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
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
Series reveals gaps in communication of hospital inspection results
Filed under: Government, Hospitals, Hot Health Headline
Jodie Jackson Jr. of the Columbia (Mo.) Daily Tribune took an in-depth look at patient safety at University Hospital, part of the University of Missouri Health Care system.
Jackson found that inspections, by CMS and the FDA, have repeatedly turned up systemic practices that compromised patient safety. At the same time, the Joint Commission awarded the hospital a full accreditation, raising questions about why the agencies don’t share information.
In a blog post, Jackson, a Midwest Health Journalism Program Fellow, says he has “examined some 700 pages of documents and have had national infection control leaders examine the reports that formed the basis for the series.”
- Patients in Peril?
- Hospital infections seen as ‘winnable battle’
- Inspection reports, hospital at odds
- Wash your hands
- ‘Superbug’ spurs patient’s activism
- Years after surgery, struggle continues
Navigators work to keep patients from falling through cracks
Filed under: Hot Health Headline, Nursing, Public health
Patient navigators - “like the air traffic controllers in health care” - captured the attention of Pamela Fayerman of the Vancouver Sun.
Fayerman explains that patient navigators are specially trained health care providers who help patients get access to care and services they need, serve as liaisons between patients and doctors and generally ensure patients don’t fall through the cracks of a complex health care system.
Fayerman’s five-day, multiplatform series on patient navigators was published last week and is a comprehensive look at this relatively new practice being applied to Canadian patients. She explores the roots of patient navigation in Harlem and goes on to document the evolution in Canada over the past decade.
In a story about one patient, Fayerman shows how the role of a navigator in getting efficient treatment, follow up and having a point of contact got the patient into the hospital for triple bypass surgery before she had a heart attack and sustained damage to her heart.
Other stories look at how navigators bring a culturally sensitive approach to treating members of the aboriginal community, as well as the unwillingness of Canadians to pay out of pocket for navigators, but:
In the U.S., where people are used to paying for health care, navigators are becoming more and more common - in both insured and non-insured settings and at for-profit and non-profit hospitals.
Fayerman, who used a $20,000 grant from the Canadian Institutes of Health Research, visited five provinces and 12 cities over eight months, interviewing nurse and other navigators, their patients and health system leaders. She explains why the series is important and how patients can be their own navigators.
Alarm fatigue hurts patient care, overwhelms nurses
Filed under: Health data, Hospitals, Hot Health Headline, Nursing
In the wake of several high-profile incidents, The Boston Globe’s Liz Kowalczyk has assembled a thorough investigation of alarm fatigue in hospitals. Alarm fatigue, for the record, is the idea that the huge arsenal of patient monitors in any given hospital floor are going off so often that nurses become slower in their responses to the alarms. For example, in one 15-bed unit at Johns Hopkins, staff found that, on average, one critical alarm went off every 90 seconds throughout the day.
With the help of ECRI, Kowalczyk has managed to attach some numbers to the issue.
The Globe enlisted the ECRI Institute, a nonprofit health care research and consulting organization based in Pennsylvania, to help it analyze the Food and Drug Administration’s database of adverse events involving medical devices. The institute listed monitor alarms as the number-one health technology hazard for 2009. Its review found 216 deaths nationwide from 2005 to the middle of 2010 in which problems with monitor alarms occurred.
But ECRI, based on its work with hospitals, believes that the health care industry underreports these cases and that the number of deaths is far higher. It found 13 more cases in its own database, which it compiles from incident investigations on behalf of hospital clients and from its own voluntary reporting system.
Kowalczyk also looks at potential solutions to the problem and how some institutions are trying to make changes to eliminate alarm fatigue, including cutting back on unnecessary monitors and having monitor warnings appear on nurses’ pagers or cell phones.
To back up the numbers, Kowalcyzk got some telling quotes from frustrated nurses.
“Yes, this is real, and, yes, it’s getting worse,’’ said Carol Conley, chief nursing officer for Southcoast Health System, which includes Tobey Hospital. “We want to keep our patients safe and take advantage of all the technology. The unintended consequence is that we have a very over-stimulated environment.’’
“Everyone who walks in the door gets a monitor,’’ said Lisa Sawtelle, a nurse at Boston Medical Center. “We have 17 [types of] alarms that can go off at any time. They all have different pitches and different sounds. You hear alarms all the time. It becomes . . . background.’’
Kowalcyzk’s investigation points out that, while alarms do tend to go off when there’s a real problem, it appears that they do so at the expense of also going off when there isn’t.
Monitors can be so sensitive that alarms go off when patients sit up, turn over, or cough. Some studies have found more than 85 percent of alarms are false, meaning that the patient is not in any danger. Over time this can make nurses less and less likely to respond urgently to the sound.
For more specifics on device design issues, see the final subheading, titled “Looking for solutions.”
For a one year, the Joint Commission made routine alarm testing and training part of their accreditation requirements, but dropped the stipulation in 2004 when it felt the problem had been solved.
Other parts of the series:
- Graphic: Hospital Alarms
- Ask a nurse how they deal with all the noise in hospitals
- Video: Watch an FDA Patient Safety News video on alarms
- ECRI Institute’s 2011 Top 10 Health Technology Hazards
Las Vegas Sun’s Allen a finalist for Goldsmith Prize
AHCJ member Marshall Allen, with Alex Richards, is a finalist for the 2011 Goldsmith Prize for Investigative Reporting for their two-year investigation into preventable infections and injuries in Las Vegas hospitals.
Marshall Allen
The Las Vegas Sun reporters reviewed 2.9 million records for the reporting of “Do No Harm: Hospital Care in Las Vegas.”
Allen recently wrote an article for AHCJ members about making some of those inspection reports available for readers to see, using DocumentCloud. The technology allows readers to see the breadth of inspectors’ findings, including those that may not grab headlines but are just as important to the public.
Allen reports on health care for the Las Vegas Sun. As a member of the inaugural class of AHCJ Media Fellowships on Health Performance, he is exploring whether transparency about hospital quality improves the quality of care for patients. He has won Awards for Excellence in Health Care Journalism for his body of work in 2007, in the limited report and medium newspaper categories in 2008 and for his body of work in 2009. He was a member of the 2009 AHCJ-CDC Health Journalism Fellowship Program.
ER scribes handle EMRs, free up doctors
St. Louis Post-Dispatch reporter Michele Munz has found that some emergency rooms are easing the transition to electronic medical records by hiring “scribes” to enter information into the system, thus freeing up the doctor to focus on the actual patient.
Photo by MC4 Army via Flickr
Munz reports that scribes are often young, well-trained, tech-savvy pre-med types who get $8 to $10 an hour and plenty of real-world clinical observation for their trouble. The use of one California-based company’s scribes has grown sevenfold in the past two years, expansion its CEO called “exponential.”
Munz’ story shows that the growth is driven by the desire to ameliorate productivity hits that many hospitals have faced in the wake of EMR adoption.
After the switch to computer records, emergency departments have reported a loss in productivity. At DePaul, patient wait times initially increased 28 percent and patient satisfaction declined 40 percent despite additional staffing, said Dr. Stephen Larson, director of the hospital’s emergency department. St. John’s Mercy also reported a peak in wait times.
While both hospitals have seen wait times drop as doctors get past the learning curve, the emergency physicians group at DePaul decided to begin the scribe program in December “to allow us to continue to add to our gains,” Larson said.
Joint Commission makes more accreditation details available on website
Filed under: Health data, Health journalism, Hospitals
Angie C. Marek, a member of AHCJ’s Right to Know Committee, contributed this update.
The Joint Commission, the largest nonprofit organization to accredit hospitals in the United States, has improved the quality of information available to consumers and journalists on its website. 
In response to a request by AHCJ’s Right to Know Committee, the agency has made it easy to tell whether a facility has recently lost accreditation or is in danger of losing it.
In the site’s Quality Check section, the search page now has a filter allowing viewers to select “Type of accreditation.” (The filter only appears in areas where there are hospitals that are not fully accredited.) Previously, to find hospitals with less-than-full accreditation, users had to examine each hospital’s record individually. Now the few that have not met standards can be quickly located.
“We’re pleased that the Joint Commission responded to our suggestion to make its website more useful,” said Charles Ornstein, president of AHCJ’s board of directors. “Reporters and consumers will now find it somewhat easier to learn about the institutions to which they entrust their health.”
Nonprofit hospital CEO earns $5 mil in severance
Filed under: Health data, Hospitals, Hot Health Headline, Public records
Writing for The (Bergen County) Record and NorthJersey.com, Lindy Washburn used recent tax filings to discover millions in severance pay given to the executives of Hackensack University Medical Center, an area nonprofit hospital. The kicker? The top executives got this money while being forced out, in part because the hospital board had been shocked to discover just how much they’d been paying the execs.
The compensation packages came in a year in which tax filings show the 775-bed medical center employed 317 fewer staff and Moody’s Investors Service downgraded its credit rating to Baa1, leading to higher interest payments when new debt is issued. Two law firms also recommended a top-to-bottom overhaul of governance, including compensation practices, after the federal conviction of a state senator who was a paid consultant to the hospital.
Beyond the headline, Washburn used the tax filings to detail national comparisons, a debate on nonprofit status and data on all sorts of compensation at the hospital.
AHCJ articles and tip sheets
- Digging into hospital finances: Recent trends and five key documents
- IRS study of community benefit activity and executive compensation in nonprofit hospitals
- Changes to 990 forms make hospital finance investigations necessary
- Reporting on the business of health care
- Deciphering cost reports helps paint picture of hospital’s financial health
- Veteran editor offers tips for finding health stories on any beat
-
Join us in Omaha to find untold rural health stories
New at HealthJournalism.org
- AHCJ offers financial data about nonprofit hospitals
- Diversity in aging: Putting gray in the rainbow
- Southeast journalists eligible for regional fellowship program
- AHCJ-NLM Health Journalism Fellowship offers hands-on medical research training
- AHCJ announces 2011 winners of top health journalism awards
