Data shows disconnect between patient perception, hospital performance
Filed under: Health data, Hospitals, Hot Health Headline, Public records
Sifting through Medicare hospital rating data, USA Today reporters Steve Sternberg and Christopher Schnaars found an enlightening disconnect between patients’ subjective ratings of hospitals and hospital performance on quantitative measures such as death and readmission rates.
“This is a very important finding,” says Donald Berwick, director of the Centers for Medicare & Medicaid Services, adding that though patient-survey data offer critical insights into how it feels to be a patient at different hospitals, patients’ perceptions don’t tell the whole story.
The story is packaged with an infographic that allows readers to look up ratings for local hospitals.
AHCJ resources
- Updated hospital data allows reporters to identify ongoing problems: The release this month of federal data on hospital quality is a good reminder for reporters to give their local hospitals a checkup. 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.
- Deciphering hospital quality data
- Sorting out hospital rankings
- Making sense of hospital quality reports
- Analyze patient satisfaction surveys to evaluate local hospitals
ProPublica investigates ties between doc groups, industry
Filed under: Conflicts of interest, Health data, Hot Health Headline, Pharmaceuticals
With an assist from Sen. Chuck Grassley, ProPublica senior reporters Tracy Weber and Charles Ornstein, AHCJ’s board president, have published their latest data-heavy investigation (USA Today version). This time, their journey into the myriad avenues pharmaceutical companies pursue to influence physicians has taken them into the world of professional societies and annual conferences. The duo writes that despite the power of these groups, their dependence upon millions and millions of dollars in industry funding has often slipped under the radar.
Professional groups … are a logical target for the makers of drugs and medical devices. They set national guidelines for patient treatments, lobby Congress about Medicare reimbursement issues, research funding and disease awareness, and are important sources of treatment information for the public.
Their strongest anecdote comes from the Heart Rhythm Society, a group which, in 2010, pulled in about $8 million – half their total income – directly from manufacturers of the drugs and devices their members specialize in prescribing for, or implanting in, patients. The society has started to disclose these relationships, but perhaps not to limit them, the reporters write. “’This is our business,’ said Dr. Bruce Wilkoff, the incoming society president. ‘We either get out of the business or we manage these relationships. That’s what we’ve chosen to do.’”
The companies also pay two-thirds of the society’s board members speaking or consulting fees, a situation Weber and Ornstein found is far from unusual. In addition to these financial conflicts, the reporters gathered some fascinating examples of just how deep industry influence can run. My personal favorite comes from the conference of a well-known collection of cardiologists.
Last month, the American College of Cardiology attached tracking devices to doctors’ conference ID badges. Many physicians were unaware that exhibitors had paid to receive real-time data about who visited their booths, including names, job titles and how much time they spent.
For more examples, I recommend Robert Durrell’s photographs from the 2011 Heart Rhythm Society annual conference, which show dozens of industry-sponsored objects alongside the amount of money each company paid for that particular privilege. Dan Nguyen and Nicolas Rapp put together an infographic that expands upon a similar theme.
Much of the disclosure data the ProPublica team depended on for their reports was released in response to a request for informationGrassley sent out in late 2009. His investigation has started to yield some preliminary results.
There are fledgling efforts to push medical societies toward stricter limits on industry funding: 34 groups have signed a voluntary code of conduct calling for public disclosure of funding and limits on how many people on guideline-writing panels have industry ties.
“The general feeling is that the societies need to be independent of the influence of companies,” said Dr. Norman B. Kahn Jr., chief executive of the Council of Medical Specialty Societies, which helped draft the code.
HHS publishes insurance prices, Consumer Reports explains reform
Filed under: Government, Health care reform, Health policy
The first big wave of health care reform implementation has brought with it a mini-boom in consumer-oriented explainer sites and publications. You may remember the Kaiser Family Foundation’s Health Reform Source from our implementation coverage. In the days since, it’s been joined by offerings from Consumer Reports and the federal government, among others.
Since its launch this summer, Healthcare.gov has slowly evolved, adding explainers, tools and a Spanish-language version. Now, it has officially entered the meat-and-potatoes, utility-belt phase with an insurance search tool that includes detailed pricing and coverage information (press release). According to USA Today’s Alison Young, the tool indexes 4,400 plans from 225 insurers, and will be updated monthly.
And while it caters to consumers with things like monthly premiums, out-of-pocket costs and deductibles, the tool also includes some great data points for reporters, including covered services, percent of applications denied in the past three months, and percent of applicants charged more than the base price. One caveat: All the information is hidden behind a little search wizard, and you’ll have to enter demographic information and click a few tabs before you get to the good stuff.
And finally, as an antidote to the sometimes bureaucratic HHS site, the Consumers Union guide to the first six months of health care reform (Six-page PDF) is heavy on bullet points and easy-to-understand, categorical statements like “Sick children can’t be denied coverage” and “Preventive health care and screenings covered.”
Each major topic area is broken down into four key elements: “What’s New?”; “You may benefit if you”; “What you get”; and “The fine print.” The last subheading is where the guide really shines, as it briefly details exactly how an insurer can slip out of that particular provision.
Agreement lets disciplined nurses work in 24 states
Filed under: Health data, Health journalism, Nursing, Public records
ProPublica’s Tracy Weber and Charles Ornstein are back on the disciplined caregivers beat, this time cooperating with USA Today to expose a licensing gap that makes it easier for disciplined nurses to find work in other states. The licensing agreement in question was signed a decade ago as 24 states agreed to recognize each other’s licenses in an attempt to alleviate care shortages by allowing nurses to work where they are needed most.
In some cases, nurses have retained clean multistate licenses after at least one compact state had banned them. They have ignored their patients’ needs, stolen their pain medication, forgotten crucial tests or missed changes in their condition, records show.
Critics say the compact may actually multiply the risk to patients. There is no central licensing for the compact, so policing nurses is left to the vigilance of member states.
Outside the compact, each state licenses and disciplines its own nurses. But within it, states effectively agree to allow in nurses they have never reviewed.
Ornstein and Weber found numerous instances in which a caregiver disciplined in one state was able to work for an extended period in another without being red-flagged, and are helping spark a debate over the costs, benefits and implementations of such agreements.
Reporters use county rankings for analysis
Filed under: Health data, Public health, Public records, Studies, Tools
On Feb. 17, rankings of the relative health of counties in each American state were released by the Robert Wood Johnson Foundation and the University of Wisconsin. The rankings used data from 13 distinct (mostly federal) sources, including the National Center for Health Statistics, the Census Bureau and the Dartmouth Atlas. With that data, researchers computed eight separate composite scores, which were then weighted to produce one overall score. The ratings are navigated by clicking through a national map to the state and county level. Enough clicks will even bring you to the raw data itself. The state only compares counties, not states, because data collection varies from state to state and isn’t always standardized.
It’s a combination of data, analysis and an intuitive interface, and journalists have been quick to localize the story. Many reporters reached beyond the easy numbers (”our county is 67th!”) to use the system for deeper stories.
For example, Robin Erb of the Detroit Free Press dissected the ratings process and how individual factors and disparities played into them before launching into the standard state breakdown.
Writing for Health News Florida, David Gulliver took a broader state view and considered how various socioeconomic factors played into the rankings of Florida counties. Gulliver’s analysis:
The strong-performing coastal counties, like Collier, St. John’s Sarasota, Charlotte, Palm Beach and Broward, all benefit from having heavy concentrations of retirees who have guaranteed health care access via Medicare. …
[Dr. Kevin Sherin, director of public health for Orange County] said that in Florida’s tourism and service industries, workers tend to be transient and less likely to have insurance or consistent primary care.
He noted the low-ranked counties were some of the poorest in Florida, like Union and Bradford in the rural north, and Glades and Okeechobee, with heavy populations of migrant workers. Those counties also tend to have more people who speak only Spanish, Creole or other languages.
Gulliver localized the story on a county level for his Sarasota Health News site.
In USA Today, Mary Brophy Marcus took the national view and looked for broad trends and generalizations. Marcus’ story was accompanied by a map by Frank Pompa highlighting each state’s healthiest and least healthy counties.
1 in 5 nursing homes pull consistently bad ratings
USA Today’s Jack Gillum crunched the numbers and found that one-fifth of U.S. nursing homes have received two consecutive poor (one- or two-star) ratings in the federal Nursing Home Compare database since its launch in 2008.
Gillum looked for homes that started with a poor rating, then received at least one more within the past year. Among other things, Gillum found that “Nearly all homes that repeatedly received few overall stars — one or two stars — were owned by for-profit corporations,” and that “the lowest-rated homes had an average of 14 deficiencies per facility.” Consistent poor-performers can be found in all 50 states.
Gillum found that one of the reasons homes weren’t improving from year to year is that they’re often given little incentive to improve their ratings unless consumers are actively using Nursing Home Compare to inform their decisions.
Medicare spokeswoman Mary Kahn says a one-star nursing home is not necessarily a terrible facility. Even the lowest-rated homes must still meet baseline Medicare conditions, she says.
…
“If homes are not motivated to get better, chances are they won’t, and you’ll wind up in homes in poor-quality purgatory,” (Larry Minnix, CEO of American Association of Homes and Services for the Aging) says. “There should be two types of homes: the excellent and the non-existent.”
Slim guide:
Covering the Health of Local Nursing Homes
Check out AHCJ’s latest volume in its ongoing Slim Guide series. This reporting guide gives a head start to journalists who want to pursue stories about one of the most vulnerable populations – nursing home residents. It offers advice about Web sites, datasets, research and other resources. After reading this book, journalists can have more confidence in deciphering nursing home inspection reports, interviewing advocacy groups on all sides of an issue, locating key data, and more. The book includes story examples and ideas.
AHCJ publishes these reporting guides, with the support of the Robert Wood Johnson Foundation, to help journalists understand and accurately report on specific subjects.
Other resources
- Aging Nation: Troublesome Health Care Issues
- Headlines an advocate for seniors would like to see
- The impact of aging upon health care
- Covering nursing homes and other issues of aging
- How will retiring boomers affect the national health agenda?
- You Can Run, but You Can’t Hide: Policy and Problems in Long-Term Care
- Biology of Aging: Sources and Resources
Airport dining proves to be a food safety challenge
Filed under: Hot Health Headline, Public health, Public records
USA Today’s Alison Young reviewed inspection reports for hundreds of restaurants at 10 airports and found a large number of critical violations, including 42 percent of the restaurants reviewed at Seattle-Tacoma and 77 percent of restaurants reviewed at Reagan National Airport.
The most common culprits? “Grab-and-go” sandwiches and related foods, which aren’t kept cold enough to ward off food-borne pathogens.
Young notes that it’s hard to pinpoint the number sickened by airport sandwiches, as it’s difficult to track foodborne illness back to a specific source even when the customers aren’t constantly boarding airplanes and taking off for all corners of the earth.
Scott Hensley, on NPR’s Shots blog, recently noted an FDA warning to a Denver kitchen that prepared thousands of meals a day for airlines:
We can sum up the findings in the LSG SkyChefs facility a few months back with a four-letter abbreviation used to describe the roaches and other insects found there: TNTC.
That stands for Too Numerous To Count.
Hensley runs down some of the other problems found there and a reaction from the company spokeswoman.
AHCJ resources
Lifting the shroud: Using multiple-cause-of-death data
Fatal Food: A study of illness outbreaks
Recent news
Loophole allows E. coli-tainted meat to be sold
Meat, dairy products transported in unsafe temperatures, overlooked by inspectors
Airlines delay testing of onboard water
Salmonella outbreak: A selection of recent stories
N.Y. school districts not meeting federal guidelines on cafeteria inspections
Private companies, not the FDA, increasingly perform food safety inspections
Web sites
Center for Infectious Disease Research & Policy
Outbreak Alert! Database
Young to report on health for USA Today
AHCJ member Alison Young has gone from The Atlanta Journal-Constitution, where she has been writing an investigative column, to USA Today, Matt Dornic reports on MediaBistro.com. 
Young, who previously covered the Centers for Disease Control and Prevention, will cover health on the paper’s national desk.
Young also is president of the Investigative Reporters and Editors’ board of directors.
USA Today matches hospital quality data, tourism
Filed under: Health data, Health journalism, Hot Health Headline
USA Today’s Steve Sternberg and Jack Gillum put a new spin on federal Hospital Compare ratings and other hospital quality data, matching the ratings, as well as data on death rates, with popular travel destinations and the locations of state parks. The reporters make the case that travelers should keep hospital quality data in mind when planning vacations.
From the story, which also includes a list of poorly-rated hospitals in travel hotspots:
A USA Today analysis finds two dozen hospitals near popular travel destinations, as compiled by the National Travel Monitor, have death rates among the worst in the USA. A separate analysis shows that one of every four hospitals with high death rates for heart attack, heart failure or pneumonia — 94 of 402 — are near state parks.
Related
AHCJ Vice President Charles Ornstein, whose own hospital quality coverage has earned national recognition, recently updated his comprehensive “Road map for covering your local hospital’s quality” tip sheet with links to state-by-state resources and additional nationwide tools for journalists looking into hospital quality.
AHCJ article: Making sense of hospital quality reports
Book: Covering the Quality of Health Care: A Resource Guide for Journalists
Slim guide: Covering Hospitals: Using Tools on the Web
Free online training
On the Beat: Covering Hospitals: An innovative simulation guides you through the sources and resources you need to tackle the beat. You’ll tap into the same tools that you’ll use on the job, and you’ll have a virtual mentor to walk you through the maze of reports, statistics and sources. One story line teaches you about reporting on hospital quality
Data
Investigating hospitals: Find stories with ready-to-use Hospital Compare data: AHCJ has made it easier for journalists to compare hospitals in their regions by generating spreadsheet files from the HHS database, allowing members to compare more than a few hospitals at a time, using spreadsheet or database software. AHCJ provides key documentation and explanatory material to help you understand the data possibilities and limits.
Tip sheets
- How to cover your local hospital - Overview of many organizations that offer hospital quality ratings
- Sorting out hospital rankings
- Intro to investigating health data using spreadsheets
- Computer-assisted reporting basics: Investigating health data using spreadsheets
Reports
- Study: Hospital quality comparisons are inconsistent
- Performance data may not affect patient decisions
- GAO report on reliability of hospital quality data reported to CMS
- 2007 state quality data available
- Hospital quality resources by state
Hot Health Headlines
- Rating Hospital Heart Care
- Government releases new hospital death rates
- Mortality data and its use in quality improvement efforts
- Surgery death rates going public in U.K.
- Ranking Hospitals on Bang for the Buck
Pentagon: War takes toll on soldiers’ children too
USA Today’s Gregg Zoroya reports the results of a Pentagon survey of more than 13,000 active-duty soldiers and their spouses intended to gauge the effect of the ongoing wars in Iraq and Afghanistan upon their children.
Among the survey’s findings:
- Six in 10 say children’s fear and anxiety increase when a parent goes to war
- A majority say their children have coped well, but a quarter say they have coped poorly or very poorly
- A third say their child’s grades and behavior in school have suffered
Zoroya also reports on all the measures the military has taken to help parents cope, including family counselors, Sesame Street kits and graphic novels.
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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
