ-CDC Health Journalism Fellowships today!
- Reporting on the intersection of health, environment
- Tip sheet: Covering cuts to Medicare reimbursements
- Briefing: Reporting on health reform between now and 2014
- Covering high-risk insurance pools: Tips for reporters
- Health care reform has passed: What's next?
- Health and education: Covering these intersecting beats
- Reporting on the business of health care
- Health reporting resources for journalists on state and local government beats
