Comprehensive series on N.C. hospitals includes national context, effects of reform
Filed under: Health care reform, Health data, Hospitals, Hot Health Headline
The (Raleigh, N.C.) News & Observer and The Charlotte (N.C.) Observer just combined forces to do a terrific five-part series on hospitals called “Prognosis: Profits.”
It’s not just a great expose/explainer/data analysis/narrative that tells readers about the state of the hospital industry in North Carolina and its national context. With lots of examples, data and sidebars that break down some complex policy ideas, it’s also a great primer for anyone who wants an easy to understand but multifaceted Hospitals 101 (without being Hospitals for Dummies). For you multimedia fans out there, it also has a video component.
In a nutshell, the series – a collaboration of investigative and health care writers - found that some of the hospitals make a ton of money and charge more than hospitals elsewhere and that the charity care many of them provide is worth less than the tax-breaks they get ostensibly for providing care to the community. And yes, it gets into many of the complexities of charity care versus community benefit versus cost-shifting versus bad debt. (We’ve written about some of that on this blog.)
They write:
During the Great Recession, their profits have stayed strong, and they’ve raised their prices. Top executives enjoy million-dollar compensation packages as they expand, buy expensive technology and build lavish facilities. Their customers buy the services before they know the cost, and they often don’t understand the bills.
And the hospitals enjoy a perk worth millions each year: They pay no income, property or sales taxes.
The series describes what it’s like to be poor and sick and have a collection agency come after what little you have to pay a big bill for a medical emergency. It describes the million-dollar plus compensation packages of hospital execs. (One got $8.7 million, including a big retirement trust payment.)
The articles blend individual patient stories with policy context and a lot of hospital financial data (which readers can search in an online database that includes total and operating margins for every hospital in the state). The fifth and final installment (as well as some of the fourth) looks at some of the solutions that have been put forth, by state legislators and patient and consumer advocates.
The series avoids one of the pitfalls that drives me crazy in some otherwise good hard-hitting reporting. It describes a problem – deeply and accessibly. But it also goes beyond looking at a snapshot of where things stand today. It connects today’s reality, today’s system, to the many underreported provisions of the Affordable Care Act that may create new tools and forces and legal and financial and cultural shifts that can bring about change – depending on the Supreme Court, the politicians, and on how much the health sector (and patients) embraces versus resists change. (That’s a sidebar in part 3.) Among the relevant elements of the health law it identifies (and the sidebar gives more specifics than I’m including here):
- Hospitals must develop financial assistance policies and the criteria for receiving the help.
- An end to the widespread practice of charging the uninsured who qualify for financial assistance more than they charge the insured
- A ban on nonprofits engaging in “extraordinary collection actions”
- A requirement that they assess community health needs every three years, and devise a plan to meet them
The series has gotten the attention of federal and state legislators. We’ll see if they stay engaged. And how that matters.
Joanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to joanne@healthjournalism.org.
Ranking may lead to sources for reporting on aging
Health reporters covering the aging beat might be interested in which hospitals offer the best geriatric services, according to recent rankings published by U.S. News & World Report.
Don’t take the magazine’s word as gospel; its method for rating hospitals has been questioned by many and is by no means the definitive word on the subject.
That said, each of the hospital departments mentioned on the U.S. News list houses experts knowledgeable about aging and health. You might want to put the list in a file so it’s handy when you’re looking for sources to comment on a story you’re covering.
These are the top 25 geriatrics departments, according to the magazine:
1. Mt. Sinai Medical Center, New York
2. Ronald Reagan UCLA Medical Center, Los Angeles
3. Johns Hopkins Hospital, Baltimore
4. Massachusetts General Hospital, Boston
5. Duke University Medical Center, Durham, N.C.
6. Mayo Clinic, Rochester, Minn.
7. Cleveland Clinic, Cleveland
8. New York-Presbyterian University Hospital of Columbia and Cornell
9. UPMC-University of Pittsburgh Medical Center, Pittsburgh
10. Yale-New Haven Hospital, New Haven, Conn.
11. University of Michigan Hospitals and Health Centers, Ann Arbor
12. UCSF Medical Center, San Francisco
13. Johns Hopkins Bayview Medical Center, Baltimore
14. Hospital of the University of Pennsylvania, Philadelphia
15. NYU Langone Medical Center, New York
16. Hospital for Special Surgery, New York
17. Beth Israel Deaconess Medical Center, Boston
18. Rush University Medical Center, Chicago
19. Barnes-Jewish Hospital/Washington University, St. Louis
20. University of Washington Medical Center, Seattle
21. St. Louis University Hospital, St. Louis
22. Brigham and Women’s Hospital, Boston
23. Methodist Hospital, Houston
24. University Hospitals Case Medical Center, Cleveland
25. Indiana University Health, Indianapolis
I’m struck by the absence on this list of hospitals in the South, the Southwest and the interior West. This may have to do with U.S. News‘ methodology, which relies heavily on recommendations from medical specialists. But it’s a bit disconcerting, nonetheless.
Judith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.
If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.
CMS-ordered report, withheld by hospital, reveals hundreds of deficiencies
Filed under: Hospitals, Hot Health Headline, Public health, Public records
When Ryan McNeill of The Dallas Morning News recently wrote for AHCJ about that paper’s investigation into patient care and safety at Parkland Memorial Hospital, he noted that the institution narrowly avoided being shut down by the federal government by agreeing to a rare form of oversight.
That oversight included a requirement that the hospital undergo outside monitoring that was carried out by the Alvarez & Marsal Healthcare Industry Group and paid for with about $7 million in taxpayer money.
When Parkland received the federally mandated report, dated Feb. 2, its governing board refused to release it to the public, “citing a fear that it could be used against the embattled public facility in court.”
Now we know why it was loathe for people to see its contents.
The Dallas Morning News has independently obtained a copy of the report and posted it online. It details hundreds of problems throughout the hospital.
Among the findings: Patient rooms were found to contain overflowing trash bins, excrement and blood. Hundreds of medications were improperly administered to patients. Dozens of beds remained empty despite crushes of patients seeking emergency care. Senior leaders kept critical information from the hospital’s board of managers. One patient died, apparently after receiving a drug without doctors’ orders.
Even after the hospital came under scrutiny, patients continued to be harmed, according to the 315-page report: “Considering that Parkland knows it has been under intense scrutiny by the State, CMS and the ICE for the past few months, the number of negative patient events that have occurred just since November 8, 2011 is surprising.”
Perhaps the most disturbing thing about the report is the conclusion that hospital employees do not share a sense of urgency and that “Large parts of the organization still operate in a business-as-usual mode.”
A CMS representative described the report as a “chilling account.” Monitors said Parkland’s “culture has failed in accountability, from top to bottom.” A Morning News editorial says the report is “scathing in its indictment of a once-respected safety-net hospital.”
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.
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