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?
Journalists to provide input in talks on information released in public health emergencies
Filed under: Health journalism, Public health, Public records
Local, state and federal health officials from around the country will gather Friday with journalists to start developing guidelines on how much information health officials should release about deaths during a public health emergency or outbreak.
The meeting springs from concerns that AHCJ raised last year about the wide variations in the type of information disclosed when people died from H1N1.
Health officials in some states revealed such details as age and town of residence. Others merely acknowledged that someone somewhere had died. The discrepancies became the topic of news reports and may have led to public distrust of health authorities.
AHCJ approached the Association of State and Territorial Health Officials, which agreed to sponsor a meeting. ASTHO invited representatives from the federal government, state health departments, county and municipal health departments, and public information officers, along with AHCJ. Fifteen people are expected to participate.
At the meeting, to be held at ASTHO headquarters in Crystal City, Va., participants plan to discuss the reasons for withholding and releasing certain types of information, and will try to agree on guiding principles for health officers as they face such decisions in the future.
“We are grateful to ASTHO for organizing and hosting this meeting,” said Charles Ornstein, AHCJ president. “We hope that it will lead to establishing minimum standards for what information should be released during public health emergencies or outbreaks, and that will result in better information for the public when it is most needed.”
AHCJ will be represented by Ornstein; Felice J. Freyer, AHCJ Right to Know Committee chair; and Rose Hoban of North Carolina Public Radio. Dr. Nicole Lurie, assistant secretary for preparedness and response, is scheduled to attend, and Gretchen Michael, ASPR director of communications, will lead the discussion.
Have you been denied information from your local or state health department during an outbreak or emergency? AHCJ wants to know so these issues can be raised during the meeting. Send your stories to felice.freyer@cox.net.
Sunshine Week: Online health data varies by state
Filed under: Government, Health journalism, Public records
The Sunshine Week 2009 Survey of State Government Information Online found that while more and more government records are being posted online, some of the most important information is being left offline. And in some cases governments are charging taxpayers to access records that they already paid for, such as death certificates.
Sunshine Week 2009:
March 15-21
Sunshine Week is a national initiative to open a dialogue about the importance of open government and freedom of information. Participants include print, broadcast and online news media, civic groups, libraries, nonprofits, schools and others interested in the public’s right to know.
Teams of surveyors scanned government Web sites in every U.S. state to look for 20 different kinds of public records.
The survey (PDF) included nursing home inspection reports, hospital inspection reports and death certificates. It found that nursing home inspection reports are available online in 29 states, hospital inspection reports are available online in 17 states and death certificates are available online in five states.
The report says that “Death certificates are apparently a revenue source for many states, as they charge relatives and “legitimately” interested parties for copies of the records, or farm out the work to a third-party service such as VitalChek. Some states provide historical access online to older death certificates, mostly prior to 1960, although there generally is a fee for hard copies.”
Other health-related highlights in the report:
In Oklahoma, hospital inspection reports are said to be “confidential by statute” and would not be disclosed publicly unless there was a case involving a licensing question or revocation/suspension of a license.
Louisiana: “We have a problem with the legality of it,” a Louisiana Department of Transportation official told the survey reporter who called the office after failing to find bridge inspection reports online. Calls to other Louisiana agencies after finding neither hospital or nursing home inspections, nor environmental citations online yielded otherwise unlinked URLs for information.
Maryland: Nursing home information got high marks for facilitating online search and for allowing users to “compare data in a variety of ways.”
Minnesota: The state’s Department of Human Services says it expects corrections orders and licensing sanctions, not currently posted, to be online “in the near future.”
California: Because the state of California is so large, surveyors looked at whether individual departments and agencies posted their audits and personal financial disclosure forms, including audits from the Department of Health Care Services. They found that the data is not clearly linked from the department’s home page, though it is free to view and download. The most recent audit reports online where from 2007.
Department of Health and Human Services
University of Missouri graduate students reviewed the Web site of the Department of Health and Human Services and reported on what documents are available in electronic reading rooms. The students noted that the HHS Web site is difficult to navigate because it is comprised of so many divisions that “vary in content, organization and utility.”
They found multiple problems with many of the HHS administrative manuals and other documents, including documents that were locked because someone else was viewing them and documents that were not clear about when they were created or modified.
Health costs, reform high on state legislatures’ lists
Filed under: Government, Health care reform, Health policy
The National Conference of State Legislatures compiles an annual list of issues it predicts will dominate the year’s legislative sessions. Number four on the “Top 9 issues of ‘09” was “health costs and reform.”
The NCSL says state budget gaps, rising health care costs and growing unemployment are coming together for some turbulent times.
“Health costs keep rising at the same time that state budgets are in trouble. An immediate challenge for states in 2009 will be to maintain and retool current health programs, especially Medicaid and diverse programs aimed at covering the uninsured. As the numbers of unemployed increase, Medicaid rolls will grow.”
See what other predictions the NCSL has about health care in individual states.
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New at HealthJournalism.org
- Data gives depth to investigation of patient safety
- What reporters should know about Alzheimer’s and related dementias
- Apply for fellowships to attend Health Journalism 2012
- AHCJ asks Supreme Court to permit broadcast of arguments in health reform case
- Tips for print, online journalists to embrace broadcast opportunities
- 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
- Access Denied: Looking at a lack of health care availability
- Transparency & medical errors: Public reporting of patient harm is a potent force
