Inspired by NHS, Lieberman calls for reporters to spotlight patient safety improvements
Filed under: Europe, Government, Health data, Health journalism, Public health
Fresh off a trip to powwow with health journalists, academics and officials in England as a Fulbright Senior Specialist, AHCJ Immediate Past President Trudy Lieberman writes on CJR.org about what American health systems can learn from the British National Health Service when it comes to patient safety.
In particular, Lieberman looks at the NHS Institute for Innovation and Improvement, which has pushed a few simple changes that have lead to measurable and marked improvements in several key safety measures and are, she writes, embraced by “almost all U.K. hospitals.”
Since 2007 the Institute has fostered nurse-led innovations to improve care in such areas as patient hygiene, nursing procedures, meals, medicines, and ward rounds that frees up more time to be with patients. Now almost all UK hospitals embrace some of these practices. Positive stats from this “Releasing Time to Care” project show a thirteen percentage point increase in the median time spent on direct care; a seven percentage point increase in median patient satisfaction scores, and a twenty-three percentage point increase in median patient observations.
The innovations include little tricks like nurses donning red pinafores to signal “don’t interrupt me, I’m dispensing medication” and charting patient falls with red dots on a hospital floor plan, so that problem areas can be easily spotted.
According to Lieberman, simple changes like these don’t get the attention or widespread adoption they deserve. Thus, she ends her piece with a call to arms for health journalists, asking them to tell the stories of the sort of simple, easy-to-relate-to steps that are saving lives on both sides of the pond (Oregon, in particular, has been quick to follow the NHS lead in these areas).
So where does the press fit into all this? Media outlets in the UK and the US have something in common—they aren’t much interested in reporting good news and what works. It’s in our journalistic DNA to ferret out the evil, bad, and ugly with the hope that press exposure will change practice. But my visit to the NHS showed that positive change does happen and should be reported. Taylor told me she tried to interest British journos in some of the Institute’s achievements but got “not a sniff.”
“Journalists don’t celebrate success,” she said, “but innovation is to be shared.” Nor has there been any interest from U.S. reporters. CareOregon hasn’t sent out any press releases partly because the results are just coming in and because officials fear that the U.S. stereotype of the NHS is so powerful the program might die a-borning. If I were still a local consumer reporter, I would forget about all that ambiguous, hard-to-interpret data about hospital quality and look for concrete improvements patients and families can relate to, like red pinafores and scorecards for reducing falls. Then I would make a how-to comparison chart showing which hospitals were embracing some of the simple technologies that appear to work.
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.
Lieberman, Ornstein on health as a top 5 beat
Earlier this month, Online Journalism Review’s Robert Niles stirred things up with his lively post on the five most important beats for a local newspaper or website. As you might have heard, health didn’t make the cut (though the related “food” beat is at the top of the list).
Under pressure from commenters and tweeters, Niles conceded that health would be a contender for any “top 6″ list. He elaborated on his health take in the comments, essentially arguing that local health coverage would fall under “Top 5″ categories like labor, business and food.
Angilee Shah, who writes the Career GPS feature over at Reporting on Health, took Niles’ bait and defended health journalism with the help of AHCJ President Charles Ornstein and AHCJ Immediate Past President Trudy Lieberman.
Ornstein’s take:
Even if you factor in the health stories that can be written by the wires, think of all the local health institutions that consumers rely on—doctors, hospitals, nursing homes, hospices, assisted living centers, other health professionals. Do you really expect the reporter who covers the local bank or the local shopping scene to parachute in and cover these institutions well? A reporter covering health understands the difference between Medicare and Medicaid, assisted living and nursing homes, etc. To ask a local government reporter or education reporter to thoroughly cover food deserts in their community or childhood obesity in their schools is too big of a stretch.
And, Shah describes Lieberman’s take:
Lieberman takes an equally adamant stance. “I argue strenuously that this should be a beat, and it should be a dedicated beat with a well-trained reporter,” she said in a phone conversation. Dwindling local health coverage has increased the gap between Washington policy makers and the communities their policies affect. Local journalists should be explaining the effects of complicated health care laws on specific communities. She points to “bright spots” in local health news, such as a Las Vegas Sun series about hospital safety in Nevada.
“I think reporters need to know what’s allowed and how that should translate into what people are seeing, and whether or not they’re being deceived at a local level,” Lieberman said. “It’s a Washington story but it’s not a Washington story. It’s a local story.”
Your take?
There are plenty of small-town reporters in AHCJ, many of whom have more than just health care on their plates. What do you folks think? How many reporters does a newspaper or website need to have before it can dedicate one of them to health care journalism?
Lieberman: Election is evidence media got reform coverage wrong
Filed under: Health care reform, Health journalism
In her column on CJRorg, AHCJ Immediate Past President Trudy Lieberman writes that this week’s elections showed just how thoroughly the media missed the mark on health care reform coverage.
After the economy (62 percent), health care (19 percent) was the second most important issue to voters. And while the media (and the administration) trumpeted the benefits of health reform and “glossed over” the drawbacks, public opinion soured. The biggest oversight, Lieberman writes, was the national insurance mandate, a policy that was more Republican than Democrat.
Lieberman says it best:
If the media failed to discuss in detail the law’s less attractive points, it also missed one of the campaign’s biggest ironies. Republicans, with their repeal and replace slogans, stirred up discontent about a law that was basically built with Republican and conservative ideas. That irony escaped the media.
She doesn’t explicitly frame it as such, but Lieberman’s column leaves me with the distinct impression that with the health care debate reignited by a Republican landslide, journalists are being given a second chance to provide the public with a clear understanding of what’s going on in Washington, an impression that’s cemented with her final sentence:
Whatever happens, the U.S. health system is still its dysfunctional, fragmented, costly self, in need of repair or wholesale reform. Going forward, this is the story the media need to tell.
A new wave of hospital consolidation looms
Nationally, the hospital consolidation craze has leveled off since its 2006 peak, but Kaiser Health News senior correspondent Julie Appleby, an AHCJ board member, reports that acquisitions are on the march again, especially in the mid-Atlantic region. Appleby found that this rising wave is due, in part at least, to health care reform and its emphasis on integrated care and Accountable Care Organizations.
Hospital leaders from Baltimore to Seattle say the health law approved by Congress in March gives them even more reason to merge with or buy rivals because of its emphasis on integrated systems where hospitals and doctors better coordinate care.
Also fueling the trend: More doctors want to be employed directly by hospitals, allowing them more job security without the hassles of running a business. But hiring groups of doctors can be an “expensive and daunting proposition” for a stand-alone facility, says Steven Thompson, senior vice president for Johns Hopkins Medicine.
Nationally and locally, he says, “it’s fair to say that (independent) hospitals are talking with everyone, feeling that they don’t want to be the last one standing.”
Other causes include increasingly contentious negotiations with insurers, more direct employment of doctors and access to the capital needed to adopt things like electronic medical records.
We were pointed to the KHN story by AHCJ Immediate Past President Trudy Lieberman’s cjr.org column, in which she compares hospital consolidation to HMOs and insurance consolidation.
It was good to see Appleby’s story, because the media pretty much gave hospitals a bye during the reform debate, instead making insurance companies the saga’s primary villains. Quietly, though, it seems the hospitals were up to the same thing as the insurers—organizing themselves into larger and larger groups with tons of market power to keep insurance premiums in the stratosphere.
‘Main Street’ informed, skeptical on health reform
In her blog on CJR.org, AHCJ Immediate Past President Trudy Lieberman updates what is becoming an annual franchise: Her summer man-on-the-street column gauging popular opinion on health reform. Just like last year, Lieberman found her subjects on the streets of Columbia, Mo., a town that’s about as close to the (population) center of the United States as you can get.
The common thread? Missourians were pretty sure health care reform wasn’t all it was cracked up to be, but still weren’t willing to vote “yes” in the state’s referendum on opting out of the individual mandate.
Lieberman added a concrete dimension to her main street opinions by prying details on income and expenses from her sources, numbers and ideas which she then used to link their stories to the larger themes surrounding reform implementation.
Keep an eye out for part two of the column, which should be coming soon.
Reform may worsen ER crowding
Filed under: Health care reform, Health data, Health journalism, Health policy, Hospitals, Hot Health Headline, Member news, Studies
Associated Press medical reporter Carla K. Johnson has found that, contrary to common assumptions, emergency rooms could become even more crowded with the passage and implementation of health care reform. Popular wisdom has it that, with more access to insurance thus to primary care, folks will be less likely to go to the emergency room for minor complaints or to allow illness to progress to the point where an emergency visit is necessary. Johnson, an AHCJ board member, gives three big reasons why it’s not that simple:
- There are not (will not) be enough primary care physicians in America to deliver that preventative care.
- At present, the uninsured are no more likely to use the ER than patients with insurance coverage.
- “The biggest users of emergency rooms by far are Medicaid recipients,” Johnson writes. “And the new health insurance law will increase their ranks by about 16 million.”
ERs are crowded, Johnson writes, not only because of a lack of insurance but also because of obstacles inherent in their structure and mission, such as an aging population, more people with chronic illnesses, the closures of many ERs in the 1990s and the demand for beds for both emergency patients and patients scheduled for elective surgeries that bring more money.
AHCJ Immediate Past President Trudy Lieberman praised Johnson’s story and linked it to reporting by The Boston Globe on the impact of that state’s reform law upon emergency room use. So far, events in Massachusetts reinforce Johnson’s predictions.
The Boston Globe revisited Massachusetts’s ER conundrum last week, and reported pretty much what it did last year—that despite the state’s reform law, which mandated everyone have coverage beginning in July 2007, emergency room use is rising. Last year, the state’s Division of Health Care Finance and Policy cautioned that it was too early to draw any conclusions from the seven percent rise in ER visits between 2005 and 2007. Now the agency is saying that expanded coverage may be one reason for the 9 percent rise from 2004 to 2008. According to commissioner David Morales, many studies have shown that expanding coverage does not reduce emergency room visits. That’s because the uninsured “are not really responsible for significant ER use,” he told the Globe.
House nixes COBRA help, opens “jungle”
Filed under: Health care reform, Hot Health Headline
On Prepared Patient Forum, AHCJ Immediate Past President Trudy Lieberman examined the fallout of the Friday House vote to toss a proposed extension of COBRA subsidies through the end of the year. The Senate has yet to vote on the extension, which Lieberman says would cost about $8 billion.
The up-to-65-percent subsidy had already been extended four times since it first passes in 2009. Lieberman says that without this latest extension all the unemployed Americans who have been relying on COBRA will be forced to wade into what she called the “insurance market jungle” to get quotes on the unsubsidized market. Lieberman even did a bit of bushwhacking of her own, wading into the online insurance market to see just what consumers are up against.
Deconstructing a NYT op-ed in three acts
On April 17, New York Times‘ op-ed columnist Thomas Friedman wrote a column about globalization, international competition and entrepreneurship. Here, as anyone who has even held a newspaper with his column in it will know, he’s on all too familiar territory. It’s not until he steps over into uncritical praise of a medical device maker that Friedman starts stepping on land mines.
He profiles EndoStim, a company working on an implant to treat acid reflux. Friedman admits that he has “no idea if the product will succeed in the marketplace,” then the cheerleading begins.
EndoStim was inspired by Cuban and Indian immigrants to America and funded by St. Louis venture capitalists. Its prototype is being manufactured in Uruguay, with the help of Israeli engineers and constant feedback from doctors in India and Chile. Oh, and the C.E.O. is a South African, who was educated at the Sorbonne, but lives in Missouri and California, and his head office is basically a BlackBerry. While rescuing General Motors will save some old jobs, only by spawning thousands of EndoStims — thousands — will we generate the kind of good new jobs to keep raising our standard of living.
Journalist Merrill Goozner, of GoozNews fame, picked up on the story the next day and asked the world “Why Is Tom Friedman Championing Higher Health Care Costs?” Goozner effortlessly chronicles the marketing-driven history of acid reflux treatments, from Pepto-Bismol to Zantac to Prilosec to Nexium, each conveniently emerging as the patent to their predecessor expired, then puts EndoStim in its place at the end of the chain.
… instead of finally being out from beneath the wasted billions now being spent on brand name acid indigestion pills like Nexium, the health care system will be lined up to move onto the next chapter in the lengthening medical text for treating what for most people is a relatively minor and passing phenomenon.
In his final paragraph, Goozner gets to the heart of what Friedman’s vision of “thousands of EndoStims” really means for the U.S. economy.
Friedman is right. Endostim’s success will create “the best jobs - top management, marketing, design” at company headquarters. But let’s not forget that to create those jobs, the entire society through its collective health care system will have to pay an unnecessary tax, which burdens every other industry and shifts scarce societal resources away from potentially more useful activities.
Finally, Trudy Lieberman, AHCJ immediate past president, catches Goozner’s post and wades into the fray in her own column on cjr.org, writing that Friedman’s column was “essentially a puff piece for EndoStim.” Lieberman ties Goozner’s observations on EndoStim into his previous writings as well as her own, writing “there’s nothing in the new law that limits the use of the device only to patients with chronic disease who don’t respond to other, less costly treatments.”
I can see hospitals advertising: “Hey acid reflux sufferers come to us. Our surgeons know how to get that thing down your gut. They are the best in the world, and by the way, insurance will pay.”
Cohn’s reform-minded blog comes to an end
Filed under: Health care reform, Health journalism
The New Republic’s Jonathan Cohn, an AHCJ member, announced Monday that he’s closing up shop at The Treatment, the “crusading” pro-health-care-reform blog he’s run since 2006. Cohn will keep blogging and writing for the magazine, but seems ready to close the reform chapter of his health care reporting and hang a big “mission accomplished” banner across the widely read blog.
Cohn used the occasion of this semi-farewell to reflect on the course journalism has taken during the reform debate, and to contrast it with prior experiences, most pointedly Clinton’s push for health care reform and his own magazine’s notorious role in the debate. In particular, Cohn considers the changes brought on by “new online media” and bloggers like himself and The Washington Post’s Ezra Klein, with whom Cohn says he collaborated as much as he competed.
In addition to The New York Times and CNN, there was the Huffington Post and Talking Points Memo. The change didn’t fully register with me until the night the House passed the Senate health care bill, clearing reform for presidential signature. Sitting up in the House media gallery, next to Politico’s Carrie Budoff Brown, I looked around at my colleagues—and realized how few of them would have been there last time around.
Was this a change for the better? I’m biased, obviously, but with some important caveats I think the answer is “yes.” We (i.e., the new online media) could generally channel policy expertise more quickly. And we could, in some cases, dispense with conventions of even-handedness—conventions that cynics had long ago learned to exploit for their own purposes.
Writing for CJR.org, AHCJ Immediate Past President Trudy Lieberman praised Cohn’s blog, but took the opportunity to remind journalists that, while a reform bill may have passed, that doesn’t mean there aren’t myriad issues related to its implementation that will need intense coverage and scrutiny in the coming years. She also talked to Cohn and found that he isn’t leaving the game entirely.
Cohn told me that when health reform was the political story of the day, the magazine “could afford to let me write on that subject exclusively and dedicate an entire blog to it. Now that it’s no longer topic A, it makes sense for me to write about some other things.” He said he will be doing just that. While the magazine is officially retiring The Treatment as a blog exclusively devoted to health care, Cohn and The New Republic are talking about creating a new blog that will include health care coverage.
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