Florida hospitals sidestep state constitution, keep records under wraps
Filed under: Health journalism, Hospitals, Hot Health Headline, Public records
Writing for BrowardBulldog.org, an independent investigative news site serving South Florida, Amber Statler-Matthews reports that hospitals are going to what one man called “extraordinary lengths” to prevent patients from accessing records that, according to the Florida constitution’s “Patient’s Right to Know Act,” should be made available.
Seven years ago, Florida voters overwhelmingly approved a Constitutional amendment that gave patients who had been hospitalized the right to see reports dealing with botched medical procedures and poor care. While the amendment could be used to give patients vital information before a medical mistake is made, its practical and more much publicized purpose was to give aggrieved patients more power in court by opening up malpractice complaints and confidential internal reviews of doctors and hospitals.
In the years since the amendment, the state’s courts have been pressed on both sides, with hospitals dedicating considerable resources to throwing up “roadblocks and legal challenges to block access to patient records,” Statler-Matthews writes. “In response, patients across Florida are using the law to ask judges to pry open reports about medical errors.”
For more on how the battle has evolved and details on how Florida hospitals are circumventing the constitution, see Statler-Matthews’ full piece.
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.
Why are some patients stuck in hospitals for weeks, months?
Yanick Rice Lamb
Patients typically complain about being released from the hospital sooner than they would like. So Yanick Rice Lamb, associate publisher and editorial director of Heart & Soul magazine, became intrigued when when she heard about patients languishing in hospitals weeks and even months after being medically ready for discharge. This can happen to uninsured and underinsured patients who need long-term care.
This could potentially happen to anyone who loses a job and the health coverage that came along with it. Rice Lamb found that delayed discharge was an underreported topic and information was fragmented and spotty, at best.
Find out what she learned from her 10-month look at this narrow slice of the population – the sickest, poorest and most invisible patients. She includes an extensive list of story ideas and angles for other reporters to look into. AHCJ members, read more …
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.
State update and hospital workers’ health
We have two unrelated topics to touch on this week.
First, just a brief reference to a recent Washington Post story that was a pretty good snapshot of the progress – and lack thereof – at the state level toward setting up exchanges. As writer N.C. Aizenman makes clear, the delays are partly because of politics.
What questions do you have about health reform and how to cover it?
Joanne Kenen is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.
Hesitant states may decide to speed up implementation as the 2012 political landscape becomes clearer. The hesitation is partly related to uncertainty about what the courts will do about the mandate (and when.) And it’s partly because it’s tough for even a pro-reform state to set up an exchange.
As we’ve noted before on this blog, HHS has offered a sort of hybrid model for states that may make progress but not be where they need to be. Instead of an all-or-nothing approach (state run or federally run) HHS may manage parts of an exchange, but let states do the rest.
The second item that may translate into a good local health reform story is a new Thomson Reuters Healthcare study (hat tip to Reuters’ Deborah Sherman) that found hospital employees, as Sherman put it, ” spend 10 percent more on healthcare, consume more medical services, and are generally sicker than the rest of the U.S. workforce,” This is sort of the un-health reform – we’re supposed to be moving toward smarter health care utilization and better care coordination and hospitals, one would think, would be ahead of the curve. (That maybe the wrong cliché if we’re supposed to be bending the curve … not just getting out in front of it.) The findings also are a rather surprising contrast to what we’ve been reading about healthy hospital workforces at places like the Cleveland Clinic. The study speculates on several reasons for the high use of resources by hospital workers. Among the possibilities:
- Location, location, location. Hospital workers saw their doctors less often but used the emergency department and the hospital itself more.
- Stressful work environment and irregular hours may add to the chronic disease burden and make it hard to maintain healthy lifestyle habits.
- Higher awareness of illness, leading to more treatment.
Taking care of these worker/patients adds to hospital costs, at a time when they may be squeezed given the economic conditions and the pressures on state and local governments. It would be interesting to check out what’s going on with health care workers in your community. Is utilization high? Is the hospital trying to deal with costs the good old-fashioned way (cost shifting, cutting fees or having workers pay more for their care?) Or are local hospitals trying any of the new ways of delivering more coordinated care and managing chronic diseases in ways that preserve – or improve – quality while holding down costs?
Dallas hospital CEO claims reporters have a vendetta
The chief executive officer of Dallas’ Parkland Hospital claims a “vendetta” held by the Dallas Morning News‘ investigative team is to blame for “chipping away” at the public’s trust in the hospital.
The newspaper used public records to extensively document billing fraud, poor supervision of residents, preferential treatment for VIPs and patient harm. The Centers for Medicare & Medicaid Services inspected the hospital in July and, less than two weeks ago, the hospital responded by posting its plan to correct deficiencies as required by CMS.
The Morning News reported that the hospital delivered the plan “just ahead of a deadline for addressing the problems or losing hundreds of millions of dollars in federal health care funding. If the agency, on reinspection, finds that the patient care deficiencies aren’t corrected, Parkland could lose nearly half its patient revenue.”
The hospital’s board decided yesterday to hire a consultant to “redefine [Dr. Ron] Anderson’s role with the system between now and the end of the year, when his five-year contract expires,” reports Bill Hethcock in the Dallas Business Journal.
Regardless, Anderson says the Morning News‘ coverage is “sincere, but sincerely wrong,” and raises the specter that people in the community will suffer because they won’t come to Parkland to seek care:
“They’ll suffer as much as anything that an investigative reporter thinks he’s doing or she’s doing for the benefit of the patients.”
In January, Maud Beelman, the DMN deputy managing editor who leads the investigative team, wrote about the project for Nieman Watchdog. She detailed some of the struggles they faced to do the project, including efforts to derail the investigation and the backlash from the hospital.
Updated hospital data allows reporters to identify ongoing problems
Filed under: Health data, Hospitals, Public records
The release this month of federal data on hospital quality is a good reminder for reporters to give their local hospitals a checkup.
Now that CMS has been reporting information on mortality and readmissions for several years, it’s possible to use the data to identify hospitals that repeatedly excel and those that have ongoing problems. While some journalists may have a been-there-done-that reaction to yet another round of data, the latest release has important information for your readers, viewers and listeners. After several years, a surprising number of hospitals can’t seem to improve — and an elite group has been able to maintain its excellence.
AHCJ not only offers the data in easy-to-analyze formats; we also offer tip sheets on using spreadsheets to analyze health data. To give you a head start, Charles Ornstein, senior reporter at ProPublica and AHCJ’s president, has done some preliminary analysis and points out states in which hospitals fared well and the states where hospitals did poorly. He also identifies the best and worst in the country based on mortality rates for patients suffering heart attacks, heart failure and pneumonia.
Fla. system forces ventilator patients to stay in hospitals, incur multimillion-dollar bills
Richard Martin of the St. Petersburg Times reports that, because Florida has few nursing homes that can care for patients on ventilators, some patients are forced to stay in hospitals and rack up enormous bills.
Photo by quinn.anya via Flickr
The patients in question have been stabilized to the point where they no longer need hospital care, though they rely on ventilators, but the hospitals can’t discharge them without finding a facility that can take patients on a ventilator.
Martin reports that fewer than two dozen nursing homes, of about 700 in Florida, care for ventilator patients. Other states pay nursing homes more to care for ventilator patients.
So, in a state where uninsured people go without even basic care, millions of dollars go to ventilator care for people who don’t need to be in hospitals — and who might not even want to be there.
Martin says no one knows how many patients need long-term ventilator care, but one hospital administrator estimates his hospital has three or four patients who fall in this category. According to the Florida Hospital Association, there are about 300 hospitals in the state. The article cites cases in which ventilator patients racked up bills of $9.2 million and $1.7 million.
Hospitals often have no way to collect such bills, and have to write them off as charity care, Martin reports.
Health reform comes with new rules for nonprofit hospitals
Filed under: Government, Health care reform, Hospitals
When I first started covering health care, I thought that a nonprofit hospital was one that didn’t make any money. It took longer than I should probably admit to come to understand that nonprofit/nonprofit status isn’t about making money. It’s mostly about paying taxes.
As this excellent recent story by M.B. Pell in The Atlanta Journal- Constitution shows, nonprofits may or may not have a healthy bottom line. They may or may not pay their top executives a lot of money. They may or may not provide really good care.
What questions do you have about health reform and how to cover it?
Joanne Kenen is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.
What they don’t do is pay taxes. Nonprofits are supposed to be mission-driven. In exchange for serving their community, they get the tax exemption.
One little-known element of the health care reform law – which I highlighted in my first tip sheet on the anniversary of the law’s passage – sets new rules for nonprofits. They are required to assess community needs, and inform patients of charity policies. Some lawmakers, notably Sen. Chuck Grassley, an Iowa Republican, want tougher rules and oversight. The goal is to make sure they are providing enough service to the community to justify the tax break.
States, which make their own determination on who is exempt, may follow suit; in fact, Illinois just denied property tax exemptions to three hospitals.
As a report from the Hastings Center said, “A 2007 Internal Revenue Service report stated that about half of nonprofit hospitals spent 3 percent or less of revenues on charity care. Nowadays, hospitals are bringing in large amounts of money, paying their CEOs record amounts of compensation, and engaging in aggressive debt recovery actions.” Many of the hospitals use “sticker” prices to value their charity care, even though that’s not what the hospital gets from most patients.
In Georgia, the hospitals get millions in tax breaks. Nationally, the latest number I saw was $13 billion for federal taxes, and that doesn’t count state and local tax breaks. Pell explains:
Residents pay more in taxes because these hospitals are exempt. In exchange, taxpayer-subsidized hospitals are expected to provide charitable services - “a community benefit.”
But Georgia, like 35 other states, has no specific requirements hospitals must meet to justify these tax breaks.
And an Atlanta Journal-Constitution analysis of hospital data reveals that some not-for-profit hospitals provide less in community benefits - specifically, charity health care for the poor - than the tax-paying, for-profit hospitals they compete with.
It’s not all black and white; the article notes complexities such as a hospital that doesn’t provide much free care - but does heavily subsidize some local community clinics. And Georgia has instituted a “bed” tax on nonprofits and for profits alike to help generate some more money for Medicaid, which has been strapped during the nation’s economic crisis. Overall, it’s a good read and a roadmap for enterprise reporting in other communities. Pell wrote an article about how he did his reporting for AHCJ that spells out a number of tips for reporters.
That tip sheet has further resources, including advice on deciphering hospital financial records from this presentation from The Philadelphia Inquirer’s Karl Stark. If you are interested in the topic and are still daunted by the data, see if you can find a reliable local advocacy group who can help you sort them out, or a health care finance professor in your state who may be able to help you out.
If you Google, you will find stories about highly paid executives at nonprofit hospitals – that’s a good part of the story, and one that readers/listeners/viewers can grasp, but it’s not the whole story. Nancy Kane, a professor at Harvard School of Public Health, (who explained a lot of this to me some years ago) wrote on this topic a lot for a while, but when I did a quick check, most of the work I found was several years old. Here are some current resources to help reporters check into the nonprofit hospitals in their areas:
Related
- Follow the numbers to report on hospital executives’ compensation packages, M.B. Pell
- Hospital CEO pay has some ill at ease: $1 million-plus salaries drawing new scrutiny, The Atlanta Journal-Constitution
- Are hospital CEOs making too much money?, The Atlanta Journal-Constitution
AHCJ tip sheets
- Digging into hospital finances: Recent trends and five key documents
- Reporting on the business of health care
- How to understand a 990
- Changes to 990 forms make hospital finance investigations necessary
- Tools for covering hospitals: Financial documents
- Tools for covering hospitals: Hospital stories to do
- Understanding hospital issues
Related stories
- Charity Care: How Much is Enough?, Wisconsin State Journal
- In Their Debt, The (Baltimore) Sun
Md. hospitals sue patients despite state subsidies: Investigation finds policies for offering charity care to low-income patients vary widely - St. Vincent’s Is the Lehman Brothers of Hospitals, New York Magazine
- Hospitals, Inc.: Rising Costs, Growing Clout, Kaiser Health News
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