Category Archives: Hospitals

Why we still need human relationships in an era of digital medicine

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in Kaiser Health News, The Atlantic.com, New America Media, AARP.com, Practical Diabetology and Home Care Technology report. She is a senior fellow at the Center for Health, Media & Policy at Hunter College in New York City, and co-produces HealthStyles for WBAI-FM/Pacifica Radio.

Is computerized medicine all it’s cracked up to be? Or has it so dramatically eliminated the human factor that we risk doing more harm than good?

Photo: @CharlesOrnstein via Twitter

Photo: @CharlesOrnstein via Twitter

That was the premise of Wednesday’s AHCJ New York City chapter meeting with guest speaker Robert Wachter, M.D., professor and associate chair, department of medicine and director, division of hospital medicine, at the University of California, San Francisco. Wachter provided the backstory of his hospital’s switch from analog to digital systems, how this process has hurt peer and patient relationships – and very nearly killed a 12-year old boy.

Wachter said he was excited about the push for computerized medicine a decade ago. “We had this grand idea that they [computers] would solve everything.” However, he since has come to believe that was that although computers are transforming his profession, it isn’t always for the better. Continue reading

Study: Little evidence that integrating hospital, physician care improves quality or reduces costs

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.

Photo" PINKÉ via Flickr

Photo: PINKÉ via Flickr

When health system executives tout the benefits of acquiring hospitals or physician groups, they often say the combined entity will benefit consumers and insurers by improving health care quality and reducing costs.

A case in point is a plan from Partners HealthCare in Boston to acquire Harbor Medical Associates, a 70-physician practice south of Boston. The goal of the acquisition is to improve patient care, coordinate care to boost patient outcomes and cut costs, reported The Boston Globe’s Priyanka Dayal McCluskey. Partners is the highest-cost health system in the state, she wrote.

In a post about the proposal in his blog, Not Running a Hospital, Paul Levy wrote that the acquisition would cause Harbor Medical doctors to steer patients to Partners’ hospitals. “So not only would local MD visits become more expensive: Follow-up secondary and tertiary care would also,” Levy wrote.

We know, of course, that acquisitions in health care are about making money, as Dan Goldberg wrote in this tip sheet and Joanne Kenen reiterated earlier this week.

Now, in a new report, researchers for the National Academy of Social Insurance, show there is little evidence that organizing hospital and physician care into integrated delivery networks (IDNs) has promoted quality or reduced costs. “Indeed, there is growing evidence that hospital-physician integration has raised physician costs, hospital prices and per capita medical care spending,” the report said. Continue reading

Health Journalism 2015 agenda covers gamut of health care

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.

<span class="credit">Pia Christensen/AHCJ</span>AHCJ President Karl Stark, the assistant managing editor, business, health and science at <em>The Philadelphia Inquirer</em>, gives tips on covering hospital finance at Health Journalism 2014.

Pia Christensen/AHCJAHCJ President Karl Stark, the assistant managing editor, business, health and science at The Philadelphia Inquirer, gives tips on covering hospital finance at Health Journalism 2014.

We have posted descriptions of nearly all of the panels planned for Health Journalism 2015 and it’s an agenda packed with timely and useful sessions for anyone covering health.

Field trips on Thursday will feature trips to Stanford University, Lucile Packard Children’s Hospital, Stanford Health Care, Stanford National Accelerator Laboratory, the Division of Clinical Anatomy at Stanford University and the VA Palo Alto Health Care System to learn about simulation training, pediatric heart care, hospital disaster preparation, veterans’ rehabilitation, early detection of cancer and much more. Continue reading

Finding the full story behind hospital mergers, consolidations

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.

Dan Goldberg

Dan Goldberg

Across the country, health systems are getting larger, gobbling up community hospitals or smaller chains. Some of this has to do with payment incentives in Obamacare, but just as much has to do with changes to Medicare, Medicaid and providers’ desire for leverage as they negotiate payments with insurance companies.

In the February issue of Capital Magazine, reporter Dan Goldberg looked at  New York’s five large health systems and the strategies they were employing to diversify their revenue base while preparing to play in a post-ACA, value-based world.

No chief executive, whether for-profit or not, wants to lose money. So every deal they make generally has financial reasoning behind it, and every deal they don’t make usually carried some financial risk that seemed too great to bear. In this new tip sheet Goldberg shares some questions to keep in mind for reporters looking at the new business landscape.

How close are we to meeting the promise of electronic health records?

Carla K. Johnson

About Carla K. Johnson

Carla K. Johnson (@CarlaKJohnson) is a medical writer at The Associated Press and has covered health and medicine since 2001. She is a member of AHCJ's board of directors, serving as liaison to the association’s local chapters and leading the one in Chicago.

Photo: Carla K. JohnsonA panel of experts discusses health information technology at an AHCJ Chicago chapter event on March 3 in Chicago. From left: Dr. Arnold “Ned” Wagner Jr., chief medical information officer, NorthShore University HealthSystem; Dr. Diane Bradley, senior vice president, chief quality and outcomes officer, Allscripts; Eric Yablonka, vice president and chief information officer, University of Chicago Medicine; and moderator Neil Versel, an independent journalist.

Photo: Carla K. JohnsonA panel of experts discuss health information technology at an AHCJ Chicago chapter event on March 3 in Chicago. From left: Dr. Arnold “Ned” Wagner Jr., chief medical information officer, NorthShore University HealthSystem; Dr. Diane Bradley, senior vice president, chief quality and outcomes officer, Allscripts; Eric Yablonka, vice president and chief information officer, University of Chicago Medicine; and moderator Neil Versel, an independent journalist.

Yes, technology is transforming health care. No, we haven’t come anywhere close to realizing the vision.

Smooth patient handoffs, data-driven performance improvement and real-time analytics are still mostly dreams, although those ambitions have been talked about for years.

Independent journalist Neil Versel, who specializes in health information technology, moderated a panel on March 3. The AHCJ Chicago chapter event was held at AMA Plaza, the new headquarters of the American Medical Association.

Electronic medical record systems “need to play nicer together so they can use each other’s information as if it was natively generated,” said Arnold “Ned” Wagner Jr., M.D., chief medical information officer of NorthShore University HealthSystem. “Can we talk to each other transparently? Well, partly. The success of communication depends on human behavior and (technology’s) job is to help understand the reality of what motivates people to do things.” Continue reading

When hospitals buy physician practices, patients hit with fees

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

WSB-Atlanta recently explored what happens when hospitals buy physician practices, which has been happening all over the Atlanta area.

Prices for patients go up.

The same physicians – in the same offices, with the same treatments – start charging more.

“Everything is exactly the same,” said cancer patient Mike Rosenberg.

Except the bill.

Sometimes it’s an “outpatient facility fee.” And sometimes it’s a “treatment room fee.”

And it’s a lot of money – sometimes thousands of dollars, not covered by insurance.

And even patients who are savvy enough to know about these fees before they get the bill have a lot of trouble finding out about them, as Erica Byfield made clear in her strong 3-minute report.


A map shows facilities owned by, operated by, or affiliated with hospitals. (Yellow: Emory, Red: WellStar, Purple: Piedmont, Blue: Gwinnett Medical, Green: Northside)

It’s not unique to Atlanta. She quotes a University of California, Berkeley, study that found that patients generally pay 10 percent more at hospital-owned practices.

Byfield doesn’t explore whether the push for hospitals to purchase practices is related to the Affordable Care Act – she just says in passing that it’s unclear how big a role the law plays.

Actually the ACA does include incentives for “vertical integration,” or having doctors and physicians part of one organization. But it’s not supposed to raise costs. It’s supposed to bring them down by improving efficiency, creating economies and encouraging care coordination. (Some of the fee problems actually stem from Medicare billing practices, not specifically the ACA.)

Last year Daniel Chang of The Miami Herald looked into integration of hospitals and physician practices – and found patients in Florida were getting hit by big fees. He wrote a “How I did” it piece for us.

If you want to look at this in your community, it’s a good story.

Advocacy groups can help you find patients. And you can just try calling yourselves and seeing if the hospitals and physician practices will talk about their policies. Only two of the big Atlanta-area hospitals were forthcoming with the Atlanta station – and they reported that, and put the policies that were shared up on the web.

Note: I periodically request that people bring good local television coverage of health care to my attention, so we’re not so print (and a dash of public radio) focused. Now I can’t remember who highlighted this one – it may have been on @charlesornstein’s Twitter feed. But please do send good work my way (joanne@healthjournalism.org), we’d like to include it.

Reporter finds nonprofit hospital’s suit against uninsured patient was just one of many

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.

Dianna Wray

Dianna Wray

In January 2012, EMTs took Ignacio Alaniz by helicopter to Memorial Hermann Hospital, one of the largest nonprofit medical centers in Texas. Alaniz had been working underneath his Buick Century, trying to get it started. When it rolled over him, he suffered a punctured lung, nine fractured ribs and a broken arm.

“By the time the helicopter landed, he was already $12,196.37 in debt,” wrote Dianna Wray, a staff writer for the Houston Press. Her article about Alaniz, “Getting Stuck: Uninsured Patients Slammed with Lawsuits by Not-for-Profit Hospital,” was recognized as one of the best examples of health journalism in the business (small) category in AHCJ’s Awards for Excellence in Health Care Journalism. In a new “How I did it” article, Wray explains how her reporting led her to many more cases of patients being sued for medical debt and some of the reaction the story generated. Continue reading

Experts share realities behind generic, specialty drug pricing

Loren Bonner

About Loren Bonner

Loren Bonner (@lorenbonner) is a reporter for Pharmacy Today. She has freelanced as a health care writer and multimedia producer, and worked in public radio in New York and Connecticut. Bonner obtained her master’s degree in journalism with a health and medicine concentration from City University of New York Graduate School of Journalism.

Photo: Abby via Flickr

Photo: Abby via Flickr

Health journalists received a few lessons in economics during a discussion last week on some alarming drug trends – largely the result of a broken market – that are threatening patient care and undermining the U.S. health care system.

At a New York City chapter eventPhil Zweig, a longtime financial journalist who also runs a group called Physicians Against Drug Shortages, spoke about the scarcity of generic drugs in hospitals and clinics – a problem that has persisted for years. Hospital group purchasing organizations (GPOs), which are not regulated and essentially negotiate supply purchases for hospitals, have the ability to charge market share to the highest bidder. Zweig said they can do this because the safe harbor provision in the 1987 Medicare anti-kickback law excluded GPOs from criminal prosecution for taking kickbacks from suppliers.

“The more you can pay to a GPO, the more market share you get,” Zweig said.

Because of the exclusive contracts that GPOs award, the number of competitors in the market shrinks, which has led to a shortage of generic prescription drugs – everything from sterile injectables to chemotherapy agents. Continue reading

Reporting on how, why hospital superusers account for bulk of health-care spending

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.

Tim Darragh

Tim Darragh

Tim Darragh has written a “How I did It“ essay on his yearlong project looking at a community-wide effort to reduce hospitalization and ER use among a group of “superusers,” people who have complex medical conditions and use a whole lot of very expensive health care. Many have multiple medical problems, often including mental illness or other behavioral issues. We also wrote about his work a few weeks ago.

Darragh looked at a specific program financed under the Affordable Care Act in the Allentown, Pa., area. (He was at The Morning Call at the time. He recently moved to New Jersey Advance Media, which publishes The Star-Ledger and NJ.com.) But hospitals and health care systems across the country are looking at ways to reduce avoidable hospitalizations and rehospitalizations; the incentives are part of the ACA, and insurers are also demanding this to reduce costs. Addressing these patients’ needs before they become a crisis that lands them in the ER isn’t just a money-saver. It’s also better health. Continue reading

Taking a different look at readmission metrics, penalties

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 high-profile programs within the Affordable Care Act is the drive to reduce preventable hospital readmissions among the Medicare population. The program focuses on fee-for-service patients who came back to the hospital within 30 days. Hospitals in the third year of the program face a fine of up to 3 percent of their Medicare payments. Kaiser Health News analyzed the most recent CMS hospital data, and found more than 2,600 hospitals faced penalties in the last round and could lose $400 million.

Reducing unnecessary hospitalizations is a good idea, pretty much a slam-dunk quality move.

But is the readmissions program using the right metrics? Are hospitals that are doing all the right things cutting both readmissions and admissions – and therefore facing penalties because the proportion isn’t dropping, the readmission rate is the same share of the total admissions? Some new research suggests that may be the case. As Joanne Lynn, M.D., a geriatrician and prominent health policy researcher put it (and I’m paraphrasing), it’s the denominator, stupid. Continue reading