Long-term care insurance premiums jump
Filed under: Aging, Government, Health care reform, Hot Health Headline, Public health
As the population ages and costs continue rising, paying for long-term care is a big issue for middle class families. Some say long-term care insurance can be a solution, but there are significant issues associated with these products.
In the Minneapolis Star Tribune, Jackie Crosby reports that, “Trapped between fast-rising costs for care and weak returns on their investments, insurers have been raising long-term care premiums by double-digit percentages in Minnesota and nationwide.”
Long-term care coverage has been around since the 1970s, and gained popularity in the ’90s, when the government started offering tax incentives. According to Crosby, it’s getting more expensive now because of what one expert called “the perfect storm.”
Insurers set their rates on assumptions that some people would let their policies lapse. But people held on to policies longer than expected. And their claims are bigger because they’re living longer.
Low interest rates have had perhaps the biggest impact, because insurers planned to cover claims based on reserves they invested. When those investments fell short of expectations, insurers turned to policyholders to make up the difference.
State and federal officials see long-term care insurance as key to limiting the strain placed upon government health programs by America’s aging popular, Crosby writes, and they have thus “spent considerable energy trying to encourage the middle class to plan ahead with long-term care insurance, without much luck.”
The Obama administration last month scrapped the CLASS Act, a long-term care insurance program and major piece of federal health care reform. Minnesota launched a program in 2008 that allows median-income households that buy long-term care policies to shelter some assets if they apply for Medicaid. Still, only about 11 percent of people in the state have the insurance.
Even though the Medicaid program was designed as a safety net for people in poverty, middle-class seniors routinely deplete their assets and turn to the state.
In Minnesota, Medicaid pays about 40 percent of elderly long-term care. Costs could rise fivefold by 2035 to an “unsustainable burden” of $5 billion, according to a report last year from the Citizens League.
Reporter’s investigation exposes inefficient charity
Filed under: Health journalism, Hot Health Headline, Public records
In the Minneapolis Star Tribune, Jane Friedmann used simple tax documents and a local woman’s complaint to show that most of the money raised by the Austim Spectrum Disorder Foundation goes toward sustaining the foundation’s fundraising, not toward families living with autism. It’s a brief, effective piece of reporting of the sort that can and should be localized more often. For the record, here are the numbers Friedmann got from the return.
The charitable group pulled in $1.2 million in 2009, according to its IRS filing, but the charity listed a negative balance of $29,679 at the end of the year. It listed three employees and 89,128 “volunteers” …
The group hired two companies to raise funds for ASDF in 2009, but neither did much to help the cause. Ohio-based Infocision kept all $876,832 it raised, while Missouri-based Precision Performance Marketing kept all but $37,842 of the $203,227 it raised.
The tax form reveals the group held no “structured, formal meetings” in 2009. It spent $313,751 on “materials and fulfillment” and $120,241 on postage.
She also called local and national autism charities for their perspective on the dubious foundation, then included a few paragraphs which helped readers make more informed choices when doling out charitable contributions.
To investigate charitable organizations in your area, find out how to to understand an IRS 990 form, the tax return that nonprofit organizations file. It tells you the organization’s revenues and expenses, and its assets and liabilities. You can see whether or not it is making a profit, and how its fund balance, or net assets, has changed over the past year.
Duluth duo investigates disciplined doctor
Filed under: Health data, Health journalism, Hospitals, Hot Health Headline, Public records
The latest crop of disciplined doctors stories, spearheaded by the work of ProPublica’s Charles Ornstein and Tracy Weber, has focused on problem caregivers in the aggregate, with liberal use of anecdotes. Now, Brandon Stahl and Mark Stodghill of the Duluth News Tribune have assembled an investigation that proves there’s still plenty of room for a disciplined docs piece with just one subject.
Working from court records and a state reprimand, the Minnesota duo found that Stefan Konasiewicz, a highly paid neurosurgeon who practiced in the city for much of the past decade, was the target of nigh on a dozen malpractice suits.
When he moved from Duluth about three years ago, Konasiewicz left behind two dead patients, one woman paralyzed from the neck down and six others who say his treatment caused them serious physical harm.
His former employer, St. Luke’s hospital, was aware of the harm Konasiewicz was alleged to have caused and yet continued to let him practice, according to records obtained and interviews conducted by the News Tribune.
The exhaustive report that follows is a tribute to their investigative tenacity, loaded with quotes from colleagues who long questioned Konasiewicz’ judgment and a careful, painstaking rundown of the malpractice cases filed against the embattled surgeon.
For more on how they searched court records to find malpractice cases, and on why malpractice suits in the state face such high hurdles, see Stahl’s sidebar.
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.
New health-related state laws for 2011
Filed under: Government, Health care reform, Health policy, Hot Health Headline, Public health
Many thanks to Melissa Preddy for pointing out, in a post on the Reynolds Center’s businessjournalism.org, the National Conference of State Legislatures’ roundup of new laws that have already go into effect in 2011, or will soon. It’s a national list loaded with localization-ready ideas and issues that should be surfacing throughout the year. Hot-button topics include expanding medical coverage and several nutrition-related laws.
Here are a few highlights, taken directly from the NCSL’s list.
Connecticut will soon be requiring health insurance policies that cover anticancer medications to cover the oral drugs at least as favorably as it does the IV ones. The law prohibits insurers from reclassifying anticancer medications or increasing the patient’s out-of-pocket costs as a way to comply.
A new Missouri law requires all group health benefit plans to cover the diagnosis and treatment of autism spectrum disorders. Coverage is limited to medically necessary treatment ordered by the insured’s treating physician. The law also requires the Department of Insurance and other institutions to submit a report to the legislature regarding the implementation of this coverage, including specified costs.
California became the first, on Jan. 1, 2010, to prohibit oil, shortening or margarine containing artificial trans fats in restaurants and other food facilities. Beginning Jan 1, 2011, the original law will extend to other foods containing artificial trans fats, primarily baked goods.
Retailers in Minnesota will now be banned from selling cups and bottles intended for children age 3 or younger that contain bisphenol A (BPA). These same restrictions went into effect for in-state manufacturers and wholesalers on Jan. 1, 2010.
California lawmakers have also enacted a new law requiring free drinking water for students in school cafeterias or food service areas. Schools must comply by July 1, 2011.
California will soon require all children under the age of 18, including patrollers and resort employees, to wear helmets while skiing or snowboarding. Resorts will be required to post notice about the law, including on trail maps and resort websites.
Rules for journalists reporting on genetics
It appears that University of Minnesota biologist and blogger PZ Myers has finally seen a few too many “x gene linked to y condition” stories. He snapped, writing that “I just get so annoyed at this tendency for the media to focus on simplistic discrete causes that are split into a black & white nature or nurture false dichotomy.” He also felt compelled to write a few rules for journalists, as scientist-bloggers so often do.
Two of the four rules cover subjects which should be old hat for most AHCJ members, namely “understand science and causality” and “put news and numbers in context,” and it’s not until he focuses specifically on genetics that the list really shines.
For the first rule, he uses a story headlined “Male infertility gene discovered” as a teaching example. The emphasis is mine.
Do not describe genes by the disease they cause when broken. This is a gene that contributes to male fertility. There is no infertility gene. If a man has a missing, damaged, or mutant form of this fertility gene, he may have problems conceiving children.
And, for the final rule, he builds on the basic, well-trod ideas of causality and context to provide a framework for interpreting gene discovery stories.
Learn this simple principle: genes affect how your body responds to environmental factors. Finding an allele associated with a particular physiological state does not mean you have described a cause. We also need to know how that gene acts, what triggers a particular pattern of expression, and what the gene changes in the cell. There are forms of genes that only have deleterious (or advantageous) effects given certain conditions; that effect must be described as a consequence of both the gene and a certain background or environment.
Ethics professor takes on clinical trials, marketing
Filed under: Hot Health Headline, Pharmaceuticals
Writing for Mother Jones, University of Minnesota medical ethics professor Carl Elliott digs into the Dan Markingson story first covered by St. Paul Pioneer Press reporters Jeremy Olson and Paul Tosto. Elliott works at the same institution as the physicians who who administered a Seroquel trial that the 26-year-old was enrolled in when he committed suicide.
Given his teaching field and institution, it’s not surprising that Elliot couldn’t stay away from the Markingson story.
…the more I examined the medical and court records, the more I became convinced that the problem was worse than the Pioneer Press had reported. The danger lies not just in the particular circumstances that led to Dan’s death, but in a system of clinical research that has been thoroughly co-opted by market forces, so that many studies have become little more than covert instruments for promoting drugs. The study in which Dan died starkly illustrates the hazards of market-driven research and the inadequacy of our current oversight system to detect them.
Elliot goes after the idea that the new wave of anti-psychotics was any safer than its predecessors, then explains the clinical trial manipulations he says were used to claim they were.
From there, Elliot takes on the use of clinical trials for marketing purposes. Clinical trials can be dangerous, which is theoretically acceptable if they have the potential to advance medical care. But what if patients are just being exposed to those dangers in an effort to sell more drugs?
Frugal Minnesota splurges on lower backs
Filed under: Health data, Health journalism, Health policy, Hospitals, Hot Health Headline, Public health, Studies, Tools
For physicians and patients, treating lower back pain is an exercise in restraint and patience. According to federal guidelines, such pain usually resolves itself within six weeks with minimum intervention, so it’s often a matter of resisting the temptation to order a $500 MRI within that time window. And in Minnesota, a state known for its health-care-related moderation, that temptation seems to be too much.
As the Christopher Snowbeck of the St. Paul Pioneer Press reports, Minnesota doctors are worse than the national average when it comes to giving lower back pain patients MRIs without exploring cheaper alternatives. And in the land of Lake Wobegon, being below average is a big deal. The conclusions come from Hospital Compare’s newly released 2008 outcomes data. To learn more about this data, check out AHCJ’s recent conference call on the subject.
For some help reading between the lines of Snowbeck’s story (and the Hospital Compare data), see Gary Schwizter’s recent blog post on the subject; he doesn’t mince words.
The story includes other excuses from local providers along the lines of “the data are outdated…we’ve changed…we’re better now…that can’t be right…it’s not us!” When have you ever seen a story on health care data that didn’t have these predictable reactions? It reminds me of The Tobacco Institute continually rejecting any new finding that showed new harms from smoking. When you don’t like the data, damn the data. For most of the history of medicine we had no outcomes data to show patterns of practice or what happens to people over time. Now that we’re starting to collect some such data, vested interests find that information is a menacing thing.
For more about treatment of back pain, particularly how much money is spent on it, see the just-released “Back Problems: Use and Expenditures for the U.S. Adult Population, 2007” (PDF) from the Agency for Healthcare Research and Quality.
Rise in uncompensated care forces hospital cuts
MinnPost.com’s Dr. Kay Schwebke reported that uncompensated care — both charity care and bad debt taken on by hospitals to fulfill moral and legal obligations — has climbed at “unprecedented rates” in Minnesota as folks lose insurance through layoffs or employer cutbacks or otherwise can’t afford out-of-pocket expenses and high deductibles.
In Minnesota, uncompensated care made up about 2.1 percent ($247.4 million) of hospital operating expenses in 2007, up from 1.6 percent ($128.7 million) in 2003, and there are indications that those numbers are rising.
Driven in large part by uncompensated care, “net hospital income fell from a positive 4.8 percent in third quarter 2007 to a negative 2.5 percent in third quarter 2008,” Schwebke reported.
Schwebke also looked at what these decreases meant in terms of layoffs, cutbacks and the availability of charity care at the state’s largest hospitals.
Barriers in 5 Midwest states chill public access
A study from the the Citizen Advocacy Center finds that open government laws in Michigan, Ohio, Illinois, Wisconsin and Minnesota have systemic barriers that chill public participation and access to government.
The Center analyzed each state’s Freedom of Information and Open Meetings Acts and found striking similarities between all states, including:
- Open government laws are sporadically enforced, which means public bodies are more likely to be unresponsive to records requests and employ exemptions to keep meetings closed.
- No state surveyed has a government office with statutory authority specifically created to oversee and enforce sunshine laws.
- State employees are not adequately trained to carry out open government policies and may be unintentionally violating the laws.
- Citizens may be able to attend meetings, but there are very few opportunities to participate.
The Midwest Open Goverment Project is a comprehensive study of the Freedom of Information and Open Meetings Acts in those five states, under the auspices of the Citizen Advocacy Center.
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- Numbers reveal how often, or how rarely, states check doctors’ disciplinary records
- How I did it: Falsified charts in nursing homes linked to patient care
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