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.
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.
Health 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.
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 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 …
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.
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
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
Photo: Pia ChristensenA Health Journalism 2014 panel about hospital rankings included (left to right) Evan Marks of Healthgrades, Marshall Allen of ProPublica and John Santa, M.D., of Consumer Reports.
If you were at Health Journalism 2014, you might have heard that things got interesting on Saturday when journalists questioned panelists who represented hospital ranking services about their business practices.
Tony Leys, a reporter for the Des Moines Register, was in the audience for “Hospital grading: Reporting on quality report cards” and asked Evan Marks, the executive vice president of informatics and strategy for Healthgrades, how much hospitals pay his organization to be allowed to advertise their ratings. Marks refused to answer the question.
After the panel, Leys pursued the question and got some details that all reporters should be aware of when they consider writing about hospital rankings, including some concrete data on how much hospitals are paying in “licensing fees” to ratings services. You might use his technique to find out how much some of your local hospitals are paying.
Read this tip sheet to find out more.
The basic calculation uninsured people had to make this first open enrollment season in the ACA is whether to get covered – or take the risks of going without health insurance and pay a penalty (unless they are exempt.)
After all, some of them probably figure, they have managed to get discounted or charity care in the past. Why should that change?
Some hospitals are pondering changes in their policies about how to treat the uninsured, according to an interesting article by Melanie Evans that appears in Modern Healthcare.
The changes they are thinking about won’t affect emergency care; under the Emergency Medical Treatment & Labor Act (EMTALA) hospitals have to stabilize someone coming in with an emergency. But it does affect what they may charge people for care, and how and when they provide non-urgent care.
Photo by Hoag Levins
Thursday’s field trip to the University of Colorado Anschutz Medical Campus included a visit to the School of Medicine’s health simulation facility, the Center for Advancing Professional Excellence. As part of that visit, AHCJ members were selected to try their hand at treating a computer-controlled dummy patient. This photo shows three of them in the simulation “emergency room” with a dummy industrial-accident patient. They are:
In the hard hat, Rachel Roubein, a health reporter at the Carroll County Times in Westminster, Md., is playing the role of “friend or family member” who delivered the patient to the ER and then became obnoxious, creating an added stress level under which medical personnel had to work.
Joey Failma, in the green scrubs, is a CAPE staffer playing the role of ER doctor.
Marijke Vroomen-Durning, in the middle, is – in real life – a registered nurse and an independent journalist from Montreal, Quebec, playing the part of an ER nurse.
Margarita Cambest, in the white coat, is a staff reporter at the Kentucky New Era in Hopkinsville, Ky. She is acting as a nurse’ aide keeping pressure on a severely cut leg.
With control room computers changing the patient’s condition to dire, and the monitors showing his rapidly declining biometrics, the scene was a frantic, but educational, one. In the end the patient died and the AHCJ members left with a much better sense of both the importance of clinical simulators in the medical education process as well as the kind of often-excruciating stress ER clinicians must work in.