Category Archives: Health care reform

Future of primary care: Who will take care of you?

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Amy Jeter

About Amy Jeter

Amy Jeter is a health journalist at The Virginian-Pilot. She attended Health Journalism 2013 on an AHCJ-Rural Health Journalism Fellowship, which is supported by The Leona M. and Harry B. Helmsley Charitable Trust.

The list of problems with primary care today is long and long-standing. Patients are frustrated and confused. Providers feel pressure to see more patients even as their reimbursements go down. Medical schools push students toward hospital-based sub-specialties. And for those who choose primary care, the training neglects important new skills, such as working in a team and engaging patients in their own care.

Resource

A new tip sheet from Felice J. Freyer, a medical writer at The Providence (R.I.) Journal and a member of AHCJ’s board of directors, addresses the changes in primary care and offers a number of story ideas and resources for reporters to cover primary care in their communities.

All this as the nation prepares for a spike in demand for primary care providers – fueled by millions of patients newly-insured through the Affordable Care Act – and a drop in supply due to retirements in the aging physician workforce and the unpopularity of the specialty, according to four panelists at Health Journalism 2013.

“I hate to be a downer,” said Andrew Morris-Singer, M.D., president and principal founder of Primary Care Progress. “We do have profound problems in the primary care pipeline.”

Solving the problem boils down to making essential changes to the way primary care providers do business, the panelists agreed.

These practices of the future – some of which already are operating – emphasize engaging patients, using technology, and distributing patient care across a primary care team. Continue reading →

Join today’s webinar on newly released hospital cost data

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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 federal government released data today showing what hospitals across the country charge Medicare for the same treatment or procedure. The 2011 data includes bills submitted by 3,300 hospitals for the 100 most commonly performed treatments. This allows a basis for some local or regional comparisons and a starting point for stories on hospital costs. 

The data is available on the AHCJ website. A webinar for AHCJ members on using the data will take place today at 2 p.m. ET with Jonathan Blum, the acting principal deputy administrator at the Centers for Medicare & Medicaid Services, and Karl Stark, AHCJ vice president and Philadelphia Inquirer health editor. Register here.

More on medical costs

The cost of medicines, devices, tests and treatment is such an important element of health reporting that it is included in AHCJ’s Statement of Principles: “Strive to include information about cost and insurance coverage in any reporting of new ideas in medicine.”

Brenda Goodman, AHCJ’s topic leader on covering medical studies says that the runaway costs of such things are arguably one of the most important issues in medicine, but it’s one that’s often missing from health stories.

Michael Schroeder, who covers health for Angie’s List Magazine, is required to include meaningful medical pricing information in his stories. He acknowledges this is no simple task but urges reporters to have a strategy and be persistent. “You won’t always get the information you’re after, but your batting average will certainly go up, and you won’t be left to routinely settle for hollow numbers.”

To that end, Goodman and Schroeder have contributed tip sheets to help reporters get that vital information. Goodman focuses on several resources where you might find pricing information, while Schroeder shares his strategy and the specific questions he asks sources about costs.

Health Data WorkshopHealth Data Workshop

For more on using data to report on health care, journalists are invited to tap into health data in a special workshop, Oct. 3 & 4 in Anaheim, Calif.

This AHCJ workshop offers something for data newcomers and  veterans – from spreadsheet basics to visualizing data online. You’ll come away with skills and ideas on teasing stories out of datasets and tools on presenting these stories.

New tip sheet breaks down how ACA applies to immigrants

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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.

We’ve posted a tip sheet from the National Immigration Law Center on how the Affordable Care Act affects immigrants. They let us put their guide on the  site with one request – that we include their website and suggest that you check their site if you write on this topic in case there are updates.

There’s no sense in repeating what you can find on the tip sheet (undocumented immigrants don’t get covered, documented ones do under  the circumstances described – generally, they can go in the exchanges with subsidies if they qualify but still face a wait to get into Medicaid). But it is worth addressing the nexis between the health law and the current debate over helping immigrants become documented.

The bill will go through changes before it passes – IF it passes (a big question mark, particularly in the House). But the key message from our perspective as health reporters: Given what’s been said so far by Democrats and Republicans alike, it is highly unlikely that undocumented immigrants will get health benefits WHILE they are going through what looks to be a multi-year process of becoming documented. However, once they are documented they will be treated like the rest of the documented immigrant population.

Keep caveats in mind when writing about climbing premiums, health reform

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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.

Climbing premiums

Photo by sbluerock via Flickr

Insurers are beginning to file their rate requests and, naturally, they are beginning to generate headlines as well as more political fodder. 

My impression is that the rate hikes (particularly for younger people) are getting way bigger attention than the rate decreases (particularly for older people). That’s partly because runaway costs are a better headline – and fit into a political narrative we’re all hearing.

It’s also because the price increases for younger, healthier people is a serious policy concern. If younger people don’t sign up for the exchanges, and only older sicker people do, the costs will keep rising and fewer people will get covered. That is precisely the opposite of what the Affordable Care Act is supposed to achieve.

But there are several caveats – and I explained several of them in an earlier post. The biggest ones to remember: these are “sticker” prices. Many, if not most, people in the exchange – millions of Americans – will be eligible for subsidies in the form of tax credits. These will be available on a sliding scale to individuals and families up to 400 percent of the federal poverty level. Continue reading →

Addiction treatment options expand under health law – but will needs be met?

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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.

Affordable Care Act could transform addiction care and make it go much more mainstream.

Photo by Thomas Marthinsen via Flickr

Here’s a great piece by Carla Johnson, an Associated Press medical writer and AHCJ board member. She highlights a little-known element of the Affordable Care Act and pulls together many strands of policy, hard numbers and real people’s needs. 

The story addresses how the health law will expand access to treatment for addiction and substance abuse – but that the system may not be up to meeting a backlog of unmet human need.

Her vivid opening sentence sets the stage:

 It has been six decades since doctors concluded that addiction was a disease that could be treated, but today the condition still dwells on the fringes of the medical community.

Continue reading →

Industry group concerned parents may drop dental coverage

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Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health, curating related material at healthjournalism.org. She welcomes questions and suggestions on oral health resources at mary@healthjournalism.org.

Once the ACA covers children's dental care, will parents drop their dental insurance?

Photo by ianus via Flickr

An estimated 5.3 million children are expected to get dental coverage next year through the Patient Protection and Affordable Care Act.

But will up to 11 million parents decide to drop their own dental benefits when their kids get covered separately?

It’s one of the still-unanswered questions surrounding the health care reform law and it worries Evelyn Ireland, executive director of the National Association of Dental Plans, the trade association representing the dental benefits industry.

The problem is this, according to Ireland: Continue reading →

Snapshot of state health spending yields some surprises

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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.

The Wall Street Journal and Louise Radnofsky did a nice package of interactive graphics and maps on state health spending. As Radnofsky noted, the high spenders are in the Northeast – but not only the Northeast. They are some rural states – but not all rural states. And Florida is up there.

It’s a fun and useful tool that gives you a snapshot of your state – and let you compare it with neighboring states or states with similar demographics.

But if you follow the work of the Dartmouth Atlas folks you’ll also know that spending doesn’t just vary by state – it varies by county, city – sometimes even neighborhood. Payment incentives is part – but only part – of the story. (They don’t explain why two hospitals in Manhattan may have such different utilization patterns, for instance). Local practice patterns, training, traditions, patient demographics all play a role.

Answering the big questions about insurance exchanges, states to watch

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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.

We write a lot on this blog about state developments, the exchanges and Medicaid expansion, as that’s a huge part of the local health policy beat. Here’s a helpful detailed guide to covering exchanges from CJR’s  Second Opinion.

It suggests Five Big Questions and gives some advice on how to think about each of them

  • Will policies be affordable
  • Who influences the exchange boards?
  • Which policies can be sold?
  • Do the networks have enough doctors and hospitals?
  • How will the exchange sell its policies?

And it includes this basic advice:

For starters, look beyond the easy sources – those academics and think tank experts always eager to dish out a quote. In fact, don’t even worry about quotes at this point. The trick is to understand what’s going on, who are the players and their special interests, what are the nuts and bolts of how these exchanges work. And then: What big questions need to be addressed. Therein lie your stories.

The exchanges are a local, ongoing story, and the best sources will be the ones on the ground in your state. That means advocacy groups, local foundations, local stakeholders like insurance brokers and agents, medical societies, hospital associations, the head of the local exchange board, the staff at the exchange board, insurance regulators, consulting actuaries, and insurance companies (whose websites can be helpful even when their PR folks are not). In other words, good coverage of the biggest health story in decades requires old-fashioned reporting—schmoozing, cultivating sources, reading reports and testimony, even attending meetings of your local exchange board. That’s how you’ll find the dots to connect.

I would add that California is a good state for you to watch to see how some of these questions get asked, and answered. California is ahead of many states in setting up the exchange; they are already thinking about marketing and messaging and outreach, officials (including those who favor the Affordable Care Act) are having frank public conversations about affordability, and there is a lot of good reporting coming out of the state.  CJR’s Second Opinion also has been tracking Connecticut’s exchange pretty closely.

Experts disagree on value of electronic health records #ahcj13

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Richard Asinof

About Richard Asinof

Richard Asinof is a contributing writer to The Providence (R.I.)Business News. He is attending Health Journalism 2013 on an AHCJ-Rhode Island Health Journalism Fellowship, which is supported by The Rhode Island Foundation.

<span class="credit">Photo by Pia Christensen</span>Farzad Mostashari, M.D., Sc.M., the national coordinator of health information technology, advocated that the nation's investment in health information technology is necessary to fix the health care system.

Photo by Pia ChristensenFarzad Mostashari, M.D., Sc.M., the national coordinator of health information technology, advocated that the nation’s investment in health information technology is necessary to fix the health care system.

Electronic health records are a tool, the bottom floor on creating standards to move from mere billing and data collection into a platform to change the way health care is delivered, the way it is paid for, and the manner in which patients are engaged, according to Farzad Mostashari, M.D., Sc.M., the national coordinator of health information technology at the U.S. Department of Health and Human Services.

Mostashari’s optimistic view of EHR implementation, presented at Health Journalism 2013 in Boston, was challenged by Stephen Soumerai, Sc.D., professor of population medicine at Harvard Medical School. Soumerai that the government’s investment of $1.6 trillion in building the health information technology infrastructure is unsupported by any research that it will create the predicted return on investment, citing the recent Rand Corporation study that said cost savings would not occur. The investment was being made without any evidence that changes in delivery, outcomes, quality and cost savings can be achieved. Continue reading →

Quick lessons for covering state implementation of the health care law

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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.

At Health Journalism 2013, I led a panel about state implementation of  the health law (Angie Drobnic Holan of the Tampa Bay Times  blogged about the session). Later that day, I asked some of the reporters – part of the group of AHCJ Regional Health Journalism Fellows and all from conservative states that have opposed the Affordable Care Act – for some takeaways that will help them cover the topic. Here’s some of what they shared: Continue reading →