Myth surrounds reform’s ‘Safeway Amendment’
Filed under: Government, Health care reform, Health policy
Throughout the health care reform process, politicians have held up Safeway’s health incentive program as a model for future government health plans. The supermarket chain’s program requires employees who fail basic health screenings for blood pressure, weight, and cholesterol to pay higher health insurance premiums. 
Safeway maintains that this policy encourages its employees to make healthy lifestyle changes to in turn lower their health care costs. The Washington Post’s David Hilzenrath looked into the grocer’s impact on proposed health reform plans. Hilzenrath reports on how misconceptions about Safeway’s wellness program could impact public health policy in the U.S. Senate’s proposed Safeway Amendment.
Under a regulation advanced during George W. Bush’s administration, incentives conditioned on meeting wellness targets are limited to 20 percent of the premium – including employer and employee contributions to the premium. The Safeway Amendment would allow employers to increase the stakes to 30 percent, and it would give federal officials license to raise the limit to 50 percent. It would also allow insurers to use the same approach – initially in 10 states and potentially in others.
Employers and insurers would be required to make exceptions for people with extenuating medical circumstances.
Supporters of the amendment maintain that it will encourage private-sector employees to monitor and improve their health. Dissenting organizations, including the American Heart Association and the American Cancer Society, suggest that the legislation will unhinge a central tenet of health reform: That an individual’s health status will no longer impact premiums.
Safeway credits its internal health plan for keeping the company’s health care costs nearly steady between 2005 and 2009. An external survey of 1,700 employers revealed that companies’ health care costs increased by 30 percent in the same time period, on average.
Hilzenrath reports that “a review of Safeway documents and interviews with company officials show that the company did not keep health-care costs flat for four years. Those costs did drop in 2006 – by 12.5 percent. That was when the company overhauled its benefits, according to Safeway Senior Vice President Ken Shachmut.”
The latest trend in medicine? Outdoor exercise
Writing for The Washington Post, physician and University of California, San Francisco, medical professor Daphne Miller makes a strong case for what she calls a growing trend: Doctors prescribing outdoor exercise for their patients. After seeing how the lure of the outdoors can motivate those who can’t stand the sight of another treadmill or stationary trainer, Miller has started handing out detailed “park prescriptions” that direct her patients to specific parks and trails. It’s a practice she says colleagues across the country are adopting.
Eleanor Kennedy, a cardiologist in Little Rock, helped create a downtown “Medical Mile” with the support of local funders and the National Park Service’s Rivers, Trails, and Conservation Assistance Program. “If my patients feel that they can get outdoors, they are more likely to be consistent about exercise,” she told me. “Whether you are waddling, walking or running, going out and exercising will help build your confidence, flexibility and adaptability.” And it will also be good for your heart — a particular benefit in Arkansas, where rates of heart disease and stroke, as well as obesity and diabetes, are among the highest in the country.
Folks on the park side of the equation are no less thrilled about the rediscovered mental and physical health benefits of the outdoors; National Park Service officials are hoping to prepare a “park prescription” tool kit for doctors and local parks and health organizations are starting to cooperate across the country.
The NPS’s Rivers, Trails, and Conservation Assistance Program has projects in nearly every state and provides a state-by-state breakdown of the projects that might help reporters localize this story.
WaPo takes the pulse of a suburban street
When she set out to do a “man on the street” story about health care, The Washington Post’s Brigid Schulte appears to have taken the second part of that phrase quite literally. She selected one middle class street in suburban Maryland and then interviewed the men (and women) who lived there.
That simple concept produced some illuminating insights into how many Americans think about health care and health care reform, which they almost seem to view as two unrelated topics. Her interviews showed that even folks who live within an easy commute of the Capitol feel disconnected from the health care debate as it now stands, and revealed the seeming contradiction between people’s stories of a broken system and a need for reform and their complete political inaction.
Evaluation of nonprofits’ charity care continues
If you’re keeping a list of issues that have been rejuvenated through inclusion in the Baucus bill, you can safely add Iowa Sen. Chuck Grassley’s crusade to keep nonprofit hospitals accountable for the provision of adequate amounts of charity care. According to the Chicago Tribune’s Bruce Japsen, the proposed bill includes Grassley’s provision to “improve the community service, transparency and billing practices of nonprofit hospitals.”
From Japsen’s story:
“For now, there’s no minimum percentage requirement for charity care and community benefit,” Grassley said in a statement on Baucus’ proposal. But Grassley is not ruling out a required level in the future, saying it needs “more study.”
“I agree with groups that take their charitable mission seriously … that a percentage payout requirement would become a ceiling, not a floor, like the private foundation payout of generally five percent,” Grassley said in a memo Thursday. “Instead, we need a formula that would maximize expenditures for charitable purposes.”
The Washington Post’s Kathleen Day, meanwhile, reported on the results of a Grassley-backed Senate investigation into the charity care provided by nonprofit hospitals:
The investigators found that while federal law requires charity care in exchange for tax-exempt status, a 37-year-old IRS rule implementing the law is so vague that nonprofit hospitals have been able to exploit it by offering some free services but often little aid to the poorest people in their communities.
Nonprofits frequently charged higher prices to poorer people with no health insurance than they did to better-off patients who had coverage, researchers found. At the same time, many of the hospitals’ top executives enjoyed generous perks such as paid country club memberships and stays at expensive hotels.
Post documents self-referred, in-house scans
Filed under: Health care reform, Hot Health Headline
The Washington Post’s Shankar Vedantam explores the well-documented phenomenon in which physicians who own scanners are far, far more likely to order scans than those who don’t, and the lack of attention this extra screening is getting in the health care cost debate. The screening, Vendantam writes, has been shown to be unhelpful and perhaps even harmful.
Government panels have found that, across several areas of medicine, ordering more procedures does not improve health outcomes. In the case of medical scans, unnecessary imaging also creates a health risk — as many as 1 percent of all cancers in the United States appear to be caused by radiation from medical imaging, according to Amy Berrington de Gonzalez, a radiation epidemiologist at the National Cancer Institute.
Defenders of in-house screening argue that it increases speed and efficiency, though those assertions aren’t always borne out by national statistics. A 1992 law aimed to prevent a too-close relationship between physicians and the profits from screening devices has fallen prey to a loophole that technology has made it possible to exploit.
The issue was ostensibly settled in 1992 when the Stark Law was enacted. The legislation prohibited physicians from referring patients to the doctors’ own scanning devices. The law offered an exception, however, for physicians whose scanners were in the same office building as their practice. The exception was designed to allow doctors to keep small X-ray machines to quickly figure out, for example, whether a limping patient had a sprain or a fracture.
But since the law was passed, high-tech MRI and CT scanners have become smaller, making it possible for many more physicians to use the “in-office” exception.
As more expensive scans are being ordered more often, the percentage of income physicians earn from scanning has risen rapidly since 2000, Vendantam reports. For their part, physicians say that they are simply taking advantage of technology to provide better care.
President Obama has pledged that health care reform will include efforts to cut costs and some in Congress have seized upon limiting self referrals for scans as one way to bring costs down.
Congress, as part of health-care-reform efforts, is considering a proposal, championed by Reps. Jackie Speier (D-Calif.), Anthony Weiner (D-N.Y.) and Bruce Braley (D-Iowa), to prohibit the practice. Maryland is the only state that bans self-referrals, but the law is rarely enforced.
Lack of performance info difficult for patients, docs
Filed under: Health care reform, Health policy, Hot Health Headline
Harlan Krumholz, M.D., writes in The Washington Post that, while better quantitative monitoring would greatly improve the experiences of both patients and doctors, such monitoring has yet to happen because of a lack of will and incentives. Krumholz, a cardiologist and professor at Yale, said that a well-conceived and executed system, while certainly difficult to create, would overcome most objects to such evaluation and go a long way to improving the system and cutting costs.
The paucity of information about medical performance not only makes it hard for patients to choose care. It also impairs our ability to improve care. If we in the medical profession could measure results, we could weed out bad practices and nurture the good ones — and save more money and lives than we could with virtually any breakthrough procedure or medication we are likely to see in the near future.
Krumholz provides a particularly accessible explanation of the issue of quantitative measurement by using anecdotes, specific and relevant examples and apt and illuminating analogies like a comparison to baseball’s statistical “Moneyball” revolution.
Washington Post launches health reform blog
The Washington Post has announced the Daily Dose, a blog they call a “one-stop source on the biggest policy debate brewing today.”
In the inaugural post, the bloggers promise “the latest news and analysis, facts and figures, and even a bit of gossip on how the inside-the-Beltway crowd is attempting to reshape an industry that accounts for one-sixth of the U.S. economy.” The same post promises that the paper’s reporters and columnists will also use the blog’s pages to weigh in on health reform issues.
Posts so far include profiles of power players like Kathleen Sebelius and Peter Orszag as well as reports and analysis of reform-related news.
More M.D.s asking for deductible up front
Spurred by higher co-pays and the ability to estimate billing amounts faster, more doctors are requiring patients to pay their full co-pays at the time of the visit, Francesca Lunzer Kritz reported in The Washington Post.
“It’s a paradigm shift from what most consumers are used to at their doctor’s office,” says Red Gillen, a San Francisco-based analyst with consulting firm Celent, who last month published a report on doctors seeking upfront payment from their patients. Gillen says that until recently, insurers paid so much of the cost of medical care that medical providers, including doctors, labs and hospitals, focused their fee recovery efforts on the companies. But in the past few years, Gillen says, employers and insurers have shifted more costs to consumers in the form of higher co-pays, higher co-insurance and higher deductibles, making those payments an increasingly large share of doctors’ incomes. According to Gillen, consumer out-of-pocket spending as a percentage of all health-care spending rose to 12 percent last year, and is expected to continue rising.
Patient advocates regard the faster billing process as a positive for consumers, Lunzer Kritz found, but some are concerned that patients are not warned about their doctor’s billing practices and that higher up-front payment demands may discourage sick people from seeking care.
Globe section eliminated; Post staff joins team
Call this the case of the disappearing health section. One of the nation’s biggest and best-known dailies - The Boston Globe - has eliminated its stand-alone Monday Health/Science section after 25 years of widely praised coverage that included a 2005 Pulitzer Prize. The move, of course, comes amid ongoing retrenchment at the paper, but health and science editor Gideon Gil is putting on a brave face.
“I don’t see it as a serious retreat,” says Gil, who expects his nine-person staff will remain intact. “The content is all running in the paper, but going in different places … It was nice to have our own sandbox to play in, the freedom to stretch. Science is quirky sometimes, so a bit of serendipity is lost when we have to fit into different niches in the paper.”
However, former Globe science editor Nils Bruzelius, who is now deputy national editor in charge of science at The Washington Post, was more blunt. “It will definitely put a crimp in the amount of science and health coverage in the paper,” he tells the Columbia Journalism Review. ”It will continue to be high-quality, but this can’t help but dim the overall breadth and scope of coverage when you’re fighting for space every day and defining what you do in a more narrowly focused way.”
Meanwhile, The Post is gathering its smattering of health, science and environment reporters into one team. Just the same, the “stories will appear all over the paper and online, just as they do now - on the front page or home page, in National, Metro, Business and the Health sections,” according to a memo written by executive editor Marcus Brauchli and publicized by Politico’s Michael Calderone.
“The aim is two-fold. One, our current structure can sometimes work against strong communication and collaboration, which means reporters only occasionally work in concert with each other and - not surprisingly - often don’t know who’s working on what at any given time. Second, we hope to break down the newsroom silos that can prevent us from using resources in the smartest, highest-impact way.”
Subsidized programs struggle to attract uninsured
Filed under: Health care reform, Health policy, Hot Health Headline
Lori Aratani reported in The Washington Post on the difficulties officials face when working to draw the uninsured into subsidized health insurance programs. Aratani gives examples from Maryland, Arkansas and Massachusetts and cites a national study (conducted by a nonprofit group underwritten partly by insurers) that found that “about 12 million non-elderly uninsured Americans — about one in four — were eligible for existing state or federal health programs but weren’t enrolled.”
“Even when low-cost health coverage is offered, many people fail to take advantage of it. People don’t think they need coverage, don’t know programs exist or don’t have the money to afford even comparatively inexpensive, subsidized programs.”
Aratani reports that many voluntary health-care programs have struggled to bring in qualified participants and implies that this traditional obstacle may increase the difficulty faced by the Obama administration as it aims to make good on the president’s pledge to extend health coverage to more Americans.
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Health Journalism 2010, AHCJ's annual conference, features a world-class program with story ideas, sources, stronger reporting skills, chances to meet newsmakers and network with other journalists.
- Health and education: Covering these intersecting beats
- Reporting on the business of health care
- Health reporting resources for journalists on state and local government beats
- Shortened Lives: How location, lifestyle affect health
- Covering a complex story for the long haul
- Aging in the 21st Century: Presentations and tip sheets
- AHCJ calls for better information from Joint Commission Web site
