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.
Attorneys: Rule stifles nursing home accountability
Cindy Skrzycki reports in The Washington Post on the effects of a Bush administration rule classifying nursing home-related state inspectors and Medicare and Medicaid contractors as federal employees, thus shielding them from providing evidence from either side in court cases. “The practical effect is to force litigants to go to greater lengths, including seeking court orders, to get inspection reports or depositions for cases they are pursuing or defending,” Skrzycki said.
The change, which affects the $144 billion nursing-home industry, was enacted with no public notice or attention.
“This is pretty stunning,” said Mark Kosieradzki, a plaintiff attorney in Plymouth, Minn. “Nobody was told. It was just done.”
Skrzycki reports that the effect of the rule change is being felt across the country, as once-routine information requests have now stalled.
“This change hurts nursing-home residents and their families by allowing bad practices to be kept in secret by nursing homes and inspectors,” said Eric M. Carlson, an attorney with the National Senior Citizens Law Center in Los Angeles. “Government inspectors have the right to go into nursing homes and investigate, and they learn things that residents and families otherwise could never find out.”
The new rule, which was issued in September, generally prohibits state health departments and contractors from participating in private lawsuits involving facilities that are in the federal assistance program without approval by the head of the Department of Health and Human Services.
Ombudsman explores nuances of science writing
Making sense of health reporting is not always easy, especially when clinical trials are concerned. Results may be interpreted in different ways to suit different views. Agendas of those involved may not always be evident. And sometimes, even expert sound bites oversimplify any murkiness. That was the takeaway from a recent column by Deborah Howell, The Washington Post ombudsman, who cited the recent debate over the results of a study of the widely used Crestor cholesterol fighter.
That particular study, known as Jupiter, highlighted the difficulties that can arise when weighing competing statistics. In this case, the debate was over relative risk versus absolute risk, two very different ways to measure whether Crestor can reduce the likelihood of a cardiovascular event compared with a placebo. Howell notes that media coverage was chastised for highlighting the measure touted by AstraZeneca, which sells Crestor and funded the research. Critics say that by describing drug as a blockbuster and emphasizing relative risk overstated the case in favor of the drugmaker. In fact, the Post’s own story was mentioned.
Her weekend essay raised the delicate and difficult balancing act that can occur when coverage requires a nuanced approach to often complicated data and concepts. In the end, she suggests something most health journalists, hopefully, know already - above and beyond anything else, look for and examine the evidence.
Just in case, here are some tip sheets:
- Evidence-based medical reporting: A brief primer
- Evidence-based medical reporting
- Understanding the scientific article
- Understanding medical publications
- What you need to know about risks, rates and ratios
- Medicine 101: Words, numbers and journals
- Lies, damned lies and medical statistics - how to interpret the evidence
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