But sometimes the spin is the study itself, and that’s a serious problem. It’s a big story that’s hiding in plain sight, to borrow a phrase Steven Brill likes to use.

By some estimates, half of clinical trials are unpublished. Half. And because positive studies are far more likely to be published than negative studies – a phenomenon called publication bias – the studies that don’t get published often throw some seriously cold water on how good a treatment looks.

If this research hasn’t been published, how do we know it exists? Some of these trials have been released because of lawsuits; others can be found in standardized documents called clinical study reports that drug companies file with the FDA and its counterpart, the European Medicines Agency. Regulatory agencies use them for their reviews, but because they’re never published in medical journals, they remain hidden to the medical community and general public.

For a case in point, consider the antidepressant reboxetine. Unpublished studies that were brought to light in a stunning 2010 meta-analysis in the British Medical Journal showed that Pfizer had failed to publish data – all of it negative – on 74 percent of patients who had participated in the clinical trials of the medication.

“Not only does the drug not work, it really doesn’t work,” wrote the blogger SciCurious in a guest post for Scientific American on the reboxetine revelations.

Hidden or unpublished clinical trial data also is at the heart of the recent questions about the effectiveness of the drug Tamiflu.

“This is a systematic flaw in the core of medicine,” said Dr. Ben Goldacre, a British physician and a leading scientific watchdog, in a 2012 TedMed talk. “This is a disaster. We cannot know the true effects of the medicines we prescribe if we do not have access to all the information.” Goldacre also is a driving force behind the AllTrials campaign, an Internet petition that aims to raise awareness about the issue.

Various remedies for the problem have been tried with limited success. Starting in 2008, the FDA Amendments Act required reporting of all clinical trials of drugs, devices, and biologics with at least one study site in the United States within a year of the study’s completion.  But a 2012 study in the BMJ found that only 22 percent of the trials subject to the new regulation have complied with the law.  A separate analysis, published in Pediatrics, found some companies were shutting down trials with negative results early in an apparent attempt to skirt reporting requirements. Proposed legislation clarifies that the law applies to trials regardless of their outcome. Well, duh. But thanks anyway, D.C.

Pharmaceutical companies have also repeatedly pledged to police themselves when it comes to reporting all their data.

Now some of the same researchers who have been working to release unpublished Tamiflu data think they may have found a fix. If studies are missing or misrepresented in the medical literature, they say outside authors should be able to publish or correct that research. In a paper and editorial published last week in the BMJ, the researchers dub this concept RIAT, for Restoring Invisible and Abandoned Trials.

In a sense, they’re calling for medical ghost writers, except these authors would get credit for their efforts and wouldn’t be paid by the trial sponsors. They’ve laid out a detailed plan for how outside authors can responsibly publish another researcher’s work.

RIAT could solve problems on several fronts. Young investigators, who are often under intense pressure to publish to further their careers, could find plenty of readymade data to dive into in these orphaned or ghost studies. That might help stem the rising tide of scientific fraud and could perhaps also put a dent in the raft of weak and unreliable data that’s picked up by predatory or junk journals.

“RIAT is about cleaning up the scientific evidence,” said Peter Doshi, Ph.D., a postdoctoral fellow in comparative effectiveness research at Johns Hopkins University School of Medicine in Baltimore, Md.  “Really, I hope this can start to set a new standard,” he said.

Doshi and his co-authors say they have already identified more than 178,000 pages of unpublished data on common drugs such as Relenza, Seroquel and Plavix. In some cases, these are not small, inconsequential studies. Studies that remain unpublished include the largest trial ever conducted on Tamiflu and the largest study of the drug gabapentin, sold under the brand name Neurontin, for diabetic neuropathy. In other cases, studies that have been published appear to be incomplete because they don’t include missing data.

So far, three medical journals, the BMJ, PLoS One and PLoS Medicine, have signed on to the idea and agreed to consider RIAT manuscripts, provided that authors first follow certain steps designed to give the original researchers a chance to set the record straight themselves.

The initiative is important, the journal editors write, because “public confidence in the credibility of medical research is at a low ebb.”

So keep an eye out for RIAT studies. Let’s hope enterprising authors embrace the concept and take advantage of the offers made by these journals to publish the work.

Because when we’re only getting seeing half of the studies, we’re only getting half the story.

Image by pennstatenews via flickr.

Is your local hospital a NICHE facility?

Nurses Improving Care for Healthsystem Elders is a nurse-driven program aiming to improve quality of in-patient care for older adults through its focus on geriatric issues, staff competence, and hospital-wide protocols for geriatric care.

The NICHE program provides facilities with the latest training, tools, and resources, including evidence-based protocols, to improve clinical outcomes, enhance nursing competencies, boost patient satisfaction, and better support their communities.

According to the organization, hospitals that obtain NICHE designation demonstrate the leadership, organizational commitment and cultural competency to achieve patient-centered care.

The program began at the NYU College of Nursing in the early 1980s and grew to some 450 participating hospitals and acute care facilities in the United States and Canada.  Institutions develop and implement their own changes in nurse-driven geriatric care using NICHE-provided tools, resources, project management approaches and best practice solutions, from medication safety to family communication, to catheter removal.

Two issues on a collision course make initiatives like NICHE valuable.First, hospital staff must continually improve their understanding of geriatric care needs; especially as more boomers reach their senior years. The older population (65+) grew by 15 percent, or 5 million people, in the past decade. It’s projected to soar another 36 percent by 2020, and by 2030, there will be twice as many older adults as there were in 2000.

Second, hospitals are under increased pressure to reduce preventable admissions and avoid readmissions at less than 30 days after discharge or face stiff penalties. NICHE gives geriatric care nurses regular, in-service training, to become leaders in care of older adults.

Talking to nurse managers at acute care facilities with NICHE designation may generate to some interesting story possibilities. Among them:

• Quality, outcome, patient satisfaction benchmarks
• Changes in 30-day readmission rates for common ailments such as pneumonia, heart problems, falls.
• Challenges in implementing organizational change
• Specific population-based opportunities and challenges — are staffing levels of geriatric care nurses adequate, how have doctors or other interdisciplinary team members responded to nurses taking a lead role, has this initiative boosted the hospital’s reputation in the community for geriatric care?
• Profiles of outstanding geriatric nurses, top leaders, or satisfied patients

You can also examine community outreach programs, advocacy or policy efforts, or speak with recently admitted/discharged older adults and family members about their experiences.

For more information:

• Hartford Institute for Geriatric Nursing
• Niche Hospitals Report Launch Announcement and Summary Report
• Choosing a NICHE hospital (brochure) Rochester Medical Center
• NYC Health & Hospitals Corporation announcement, NICHE status
• One Hospital’s NICHE Journey (article)

Six of the 12 director positions come up for election each year for two-year terms. Incumbent board members are allowed to run for re-election.

Service on the board is a serious commitment. It has commensurate rewards (but no pay). In addition to participating in two in-person board meetings each year and occasional conference calls, board members are responsible for making decisions about association policies and statements, as well as working with the executive director on training projects, financial matters and other efforts to achieve AHCJ’s strategic goals.

Board members take on committee duties and contribute to association activities, including fundraising, advocacy, helping plan sessions at training events, membership outreach and writing/editing contributions. They may be asked to play a role in other association projects that arise. They also are asked to show their support through an annual donation to the Center for Excellence in Health Care Journalism, although there is no minimum required.

Read more about running for the board.

Image by ktpupp via flickr.

New research is suggesting that while people at high-risk of periodontal disease should visit the dentist at least twice a year, others at lower risk may be fine with an annual checkup.

The new findings, just published in the Journal of Dental Research, raise questions about the standard six-month recall for all adults, suggesting instead an approach that stratifies care according to risk. In an era where health costs are skyrocketing, the researchers say their findings could cut wasteful spending and better target care.

“Prevention reduces tooth loss, but little evidence supports biannual preventive care for all adults,” concluded the researchers, led by William Giannobile, D.D.S., M.S., D.M.Sc., chairman of the department of periodontics at the University of Michigan School of Dentistry, in the article “Patient Stratification for Preventive Care in Dentistry.”

In a June 10 piece for The New York Times, “Rethinking the Twice-Yearly Dental Visit,” Katherine Saint Louis reported on the findings.

“For decades, dentists have urged all adults to schedule preventive visits every six months. But a new study finds that annual cleanings may be adequate for adults without certain risk factors for periodontal disease while people with a high risk may need to go more often,” she wrote, noting that almost half of Americans age 30 and older have periodontal disease which can lead to tooth loss.

“The findings suggest that for low-risk patients, a yearly prophylactic visit does prevent tooth loss over a protracted period of 16 years, and there’s no significant difference in an added visit,” Dr. Robert J. Genco, a periodontist and SUNY distinguished professor of oral biology at the University at Buffalo, who was not involved in the study, told Saint Louis. “They found if you had more than one risk factor, that maybe two visits isn’t optimal.”

The team evaluated 16 years worth of insurance claims for 5,117 adults to determine whether tooth loss could be linked to once- or twice-annual dental visits in patients at varying risk of disease. Patients were determined to be at high risk it they had diabetes, were smokers, or had certain variations in the interleukin-1 gene, which some studies have suggested may be linked to periodontal disease. Low-risk patients did not have any of those factors.

Researchers found that statistically speaking, low-risk patients fared as well whether they got one visit a year or two. But for high-risk patients, the frequency of preventive visits seemed to make a significant difference. Slightly more than 22 percent of the high-risk patients who got one visit a year had a tooth extracted, compared with roughly 17 percent who had two visits a year.

“If you are high risk, it is much more important for you to be seen frequently, but for the low-risk people it’s not,” Giannobile noted in the Times.

“The take-away is not that you don’t need to see the dentist, it’s that each patient needs to be treated in their own individual way,” he added.

Saint Louis wrote that two authors of the study own shares in Interleukin Genetics, the company that makes the genotype test for interleukin-1. The company helped finance the study along with the National Institutes of Health, she added..

One critic of the study noted that research did not address the subjects’ oral hygiene which plays an important role in tooth retention.

“Nonetheless,” Saint Louis wrote, “ he praised the research because it “sounds the signal that it is time to make dentistry more individual and more personalized” and added, “We ought to be able to tailor the treatment to the need.”

Photo: Carla K. JohnsonJulie Goldstein, M.D., Martha Twaddle, M.D., Mary Mulcahy, M.D., and Randi Belisomo (left to right) discussed end-of-life care at an AHCJ Chicago chapter event on June 11.

A series of chats between two women on side-by-side elliptical trainers at a health club led to the founding of a nonprofit organization dedicated to raising awareness about end-of-life care.

On one machine was Randi Belisomo, a WGN reporter in Chicago and now a member of AHCJ. Beside her was Northwestern University oncologist Mary Mulcahy, M.D., who had treated Belisomo’s husband, political reporter Carlos Hernandez Gomez, as he died of colon cancer at age 36.

Belisomo and Mulcahy told the Chicago chapter of AHCJ how they co-founded Life Matters Media to spread the word about the importance of planning ahead to make one’s wishes known about medical care and quality of life before one’s death.

“We like to take the stance there’s no right or wrong in end-of-life decision making,” Belisomo said. “There’s only decision making.”

Photo: Carla K. JohnsonJulie Goldstein, M.D., and Martha Twaddle, M.D., discussed palliative care and hospice.

Life Matters Media intends to be a resource for journalists who want to tell stories about death and dying in the U.S. health care system.

“What I’ve learned through these stories is they really have the power to touch people,” said Belisomo, acknowledging that pitching a story about the end of life can be a tough sell to a producer or editor, despite its rich context of cost, policy and politics.

Belisomo and Mulcahy are now friends. Mulcahy, the oncologist, said there was one comment in particular from Belisomo as they exercised at their health club that shaped the way she now speaks to patients and their families. Belisomo told her that instead of saying that her husband was “going to die,” she should have said, “He’s dying.”

It’s easier, somehow, to tell a family that their loved one is “going to die,” Mulcahy said. “It’s nebulous. It’s out there.” But to say a patient “is dying” has the power to change the conversation.

Photo: Carla K. JohnsonMark Taylor introduces WGN reporter Randi Belisomo, co-founder of Life Matters Media

Two other speakers at the June 11 chapter event – Martha Twaddle, M.D., medical director of Midwest Palliative & Hospice CareCenter, and Advocate Illinois Masonic palliative care physician Julie Goldstein, M.D., – talked about what can happen next after that crucial recognition of dying: palliative care and hospice.

Reimbursement issues came up repeatedly. The speakers expressed guarded optimism that getting away from a fee-for-service funding model – as encouraged by the Affordable Care Act – may help encourage more direct conversations about dying between doctors and patients.

AHCJ member and independent journalist Mark Taylor organized the event and moderated the panel discussion at Columbia College in Chicago.

Photo: Andrew M. Seaman.

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 article “Bitter 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.

“The media was full of reports about the high cost of health care,” Brill said. “What no one was asking was why it was so high in the first place?” So he decided to take an in-depth look at actual bills sent to several patients around the country.

“I was amazed at the costs, which seemed to have no rationale behind them,” he said. “And I was disturbed to learn just how high the hospital profit margins are for basics like Tylenol and bandages, let alone screening tests like CT scans.”

Worse, Brill said, was that an examination of 990 forms revealed the exorbitant CEO salaries at many teaching hospitals – often several times more than the president of the university they were affiliated with. It took Brill weeks, or sometimes months, to get on-the-record comments from institution executives.

“I had the bills, so they couldn’t dispute the facts,” he said. He reminded the audience that “no comment” does not mean “no access.” Eventually several hospital executives did speak with Brill – reluctantly – to rationalize their paychecks. As he wrote in the article, they could not explain why “a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down? “

He told members that while it’s good that more people will have health insurance under health reform, the Affordable Care Act is missing the point because it doesn’t address these high costs and profit margins. While Medicare pays less than private insurance, and private insurers pay many times less than direct-billed patients do for the same chargemaster items, information must be made more transparent.

“Our job is to report it,” he said. “The public must see it and demand change. If these costs are not curtailed, they’re only going to keep rising.” He would like to see more reporting on the connection between lobbying and policy, especially on the money going to Congress to enact legislation favorable to drug companies and hospitals. The public has to get “pissed off” and the press needs to help draw the connection between the two, he said.

In a brief Q&A following the presentation, Brill discussed CMS efforts to post charge data [good start but needs to go further], more about the development of the article [a total of six months to compile and write, including many dead-end calls, privacy issues, and connecting the dots ]. He also spoke about additional health topics journalists need to emphasize, including malpractice reform, drug labeling, direct-to-consumer advertising by insurers and drug companies.

Whatever the issues are in health care, it all comes back to money, he said. “Why does it cost so much?”

Steve Beale, editor of Bulldog Reporter’s Inside Health Media and news editor for Bulldog Reporter, is writing a column for Daily Dog called “Deskside.”

Independent journalist Laura Beil won a first-place award from the American Society of Journalists and Authors in the category of “Reporting on a Significant Topic” for her Men’s Health story “The Dirty Truth About Hospitals.”

Susan Brink’s book, “The Fourth Trimester: Understanding, Nurturing, and Protecting an Infant Through the First Three Months,” was published by the University of California Press.

Yolanda (Linda) Reid Chassiakos, M.D., director of the Klotz Student Health Center at California State University, Northridge, is a co-author of “New Leadership for Today’s Healthcare Professionals.”

Elbert Chu is now an associate producer at MedPage Today.

Daniel J. DeNoon, formerly at WebMD, is now executive editor of the Harvard Heart Letter.

Coshandra Dillard, a staff writer at the Tyler (Texas) Morning Telegraph, received an Anson Jones, M.D., award from the Texas Medical Association in the category of publications with circulation less than 100,000. The award was for reporting on a program that promotes healthy habits in children. She also recently earned a third place award from the Texas Associated Press Managing Editors for her feature series on the 75th anniversary of the New London school explosion.

Bob Finn has left Medscape Medical News, where he had been assignment editor, to join the Accelerated Cure Project for Multiple Sclerosis as executive editor of the MS Discovery Forum.

The “Labor Pains” series written by John George, senior reporter at the Philadelphia Business Journal, won the grand prize for public service presented by the Philadelphia Press Association and a first-place award for investigative reporting from the Pennsylvania NewsMedia Association. He was the first journalist honored by the Maternity Care Coalition with its annual “Spirit of Motherhood Award” for the series. The series, which looked at the impact of maternity ward closings on obstetrical care in and around Philadelphia, was the result of George’s selection to be part of the 2012 AHCJ Reporting Fellowships on Health Care Performance.

Kristin Gourlay, a health care reporter at Rhode Island Public Radio, received a regional Edward R. Murrow Award for her 10-part documentary series about medical education and the future of health care, “Future Docs.”

Shuka Kalantari, previously the health outreach coordinator at KQED-San Francisco, is now a freelance reporter. She will be reporting for KQED, PRI’s The World, BBC World News Service, and other radio and online media outlets. She received the International Center For Journalists “Bringing Home the World: International Reporting Fellowship Program for Minority Journalists,” for which she will travel to Canada and Turkey to report on health and social issues affecting Iranian refugees who are sexual minorities.

Richard Kipling will take over the California HealthCare Foundation Center for Health Reporting in June, when current editor David Westphal retires. The Center, based at the University of Southern California, partners with local news organizations to produce in-depth coverage of health issues. For nearly 25 years, Kipling was an editor at the Los Angeles Times.

Dirk Hanson’s fourth book, “Addiction Inbox: Cutting-Edge Research on Drugs and Dependence,” was published by CreateSpace in April.

Whitney Howell was awarded a press fellowship to cover the 66th Annual World Health Assembly, hosted by the United Nations Foundation and the World Health Organization, in Geneva.

Roma Lightsey graduated from the University of Alabama at Birmingham with a master’s degree in clinical research management. She is now an adjunct faculty nursing instructor at Fortis Institute in Birmingham and continues to write health and medical articles.

Maryn McKenna was awarded the June Roth Memorial Book Award and an honorable mention for the Donald Robinson Award for Investigative Reporting, both from the American Society of Journalists and Authors. McKenna was Science Writer in Residence for spring 2013 at the University of Wisconsin.

Jennifer Ringler has completed a master’s degree in health communication through the distance education program at Boston University.

Wally Roberts has been awarded a fellowship by Investigative Reporters and Editors to support research of a book on the nursing home industry.

Margot Sanger-Katz, a health care correspondent for National Journal, has been named a Knight-Bagehot Fellow in economics and business journalism by the Columbia University Graduate School of Journalism.

Nazli Senyuva, a medical researcher for The Dr. Oz Show, has been accepted into Columbia University’s Journalism School to pursue a master’s degree in health and science journalism next year.

Curtis Skinner was chosen by the Kaiser Family Foundation as the summer health reporting intern for 10 weeks at The Philadelphia Inquirer. After his internship, he will start a Reuters nine-month traineeship in New York City.

Sarah Jane Tribble is now a health reporter at ideastream, Cleveland’s local NPR affiliate. She was most recently a reporter at The Plain Dealer.

Kelly Tyrrell won a Maryland-Delaware-DC Press Award for a story or series of stories that she wrote last year in The (Wilmington, Del.) News Journal.

Matthew Weinstock was promoted to assistant managing editor of Hospitals & Health Networks. He’s been with the publication for nearly 10 years. In his new role, Weinstock adds management of H&HN Daily to his responsibilities. He received the 2013 McAllister Editorial Fellowship, jointly awarded by the Association of Business Information & Media Companies and Northwestern University’s Medill School of Journalism, and will serve as a guest lecturer at Medill in the fall. H&HN was named “Publication of the Year,” by the American Society of Healthcare Publication Editors.

Karen Weintraub, a freelance health and science journalist has written a book, “Fast Minds: How to Thrive if You Have ADHD (Or Think You Might),” with psychiatrists Craig Surman and Tim Bilkey. The day after its Feb. 5 publication, it rose to #14 on the Amazon best-seller’s list in Canada, right below “How to Tell If Your Cat Is Plotting to Kill You.” Her first book, “The Autism Revolution,” co-written with Harvard pediatric neurologist Martha Herbert, came out in paperback in March.

Theheart.org, under managing editor Shelley Wood, was named “Best Website” in the American Society of Healthcare Publication Editors 2013 Awards.

Amy Yee, a freelance journalist based in New Delhi, India, who focuses on development, business approaches to reducing poverty and stories with social impact, has been named a Knight-Bagehot Fellow in economics and business journalism by the Columbia University Graduate School of Journalism.

Three of his main points – understanding the health law is not just a Washington story, knowing what to cover and finding solid resources to get at the facts instead of contrived “balance” – are topics we try to address on Covering Health and on the AHCJ health reform core topic site. Balance is fine – fair and essential – in complex stories where there are many points of view, different ideologies, and legitimate questions about how the health law will unfold over time.

It’s not “balance” if there is clear, solid data on a specific topic, and another side gets equal time just because they don’t like it (or because your editor insists that it get equal time).  Knowing what’s in the law, what it does and what it doesn’t do, helps us report with authority and find that balance.

The aspect I want to address here, related to the “balance” question, is what Altman calls “judgment by anecdote.” Here’s what he’s worried about:

“Critics will feed reporters ACA horror stories and supporters will sell them success stories.

Every journalist will be able to find a bad ACA story or a good one.

When does “one” person’s experience represent “many,” or “most”? The gold standard is to take examples from a statistically representative group using a scientifically valid survey, but that’s just not going to happen very often with reporters working under deadlines.

Journalists will need to do interviews, check with experts, scrape together what early data exist and make judgment calls about whether the anecdote they have is an outlier or representative of broader experience.

Let’s say Bill Smith in Arkansas chains himself to the IRS building and refuses to pay his fine in protest of the law’s requirement that Americans buy health insurance, but that overall, the mandate works smoothly, as it has in Massachusetts. No doubt, Smith will be “breaking news” on your favorite cable channel. With complex stories like ACA, there is a temptation to cover only breaking news and not the broader story. These news judgments matter because powerful anecdotes stick in the public mind in ways statistics never will.”

All of us reporting on implementation of the Affordable Care Act already are dealing with this.  Haven’t we all heard anecdotes about people blaming higher health care costs on the health law, even though most of it’s not yet in effect and costs were rising long before the law was passed –  at an even faster rate. We’ve all heard anecdotes of people blaming gaps in coverage on the health law – even though generally there will be more benefits and consumer protections. And we’ve had an anecdote avalanche of businesses saying they are cutting back their work force because of the health law – even though the trend to more part-time workers has been going on for years. I don’t mean that the law isn’t a factor in workforce composition or certain industries and, for certain businesses, it is.

But all this shows the danger of reporting by warring anecdotes. You need context, knowledge and experts who can help you provide both.

• Ken Alltucker, health reporter, The Arizona Republic, Phoenix  (@kalltucker)
• Chinyere Amobi, student, Tufts University, Somerville, Mass.  (@chinyereamobi)
• Jennifer Edwards, staff writer, Times Daily, Florence, Ala.  (@td_jedwards)
• Eric Griggs, independent journalist, New Orleans (@docgriggs1)
• Kate Harrison, reporter, Chattanooga Times Free Press, Chattanooga, Tenn.  (@katejharrison)
• James Kling, independent journalist, Bellingham, Wash.  (@jimkling)
• Mike Oliver, health care reporter, The Birmingham News/AL.com, Birmingham, Ala.  (@mikeoliveral)
• Maria Ortiz-Briones, health reporter, Vida en el Valle, Hanford, Calif.  (@TuValleTuSalud)
• LaQuita Owens, managing editor, OTI Communications, Birmingham, Ala.
• Molly Rosbach, health reporter, Yakima Herald-Republic, Yakima, Wash.

If you haven’t joined yet, see what member benefits you’re missing out on: Access to more than 50 journals and databases, tip sheets and articles from your colleagues on how they’ve reported stories, conferences, workshops, online training, reporting guides and more. Join AHCJ today to get a wealth of support and tools to help you.

Photo by ianus via Flickr

The new health insurance exchanges mandated by the Patient Protection and Affordable Care Act are required to offer pediatric dental benefits. 

But what procedures will be covered under the plans being offered in the states?

Will the benefits be affordable?

Will families actually buy them?

Three million children are expected to gain dental coverage through these insurance marketplaces over the next five years, according to the American Dental Association.

But states are still in the process of integrating dental benefits into the coverage that will be offered when their marketplaces open in the fall.

Oral health advocates, who fought hard for the inclusion of pediatric dental benefits under health care reform, are paying close attention to the process.

Each state is required to decide upon a benchmark insurance plan that sets standards for coverage by insurance carriers participating in the state insurance exchange.

The states have latitude in choosing their benchmarks. The benefits being offered will vary.  So will the carriers selected, and the details of the plans that will be offered. Then there is the fact that dental insurance is nearly always sold separately from medical insurance.

That gap remains under the ACA and, with it, the worry, at least among some oral heath advocates and legislators, that the cost of dental care may remain out of reach for the families who need it most.

Groups including the Children’s Dental Health Project and Community Catalyst are concerned that federal tax credits intended to help qualifying families buy insurance will not be sufficient to cover the cost of stand-alone dental insurance.

Then there are the separate out-of-pocket limits for dental care that can be incurred over and above the limit set for other health benefits. A group of U.S. senators, led by Maryland Democrat Ben Cardin, has objected to a proposal by the Centers of Medicare and Medicaid asserting that a separate out-of-pocket limit of up to $1,000 per child for dental services be considered “reasonable” in the federally facilitated exchanges taking shape in many states.

The answers may take a while to become clear, but now is a good time to try to find out more about what is going on with pediatric dental benefits in your state’s health insurance exchange.