Tag Archives: doctors

Chicago members learn about changing end-of-life conversations

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.

Julie 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.

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.” Continue reading

Medicare data shows dangerous prescribing habits, lack of oversight

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.

ProPublica’s Tracy Weber, Charles Ornstein and Jennifer LaFleur, in an analysis of Medicare prescription records, found that “some doctors and other health professionals across the country prescribe large quantities of drugs that are potentially harmful, disorienting or addictive,” with no attempt by the federal government to monitor or deter the practices.

“… officials at the Centers for Medicare and Medicaid Services say the job of monitoring prescribing falls to the private health plans that administer the program, not the government.”

Continue reading

All in the family: When medical experts disagree #ahcj13

Stephanie O'Neill

About Stephanie O'Neill

Stephanie O'Neill is a health care reporter at KPCC-Los Angeles. She is attending Health Journalism 2013 on an AHCJ-California Health Journalism Fellowship, which is supported by The California HealthCare Foundation.

Photo by Len BruzzeseJerome Groopman and Pamela Hartzband.

Oncologist Jerome Groopman and endocrinologist Pamela Hartzband both attended Ivy League medical schools. He went to Columbia. She went to Harvard. They both spent their residencies at Massachusetts General. They’re both Jewish. And they’re husband and wife.

But ask them their opinion on a particular medical treatment and you’re likely to get the opposite advice. Continue reading

Using data to track doctors’ referrals, relationships #ahcj13

Jason Hidalgo

About Jason Hidalgo

Jason Hidalgo is a business reporter at the Reno (Nev.) Gazette-Journal. He is attending Health Journalism 2013 on an AHCJ-Healthier Beat Fellowship, which is supported by the Leona M. & Harry B. Helmsley Charitable Trust.

Fred Trotter

Photo by Pia ChristensenFred Trotter.

Going online is usually a great way to waste time or — for adventurous social media users — get in trouble.

For resourceful journalists, however, the Internet is a treasure trove of information that can be invaluable for reporting. These include providing access to open-source tools such as DocGraphs, which can provide crucial data that may not easily be available anywhere else.

A crowdfunded project from open source developer Not Only Dev, DocGraphs aims to shed light on the relationships between various medical providers, and make that information more accessible to the public. Examples include which doctors and medical centers a specific doctor refers patients to or which laboratories a physician group tends to use. Continue reading

Member uses data to track doctors’ referrals; AHCJ members get a first look

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.

AHCJ member Fred Trotter publicly unveiled a major data set last week that could reshape how journalists report on medical professionals. At the Strata Rx conference in San Francisco, Trotter showed off data he received from the U.S. Centers for Medicare and Medicaid Services that could show the relationships among physicians, as well as their referral patterns.

Fred Trotter
Fred Trotter has agreed to let AHCJ members have access to his development website so they can look up specific doctors. To access it, click here and login to the AHCJ site.

Trotter plans to release the full data set and the search tool to the public at a later date (see below). Trotter answered some questions from AHCJ President Charles Ornstein:

Q. Tell us about the data set you just unveiled.

A. This is the social graph of medicine. It is the referral patterns for most of the doctors, hospitals and labs in the country, based on a FOIA request for Medicare data. For any given physician in the United States, there is a good chance that this data set reveals what other doctors, hospitals and labs they typically work with.

Q. How could it be useful for journalists?

A. Using the data, journalists will be able to figure out “who to gumshoe” for health care stories.

Some ideas:

●     You have a “bad doctor” story. This works for crime, fraud, etc. Who was referring patients to that doctor, what hospital was he or she working with? At the least, the people you identify would be interesting to interview. At worst, these people may be co-conspirators.

●     Who are the best doctors in your city? Who is the best local resource to interview about cardiology, neurology, etc. Specialists who have lots of inbound referrals from different doctors implicitly have the respect of other doctors in the community.

●     By grouping doctors by hospital referrals, it will be possible to see which ones are “aligned” with different hospitals. It is also possible to measure how exclusive this affiliation is. Most local health care reporters have an intuition of how the local health care market operates, but this will provide specific details.

●     By working with data scientists we can make lots and lots of pretty diagrams to support journalistic assertions. Continue reading

Patients paying for confusion over prevention vs. treatment under ACA

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.

Under the Affordable Care Act, certain high-value preventive services – such as colonoscopies – are supposed to be free. No co-pay for the patient.

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But some patients are getting charged when they don’t expect it and perhaps shouldn’t be.

And there is a lot of inconsistency on who gets charged, depending on individual circumstances, what state they live in and what health plan they have. Part of it is confusion about what constitutes “screening” and what constitutes treatment. Plus doctors vary in how they “code” and bill for these services.

The variance is not just based on the individuals’ health circumstances (i.e. whether they had a polyp or not), but what state they live in, what health plan they have. The whole thing is generating confusion and complaints – and it’s a good story.

The thinking behind making preventive care free – specific preventive services, graded A or B by the U.S.  Preventive Services Task Force (USPSTF) – is that it makes it more accessible. It’s easy to put off – and put off and put off – screening. Research has shown that having to pay for it is an additional barrier.

The Kaiser Family Foundation, the American Cancer Society and the National Colorectal Cancer Roundtable just put out a report examining the problem. Three scenarios seem common: Continue reading

Berwick reminds next class of doctors of their responsibility

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.

Several weeks ago I got an email from a Democrat on the Hill that said, “This might make you cry, right there at your desk.” She attached  an essay by Donald Berwick in the Journal of the American Medical Association.



Donald Berwick

I  saved the email but didn’t open it right away. It was a busy day  in a busy month; I’ve heard Berwick speak often, during and after his stint as the head of the Centers for Medicare and Medicaid and when I was lucky enough to attend Institute for Healthcare Improvement conferences and  hear  his soaring, provocative keynotes.  And I had just spoken to him myself a week or so earlier, after the Supreme Court ruling.  I promised myself I’d read this. But later.

August finally arrived, work quieted down (sort of) and as I was trying to slash and delete  my way through the email jungle, I found the Berwick essay.  I clicked.  The person who sent it had been right. I cried right there at my desk.

It was his commencement speech to the graduating class of Harvard Medical School this spring, and it seems on the 40th anniversary of his own HMS graduation.

“You will soon learn a lovely lesson about doctoring; I guarantee it. You will learn that in a professional life that will fly by fast and hard, a hectic life in which thousands of people will honor you by bringing to you their pain and confusion, a few of them will stand out. For reasons you will not control and may never understand, a few will hug your heart, and they will become for you touch points – signposts – like that big boulder on that favorite hike that, when you spot it, tells you exactly where you are. If you allow it – and you should allow it – these patients will enter your soul and you will,  in a way entirely right and proper, love them. These people will be your teachers.”

One of his teachers was a patient he called  Isaiah. Continue reading

Disciplined doctors in Conn. continue to get drug industry payments

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.

Lisa Chedekel of the Connecticut Health I-Team reports that, even as doctors are investigated and disciplined for violating medical conduct rules – including over-prescribing – they have collected thousands of dollars from pharmaceutical companies for meals, speaking or consulting work.pills-and-money

Chedekel used records from Connecticut’s Department of Public Health and public disclosures from pharmaceutical manufacturers: “A check of physician records shows about a dozen Connecticut doctors receiving drug company benefits either shortly before or after being sanctioned by the state for various offenses.”

Her reporting reveals a doctor received payments from three drug companies while he was being investigated for allegations that he over-medicated patients. Some of the payments continued after his license was suspended. Another doctor got payments from four companies while “federal prosecutors were investigating allegations that he wrote out 11 illegal prescriptions for controlled substances.”

Other doctors reaping the benefits from drug companies were disciplined for things that included failing to provide proper post-operative care, referring a patient for an MRI despite the fact the patient had a pacemaker, over-prescribing narcotics, allowing unlicensed employees to practice medicine and nursing and more.

Currently a dozen pharmaceutical manufacturers publicly disclose their payments to physicians. As Chedekel points out, many do so as the result of legal settlements with the government. Beginning in September 2013, such payments will be posted online in accordance with the Physician Payment Sunshine Act, though it’s not yet clear exactly how the law will be implemented.

Chedekel notes that ProPublica’s Dollars for Docs investigation also has revealed payments to doctors who had been accused of professional misconduct, had been disciplined or lacked credentials.

AHCJ calls for accessible reporting of physician payments

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 Centers for Medicare & Medicaid Services should create an easily usable and searchable database when it publishes information from drug and device makers about payments to physicians, according to comments (PDF) submitted by the Association of Health Care Journalists  on proposed rules for carrying out the Physician Payment Sunshine Act.

The act will open a window on financial relationships between physicians and industry. Starting in 2013, pharmaceutical and device manufacturers must report to CMS any “transfer of value” worth more than $10 to a physician, and CMS will post the information online.

“Overall, we believe your regulations would faithfully enact the provisions of the Payment Sunshine Act,” AHCJ President Charles Ornstein wrote. “To serve its purpose, the information must be easily accessible to anyone who wants to know about an individual doctor or doctors in a community, as well as for researchers and reporters seeking a larger view.”

The law comes in response to growing concerns that industry payments to doctors can skew prescribing decisions and encourage use of brand-name drugs.

AHCJ made several specific recommendations: provide unique identifiers for each physician, note when a company updates its information, include gifts of textbooks and educational materials in the reporting requirements, and include partial data from 2012.

Additionally, the association noted that because the law applies exclusively to physicians, companies do not have to disclose payments to nurse practitioners and physician assistants. AHCJ urged CMS to consider reporting payments to non-physician prescribers who work in group practices with physicians.

Related

The Pew Prescription Project has a collection of documents about the Physician Payment Sunshine Act.

Secrecy around data bank protects ‘Practitioner No. 222117′

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.

Alan Bavley of The Kansas City Star provides us with a stark illustration of why new restrictions on the use of the National Practitioner Data Bank are not in the public interest.

In the most straightforward example yet, Bavley reports on “Practitioner No. 222117,” a doctor whose medical licenses have been revoked or suspended by 20 states, who was banned from billing Medicaid or Medicare and whose license to prescribe was yanked by the Drug Enforcement Administration. Bavley learned all of that from perusing the data bank’s Public Use File.

The NPDB includes reports on malpractice payments and disciplinary actions involving health care professionals. Hospitals and state medical boards can use the data when deciding to grant staff privileges or when reviewing license applications, though AHCJ found state medical boards do that less than you might expect. The NPDB’s Public Use File, available for download on a public website, removes identifying information. Bavely’s article explains more about how they de-identify the data.

Despite all we know about Practitioner No. 222117, we don’t know if he or she is still practicing medicine. The public, including journalists, is restricted from using the data to identify this doctor.

In the past, reporters have used information in the Public Use File, in combination with other records, to identify to flesh out their reporting on troubled doctors and show the failure of medical boards to act against doctors with multiple malpractice awards.

That ended on Sept. 1, when the U.S. Health Resources and Services Administration, which runs the database, removed the public use file because one doctor complained about stories that Bavley was writing.

AHCJ, along with other journalism groups and patient-safety advocates, decried the database’s removal. In November, HRSA restored the Public Use File – but with restrictions on how it can be used. Reporters and researchers have to agree not to connect any individual to information in the database. Reporters can be barred from future access to the database if HRSA decides they have violated the rules. For more background, please see AHCJ’s Right to Know page or this timeline.