Category Archives: Europe

Tips for finding local stories about health reform

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Last week, Stacey Singer, of The Palm Beach Post, and I led a workshop on  “Ten Local Health Stories” (actually we sort of went quite a bit over the “10″ limit) for the Excellence in Journalism (EIJ12) conference, sponsored by SPJ and RTNDA in Fort Lauderdale. We’ve posted my overview, Stacey’s very hands-on and helpful local take, and a resource list (adapted from, but not identical too, the resources we’ve been assembling for more than a year on the AHCJ Health Reform core topic pages).

Core Topics
Health Reform
Aging
Oral Health
Other Topics

We also wanted to thank the Alliance for Health Reform for shipping to Florida a box of its very handy resource guide . (Disclosure: I wrote one of the overview chapters, although wasn’t involved with the more recent updates to it.)

The session went on for more than an hour, so I’m not going to try to describe it all, but wanted to just share a few points we made: Continue reading

Explaining the numbers behind the Medicaid expansion

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

One of the questions that I got from colleagues after AHCJ’s post-Supreme Court webcast was about the cutoff for expanded Medicaid (in states that opt in to Medicaid expansion). The health law says it’s open to people or families with income up to 133 percent of the federal poverty level. Yet some experts and advocates talk about 138 percent. Which is right?

Core Topics
Health Reform
Aging
Other Topics

Both, sort of.

The Affordable Care Act certainly states 133 and that’s the number you will commonly see, in the media and in the policy world.

But there is some small print. The law specifies that people qualify with “modified adjusted gross income” (MAGI) at or below 133 percent FPL. But there is a provision in the law that, in effect, adjusts the level to a de facto 138 percent. If you are a state official, budgeting and planning and figuring out who is eligible and who isn’t, this is important. If you are a journalist writing about it, you can probably stick with 133. (I do.) Continue reading

How Britain’s new health law got through Parliament

John Lister

About John Lister

John Lister, European web coordinator for AHCJ, has been a journalist for 35 years, specializing in reporting health policy in England. He is the author of "Health Policy Reform: Driving the Wrong Way?," a critique of market-style reforms, and "The NHS After 60: for Patients or Profits?," a critical history of the British National Health Service.

Most health care professionals vociferously opposed Britain’s new Health and Social Care Act in the final few months as the House of Lords debated its fate.

Opposition was especially strong from family doctors (GPs), who, on the face of it, should have seen themselves as beneficiaries of new powers and control, but most of whom have seen the proposals as a threat to them and to the National Health Service. Continue reading

Britain passes NHS reforms amid controversy

John Lister

About John Lister

John Lister, European web coordinator for AHCJ, has been a journalist for 35 years, specializing in reporting health policy in England. He is the author of "Health Policy Reform: Driving the Wrong Way?," a critique of market-style reforms, and "The NHS After 60: for Patients or Profits?," a critical history of the British National Health Service.

The British government’s highly controversial “Health and Social Care Act” finally completed its bruising 15-month journey through the Houses of Parliament in March, in the teeth of opposition from doctorsnursing unionspublic health professionals, and mounting public concern. The debate on the merits and implications of the proposals is far from over. Continue reading

‘Anti-agenda’ influencing journalists’ health coverage

Esther Paniagua

About Esther Paniagua

Esther Paniagua is editor in chief of the Spanish edition of Technology Review, published by MIT, and is a freelance health writer for the popular science magazine, Muy Interesante. She manages the Spanish participation in the European co-funded project HeaRT (Health Reporting Training), with support of the European Commission.

For whom does the media write? It seems a stupid question with an obvious answer. However, I wouldn’t give a categorical answer because, too often, media seem to be more interested in offering information not always in their readers’ best interests. Continue reading

Controversy over breast implants spreads across Europe

John Lister

About John Lister

John Lister, European web coordinator for AHCJ, has been a journalist for 35 years, specializing in reporting health policy in England. He is the author of "Health Policy Reform: Driving the Wrong Way?," a critique of market-style reforms, and "The NHS After 60: for Patients or Profits?," a critical history of the British National Health Service.

British clinics delivering cosmetic surgery were thrown into crisis by the decision last month of the French government to fund the removal of thousands of breast implants manufactured by the now-closed French company Poly Implant Prostheses (PIP). The implants were found to have used industrial grade silicone made for use in mattresses. Continue reading

Investigation delves into Wash.’s prescription drug problem

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Everything time we think prescription drug abuse stories have peaked, something comes along to push the story further. This time, InvestigateWest’s Carol Smith sets herself apart by starting from square one and clearly explaining the origins and dimensions of Washington’s particularly nasty drug issues, tracing back each facet of the problem to its source and spotlighting what makes the Evergreen State unique.prescription-drugs

Washington has been one of the hardest hit states in the country, in part because of aggressive prescribing practices. That, coupled with lack of oversight of doctors who over-prescribe, has led to the spectacular run-up in the number of deaths from prescription overdoses.

The backdrop for her work is an epidemic that shows no signs of abating, despite a recently implemented state law Smith calls “a bold attempt to reduce overdose deaths by launching the first-ever dosing limits for doctors and others who prescribe these medicines.”

Prescription drug abuse is at epidemic levels throughout the state, and elsewhere in the country, despite lawmakers’ attempts to get a grip on it. Washington now has one of the highest death rates in the nation. Deaths from prescription drug overdoses in this state have skyrocketed nearly twenty-fold since the mid-1990s, and now outstrip those from traffic accidents.

Why caused it to leap so quickly? Smith tracks down several key tipping points. “There’s plenty of blame to go around for what caused the epidemic,” she writes. “Aggressive marketing of opiates by drug companies, nonexistent tracking of overprescribing, lack of insurance coverage for alternative treatments for pain, and demand by patients for quick fixes, to name a few.”

She drills down into many of those causes, with my personal favorites being two key origin stories:

  • How marketing by OxyContin maker Purdue Pharma led to relaxed guidelines for chronic pain treatment and a “1999 law specified ‘No disciplinary action will be taken against a practitioner based solely on the quantity and/or frequency of opiates prescribed,’” both of which helped cause a jump in prescriptions.
  • How “the rise in the death rates of Medicaid patients tracks along with the state’s cost-saving decision to move many of its poorest residents to the cheapest, most potent pain reliever available: Methadone.”

See the upper right-hand sidebar for more stories from the six-month investigation.

Journalists discuss reporting from the heart of a pandemic

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Recently, New York Times health and science reporter Donald McNeil joined the National Journal‘s Maggie Fox, the Nieman Foundation’s Stefanie Friedhoff and the Canadian Press’ Helen Branswell on a Global Journalist radio panel to discuss reporting on international pandemics and global diseases. The full episode is available to download, listen or watch online.

Host David Reed

Host David Reed

McNeil provided his take on everything from what he packed to keep himself safe from SARS to his take on the accuracy of the movie “Contagion,” but his most relevant thoughts for AHCJ readers were in response to questions about sourcing and a journalist’s obligations in an outbreak situation.

GJ: What are some of the ways you, as a journalist, verify the information you receive, and where do you get that information?

McNeil: … it all depends on the disease. But generally, you get fairly accurate, careful information out of the Centers for Disease Control and Prevention in Atlanta and the World Health Organization (WHO) in Geneva. There are times when you aren’t happy with the information you are getting or the decisions they make, but most of the time, I think they are both extremely careful science-driven organizations.

GJ: In reporting on the potential danger of flu and warning people to stay vigilant, are you ever concerned that some reports from the media might cause panic among people?

McNeil: I don’t see my job as being a public health official; I see my job as a journalist. So my job is to tell the truth, and the truth is basically the one goddess I serve. Obviously, people care about this stuff, so in the same way another journalist who covers the White House wants to tell people accurately what the president did or didn’t do yesterday and what it means, I am trying to tell my audience how dangerous the virus is if it’s a virus, and how many people are killed, and what can be done about it. My job is telling the truth and getting the news out.

Agency re-posts National Practitioner Data Bank file, but restrictions draw fire

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

The U.S. Health Resources and Services Administration today republished the public version of the National Practitioner Data Bank, after intense pressure from journalism groups, researchers and members of Congress.

But the action comes with a major catch: Those who want to access the data will have to agree to certain restrictions that were not in place before.

National Practitioner Data Bank public use file

Nov. 9 statement by HRSA Administrator Mary K. Wakefield, Ph.D., R.N.

Earlier coverage:

See an interactive timeline of the National Practitioner Data Bank controversy.

Nov. 3: Grassley blasts HRSA over data removal after seeing letter exchange with doc

Oct. 7: Grassley criticizes federal agency over removal of doctor discipline data
Grassley’s letter to HRSA Administrator Wakefield (PDF)

Oct. 2: Former Practitioner Data Banks official says HRSA ‘erroneously interpreting the law’
Oshel’s letter & statement (PDF)
Letter to Sebelius & Wakefield (PDF)

Sept. 28: Journalists turn to Sebelius for access to National Practitioner Data Bank file
Letter to Sebelius (PDF)

Sept. 22: Agency declines to restore public data
Letter from HRSA (PDF)

See how reporters have used NPDB’s public use file to expose gaps in oversight of doctors

Sept. 21: More journalism groups join effort, send letters to Congress to restore access
Letter to members of Congress
(PDF)

Articles, editorials about public access to the NPDB public use file (PDF)

Sept. 15, 2011: AHCJ, other journalism organizations protest removal of data from public website
HRSA letter to Bavley (PDF)

Earlier version of NPDB public use file posted by Investigative Reporters and Editors, working with AHCJ and the Society of Professional Journalists.

The National Practitioner Data Bank is a confidential system that compiles malpractice payouts, hospital discipline and regulatory sanctions against doctors and other health professionals. For years, HRSA has posted aggregate information from the data bank in a Public Use File that did not identify individual providers.

HRSA officials removed the public file from the data bank website on Sept. 1 because a spokesman said the agency believed it was used to identify physicians inappropriately. The Association of Health Care Journalists has protested the action, along with Investigative Reporters and Editors, the Society of Professional Journalists, the National Association of Science Writers, the Reporters Committee for Freedom of the Press and the National Freedom of Information Coalition.

Other groups likewise protested, including Public Citizen, Consumers Union and prominent health researchers. U.S. Sen. Charles Grassley has twice written to federal officials condemning the action.

AHCJ president Charles Ornstein commended the Obama administration for working with reporters on this issue but said he is concerned about the restrictions HRSA is imposing for those seeking access to the data.

“How can the government say data is public but then say it’s only public with strings attached?” Ornstein said. “I am troubled that HRSA is overstepping its legal authority with these new rules and may be imposing unconstitutional prior restraints on reporters.”

To gain access to the Public Use File, reporters must agree to three conditions: they will not use it alone or in combination with other data sets to identify any individuals or entities; they will not repost the raw data; and they will return it to HRSA upon request. Violating the rules could result in having to return the data and being barred from receiving it in the future, HRSA says.

“Having access to information on physician discipline, malpractice payouts and hospital sanctions is important for those who care about patient safety and oversight of physicians across the country,” Ornstein said. “But the restrictions put in place by HRSA are unworkable.”

Ornstein encouraged HRSA to abide by its longstanding practice of refusing to confirm or deny the identity of individual physicians in the Public Use File. In doing so, reporters and their news outlets bear the legal liability for ensuring their information is correct, and newsrooms must ensure they have exercised due diligence in their reporting.

Reporters have used the Public Use File for two primary tasks. The first is for statistical information (the number of doctors in their state with malpractice payouts who have not been disciplined) and that would be allowed under the new rules.

The second is to fill in information about particular physicians whom they have identified through other records and means. That would be barred under the new rules.

“In the past, the Public Use File has been a vital tool for journalists writing about insufficient oversight of physicians in their states,” Ornstein said. “Without such articles, some unsafe doctors would very likely continue to be practicing with clean licenses and patient protection legislation in several states likely would not have been enacted. I worry such reporting may be chilled by those new rules.”

HRSA removed the public version of the data bank only after the urging of a Kansas neurosurgeon with a long history of malpractice payouts, according to records released Nov. 3 by Grassley. The doctor, Robert Tenny, sent six letters to HRSA before and after The Kansas City Star wrote a story that said he had been sued at least 16 times for malpractice and had paid out roughly $3.7 million since the early 1990s.

An earlier version of the Public Use File, accessed in August before it was removed, is available on IRE’s website. It does not include some updated information that is available in the file that HRSA republished today. At the same time, reporters are not bound by the new restrictions imposed by HRSA.

Update: Comment from Grassley

Sen. Charles Grassley

Sen. Charles Grassley

Grassley released this statement this afternoon:

“HRSA is overreaching and interpreting the law in a way that restricts the use of the information much more than the law specifies. Nowhere in the law does it say a reporter can’t use the data in the public use file to combine that with other sources and potentially identify doctors who have been disciplined in their practice of medicine.This agency needs to remember that half of all health care dollars in the United States comes from taxpayers, so the interpretation of the law ought to be for public benefit. It’s also hard to see how HRSA has the resources to require the return of supposedly misused data or how that would even work. It seems the agency’s time would be better used in making sure the database is up to date and as useful as possible. I continue to expect a briefing from HRSA on this situation, including participation from the person who pulled the public data file after a single physician complained that a reporter identified him through shoe leather reporting, not the public data file. One complaint shouldn’t dictate public access to federally collected data for 300 million people.”

Ohio’s hospital transparency law under fire

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Thanks are due to blogger and one-time hospital executive Paul Levy for drawing our attention to the Ohio hospital industry’s recent push to overturn much of the state’s recently passed transparency legislation.

The law required hospitals to post performance data, such as infection rates and patient satisfaction, on the Ohio Hospital Compare site.

According to Brandon Glenn’s report in the MedCity News, the hospital industry opposes the site, online since Jan. 1, 2010, because it serves the same purpose as the federal Hospital Compare site.

The OHA supports the new legislation… because it wants to remove “duplicative” reporting requirements on the state’s hospitals. Ohio hospitals already report the same data to a federal Hospital Compare website maintained for the public by the Centers for Medicare & Medicaid Services, said OHA spokeswoman Tiffany Himmelreich.

The new legislation “doesn’t reduce reporting. It just eliminates reporting the same information to two different places,” she said. “We don’t want the public to feel that this is taking a step backwards in terms of data availability.”

For their part, consumer advocates say website maintenance is not an onerous burden, and that the hospital association’s push is part of a larger, statewide antitransparency trend.

As an interesting side note, Glenn found the Ohio Hospital Compare site to be rendered inoperable by apparent bugs on an initial visit but discovered that, after his inquiries to the state health department, the site was put into working order.