Category Archives: Hospitals

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

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 ‘superusers’ in Pennsylvania

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:

Continue reading

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.

Continue reading

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.