Category Archives: Hospitals

Report reveals the challenges behind covering patient safety

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Michael L. Millenson

Patient safety is a critically important topic for health care journalists. Yet collecting the data needed to report on it thoroughly can be frustratingly difficult.

For a new report, former journalist Michael L. Millenson (@MLMillenson), explains the challenges he and his colleagues encountered collecting the data they needed to produce a nonpartisan report, “The Politics of Patient Harm: Medical Error and the Safest Congressional Districts.” The first analysis of patient safety by congressional district, the report ranks each district as good, fair or poor on patient safety.

Early in his career, Millenson covered health care for The Chicago Tribune. He is the author of “Demanding Medical Excellence: Doctors and Accountability in the Information Age,” and president of Health Quality Advisors LLC.

For this patient safety report, he found that – even in the best districts – at least one person dies needlessly every day and eight patients are harmed. The report also shows that 14 more individuals die and 105 are injured every month in hospitals in districts rated “poor” on safety than in those rated “good.”

In poor districts, preventable medical errors cause an average of 553 deaths and 4,148 injuries annually. In fair districts the average annual rate was 469 deaths and 3,518 injuries and in good districts, the rate was 385 deaths and 2,888 injuries.

In a new “How I did it” article, Millenson explains the challenges of collecting and reporting the data needed to compare one congressional district against others.

“In health care, cooking up answers to what look like simple questions can quickly get complicated,” he writes. Surprisingly, it was difficult just to determine how to define the term “hospital” because there are so many different types of hospitals. Just distinguishing a local hospital’s performance from that of another hospital miles away was challenging because multiple hospitals owned by one system may share a provider billing number, he explains.

For journalists, this report and Millenson’s explanation of how it was compiled is useful for comparing patient safety scores in one district versus others, and it’s useful as a way to keep the issue of patient safety in the public eye 15 years after the publication of the Institute of Medicine’s landmark report on the subject, “To Err is Human: Building a Safer Health System.”

Covering an ACA grant for ‘super-users’ in Lehigh Valley, Pa.

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.

Photo: Chris Wong via Flickr

Photo: Chris Wong via Flickr

Most of us have heard about “super-users” – patients who are constantly in and out of the hospital, running up large bills. Most have multiple chronic diseases, are poor, and often have mental illness or substance abuse problems. Most live alone, and some are homeless.

Four communities – Lehigh Valley, Pa.; Kansas City, Mo.; San Diego and Aurora, Colo. – have received grants under the Affordable Care Act to tackle the super-user problem. (Other non-ACA-funded initiatives are also underway). Investigative reporter Tim Darragh, formerly of The Morning Call in Allentown, Pa., spent a year tracking the grant in the Lehigh Valley. The super-user innovation grants, which were issued in 2012, provide $14.3 million and (at least for Lehigh) expire in mid-2015.

Darragh, now a reporter at The Star-Ledger in New Jersey, looked at a broad range of issues in the project. He also was able to weave narrative into the policy reporting. The Morning Call recently published five pieces:

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Putting a human face on Maryland’s unique all-payer system

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.

Sarah Gantz has been fascinated with Maryland’s Medicare waiver since the Baltimore Business Journal hired her to write about health care more than two and a half years ago. She describes the policy as “the lifeblood of Maryland’s $15 billion hospital industry.”

Photo: hea_medev via Flickr

Photo: hea_medev via Flickr

Maryland is the only state with an “all-payer” hospital system – a system in which every health plan and every payer pays about the same rate to a given hospital for a given procedure or treatment. That includes Medicare, under a waiver from the federal government.  A commission sets the costs and there’s a lot less cost-shifting in the system if everyone is playing by the same rules.

Despite its importance, Gantz says that most people write it off as a wonky hospital rule that doesn’t affect them. With help from the AHCJ Reporting Fellowship on Health Care Performance, Gantz set out to explain why the policy is worth taking the time to understand. In this piece for AHCJ, she tells our readers what she learned and how she turned wonky policy into stories about real people.

Tips on covering hospital mergers and acquisitions

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.

Photo" PINKÉ via Flickr

Photo: PINKÉ via Flickr

Hospitals across the country are merging – both with other hospitals and with other health care entities such as clinics and rehab facilities. (Those are sometimes called, respectively, horizontal and vertical integration.)

The question is whether the consolidation is creating more efficiency in the health care system, as hospitals generally argue, or whether it’s creating big monopolistic health care entities that will have more clout in negotiating with insurers and thus will lead to higher, not lower, prices.

Antitrust/ mergers and acquisitions is a topic health reporters often shy away from. But it’s important and we need to pay more attention. To help you, we just posted a tip sheet, “Getting the facts on hospital mergers and acquisitions,” based on an email-interview with Barak Richman of Duke Law School, one of the foremost experts on health care antitrust law. In addition, here are a few additional resources on the topic and some recent coverage about the issue nationally and locally.

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Searchable hospital data now includes June inspections

Jeff Porter

About Jeff Porter

Jeff Porter is the special projects director for AHCJ and plays a lead role in planning conferences, workshops and other training events. He also leads the organization's data collection and data instruction efforts.

AHCJ just added 3,522 detailed records of hospital deficiencies on its HospitalInspections.org website. The latest addition includes inspections into June.

The searchable site includes 12,674 different deficiencies among 2,055 hospitals in the United States. The data comes from the Centers for Medicare and Medicaid Services, part of the U.S. Department of Health and Human Services.

In addition, the site includes records showing that 492 hospital inspection reports have yet to be added to the CMS computer system.

The website includes the results of government inspections of acute-care hospitals, critical-access (rural) hospitals and psychiatric hospitals resulting from complaints. It does not include reports of deficiencies found at long-term care hospitals, nor does it include the results of  routine hospital inspections.

The site offers inspections since Jan. 1, 2011, searchable by keyword, city, state and hospital name. The website is open to anyone. AHCJ members can also download the latest data to perform their own searches and analysis.

HospitalInspections.org was launched in March 2013 following years of advocacy by AHCJ urging the government to release the deficiency reports in an electronic format. Until then, reporters and the public had to file Freedom of Information Act (FOIA) requests with CMS to obtain the documents, a process fraught with delays. A December 2013 update added data on psychiatric hospitals.

The site is public but AHCJ members get the added bonus of being able to download the entire dataset and also get access to resources and tip sheets about how to best use the data in their reporting.

Six (or more) things to remember when reporting on health care costs

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.

health-care-costs-reportersHealth care costs lack transparency and are wildly variable, not just from region to region but sometimes from block to block within the same city.

It is a complex topic, with chargemaster prices, what insurers paid and what consumers pay (if anything). Then there are the administrative rules set by Medicare and Medicaid and the negotiated rates between insurers and providers.

It’s daunting, but Lisa Aliferis of KQED, Rebecca Plevin of SCPR and Jeanne Pinderof clearhealthcosts.com have teamed up to offer guidance for reporting on health care costs in this new AHCJ tip sheet.

Going deep on hospital closures and their human impact

Joe Rojas-Burke

About Joe Rojas-Burke

Joe Rojas-Burke is AHCJ’s core topic leader on the social determinants of health, working to help journalists broaden the frame of health coverage to include factors such as education, income, neighborhood and social network. Send questions or suggestions to joe@healthjournalism.org or @rojasburke.

Pittsburgh’s dominant health system closed a hospital in the economically depressed town of Braddock four years ago and soon after opened a new hospital in the more affluent suburb of Monroeville, Pa.

Lillian Thomas

Lillian Thomas

Lillian Thomas of the Pittsburgh Post-Gazette wanted to know how common it was for hospital corporations to abandon disadvantaged towns and inner cities. That was the beginning of a reporting journey that has produced a hard-hitting, ongoing series by Thomas and colleagues at the Post-Gazette and Milwaukee Journal Sentinel.

The first installments revealed how most of the defunct hospitals were small to mid-size community hospitals and public hospitals that had served poor urban neighborhoods. The closures left many low-income neighborhoods without an effective safety net, undermined efforts to recruit doctors and did away with high-wage jobs for local residents. An incredibly detailed interactive map allows readers to track where old hospitals have closed and new ones have opened in cities across the U.S. since 1991.

I asked Thomas to share how she approached the project and mustered the resources to pull it off. Read more …

Hospital survey data updated, with changes

Jeff Porter

About Jeff Porter

Jeff Porter is the special projects director for AHCJ and plays a lead role in planning conferences, workshops and other training events. He also leads the organization's data collection and data instruction efforts.

AHCJ has just updated its easy-to-use Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) survey data to include the latest release of the data by the U.S. Centers for Medicare and Medicaid Services and reflect changes in the data by CMS.

The data include survey questions about how doctors and nurses communicate, how hospitals are controlling patients’ pain, how hospitals are keeping clean and quiet, and more. AHCJ also creates a spreadsheet file that contains a timeline of the overall ratings of hospitals, with results from October 2006 to September 2013.

Each data release now includes the beginning and ending dates covered in the survey. The latest hospital survey results cover Oct. 1, 2012, through Sept. 30, 2013.

Early trends emerge following 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.

Image by Colin Dunn via flickr.

Image by Colin Dunn via flickr.

A couple of stories have begun to trickle out from states about the impact of Medicaid expansion on hospitals.

This one from the Arizona Daily Star by Stephanie Innes, for instance, reports that uncompensated care dropped by a third in the first four months of 2014 from the prior year – a pretty significant number. The hospitals in that period wrote off $170 million in 2014, versus $246 million from Jan through April in 2013.

She uses data from the state’s hospital industry to report on uncompensated care (both bad debt and uncompensated care) and the hospitals’ bottom line.

“The Arizona hospital report shows the average operating margin of Arizona hospitals has gone up from 4 percent in 2013 to the current rate of 5.2 percent — a signal to some health experts that the Affordable Care Act will be a net positive for hospitals’ bottom lines,” she wrote. Continue reading

What happens when hospitals abandon inner cities

Joe Rojas-Burke

About Joe Rojas-Burke

Joe Rojas-Burke is AHCJ’s core topic leader on the social determinants of health, working to help journalists broaden the frame of health coverage to include factors such as education, income, neighborhood and social network. Send questions or suggestions to joe@healthjournalism.org or @rojasburke.

Image by ken fager via flickr.

Image by ken fager via flickr.

Hospitals in the U.S. have been abandoning inner cities for years. By 2010, the number of urban hospitals still operating in 52 big cities had fallen to 426, down from 781 in 1970. Meanwhile, hundreds of medical centers built with cathedral-like grandeur have opened for business in affluent suburbs. A hard-hitting series produced by the Pittsburgh Post-Gazette and Milwaukee Journal Sentinel explains the consequences of this trend for people in neighborhoods where hospitals closed.

The series shows how most of the defunct hospitals were small to mid-size community hospitals and public hospitals that had served poor urban neighborhoods. The closures left many low-income neighborhoods without an effective safety net, undermined efforts to recruit doctors, and did away with high-wage jobs for local residents. An incredibly detailed interactive map allows readers to track where old hospitals have closed and new ones have opened in cities across the U.S. since 1991. Continue reading