Category Archives: Hospitals

Covering hospital ratings? Here’s one aspect consumers need you to report #ahcj14

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.

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

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.

Hospitals rethink charity for those passing on Obamacare

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.

columbiahospitalThe 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?

It might.

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.

Continue reading

Simulating an emergency room response #ahcj14

Hoag Levins

About Hoag Levins

Hoag Levins is managing editor for digital publications at the Leonard Davis Institute of Health Economics (LDI), a center within The Wharton School at the University of Pennsylvania.

Photo by Hoag Levins

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.

Cost reports show financial health of hospitals, amount of charity care they provide

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.

Clifton Adcock

Clifton Adcock

Oklahoma Watch, a nonprofit investigative journalism team, recently published a two-part series on hospitals based on financial data obtained for every hospital in the state. As reporter Clifton Adcock writes in an article for AHCJ, the series revealed that between half and three-fourths of small general hospitals in Oklahoma were losing money, and that hospitals had spent only small fractions of their net patient revenues on charity care.

Hospitals get “disproportionate-share” (DSH) payments from the federal government to help cover costs for treating the indigent. Because Oklahoma was not expanding Medicaid under the Affordable Care Act, hospital groups said they expected to take a big financial hit from the law’s cuts to DSH payments. Oklahoma Watch wanted to see how much they relied on such payments. Continue reading

What really happens if hospitals lose ‘critical access’ status?

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.

David Wahlberg

David Wahlberg

In rural areas, the federal Centers for Medicare & Medicaid Services designates more than 1,300 hospitals as being “critical access hospitals.” So designated, these facilities get a bit more in reimbursements to ensure that Americans outside of cities and suburbs can get the care they need without having to travel too far. In August, a report from the Office of Inspector General of the federal Department of Health and Human Services recommended that 80 percent of these facilities be decertified.

When he learned of the report, David Wahlberg, a health/medicine reporter for the Wisconsin State Journal, interviewed administrators at critical access hospitals in Wisconsin and found that the administrators believed closing these hospitals would have a detrimental effect on care for Medicare patients. Continue reading

Should journalists cover hospital ratings?

Charles Ornstein

About Charles Ornstein

Charles Ornstein is a senior reporter with ProPublica in New York. The Pulitzer Prize-winning writer is a member of the Association of Health Care Journalists' board of directors and past president.

(Editor’s note: This was originally published on Ornstein’s Tumblr site and re-published here with his permission.)

Few things in health journalism make me cringe more than news releases touting hospital ratings and awards. They’re everywhere. Along with the traditional U.S. News & World Report rankings, we now have scores and ratings from the Leapfrog Group, Consumers Union, HealthGrades, etc.

I typically urge reporters to avoid writing about them if they can. If their editors mandate it, I suggest they focus on data released by their state health department or on the federal Hospital Compare website. I also tell reporters to be sure to check whether a hospital has had recent violations/deficiencies identified during government inspections. That’s easy to do on the website hospitalinspections.org, run by the Association of Health Care Journalists (Disclosure: I was a driving force behind the site.)

Last week, I got an email from Cindy Uken, a diligent health reporter from the Billings (Mont.) Gazette. She was seeking my thoughts on covering hospital ratings. I sent her a story written by Jordan Rau of Kaiser Health News about the proliferation of ratings. Two of every three hospitals in Washington, D.C., Rau reported, had won an award of some kind from a major rating group or company. He pointed out how hospitals that were best-in-class in one award program were sometimes rated poorly in another.

This got me thinking: What should reporters tell their editors about hospital rankings, ratings and awards. I sought advice from Rau, ProPublica’s Marshall Allen, Steve Sternberg of U.S. News & World Report and John Santa of Consumers Union. Here’s what they told me: Continue reading

Hospital inspections website, data updated

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 updated its hospitalInspections.org website and the downloadable version of the data to include reports through June.

Obtained from the Centers for Medicare and Medicaid Services, the database includes reports about deficiencies cited during complaint inspections at acute-care and critical access hospitals throughout the United States since Jan. 1, 2011. It does not include results of routine inspections or those of psychiatric hospitals or long-term care hospitals. It also does not include hospital responses to deficiencies cited during inspections.

The update added 919 records with inspection details, giving the database a total of 6,175 records. Some state health departments and CMS regional offices have lagged in uploading deficiency reports to the agency’s main database. CMS has identified the hospitals with missing reports, and they are labeled as such on hospitalinspections.org. CMS has committed to working with its regional offices and state counterparts to speed the uploading of inspection reports so that the public has access to this important information. The updated database includes 850 inspections lacking details.

AHCJ launched the free, searchable news application in March. The inspection reports have been configured by AHCJ to be easily searchable by keyword, city, state and hospital name. The website is open to anyone, but only AHCJ members have access to a downloadable version and additional resources to help users understand what is being reported and what is not. These caveats are important for putting the information into context.

Funding for the hospitalinspections.org project was provided by the Ethics and Excellence in Journalism Foundation.

Brill reminds New York AHCJ members to follow the money

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, Home Care Technology report and on HealthStyles Radio (WBAI-FM, NYC). She is a senior fellow at the Center for Health, Media & Policy at Hunter College, NYC, and a co-produces HealthStyles for WBAI-FM/Pacifica Radio.

AHCJ New York members gained a unique look this week into how journalist, author, and businessman Steven Brill researched and compiled his now-infamous 36-page Time Magazine articleBitter Pill: Why Medical Bills Are Killing Us.” The article took a hard look at the costs of hospital care in the United States – from the $70 box of gauze pads to a $50,000 up-front payment demand by one top cancer facility before doctors there would even evaluate a terminally ill patient.

That March 4 opus added fuel to an already contentious debate about the skyrocketing cost of U.S. health care. Brill emphasized the huge price discrepancies between what it costs hospitals and what they charge Medicare, private insurers, and direct-billed patients for identical care. “It was really a question of just doing some math,” he said.

Brill detailed his efforts to get satisfactory explanations from hospital CEOs about their multimillion dollar salaries while someone who had no health insurance was paying perhaps hundreds of dollars for a product that could be purchased in a local drugstore for pocket change.  He explained how he obtained copies of actual hospital bills – for hundreds of thousand of dollars in some cases – and how he tracked down and analyzed the price differentials charged to public, private and non-insured patients. Continue reading

CMS unveils dataset on top hospital discharge payments

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, Home Care Technology report and on HealthStyles Radio (WBAI-FM, NYC). She is a senior fellow at the Center for Health, Media & Policy at Hunter College, NYC, and a co-produces HealthStyles for WBAI-FM/Pacifica Radio.

The public can now compare hospital-specific charges for the top 100 most frequently billed discharges at the 3000+ hospitals across the US that receive Medicare payments.  The Center for Medicare and Medicaid Services unveiled its free Medicare provider charge dataset which can be analyzed down to ZIP code level.

Jonathan Blum, acting principal deputy administrator of CMS, said in a webinar with AHCJ members that this effort has been years in the making, as part of the agency’s effort to be more transparent.

Data for FY 2011 is on the AHCJ website, downloadable as an Excel file (a CSV file is available from CMS). From there, it can be sorted by diagnosis related group (DRG) codes, city, state, ZIP and charges. This tool allows journalists, advocates and consumers to compare costs nationally, between or among states, cities, or counties. Data is only available for Medicare Inpatient Prospective Payment System (IPPS) — the fee-for-service component — based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG). These DRGs represent almost 7 million discharges or 60 percent of total Medicare IPPS discharges. It does not include data for U.S. territories or Puerto Rico, or for any Medicare Advantage payments.

Chris Powers, acting director of the Information Products Group, Office of Information Products and Data Analytics demonstrated the dataset by comparing the varying cost of a total joint replacement. Selecting the specific DRG code netted charges ranging from $321,000 to just over $20,000.

The goal is to empower consumers, particularly those who are uninsured and may have to bear the entire cost, who may be underinsured, or who have a high deductible, to ask about appropriate charges  for a given procedure and question discrepancies that cannot be explained by geography, patient population, or affiliation differences. Medicare IPPS pays a fixed cost to hospitals, however, this data can be used as a guideline for non-Medicare fee-for-service charges.

In the Q&A section of the webinar, I asked if there would be a similar data set compiled for Medicare Advantage payments so consumers insured under those plans can also compare charges. Powers said CMS is looking at what the next steps are in terms of data release. “That is a very good question and certainly those concerns are in our minds as we make those considerations.”

Join today’s webinar on newly released hospital cost data

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.